CASE SCENARIO FOR COR NPULMONALE

A case of Artem 51 years old male has been hospitalized twice at Eastern Visayas Regional

Medical Center because of easy fatigability and shortness of breath upon exertion. Bronchodilators

And diuretic therapy was prescribed and afforded relief, subsequently discharged from the hospital.

Home medication were ordered and follow up checkup was scheduled after one week from discharge.

He was diagnosed with COPD (Chronic Obstructed Pulmonary Disease}

The same lifestyle was being followed at home. He continued his vices in smoking, drinking liquor and

eating fatty foods. He was constantly in association with friends who were smokers too.

On September 22, 2020 at around 8:30 PM, the patient experience severe dyspnea, dry cough

and edema of the feet and legs. He was brought to the hospital for consultation, hence admission.

At the ER of EVRMC, he was first seen at the triage area where his vital signs were taken as

Follows: T – 37.5 C, HR – 150 beats/minute, RR – 30 breath/minute and BP – 150/100 mm Hg. An ROD

came to see the patient were physical examination and history taking was done. The following orders

were made.

Date/Time Doctor’s Order

Sept. 22, 2020  Please admit to medical ward under Team A {PULMO}
8:30 P.M.  Secure consent for admission.
T- 37.5 C  Full Low Salt, Low Fat
HR – 150 beats/min  NPO temporarily while dyspneic.
RR – 30 breaths/min  Give O2 inhalation at 3L/minute via nasal prong.
BP – 150/100 mmhg  Insert heplock.
)2 sat – 90%  Start Nebulization of Salbutamol + Ipratropium I nebule stat x 3
doses and every 6 hours.
 Furosemide 40 mg IVTT stat and every 12 hours with BP precaution.
 Digoxin 0.5 mg. IVTT stat.
 CBC, platelet, Prothrombin Time, Urinalysis and Stool Examination.
 12 Leas ECG.
 2D Echo.
 Spirometry.
 Monitor vital signs every shift and record please.
 Date & Time
Doctor’s Order

September 23, 2020  Continue IVTT and PO meds.

9:15 AM  Maintain O2 therapy.
HR – 110 beats/min  Clopedogril 75 mg. 1 tab OD.
BP – 130/90 mmHg  Pepiracillin + Tazobactam 4.5 grams IVTT every 8 hours ANST.
RR – 25 breath/min  Monitor HR and BP.
 Refer accordingly.

September 24, 2020  Continue nebulization.

HR – 90 bpm  Discontinue Furosimide . Consume Salbutamol nebulization.
RR – 22 bpm  Start Spironolactone 25 mg 1 tablet OD.
BP – 125/90 mmHg  Please relay result of Chest X – ray and 2 D Echo.
O2 sat – 98%  Continue medications.
 Discontinue Peptaz.

September 25, 2020  May go home

HR – 85 bpm  Home medicationsw:
RR – 21 bpm  Fluticasone Propionate/Salmeterone Xinafoate {Seritide}
BP – 127/ 90 mmHg 2 puff BID.
O2 sat – 99 %
 Spironolactone 1 tablet OD, with BP precaution.
 Cefixime 400 mg 1 capsule OD x 7 days.
 Doxophylline 200 mg 1 tablet BID
 Telmesartan80 mg/Anlodipine 5 mg 1 tablet OD.
 Tiotropim Bromide Monohydrate 18 mcq/capsule oral inhalation
with inhaler device.
 Follow up check upo on October 1, 2020 at OPD medicine.

Questions:

1. Identify factors that have contributed to the health condition of the patient.
2. What were the significant laboratory & Radiologic exams done to confirm the diagnosis. Please
Include nursing responsibilities in the preparation of patient.
3. Identify probable finding of laboratory and Radiologic exam based on the book to confirm the
The diagnosis of COR PULMONALE.
4. Make a concept map related to the case to integrate laboratory and radiologic exams done.
5. Make a pharmacologic study of the drugs prescribed to the patient using the format.
6. Formulate a comprehensive nursing care plan, identifying 5 priority problems related to the case.
7. Make a discharge planning to prevent condition to recurrence of the disease.