Question

MC is a 52-year old African American female who presents to the emergency department with reports of shortness of breath, productive cough, and pain to her chest. She reports her cough is worse at night with chronic pain due to coughing. She denies wearing home oxygen and can been seen purse lip breathing. The nurse observed dyspnea on exertion when MC ambulated to the restroom. She states that she must stop halfway up the stairs in her home to catch her breath when she goes upstairs and sleeps in the recliner 3-4 days per week in the den downstairs. She states this has been going on for the last 5-6 months. She smokes 1.5 packs per day of cigarettes and has for the past 25 years. MC is diagnosed with chronic obstructive pulmonary disease (COPD) and is admitted to the medical surgical unit.

1. As the registered nurse, what other subjective data would you collect from MC?
2. Describe the physical assessment of MC that you would complete.
3. What are the expected findings of MC when diagnosed with COPD?
4. As the registered nurse, describe the assessment data you would collect related to MC’s ability to complete activities of daily living (ADLs).
5. How might MC’s ADLs be affected by COPD?

Answer 1

Subjective data

• cough(productive or non productive )
• initially cough only at night later cough occurs throughout day
• difficulty in breathing.
• Difficulty coughed out or not
• activity level intolerance due to dyspnea
• ​​​​​​lack of appetite
• patient has unable to do ADL
• history of smoking

Physical assessment

• Large barreled shaped chest
• Prominent accessory respiratory muscle in neck
• Low flat diaphragm costal margin retractions on inspiration
• Diminished breath sound, distant heart sound
• Prolonged expiration with generalized wheezing predominantly on expiration
• The blue bloater type of COPD patient have cyanosis at rest or mild exertion, edema of ankles, crackles at lung, difficult to hear second heart sound in pulmonic area

Expected finding

• cough with sputum production throughout day
• Purulent sputum due to exacerbation otherwise it may be mucoid
• Insidious onset of breathlessness on exertion with wheezing or tightness of chest
• Fatigue
• Anorexia, weight loss or weight gain
• Fever, myalgia and sore throat
• Cyanosis(lips and nail beds)
• Barrel chest (sign of hyperinflation -enlarged lung volume with poor diaphragmatic excursion )
• Use of accessory muscle of respiration
• Sitting in the characteristics of tripod position to facilitate the action of sternocleido mastoid, scalene and intercostal muscles
• Paradoxical inward movement of chest (Hoover's sign )

Assessment data related to ADL

• Activity intolerance related to generalized weakness and debilitation from COPD. It also due to malnourishment
• ADL related to imbalance between oxygen supply and demand
• Assessment data include assess the capillary refills both upper and lower extremity
• Assess vital sign immediately after activity