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Use the Sherpath case study for the patient with chronic obstructive pulmonary disease with exacerbation to answer the following questions. Review the client profile, subjective date, objective data and diagnostic studies to complete the case study in Sherpath. After completing the case study, use the information to answer the discussion question.

What in the clients history is commonly associated with pulmonary disease?
Interpret the clients arterial blood gasses.
What is the likely medical diagnosis for this client? Explain the pathophysiology?
What assessment data and diagnostic study results led you to this diagnosis?
What would you want to teach this patient about his disease process?
What treatment and nursing management would you provide for this patient? Be sure to follow the nursing process in your discussion and include two priority nursing interventions.

Diagnostic Studies

Arterial blood gases: pH 7.32, SaO2 86%, PaCO2 55 mm Hg, PaO2 70 mm Hg
Chest x-ray shows hyperinflation of lungs
FEV1 65%

Question 1
What in Mr. Artusos history is commonly associated with pulmonary problems?

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Correct
Cigarette smoking is commonly associated with pulmonary problems.
Rationale
No rationale provided.

Question 2
Interpret Mr. Artusos arterial blood gases.

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Correct
Mr. Artuso’s pH indicates that he is acidotic. His PaCO2 level is high, which indicates that he is retaining carbon dioxide, consistent with poor respiratory function. This means he has respiratory acidosis. The 86% SaO2 and the PaO2of 70 indicate hypoxemia.
Rationale
No rationale provided.

Question 3
What is a likely medical diagnosis for Mr. Artuso?

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Correct
The most likely diagnosis is chronic obstructive pulmonary disease (COPD) with possible acute exacerbation.
Rationale
No rationale provided.

Question 4
What assessment data and diagnostic study results led you to this diagnosis?

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Correct
Dyspnea with exertion, orthopnea, morning cough, labored respirations with prolonged expiration, increased anterior-posterior diameter, ABG values, findings of hyperinflation on chest x-ray, decreased FEV1.
Rationale
No rationale provided.

Question 5
What complication associated with this diagnosis does Mr. Artuso also have? What clinical manifestation led you to that and what is the cause of it?

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Correct
Mr. Artuso has cor pulmonale as evidenced by his shoes fitting tightly at the end of the day because of edema. This is a result of pulmonary hypertension caused by constriction of the pulmonary vessels in response to alveolar hypoxia, which can lead to acidosis, which further potentiates the vasoconstriction. When pulmonary hypertension develops, the pressures of the right side of the heart must increase to push blood into the lungs and eventually, right-sided heart failure develops and peripheral edema can occur. Other manifestations of right-sided heart failure that may develop are crackles in the lungs, distended neck veins, hepatomegaly, and weight gain.
Rationale
No rationale provided.

Question 6
What are the priority nursing diagnoses for Mr. Artuso at this time?

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Correct
The priority nursing diagnoses are ineffective breathing pattern, impaired gas exchange, imbalanced nutrition: less than body requirements, fluid volume excess, and ineffective self-health management and activity intolerance.
Rationale
No rationale provided.

Question 7
What interventions are indicated for Mr. Artuso and what outcome is expected for each intervention?

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Correct
Interventions indicated for Mr. Artuso include (1) administration of bronchodilators to relax smooth muscles in the airways and improve the ventilation of the lungs; (2) administration of continuous low-flow oxygen to reduce the work of breathing, maintain the PaO2, and/or reduce the workload on the heart; (3)chest physiotherapy (percussion, vibration, and postural drainage) to assist in removal of excessive bronchial secretions; (4) breathing retraining, including pursed lip breathing to prolong exhalation and prevent bronchiolar collapse and air trapping; and (5) nutritional therapy to attain and maintain a normal weight and to supply balanced nutrition to meet the increased metabolic needs.
Rationale
No rationale provided.

Question 8
As part of patient teaching, is it too late to encourage Mr. Artuso to stop smoking? Why?

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Correct
No. When smoking is discontinued, the accelerated decline in pulmonary function slows and pulmonary function usually improves.
Rationale
No rationale provided.

Question 9
What other teaching needs would you review with Mr. Artuso while he is hospitalized?

Review with Mr. Artuso measures to use at home to reduce the risk of his acquiring an infection, such as hand washing and avoiding those with cold or flu symptoms; the importance of yearly flu vaccinations and 5-year pneumonia vaccinations; specific instructions regarding any prescribed medications, energy conservation techniques, measures to ensure adequate sleep, and participation in sexual activity; and when to seek medical attention, focusing on the manifestations of heart failure and infection.
Rationale