Brian, 84 years old, 77 kg, 71 in

● Brian is an 84 year old African

American male who arrives in the ER
with shortness of breath and has been
having a persistent cough for the last
two weeks. He reports chest
tightening and yellowish sputum when
coughing. The nurses notices
accessory muscles usage and the
barrel shape of his chest. He states
“my chest feels tight and it is hard to
breath.”

Created By: Ashley Graffice

History
Medical: The patient was diagnosed with hypertension at age 65
and takes medication for this condition, also has a history of
anxiety and PTSD

Social: Brain has been smoking since he was 25 years old and he
was in the army for 20 years where he was exposed to many
chemicals when he fought over seas

Surgical: He has a surgical history of a right knee replacement

Family: His wife, Lily, passed away 2 years ago and he now lives
alone. His three children live in different states and call him
every week. They visit when it is convenient for them
Physical Assessment
Neuro: full consciousness, PERRLA, oral GU: voids normally, urine is clear and yellow,
mucous moist and intact
MSK: 3+ edema in lower extremities
CV: cardiac apex dull, bounding pulse
Skin: bluish tone around lips and fingernail
Resp: crackles in the lungs, increased beds is present, other skin is clean dry and
exhalation time, pursed lip breathing, unable intact
to finish a full sentence without being short of
Psych: patient and cooperative, anxiety is
breath
getting worse upon assessment
GI: Bowel sounds active in all four quadrants,
last bowel movement yesterday, appetite is
fair, soft, nondistended abdomen
Medications
● Amlodipine
○ Taken for hypertension
○ Possible side effects: swelling of the extremities, fatigue,
nausea, stomach pain
○ Observe lower extremities for edema
● Benazepril
○ Taken for hypertension
○ Possible side effects: cough, dizziness, nausea, and fatigue
○ Observe for consciousness
● CBD gummies
○ Taken for anxiety at night
○ Possible side effects: dry mouth, reduced appetite, fatigue,
drowsiness
○ Observe eating habits
Vital Signs and Lab Results WBC: 7,000

Hgb: 13.1 (abnormal)

● Administer oxygen

HCT: 39% (abnormal)

● Administer oxygen

BP: 110/62 Pits: 250,000

Glusc: 120
HR: 95
Creat: 1.75 (abnormal)
RR: 24 (abnormal)
● May have underlying kidney issue
● Deep breathing ● Avoid smoking

O2: 94% (abnormal) K: 4.1

● Administer oxygen Mg: 1.7

Temp: 37.2 C Na: 140

Cl: 105
Height: 71 in
Ca: 10.4 (slightly abnormal)
Weight: 77 kg
● Administer IV fluids
BMI: 23.6
Basic Order Set
● Administer oxygen stat
● Administer short-acting bronchodilators (albuterol)
● Order chest X-ray
● CT scan
● Administer corticosteroids
● Administer antibiotics
Nursing Diagnosis
1 At risk for hypoxia as evidence by oxygen saturation less than 95%

2 At risk for activity intolerance as evidence by shortness of breath

3 Ineffective airway clearance related to tachypnea as evidence by increased

respiratory rate, wheezing, and low oxygen saturation
Nursing Action
● Observe O2 saturation is above 95% and administer oxygen when it is
not, to ensure patient is getting enough oxygen
● Administer short acting bronchodilator
○ They will relax the muscle around the airway to promote better airflow
● Education on smoking cessation
○ Smoking is the main cause of why this condition is occuring
● Observe respiratory rate
○ Tachypnea is a normal manifestation, controlling breathing is important for oxygen
saturation
● Teach breathing exercises
○ Promotes efficient gas exchange
● Place patient in semi fowler's position
○ This position is best for lowering shortness of breath
Potential Complications
● Infections
○ Most likely pneumonia
● Lung cancer
○ Smoking is a risk factor of this condition and also leads to lung cancer
● Heart failure
○ The lungs can't return enough oxygen to the heart
● Depression
○ Hard to cope with the illness
Case Study Follow up
● What is causing Brian to have shortness of breath?

● Why did Brian develop this condition?

● What are way Brian can prevent this from happening again?
References
● Agarwal, A. K., Raja, A., & Brown, B. D. (2021). Chronic obstructive pulmonary disease. In StatPearls.
StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32644707/
● Capriotti, T. (2020). Davis advantage for pathophysiology: Introductory concepts and clinical perspectives
(2nd ed). FA Davis Company.
● Devine J. F. (2018). Chronic obstructive pulmonary disease: An overview. American health & drug
benefits, 1(7), 34–42.
● Gentry, S., & Gentry, B. (2017). Chronic obstructive pulmonary disease: Diagnosis and management.
American family physician, 95(7), 433–441.