COPD

Bill Smith is a 55-year-old disabled car salesman who is cared for at home by his wife of
36 years. Mr. Smith is being seen in the office today for a routine visit. He reports that he
has been coughing up more sputum than normal and that sometimes he feels as if he is
choking. Mr. Smith's wife also reports that she is afraid he is not getting enough to eat,
because she has noticed he has put three more holes in his leather belt to hold up his
pants.

Nursing Admission Assessment

On his last hospital admission 6 months ago, Mr. Smith went into respiratory failure and
was placed on ventilator support for 21 days. A permanent tracheostomy tube was placed
at that time. Mr. Smith had been smoking one to two packs of cigarettes daily before that
admission and has attempted to smoke only once or twice since. He states, "It's hard to
smoke with this breathing tube, and my wife is afraid I'll blow the house up." Until last
week, Mr. Smith had been getting along "OK" according to his wife. Mr. Smith uses an
oxygen concentrator to deliver 3 L of oxygen per minute via a trach mask. Mr. Smith
takes his aerosol treatments and is able to cook for himself while his wife is at work. She
admits, however, that most of the time she is afraid he eats candy bars and drinks sodas
for lunch. She states, "I can't be with him all the time. Someone has to work to pay the
bills." Mr. Smith spends most of the time leaning forward, resting his elbows on his
knees and looking at the floor. His wife states that he has been sleeping in the recliner for
the past month.

Nursing Physical Examination

Height: 6 feet, 1 inch

Weight: 145 lb (65.9 kg)
Vital signs: BP 140/85; TPR 99.4, 88, 26
LOC: Alert and cooperative, although his wife answers most questions for him
EENT: Nasal mucosa and pharynx are unremarkable; crusty drainage noted around
tracheostomy and on dressing
Cardiac: Regular rate and rhythm without gallop or murmur
Pulmonary: Chest is barrel-shaped; decreased breath sounds at both bases; coarse breath
sounds with scattered wheezes and rhonchi noted throughout
Abdominal: Scaphoid, nontender with normoactive bowel sounds
Genitourinary: Deferred
Peripheral pulses: 3/3 with mild pitting edema of ankles and feet noted

A chest x-ray study is performed and reveals diffuse infiltrates in both lungs. Mr. Smith's
physician remarks that he is concerned he is aspirating. On further questioning, Mr.
Smith states that he really only chokes when he is eating. Liquids seem to give him more
trouble. Mr. Smith relates that last week he coughed so hard that he vomited and that he
has been trying to watch what he eats ever since. He states, "I'm almost afraid to eat when
I'm alone. I'm afraid I'll stop breathing, and I don't want my wife to find me like that."
The physician orders a complete blood count and blood chemistry profile.

Selected Laboratory Results

WBC: 10,000
Hb: 12.0 g/dL
Hct: 36.0%
RDW: 10%
Total protein: 5.0 g/dL
Serum albumin: 2.0 g/dL

In addition, arterial blood gases are performed and the results are as follows: pH 7.38;
PaO2 70; PCO2 55; HCO3 30

ANSWER THE FOLLOWING QUESTIONS:

1. Interpret the client’s Arterial Blood Gases.
- Is the Client experiencing Hypoxemia & Hypercapnia? Explain & Defend your
Answer.
- Is the client experiencing Respiratory Alkalosis or Respiratory Acidosis? Explain
& defend your Answer.
2. What clinical manifestations is this client with COPD experiencing?
3. Are there specific triggers or times when manifestations occur (e.g., stressful
situations, environmental factors) in a client with COPD?
4. What is the impact of this illness on activities of daily living, family roles, and
ability to work or attend school?