CASE STUDY 29-Emphysema
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 (PHM) of hypertension (HTN), which has been well controlled by enalapril (Vasotec) for the past 6 years, and a diagnosis (Dx) of pneumonia yearly for the past 3 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 when he tells you that he has been a 2-pack-per-day smoker for 38 years. He complains of (C/O) sleeping poorly and lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation, etiology to be determined.
His admitting orders are as follows: diet as tolerated; out of bed with assistance; oxygen to maintain SaO2 of 90%; maintenance IV of D5W at 50mL/hr; intake and output (I & O); arterial blood gasses (ABGs) in am; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q 24h; prednisone 60mg/day PO; doxycycline 100 mg PO q 12h x 10 days, PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 mL) in 3 mL normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q am. 1. Explain the pathophysiology of emphysema. 2. Are D.Z.’s VS and SaO2 appropriate? If not, explain why? 3. Identify three measures you could try to improve oxygenation. 4. Explain the main purpose of the following classes of drugs: antibiotics, bronchodilators, anticholinergics, and corticosteroids. 5. What are two of the most common side effects of bronchodilators? 6. You deliver D.Z.’s dietary tray, and he comments how hungry he is. As you leave the