Acute Exacerbation In Copd Essay

833 words - 3 pages

Mrs. Jones, An elderly woman, presented severely short of breath. She required two rest periods in order to ambulate across the room, but refused the use of a wheel chair. She was alert and oriented, but was unable to speak in full sentences. Her skin was pale and dry. Her vital signs were as follows: Temperature 97.3°F, pulse 83, respirations 27, blood pressure 142/86, O2 saturation was 84% on room air. Auscultation of the lungs revealed crackles in the lower lobes and expiratory wheezing. Use of accessory muscles was present. She was put on 2 liters of oxygen via nasal canal. With the oxygen, her O2 saturation increased to 90%. With exertion her O2 saturation dropped to the 80's. Mrs. Jones began coughing and she produced large amounts of milky sputum.

Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).

Based on her history and presenting symptoms, the doctor suspected an exacerbation of her COPD. He ordered a chest x-ray which revealed that fluid had accumulated in her lungs. Part of the disease process of COPD is hypersecretion of mucus which collects and fills the lungs (D., Chojnowski, 2003). The consolidation seen was most likely due to this process. Mrs. Jones's symptom work up revealed no obvious cause for this exacerbation, but up to 1/3 of COPD exacerbations have an unknown etiology (D., Chojnowski, 2003). Since Mrs. Jones was already on a bronchodilator, she was prescribed an anticholinergic inhaler and prednisone for a 10 day course. These proved effective. Mrs. Jones's O2 saturation increased and was stable at 95% after the removal of the oxygen. While this exacerbation was successfully resolved, a concern remains. Acute exacerbations increase the mortality for elderly patients within one year of that exacerbation. Close...

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