Exacerbation of COPD
Patient Information
Patient: Susan
Ethnocultural background: African descent
Age: 51
Related Clinical Chapters
Chapter 4: The Interview
Chapter 9: Assessment Techniques and the Clinical Setting
Chapter 19: Lungs and Thorax
Susan is a 51-year-old female. She is in the medical surgical department with exacerbation of chronic obstructive pulmonary disease (COPD). She has a 66-pack-year history of smoking and occasional drug and alcohol use. She is divorced and lives alone in an older apartment. Initial assessment on the day shift:
Subjective:
Denies pain, states cough is tiring at times, productive with yellow sputum, remaining dyspneic at rest and upon exertion.
Misses her three cats and asks if the nursing assistant can take her outdoors for a cigarette.
Objective:
T 37.4° C; P 78 regular rate and rhythm, R 26 regular and shallow, BP 136/94 LA, pulse oximeter 95% on 4 litres of oxygen by nasal cannula
Pain 0/10
Inspection: Sitting on side of bed with elbows on overbed table, cyanosis absent, use of accessory muscles with breathing
S1 and S2 regular rate and rhythm, no extra sounds.
Palpation
Radial pulse 2+ and symmetric
Doralis pedis pulse 1+ left, and 2+ right
Skin cool with flaking on the lower legs and feet. No edema noted.
Answer the following questions- Week 2- Lungs and Thorax
Q1. Briefly describe COPD and what is might look like on clinical presentation.
COPD or chronic obstructive pulmonary disease is an inflammatory disease that causes obstructed airflow from the lungs. On clinical presentation it might present itself in the form of wheezing, shortness of breath, chest tightness, lack of energy or a cough that may produce mucus.
Q2. What is the best description for the way Susan is sitting? How may this be related to the way she prefers to sleep?
The best to description for the way Susan is sitting is Orthopneic position. Since this position helps expand the chest and lungs to allow more oxygen to enter, making it easier for people with respiratory problems to breath, this could result in having Susan’s preferred method of sleep be in a fowlers or semi-fowler’s position.
Q3. What lung sounds might you expect to hear in this patient? Explain what side of your stethoscope you would use and why.
The lung sounds I would expect to hear are crackling sounds, also known as abnormal breaths. To listen to the lung sounds I would use the diaphragm of a stethoscope since it is made to listen to high pitched sounds such as breaths, bowel, and normal heart sounds.
Q4. Describe the best way to assess Susan’s for cyanosis.
Cyanosis is described as the change in the colour of your skin to the colour blue due to lack of Oxygen, so I believe that the best way to assess Susan for cyanosis would be using objective information by observing places in the body where cyanosis is easily noticed like the lips, nails, skin or around the eyes.
Answer the following questions- Week 4- Peripheral Vascular System
Q5. What other questions would you ask in regards to her peripheral vascular review of systems?
Any leg pains?
Location, type (how it feels), how often and what makes it worse or better?
Foot routine, type of exercises if any or job
History of vascular problems
Any skin changes on arms or legs?
Colour, temperature
Look of veins
Any sores or ulcers
Any swelling on legs or arms?
Onset
Is it constant?
When is it worst and what relieves it?
Any swollen glands?
Any change?
Is it hard or soft?
Where in the body and how long it has been there
What medications are you taking?
Q6. Why would you include an assessment of pedal pulses for this patient?
Bilateral, dependent, pitting Edema occurs with diabetic neuropathy, hepatic cirrhosis, and heart failure, which are all things that smoking can lead to. An assessment of pedal pulses will assist in determining whether this patient is experiencing any of these types of Edemas and as a result could help in identifying what may be causing the problems she is going through.
Q7. You assess Susan further. You note that her DP pulses remains 1+ left, and 2+ right. You are concerned that she might have a DVT. What is this? How could is a DVT related to smoking?
DVT, Deep vein thrombosis, occurs when a blood clot forms in one or more of the deep veins in the body. Smoking is a major risk factor for DVT because the nicotine in cigarettes increases the number of platelets in the blood and makes them sticky, as a result increasing the probability for them to clump together and create blood clots.