503 CASE SCENARIO. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD EXACERBATION).

KINGDOM OF GOD HOSPITAL LOS ANGELES ,CALIFORNI A 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 80years old man 🧓

Account number Q006543299.

MR # Q00049593422.

Admitted 06/19/2021@ 0930am.

Status: Inpatient admit.

Location: MedTelemetry.

Room 42114.

Attending doctor Tommy Holbib.

Patient name Coconute,David.

Resuscitation Status: Full code.

Primary diagnosis COPD Exacerbation.

Secondary Diagnosis:DM, Hypertension, CHF,Pacemaker, Hx pancreatitis. Coughing out whitish secretions, on breathing treatment.,Shortness of breath. Ejection fraction of 40%. Shortness of breath excertion,wheezing.

Ambulates with front wheel walker.

Doctor orders:

Azithromax 250mg po Q12hours.

Solumedro 125mg IV Q12hours.

Saline lock right Ac intact and clean 20guage. Flush Q8hours.

Metoprolol for blood pressure 10mg po Bid.

Nebulizer without atrovent added.

Breathing treatment with Respiratory therapist Q4hours.

Tylenol 500mg po Q4hours prn pain.

Pancreanase 1capsule before meals.

Humalin 15units Bid.

Accucheck Qac/Qhs.

NKDA, Alert and oriented ×4.

Wife at his bedside .

Phone number 900- 00- 0000.

Laboratory tests:

WBC 8.5.

H/H 12.0,37.2%.

K 3.9.

Na 140.

Plans:

Discharge home with wife in two days when medically stable. Home health nurse x3/ week.

Questions:

Patient has short of breath with exertion,has thin,clear secretions chest Xray was done.Upon assessment of the patient the nurse noticed that patient has a barrel-shaped chest.How do you describe your findings?.

A.Asthma attack.

B.Posterior and anterior displacement of sternum.

C.An increased anteroposterior diameter of the chest wall.

D.Atelectasis .

Correct answer C.

Rationale: In some patients the chest wall becomes chronically expanded which is because of the expansion of the lungs with time 🫁 will result in a barrel-shaped chest.A,B,and D are all wrong.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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