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Health and Healing 2 – Group Assignment
COPD Case Scenario
Complete this assignment as a group – only 1 person needs to submit the completed worksheet for
the group. Please label the document “CAD group N/A”
Group #: N/A
Group Names: Shazel Chiasaokwu
M.B. is a 65-year-old male who is being admitted from the emergency department to the
cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD).
M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for
control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg,
heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 38.4° C, and SaO 2 85%.
He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest.
1. Which assessments or actions should you take at this time?
- Respiratory assessment is priority number one as this patient has airway problem.
o COPD exacerbation AEB tachypnea and decreased O2 sats despite use of
bronchodilators
o We want to assess for the presence of potential pneumothorax, or pneumonia
by auscultating the lung fields.
2. What do you know about his medications? M.B. is receiving ipratropium and albuterol
(DuoNeb) in his nebulizer treatments. Identify the common side effects that might occur
as a result of inhaled β-adrenergic agonists and what information would you teach him
about so he can give this medication to himself?
o Ipratropium and Albuterol are both bronchodilators, meaning they help dilate or
open the airways making it easier for air to flow in and out of the airways. Both
these medications have additional similarities including that they are both
delivered directly into the airways via inhalers/nebulizers and they both relieve
symptoms rather quickly.
Their main differences include the way they act on the body and their correlating
side effects.
o Ipratropium blocks anticholinergic agents which are responsible for restricting
airways and increasing mucous production. By blocking these anticholinergic
agents, Ipratropium makes it easier for a patient to breathe.
o Side effects for Ipratropium include heartburn, constipation, nausea, dizziness,
dry mouth, pain when urinating, and back pain.
o However, Albuterol works by stimulating b2 adrenergic receptors that release
epinephrine. This results in our fight or flight response being trigger which does
several things including expanding our airways, this allows for easier breathing.
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o Side effects for Albuterol include irregular heartbeat or palpitations, shaking,
nervousness, headaches, and nausea.
o The health teaching I would provide would include the proper method to use
inhalers (exhale as much as possible, get a firm seal of the mouthpiece around
your mouth, breath in slowly and deeply as you press on the cannister, holding
their breath for ten seconds, and how long to wait in between puffs), also to take
the medication around the same time every day, in addition I would advise the
patient to not adjust the dosage without speaking to their medication prescriber.
3. What concerns do you have with his other assessment data?
- Cardiac assessment is second priority to assess patients circulation.
- Check ABGs to assess if the patient is in respiratory acidosis.
- Obtain orders for inhaled steroids and O2.
- Ask patient if they are in pain.
4. While continuing M.B.'s assessment, you recognize that sometimes it is difficult to
distinguish COPD from asthma since clinical manifestations may be identical. However,
there are some clinical features that are different. Select the appropriate column for
each clinical feature to indicate whether each is specific to COPD or asthma.
Clinical Features COPD Asthma
Onset usually less than 40 YES
Long history of smoking YES
History of allergies YES
Clinical symptoms intermittent YES
Smoking not a cause YES
Thick tenacious sputum YES
Progressive worsening of disease YES
Onset usually 40-50 years old YES
Infrequently associated with allergies YES
Dyspnea during exertion YES YES
Stable disease course YES
Infrequent sputum YES
Slowly progressive clinical symptoms YES
5. What are the rationale for the MD orders?
MD orders
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Activity as tolerated with assistance – the rational behind this order is that patients with
exacerbated COPD tend to be more sedentary which may lead to muscle weakness, this
associated with shortness of breath makes it more likely for the patient to experience a
fall; they should pay mind to not over exert themselves and have assistance in the case
they need to sit down and cannot make it to a seat safely on their own.
O2 at 2 L/nasal cannula – giving oxygen will help increase the patient’s o2 sats.
IV of D5W in 0.45 NS at 50 ml/hr – the rationale for this is to provide the patient with
energy through the glucose and rehydrate them which will improve circulation and
blood pressure through the normal saline.
sputum C&S x3 – by analyzing the patients sputum, we are able to identify if the cause
of the exacerbation is due to bacteria or a virus in the sputum.
CBC, ABGs, and electrolytes – checking these values will allow us to see how much
carbon dioxide is still in the body and how close the patient is to entering respiratory
acidosis.
chest x-ray – a chest x-ray will allow the MD to see if there is a visible pneumothorax or
any indications of pneumonia.
cefuroxime axetil (Ceftin) 1 g q8hr IVPB – seeing as COPD exacerbations are often
caused by bacterial infections, giving cefuroxime, which is an antibiotic, will treat any
suspected bacterial infections.
prednisone 40 mg PO bid – prednisone will help reduce inflammation in the airways and
improve breathing.
ipratropium and albuterol (DuoNeb) nebulization – these medications will open the
airways and reduce mucous production which will allow for easier breathing.
6. You also need to teach him about pursed lip breathing. Why is this helpful and how
would you explain that to him?
Pursed lip breathing is a technique that is often recommended to patient with
respiratory issues. It involves inhaling through your nose and exhaling through pursed
lips as if you were blowing out a candle. This day of breathing has many benefits
including:
o Helping to clear airways by promoting coughing and increasing airflow.
o Improves oxygenation by keeping the airways open for a longer amount of time.
o Reduces the amount of work your body must exert to breathe by slowing down
the breathing rate.
o Reduce the feeling of shortness of breath.
