A Case Study on COPD and Peripheral Arterial Disease, Exams of Nursing

Download A Case Study on COPD and Peripheral Arterial Disease and more Exams Nursing in PDF only on Docsity! pg. 1 1 NRNP 6540 Week 5 Case Assignment Case Title: A 67-year-old With Tachycardia and Coughing Ms. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking, and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration. Ms. Jones reports she has been coughing a lot lately, and notices some thick, browntinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine. Vital Signs: 99.2, 126/78, 96, RR 22 Labs: Complete Metabolic Panel and CBC done and were within normal limits pg. 2 2 CMP Component Value CBC Value Component Glucose, Serum 86 mg/dL White blood cell 5.0 x 10E3/uL Count BUN 17 mg/dL RBC 4.71 x10E6/uL Creatinine, Serum 0.63 mg/dL Hemoglobin 10.9 g/dL EGFR 120 mL/min Hematocrit 36.4% Sodium, Serum 141 mmol/L Mean Corpuscular 79 fL Potassium, Serum 4.0 mmol/L Mean Corpus HgB 28.9 pg Chloride, Serum 100 mmol/L Mean Corpus HgB Conc 32.5 g/dL Carbon Dioxide 26 mmol/L RBC Distribution Width 12.3% Calcium 8.7 mg/dL Platelet Count 178 x 10E3/uL Protein, Total, Serum 6.0 g/dL Albumin 4.8 g/dL Globulin 2.4 g/dL Bilirubin 1.0 mg/dL AST 17 IU/L ALT 15 IU/L Allergies: Penicillin Current Medications: Atorvastatin 40mg p.o. daily Multivitamin 1 tablet daily Losartan 50mg p.o. daily ProAir HFA 90mcg 2 puffs q4–6 hrs. prn pg. 5 5 measuring airflow limitation with COPD patients. Forced expiratory volume in one second (FEV1), FEV6, forced vital capacity (FVC), and FEV1/FVC ratio before and after bronchodilator challenge can indicate reversible airway obstruction which is vital in differentiating COPD form asthma (National Heart, Lung, and Blood Institute, n.d.). Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning. a. DVT (Deep Vein Thrombosis) b. Intermittent Claudication c. Cellulitis d. Electrolyte Imbalance The best choice for Ms. Jones would be intermittent claudication. Painful cramping when walking is a key indicator of IC which resolves with rest. A DVT is not commonly bilateral and does not resolve with rest, rather it is a consistent and sustained pain and tenderness of the affected area and surrounding muscle or skin. Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this? First-line testing for IC which is an early sign of peripheral arterial disease, is ankle-brachial index and systolic arterial pressure measurement with pg. 6 6 continuous doppler. The ankle-brachial index is a test that can be completed with the patient lying on their back and bilateral brachial BPs are checked as well as bilateral ankle BPs. These values are compared, and an index is created. A normal ABI is between 0.9 and 1.3. Mild PAD score is 0.41-0.9 and 0.40 and lower is indicated of severe disease (HopkinsMedicine.org, n.d.) Question 8: Name three (3) differentials for Ms. Jones’ initial presentation. COPD exacerbation Bronchitis Pulmonary edema Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions? Important education for Ms. Jones and Sandra would include the importance of completing the entire course of antibiotics. This is necessary to prevent reinfection as well as antibiotic resistant organisms. Ms. Jones will need to drink plenty of water with antibiotics in order to help clear the medication and protect her kidneys as well as to help loosen secretions and clear the infection. Education on managing COPD with an infection will also be important to prevent an exacerbation. While the infection typically clears within the week of antibiotics, the feeling of fatigue as well as a cough can persist for a month or more. pg. 7 7 Worsening of symptoms would be indication to return to the clinic or present to the hospital for treatment. A follow-up appointment, in person or via tele-health should be made about one week after being seen to make sure symptoms are not worsening (File, Jr., 2020). Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not. Amoxicillin/clavulanate and a macrolide would not have been an appropriate medication for Ms. Jones due to her penicillin allergy. Amoxicillin is a penicillin class antibiotic and will illicit the allergic reaction she had with other penicillins. References File, T. M., Jr. (2020, August). Patient education: Pneumonia in adults (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/pneumonia-in-adultsbeyond- the-basics HopkinsMedicine.org. (n.d.). Ankle Brachial Index Test. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and- therapies/anklebrachial- index-test Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Chest disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 152–214). F. A. Davis.