Case Introduction – COPD Nursing Care in ER

by Rhonda Lawes, PhD, RN

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    00:00 Hi. Welcome to our video series about respiratory disorders.

    00:05 Now in this one, we're gonna walk through step by step what you'll be doing as a nurse for a patient with COPD.

    00:11 So get ready. Now, you need something to write with because I want you to practice being a nurse as we step through this.

    00:18 Okay, so here's our case study. I'm gonna introduce you to Mrs. Taylor.

    00:23 So we're gonna start with Mrs. Taylor at home.

    00:25 Now, I'm gonna read the background to you.

    00:28 Mrs. Taylor is a 63-year-old female who retired from truck driving after being diagnosed with COPD.

    00:35 She lives alone and her daughter called her this morning to see how she was feeling as she blah, blah, blah.

    00:42 Okay, I know you've probably already tuned me out, right? You're looking at Instagram, you're looking at something else but this is where I need you to really zero in.

    00:52 So as we walk through this case study, don't just skim through it like we normally do with a test question, right? I want you to break it down with me so let's look at the things, underline the key points as we walk through.

    01:04 First of all, the patient's name. Very important.

    01:07 Mrs. Taylor. She's 63 so right there, that tells me age. She's 63 years old, she's female.

    01:15 She retired from truck driving so we know that her former career was truck driving after being diagnosed with what? Okay, there is a diagnosis. COPD.

    01:28 Now, you know that's chronic obstructive pulmonary disease. Circle that.

    01:32 That's really important because we know a lot about COPD, right? So the minute you see a diagnosis, you're already thinking as a nurse, right? We're problem solvers so you're thinking COPD.

    01:44 What's the worst case scenario for COPD? Respiratory failure, right? So what are the types of signs and symptoms that I would be looking for? How would I recognize that a patient with COPD is getting into trouble heading towards respiratory failure? Well, I'm gonna be looking for clues in the background of this statement.

    02:05 Things that tell me she's having an exacerbation or some type of attack that would require more nursing care, more medical care.

    02:13 So I know that she lives alone.

    02:16 That's very important for discharge planning.

    02:18 I know that by the time she -- if we discharge her from the hospital or we admit her, we're still gonna be very cognizant or aware of what her living status is.

    02:26 So we know she lives alone and her daughter called her in the morning.

    02:31 Okay, so she does have a support system but we're thinking about COPD.

    02:35 I'm thinking what are the signs and symptoms that she's getting into trouble.

    02:39 Well, she's gonna tell us that she's having a harder time breathing.

    02:43 She may have an increased cough, increased sputum.

    02:46 Because, you know, chronic obstructive pulmonary disease usually involves emphysema and bronchitis-like symptoms so I'm gonna be looking for signs that tell me she's having a difficult time breathing.

    02:58 Lives alone, her daughter called to check on her this morning to see how she was feeling and she had recently developed OO.

    03:06 Okay, so she had recently developed what? A respiratory infection. COPD and a respiratory infection.

    03:15 Wow, now we've got two diagnosis here and we know that a respiratory infection can really exacerbate COPD.

    03:24 It can make it worse.

    03:25 So we don't like anyone having a respiratory infection but somebody with COPD already has lungs that are kinda struggling so a respiratory infection is really gonna make things worse.

    03:37 So from that first paragraph, we know her name, we know how old she is, we know what she used to do, we know that she has lungs that have been diagnosed with COPD, she lives alone but has a daughter that checks on her so something of a support system, and we know that she's recently had a respiratory infection.

    03:55 Alright, let's see where things go from here.

    03:58 Now, the daughter noted that Mrs. Taylor didn't seem herself.

    04:04 COPD, respiratory infection, I'm worried about oxygenation, and didn't seem herself.

    04:12 I need more information. She became concerned and the daughter went over to Mrs. Taylor's home.

    04:18 She discovered that she was -- right there, underline it. Short of breath.

    04:23 I know with people with respiratory problems, when they don't seem their self that means they're acting a little differently, poor oxygenation might be the cause particularly with her history.

    04:34 So when the daughter went over there, that was a really good move that she did that.

    04:38 She found that she was short of breath just sitting in her chair.

    04:43 Okay, red flag. COPD, lungs that are struggling, respiratory infection, not acting herself, that's a sign of not being oxygenated well, and now her shortness of breath is getting worse because just sitting in her chair, she's short of breath.

    05:00 And she was complaining of this terrible headache.

    05:04 That's also a sign of elevated CO2, carbon dioxide levels.

    05:11 Okay, we're getting a lot of really, really good information from here.

    05:15 Terrible headache, coughing frequently, short of breath just sitting in the chair, and there was changes in her sputum because look, it appear to be darker than usual so that's telling you that infection, an ongoing problem, might even be thicker.

    05:32 We don't know but it likely probably is. Okay, so it's darker.

    05:36 She's having a hard time answering questions.

    05:40 So Mrs. Taylor's daughter decided to bring her into the ER for help.

    05:45 Now, you go back through that and pretend that you're Mrs. Taylor's daughter but you're also a nurse.

    05:51 I want you to pause the video, walk through this case history again, and identify all the factors that indicate that Mrs. Taylor is having exacerbation of COPD.

    06:07 Okay, welcome back.

    06:10 That was time well-invested because we're part interviewers when we're nurses.

    06:16 We get information and data from family members, from the patient.

    06:20 We put all that together in a way that helps the patient get the best care possible.

    06:26 So when you see a case study introduced like that, make sure that you break it down just like we want you to do with a test question.

    06:33 Look at each piece of information, see how it fits together because that's how nurses synthesize and apply the information that they're gathering.

    About the Lecture

    The lecture Case Introduction – COPD Nursing Care in ER by Rhonda Lawes, PhD, RN is from the course Respiratory Case Study: Nursing Care of COPD Patient.

    Included Quiz Questions

    1. A recent infection
    2. Severe headache
    3. Increased fluid intake
    4. Excessive coughing
    1. Frequent coughing and darker sputum
    2. Shortness of breath when speaking
    3. Shortness of breath when sitting in a high Fowler's position
    4. Severe headache
    5. Bilateral lower leg edema
    1. Increased CO2
    2. Increased mucus production
    3. Increased stress
    4. Increased O2

    Author of lecture Case Introduction – COPD Nursing Care in ER

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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