Question

H.M. is a 68-year-old white, married, retired traffic police officer. She has been in the hospital for 3 days with a COPD exacerbation and will be discharged tomorrow.

Subjective data:

Before admission 7days of exceptional shortness of breath and increased volume of sputum, which turned a greenish color

Had increased albuterol MDI use at home to five or six times a day for dyspnea

Had jitters and racing heart

Had three or four bouts of bronchitis in the past year that she treated at home

30-pack-year history of smoking; smokes half a pack per day now to “clear out lungs” in the morning

Eats a regular diet but “gets full fast”

Cannot climb one flight of stairs without stopping; walks down the flat driveway 10 yards without difficulty

Awakens two or three times per night coughing and short of breath

Objective Data:

Weight 129 lb, height 5 ft 8 in, BMI 20 kg/m²

BP 135/76 mm Hg, pulse 86, respiratory rate 28

Increased anterior-posterior diameter of chest (barrel shaped)

Slight use of accessory (neck) muscles with breathing

Distant breath sounds with occasional rhonchi

No peripheral edema

Diagnostic Studies:

Last PFT: decreased FEV₁ (48%) and FEV₁/FEV (62%)

ABGs on admission: pH 7.34, PaCO₂ 49 mm Hg, HCO₃^- 27 mEq/L, PaO2 70 mm Hg

WBC: 14,000 mL on admission

Chest x-ray: hyperinflation, flat diaphragm, no sign of pneumonia

Discussion Questions

Identify the categories of the health history that have been addressed and those for which additional data must be obtained.

Why would H.M. “feel full fast” when eating? What could you do to minimize this issue?

Interpret the ABGs. What pattern do you see?

Discuss the developmental (physical, cognitive, psychosocial, behavioral), age, socioeconomic, and cross-cultural considerations that should be considered during the gathering of subjective and objective data, the provision of health care, and in preparation for H.M.’s discharge.

Relate expected (normal) findings to those described for this patient and discuss any additional information that might be needed before a judgment or diagnosis can be made.

Based on the assessment data presented, what are the priority health needs at this time?

Answer 1

Patient profile and socio-economic history are obtained partially.Family history need to be address here.personal history (Bladder and bowel pattern) need to be address. More history elicitation needed in past health history.Information should collect under the category of Past surgical and Menstural and obstetrical history.Reviewing the old investigations profile and medication prescription is important.

Hyperinflation results in larger lungs than normal. Hence their large lungs occupy the space of the upper stomach. Hence while they eating they have the feeling of full stomach and get satiety as soon as they start to take food.

If they take three normal meals per day they cannot consume it fully and cannot get the nutrition fully. Hence they can consume small snacks.Light and frequent meals can be consume.

PaO₂ 70 indcates insufficient oxygen.pH value indicates mild acidosis.other parameters are normal.paCO₂ value is high.compensated respiratory acidosis.

The needed data to be collect mentioned above.Needed physical data collected.Cognitive ,psychosocial and behavioral data can be collect.According to that only the health education will be given.

Bronchodilator and oxygen therapy is the first line of treatment.This is the first priority health needs.