Respiratory Case Study
Read the following case study below and answer the 6 questions at the end.
Mrs. M is a 71-year-old female with advanced COPD admitted to the Critical Care Unit (CCU) for progressive respiratory distress. The patient’s respiratory status began deteriorating three months ago following an upper respiratory tract infection. Since then, she has required home oxygen, is producing a moderate amount of purulent, non-bloody sputum, and lost 13 pounds. Mrs. M works as the owner of a Pilates Studio and is involved in her church. She has a smoking history of 40 years and has been exposed to agricultural chemicals as a child growing up on a farm.
Past Medical History
Mrs. M has a history of asthma since she was a teenager. Twenty-one years ago, she underwent a left upper lobotomy requiring tracheotomy, secondary to lung abscess. For the past 20 years, she has had progressive emphysema. Eleven years ago, Mrs. M had an appendectomy and repair of perforated sigmoid colon. Twenty months ago, she was diagnosed with adenocarcinoma of the lung. Mrs. M reports an allergy to penicillin.
Assessment and Diagnosis
Upon admittance to the CCU, a full physical exam is performed. Complete blood count (CBC), electrolytes (lytes), and urinalysis (UA) are all within normal limits (WNL).
PHYSICAL EXAM RESULTS
Parameter Findings
General -Thin looking female in acute respiratory distress.
appearance -Height: 5 feet 7 inches (170.18 cm)
-Weight: 125 pounds (56.81 kg)
Head and eyes -Normocephalic.
-Pupils equal, round, reactive to light, accommodation.
Ears -Tympanic membranes intact and clear.
Neck -Supple, no masses.
Chest -Increased anteroposterior diameter.
-Decreased breath sounds in the right lower lobe (RLL) posteriorly and anteriorly with
scattered wheezes, and rhonchi.
-Prolonged expiratory time, rib retractions with dyspnea and tachypnea
Abdomen -Several mature scars
-Bowel sounds active in all quadrants
-Soft, non-tender without masses
-Lower liver edge palpable 2 cm below right costal margin
Extremities -Peripheral pulses full, equal
-Pitting edema (2+) noted on lower extremities and sacrum
Genitourinary -Within normal limits
system
Neurologic status -Oriented to person, place, and time
-Sensory and motor function intact
-Patient fatigues quickly
Cardiovascular -Sinus tachycardia
system -Normal S1 and S2
-Skin warm and moist
Vital Signs
- Blood pressure 148/96 mm Hg
- Temperature 98.2° F
- Heart rate 127 beats per minute
- Respiratory rate 38 breaths per minute
Table 2
Based on the results of the assessment, Mrs. M is diagnosed with:
-Acute respiratory failure
-COPD
-Adenocarcinoma of the lung
Management
Mrs. M is given inhaled bronchodilators every one to two hours initially. An aminophylline infusion is administered as well. The aerosol treatments is reduced to every four hours, with supplemental oxygen administered by nasal cannula ranging between 2-6 liters/minute. Mrs. M’s ventilation and oxygenation are managed by arterial blood gas results.
ARTERIAL BLOOD GAS (ABG) RESULTS- normal blood values in parentheses
Time O2 pH (7.35-7.45) PCO2 (35-45) PaO2 (75-100) CaO2 (16-22)
0 hours (admission) 2 L/minute 7.05 93 30 9
4 hours 6 L/minute 7.22 72 71 22
9 hours 4 L/minute 7.35 53 50 20
24 hours 4 L/minute 7.38 52 65 22
Discharge 2 L/minute 7.41 56 70 21
Table 3
Nursing and dietitian provide small, frequent, high-calorie, and high-protein meals tailored to her current anorexia and dyspnea, improving Mrs. M’s nutritional status. The patient is transferred out of critical care on hospital day three and discharged on day five.
Case Study Questions
1. Discuss the etiology of COPD. What risk factors for COPD does Mrs. M have? What lifestyle restrictions does the patient face?
2. Define lobectomy and tracheotomy. Why are these medical procedures indicated for this patient?
3. Mrs. M had a perforating sigmoid colon? What does this mean? How could she have ended up with this condition? Left untreated, this condition leads to peritonitis. What is that and how can it be treated?
According to the arterial blood gas results, has Mrs. M. improved at discharge? Defend your answer using blood gases.
4. Mrs. M is diagnosed with Adenocarcinoma. Define this medical condition. What diagnostics are used to confirm this condition? What interventions are prescribed to treat this condition?
5. Identify Mrs. M’s nursing problems. What outcomes are appropriate for her in view of her end-stage respiratory failure?