Question

The client is an elderly man admitted for a COPD exacerbation. He appears cachectic and is having difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. His vital signs are: T 102 F, P 124, RR 36, BP 162/84, SpO2 88% on room air.

• Identify the primary nursing goal at this time and discuss 3 priorities for nursing care and explain the rationale for each.
• Develop a teaching plan for the use of a metered dose inhaler (MDI) and a small volume nebulizer.
• Identify 2 methods to administer oxygen to the client, including the nursing considerations for each. Which method of delivery is appropriate for a COPD client and why?
• Compare and contrast the manifestations and treatment for an asthma exacerbation versus a COPD exacerbation.
• The client is ordered Azithromycin 500 mg IVPB to be given over 45 mins. Pharmacy supplies Azithromycin 500 mg in 250 mL of D5W. The IV tubing has a drop factor of 15 gtt/mL. At what rate will the nurse set the pump?  

Answer 1

Nursing care palns.

1. ineffective breathing pattern related to disease condition.
2. imapired gas exchange related thick secretion.
3. altered body tempreature hyperpyrexia related to disease condition.

Maintain the respiratory status first.patient oxygen saturation level shows 88%neds immediate management.On the other hand patient had productive cough and hyperpyrexia.

Teaching plan

Metered dose inhaler.

• Advise the patient to situp.
• Observe the patient capacity to hold the inhaler.
• Explain in detail about how to use.
• Insert the drug canister in the inhaler and remove the mouth piece.
• Hold the inhaler upright.
• Hold with thumb under the mouthpiece with one finger at the top.
• Take a deep breath and inhale slowly.
• Hold the breat for some time.
• Exhale slowly
• after use clean it and replace.

Small volume nebulizer.

• Place the nebulizer near to power supply.
• Maintain hand hygiene.
• clean the nebulizer
• Add correct dose medications
• Connect tubings
• attach mouth piece.
• check all connections
• Hold nebulizer in upright position
• Clean after use.

In COPD patients only 24 % to 28% oxygen is administerd by venturi mask or nasal prongs.

asthma is caused by inflammatory reaction ,COPD is caused by damage .Main difference in asthma attack of wheezing and chest tightness occurs .COPD symptoms are constant and have cough.

Treatment of asthma include corticosteroids,COPD include broncho dilators.

Ordered dose is 500mg

Duration of administrion 456 minutes.

Avilable dose is 500mg in 250 ml

To find out drop rate Total volume/Time in minutes xdrop factor.

here drop factor is 15

250/45 x15= 83 drops....

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