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Please see below the question ask by the professor that needs to be answered
Professor Andrews and classmates
Week 2: COPD Case Study Part 2
Requirements/Questions:
What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
COPD with severe exacerbations, and dyspnea.
According to (Neumeier & Keith, 2020) GOLD and NICE guidelines:
Diagnosis for COPD, post-bronchodilator FEV1/FVC ratio of < 0.7 (p. 240). The patients FEV1/FVC ratio is 0.52.
Assessment of severity of airflow obstruction, reduction in the post-bronchodilator FEV1, GOLD 3: Severe FEV1 = 30%-49%. The patients FEV1 is 47%.
Medical Research Council dyspnea scale mMRC Grade 2.
CAT score of patient > 10.
According to the ABCD assessment tool (GOLD, 2020), the patient is group B.
The patient is classified as GOLD grade 3, group B.
Identify the corresponding ICD-10 code.
J44.1
Provide a treatment plan for this patients primary diagnosis which includes:
Medication*
Metoprolol ER (Toprol XL) 50 mg po daily.
Combination therapy with a long-acting bronchodilator (LABA or LAMA) as maintenance therapy for improving FEV1 and reducing exacerbations (GOLD, 2020).
Fluticasone furoate/vilanterol, Inhaled, 100 mcg/25 mcg
1 puff inhaled qd.
Dispense 1 inhaler. 0 refills
Short-acting agent for immediate relief from dyspnea (GOLD, 2020).
Albuterol (Ventolin HFA), 90 mcg/puff
2 puffs, every 4-6 hours, PRN
Dispense 1 inhaler. 0 refills
Any additional testing necessary for this particular diagnosis*
Annual spirometry.
COPD assessment with CAT and mMRC.
Patient education
Understanding of maintenance therapy should be checked.
Emergency use of short-acting inhaler should be cleared.
Reassess proper inhaler technique.
Management plan for comorbidities. No smoking.
Management for physical, and daily activities.
In case of medicine failure to suppress acute exacerbation, immediately visit the hospital.
Referral
Oxygen therapy can improve survival in patients (Neumeier & Keith, 2020).
Complete smoking cessation.
Pulmonary Rehabilitation is referred (GOLD, 2020).
Influenza and pneumococcal vaccinations are recommended (Neumeier & Keith, 2020).
Follow up
1-4 weeks follow up: Evaluation of patients ability to cope in daily life and assessment of comorbidities. Review patient education.
Provide an active problem list for this patient based on the information given in the case.
HTN
PCN allergy
Chronic Cough
Wheezing (Ex-Smoker)
Obesity
Activity Intolerance, and SHOB with exacerbation.
Are there any changes that you would also make to this patients overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.
None, at this time. There is no change in his blood pressure medication of metoprolol 50mg qd, as he has another visit next month to evaluate his COPD symptoms and other comorbidities. In the next follow-up, his primary HTN management will be assessed. In the meantime, a log for his daily blood pressure reading will be maintained.
References
GOLD, G. I. f. C. O. L. D. (2020). 2020 GLOBAL STRATEGY FOR PREVENTION, DIAGNOSIS AND MANAGEMENT OF COPD (2020 GOLD REPORTS, Issue. https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf (Links to an external site.)
Neumeier, A., & Keith, R. (2020). Clinical Guideline Highlights for the Hospitalist: The GOLD and NICE Guidelines for the Management of COPD. Journal of hospital medicine, 15(4), 240-241.
COPD is the probable primary diagnosis for the patient presenting from the case. Many findings in the scenario, including the Spirometry results, help to support this diagnosis. Good job ordering a Long acting inhaler. Would you order a rescue inhaler?
Christelle or Peers what differences of classification of COPD severity exist, as based upon the GOLD guidelines? What PFT results correlate with what severity levels of COPD? Explain what PFT results correlate with the different levels of COPD severity.
Week 2: Readings
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O. & Thomas, D. J. (2019). Primary Care-The art and science of Advanced Practice Nursing-An interprofessional approach. (5th ed.). F.A. Davis Company.
Chapter 28: Common Respiratory Complaints (p.357-361); (WO2.1-2.3)
Chapter 29: Sleep apnea (p. 363-370); (WO2.4)
Chapter 30: Pneumonia (p.375-384); (WO2.1)
Chapter 31:(397-423); (WO 2.1-2.4)
Kennedy-Malone, L., Plank, L. M., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults (2nd ed.). F.A. Davis Company.
Chapter 8: Chest Disorders; (WO2.1)
Assessment of the respiratory system (p.154); (WO 2.1)
Chronic obstructive pulmonary disease (p.164-170); (WO2.1-2.2)
Pneumonia (p.191-196); (WO2.1-2.2)
