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 NR 601 WEEK 2: COPD CASE STUDY: PART 2

 NR-601 Primary Care of the Maturing and Aged

Family Susan Brown

 January 2020

 Primary diagnosis:

1. Chronic Obstructive Pulmonary Disease (COPD)

Pertinent positives to support the diagnosis of COPD include: Spirometry results prebronchodilator FEV1/FV ratio 0.52 and a post-bronchodilator FEV1/FV 0.52. A FEV1/FVC

ratio of less than 0.7 constitutes a diagnosis of COPD in symptomatic patients (GOLD, 2019).

J.D. is a former smoker with a 20 pack -year history, over the age of 40. Individuals that smoke

or have a history of smoking and are over the age of 40 are at an increased risk for COPD

(Dunphy, Winland-Brown, Porter, & Thomas, 2019). Chronic cough with 6-month duration; that

is productive with white-yellowish phlegm and is worse in the morning. SOB upon activity and

relieved by rest. Symptoms of COPD include chronic cough, production of phlegm, and SOB,

particularly upon exertion. The phlegm or mucus that is produced may be clear, white, yellow or

greenish in color (Rabe & Watz, 2017). Faint forced expiratory wheezes in bilateral bases could

be heard on auscultation. In COPD wheezes and crackles in the bases of the lungs can be heard

upon auscultation (Rabe & Watz, 2017). O2 sat on RA 94%. Typically, normal O2sat readings

should be between 95-100% on RA (Hafem & Sharma, 2019).

2. ICD-10 (J44.9)

3. Treatment plan:

According to GOLD (2019), J.D. falls into group B; he is having symptoms and is at low risk for

exacerbations at this time. The initial step would be to place him on a long acting bronchodilator.

The first line therapy is a long-acting muscarine antagonists (LAMA) or long-acting beta-2-

agonist (LABA).

Rx: Olodaterol inhaled MDI: 2.5mcg per actuation

Sig: 2 puffs inhaled every 24 hours

Disp: #1 (one)

Refills: 5 (five) [ CITATION Epo19 \l 1033 ].

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Additionally, it is recommended that patients with COPD have a short-acting bronchodilator or

rescue inhaler as needed (GOLD, 2019).

Rx: Albuterol inhaled MDI: 90mcg per actuation

Sig: 2 puffs inhaled every 4 to 6 as needed for shortness of breath or

wheezing Disp: #1 (one)

Refills: 5 (five) [ CITATION Epo19 \l 1033 ].

 Additional tests/procedures:

 Oxygen saturation (O2) monitoring:

This is a way to noninvasively assess the arterial oxygen saturation and the potential need for

supplemental therapy with oxygen (GOLD, 2019). The target O2 sat for a patient with COPD

is 88-92% (Lacasse, Tan, Maltias, & Krishan, 2018). Recommendations from GOLD (2019)

arterial or capillary blood gases should be drawn if O2 sats are below 92%.

 Alpha -1 antitrypsin level:

The World Health Organization has recommended that all patients with a diagnosis of COPD

should be screened for alpha-1 antitrypsin deficiency (GOLD, 2019).

 Sleep study:

Patients with COPD exhibit a common finding of obstructive sleep apnea. Identification of

obstructive sleep apnea can improve outcomes. Patients with COPD and OSA have an increased

risk of death, as well as hospitalizations (GOLD, 2019).

 Exercise testing:

According to GOLD (2019), exercise testing can provide valuable information for selection of

patients that are appropriate for rehabilitation.

 Patient Education:

All patients should be educated on the disease process and the progression of disease, as well as

how to identify the symptoms of an exacerbation and decompensation (GOLD, 2019)

Education on a realistic goal of disease management should be included. In treatment, the

primary goal is symptom control and complication prevention. It is imperative to educate the

patient on the fact that COPD is an irreversible and progressive disease

Development of an action plan for acute exacerbations is beneficial in reducing hospital

admissions and improving quality of life

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