Miguel is a 63 year male patient who presented to the emergency…

Question Answered step-by-step Miguel is a 63 year male patient who presented to the emergency… Miguel is a 63 year male patient who presented to the emergency department complaining of a week history of progressive dyspnea, wheezing and productive cough with whitish phlegm. He denies any recent cold or flu-like symptoms. Miguel also denies any fever or chills. He has been using his Ventolin MDI but symptoms are worsening. On assessment you noted that the client developed severe dyspnea with exertion. He was assuming a tripod position and became pale and diaphoretic with movement. He presented with 2-3 dyspnea. Past Medical HistoryDiagnosed with COPD for 8 years  Hypertension  Smokes cigarette 1.5 pack/day for 25 years  Reduce to about 5 cigarettes per dayMedicationsSalbutamol MDI 4 inhalations every 4-8 hours PRN  Ipatropium bromide MDI 2 inhalations QIDPhysical examination findingsBlood pressure 178/90 Pulse 110 Respirations 36 laboured & shallow Temperature 36.2 0C SaO2 80% on room airSkin & mucous membranesdiaphoretic  Cool & clammy to touchRespiratory  2-3 dyspnea  Use of accessory muscles at rest  “Barrel chest” appearance  Poor breath sounds bilaterally  Productive cough with whitish phelgm  Purse lip breathing with prolonged expiration Cardiovascular  Heart sounds are normal  tachycardia Extremities  peripheral pulses 2+ bilaterally in all extremities  clubbing  cyanotic nail beds  +2 bilateral pitting edemaGastrointestinal  no nausea & vomiting  abdominal distention  anorexia & weight lossTests Results Normal value White blood cell count 11.0 × 109 /L 4.0-10.0 × 109 /L Reb blood cell 6.4 X 1012/L 4.0 – 5.2 X 1012/L Serum sodium . 148 mmol/L 135-145 mmol/L Serum chloride 110 mmol/L 98 – 106 mmol/L Serum potassium 3.8 mmol/L 3.5-5.0 mmol/L Blood urea nitrogen (BUN) 7.0 mmol/L 2.5-8.0 mmol/L Serum Creatinine 100 μmol/L 70 – 120 μmol/LChest X-ray  hyperinflated lungs with a flattened diaphragm  large anterior posterior diameter Pulmonary Function Tests (PFTs)  increased residual volume and total lung capacity  decreased forced expiratory volume and vital capacity. Diagnosis Miguel was diagnosed with acute COPD exacerbation. He was ordered the following medications:  salbutamol (Ventolin®) 5 mg q1hr PRN by nebulizer  Ipatropium bromide (Atrovent®) 500 mcg by nebulizer PRN (max. 3 doses)  Prednisone 50 mg po X 3 days1. What are some risk factors for the development of COPD? What is the single most risk factor for the development of COPD in Miguel? 2. Provide the pathophysiology of how airway obstruction develops in a patient with COPD. 3. Explain why heart failure may develop in patients with COPD particularly patients with emphysema. Explain in detail. 4. Provide a detailed rationale for the abnormal vital signs noted in your patient on physical examination. 5. Explain in detail why expiration is significantly impaired and an increased residual volume was noted in Miguel. 6. Define polycythemia. Is Miguel presenting with polycythemia? If yes why if not why not? Explain your answer in detail using pathophysiology. 7. The patient’s chest x-ray reported hyperinflated lungs with a flattened diaphragm. Explain the pathophysiology for this finding in the patient. 8. Explain each medication in detail (mechanism of action, therapeutic effect and side effect) in the treatment and management of Miguel’s COPD exacerbation.  Health Science Science Nursing PATH 122 Share QuestionEmailCopy link Comments (0)