Question

WK is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea. She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is new onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath. There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies. Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy.

1.What is a likely medical diagnosis for W.K.?

2.What is the priority nursing diagnoses for WK. at this time?

3.What interventions are indicated for WK. and what outcome is expected for each intervention?

Answer 1

Ans 1 : The most likely medical diagosis for WK is Acute Exacerbation of COPD, as she had the same symptoms with her previous hospitalization and requiring BIPAP at home,eventhough she denies cough and wheezing, she had symptoms of urinary incontinence, swelling on both lower extrimities and difficulty breathing at rest along with forgetfulness are associated with COPD.

Ans 2: The priority nursing diagnosis for WK

• Ineffective breathing pattern related to alveolar hypoventilation as evidenced by statement of difficulty in breathing

Ans 3: Interventions

• Monitor respiratory rate and oxygen saturation frequently.
• Promote Fowlers or semi-Fowlers position as per onfort.
• Monitoring serial ABGs, chest X rays and other investigations
• Provide oxygen therapy as per physician's order
• Auscultate for abnormal breath sounds
• Encourage breathing exercises and chest physiotherapy
• Administer medications as per physician's order

Expected Outcome

• Patient should verbalise relief in her symptoms especially shortness of breath, has able to complete activities of daily living with minimal assistance and without any associated complications.