NUR 612CL Nursing Chronic Obs

reply to Arnine

This week’s clinical encounters did not provide any difficulties for me. My experience at the clinic has been nothing short of amazing and rewarding. As a nurse, I’ve gained knowledge and experience in providing effective and efficient patient care, which I will apply into my practice as a nurse practitioner.

Subjective

           84-year-old man who smoked two packs every day for 45 years. He has not smoked in ten years. He came in for a usual physical examination. He does not take any of his regular prescriptions on a daily basis. He says he still having problems with “belching,” but otherwise he’s in good spirits. The patient complains of productive coughing, which is worse in the morning and is accompanied by thick clear to white phlegm. He states that he now experiences SOB more easily than before.

Objective

BP 112/60, P 68, T 97.4 temporal, R16, SpO2 95% on room air, Ht. 64 inches, Wt. 127, (BMI 21.8).

The patient appears to be awake and alert, and he is responding appropriately. Afebrile. Integument:  Pink, warm and dry to touch Eyes:  No issues with eyes. Cardiovascular:  Heart regular rate and rhythm, S1 and S2, no S3 or S4, murmur or gallop, no carotid bruits; radial pulses palpable and pedal pulses 2+; no lower extremity edema; capillary refill < 3 seconds bilateral.  Pursed lip breathing with faint “whistling” sounds with respiratory effort

Assessment

Course and diminished breath sound in bilateral lower lobes

Diagnosis of COPD

Chronic obstructive pulmonary disease (CPD) is indicated by chronic, increasing airflow restriction. (Arcangelo et al., 2017).  COPD is stereotypically judged as lingering bronchial inflammation and/or emphysema.  (Arcangelo et al., 2017). Cigarette smoking is the most significant universal hazard for COPD. (Arcangelo et al., 2017). The signs and symptoms of COPD comprise chronic coughing, which will have productive sputum creation and increasing shortness of breath that gets worse with working out; patients with COPD may also have tightness in the chest area or have distinct wheezing sounds. (Arcangelo et al., 2017). During a physical assessment, patients with COPD might develop loud wheezing when breathing, bluish skin, drum-shaped chest cavity, short diaphragms, and indicators of core pulmonale (edema to the extremities and an engorged heart. (Rhoads et al., 2018).

Therapeutics

The treatment of COPD is primarily centered on the administration of bronchodilators and the use of inhaled glucocorticoids, as there is currently no therapy that allows people suffering from COPD to modify the long-term deterioration in lung function. 2-agonists, anticholinergics, and methylxanthines are the most common bronchodilators utilized in the treatment of COPD in older people (Matera et al., 2015). Although the use of inhaled corticosteroids is limited to certain circumstances, inflammatory response suppression is another mechanistic method for treating COPD in the elderly. Indeed, there is a pressing medical need for new COPD treatments for the elderly today. Agents that minimize inflammatory mediator overflow from the lungs and substances that suppress the chronic systemic inflammatory syndrome are the most common examples (Matera et al., 2015). COPD patients will need at least one brief operating bronchodilator for home use of severe symptoms. (Arcangelo et al., 2017).

Educational: This patient indicated at the start of his exam that he hasn’t smoked in 10 years, which is fantastic since I would strongly advise him to do so. Inhalers may be a safer alternative for him because he is an older patient who is at risk of heart disease from the usage of certain of these medications. (Arcangelo et al., 2017).

Reference

Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics  for Advanced Practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer

Matera, M. G., Calzetta, L., Rogliani, P., Cesario, A., & Cazzola, M. (2015). New treatments for COPD in the elderly. Current pharmaceutical design, 20(38), 5968–5982.             https://doi.org/10.2174/1381612820666140314154331.

Rhoads, J., & Wiggins Petersen, S. (2018).  Advanced Health Assessment and Diagnostic  Reasoning. Burlington, MA: Jones and Bartlett Learning

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