D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema.
Diet as tolerated
Out of bed with assistance
Oxygen (O2 ) to maintain Sa O2 of 90%
IV of D5W 1/n NS with 20KCl meq/L to run at 50 ml/hr
Continuous ECG monitoring
Pulmonary function tests (PFT’s) in AM
Arterial blood gases (ABGs) in AM
CBC with differential and Na+ /K+ now
Basic metabolic panel (BMP) now and fasting in AM
Chest x-ray (CXR) on admit and QAM
Sputum culture now (obtain culture prior to starting anbiotics)
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Incentive Spirometery Q10x’s per hour while awake
1. Explain the pathophysiology of emphysema.
Abnormal permanent enlargement of lung spaces distal to terminal bronchioles accompanied by destruction of walls without obvious fibrosis. This leads to decline in alveolar surface area available for gas exchange. Loss of alveoli leads to airflow limitation in 2 ways: first, loss of the alvoelar walls results in a decrease in elastic recoil (leads to airflow limitation). Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.
2. Are D.Z.'s vital signs and SaO2 appropriate? If not, explain why. vital signs (VS) are 162/84, 124, 36, 102 F,