Name: Meredith Hillegass Date: 04/10/16
Instructions: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it.
Scenario
D.Z., a 65 year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD, emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years, has had pneumonia yearly for the past 3 years, and has been a 2 pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124 HR, 36 RR, 102 degrees F, Sao2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema.
Chart View Physician’s OrdersDiet as toleratedOut of bed with assistanceOxygen (O2) to maintain Sao2 of 90%IV of D5W at 50 ml/hrECG monitoringArterial blood gases (ABGs) in AMCBC with differential nowBasic metabolic panel (BMP) nowChest x-ray (CXR) q 24 hrs. Sputum cultureAlbuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT |

1. Explain the pathophysiology of emphysema.
Emphysema is characterized by destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces. Deficiency of a₁-antitrypsin contributes to the development in some individuals, especially when combined with exposure to cigarette smoke (Pearson, 1006).

2. Are D.Z.’s vital signs and Sao2 appropriate? If