Question

J.T a 68-year-old man, is admitted to a medical floor with an acute exacerbation of chronic obstructive pulmonary disease (COPD). His other medical history includes hypertension and type 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide, metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears a cachectic man who is having difficulty breathing at rest. F.F. seems irritable and anxious; he complains of sleeping poorly and states that lately he feels tired most of the time. He reports cough productive of thick yellow-green sputum. You auscultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F (38.9° C), and Spo2 88%.

9. What other interprofessional team members could you involve in F.F.’s care and how?
10. The UAP reports that F.Fs blood glucose level is 366 mg/dL (20.3 mmol/L). What action do you need to take and why?

The next morning, F.F. is sitting in the bedside chair and appears to be experiencing less difficulty breathing. He states his cough remains productive of yellow-green sputum, although it is “easier to cough up” than it was the previous day. You auscultate decreased breath sounds and a few coarse crackles in both lower lobes posteriorly. His VS are 150/78, 94, 24, 99.7° F (37.6° C). His Spo2 is 92% with O2 on at 2 L per nasal cannula.

12. Has F.F.’s status improved or not? Defend your response.
13. What interventions would you include in your plan of care for F.F. today?
14. What topics do you need to address with F.F to reduce his risk for readmission?

Answer 1

1. Interprofessional team members like Pulmonalogist, endocrinologist and cardiologist are required to treat the patient.

Pulmonologist will treat for COPD

Cardiologist will treat for hypertension

Endocrinologist will treat diabetes.

2. Since 366 mg Glucose fasting result even after taking regular metformin indicates big problem to patient. Endocrinologist may try to give Insulin like insulin pump eyc and continuous monitoring of the blood glucose.

3. Patient's status had improved slightly because of the following findings

1. Vital signs improved
2. Oxygen saturation increased to 92%
3. Dyspnoea is reduced
4. Wheezing is not present.
5. Patient able to sit
6. Cough without difficulty.

4. Treatment for today:

Beta agonists

anticholinergics

Antibiotics

Steroids

Color of the sputum indicates that pneumonia had come up. So treatment to be started for the same.