NR 341 Pneumonia-COPD Case Study Solutions

## NR 341 Pneumonia-COPD Case Study Solutions — Complete Case Study Solution with Nursing Process This page provides a **complete nursing case study analysis** for **NR 341 Pneumonia-COPD Case Study Solutions** in **NR-341** at Chamberlain College of Nursing, including full nursing process application and NANDA-I diagnoses. --- ## Case Overview **Course:** NR-341 — Chamberlain College of Nursing **Assignment Type:** Clinical Case Study Analysis **Framework:** Nursing Process (ADPIE) with NANDA-I Taxonomy --- ## COPD Case Study — Full Nursing Process Analysis ### Patient Presentation **Chief Complaint:** Progressive shortness of breath, productive cough with yellow-green sputum, and worsening exercise intolerance over the past 5 days. **Medical History:** - COPD (GOLD Stage III, FEV₁ 35–49% predicted) - 45-pack-year smoking history (currently smokes 1 PPD) - Hypertension (controlled on lisinopril 10mg daily) - Type 2 Diabetes Mellitus (HbA1c 8.1% at last visit) **Current Vital Signs:** - BP: 148/92 mmHg - HR: 108 bpm (sinus tachycardia) - RR: 28 breaths/min (labored) - SpO₂: 88% on room air - Temperature: 38.7°C (101.7°F) - Weight: 68 kg **Relevant Labs:** - ABG: pH 7.32, PaCO₂ 58 mmHg, PaO₂ 54 mmHg, HCO₃⁻ 28 mEq/L (chronic respiratory acidosis with metabolic compensation) - WBC: 14,200/μL (elevated — infection) - Sputum culture: Pending - Spirometry (previous): FEV₁/FVC ratio 0.58 --- ### Step 1 — Assessment **Subjective Data (Patient/Family Report):** - Patient reports: 'I can't catch my breath even sitting still. My cough is worse and the mucus changed color 3 days ago.' - Family confirms increased respiratory effort, use of pursed-lip breathing at rest, and reduced activity tolerance **Objective Data (Physical Examination):** - **Inspection:** Barrel chest, accessory muscle use (scalene, sternocleidomastoid), tripod positioning, digital clubbing - **Auscultation:** Diffuse expiratory wheezes bilaterally, prolonged expiratory phase, diminished breath sounds bilateral bases - **Palpation/Percussion:** Hyperresonance throughout all lung fields (air trapping) - **Cardiovascular:** S1S2 regular, no murmurs, 1+ bilateral lower extremity pitting edema - **Neurological:** Alert and oriented ×4, mildly anxious --- ### Step 2 — Diagnosis (NANDA-I Priority Nursing Diagnoses) **Priority Nursing Diagnosis #1 (Highest Priority):** **Impaired Gas Exchange** related to alveolar-capillary membrane changes and ventilation-perfusion mismatch, as evidenced by: SpO₂ 88%, PaO₂ 54 mmHg, PaCO₂ 58 mmHg, pH 7.32, RR 28, accessory muscle use. **Priority Nursing Diagnosis #2:** **Ineffective Airway Clearance** related to excessive mucus production and ineffective cough mechanism, as evidenced by: productive cough with purulent sputum, adventitious breath sounds (wheezes), and elevated WBC suggesting acute infectious exacerbation. **Priority Nursing Diagnosis #3:** **Anxiety** related to dyspnea and perceived threat to health status, as evidenced by: patient verbalization of distress, tripod positioning, inability to complete sentences, and SpO₂ 88%. --- ### Step 3 — Planning (SMART Goals) **Goal 1 (ND #1):** Patient will maintain SpO₂ ≥ 92% on supplemental oxygen ≤ 2L/min NC within 4 hours of intervention initiation. **Goal 2 (ND #2):** Patient will demonstrate effective cough technique and expectorate secretions, with reduction in adventitious breath sounds within 8 hours of pulmonary hygiene interventions. **Goal 3 (ND #3):** Patient will verbalize reduced anxiety and demonstrate use of 3 non-pharmacological coping strategies within 2 hours of nursing intervention. --- ### Step 4 — Implementation (Evidence-Based Nursing Interventions) **Interventions for Impaired Gas Exchange:** 1. Apply controlled-flow supplemental oxygen via Venturi mask — target SpO₂ 88–92% in COPD (avoid hyperoxia → hypercapnia worsening) 2. Continuous pulse oximetry monitoring 3. Position: Fowler's or high Fowler's with supported upper extremities (tripod position promotes diaphragmatic descent) 4. Administer ordered bronchodilators (SABA: albuterol 2.5mg nebulized q20 min × 3 doses; SAMA: ipratropium 0.5mg nebulized) 5. Monitor for signs of respiratory decompensation requiring NIV (BiPAP) **Interventions for Ineffective Airway Clearance:** 1. Encourage controlled coughing technique: deep breath → hold 3 seconds → 2–3 productive coughs (Huff coughing) 2. Chest physiotherapy/postural drainage if ordered 3. Increase fluids to 2–3L/day to thin secretions (unless contraindicated) 4. Administer antibiotics as ordered (empiric coverage for AECOPD: azithromycin or doxycycline if purulent exacerbation) 5. Administer systemic corticosteroids (methylprednisolone) to reduce airway inflammation **Interventions for Anxiety:** 1. Provide calm, reassuring presence — remain with patient during acute distress 2. Teach pursed-lip breathing (reduces air trapping, provides sense of control over breathing) 3. Administer anxiolytics as ordered with close respiratory monitoring 4. Encourage family presence for emotional support --- ### Step 5 — Evaluation **Goal 1 Evaluation (4 hours post-intervention):** SpO₂ improved to 94% on 2L/min NC via Venturi mask. Respiratory rate decreased to 22 breaths/min. Patient reports subjective improvement in dyspnea. **Goal MET.** **Goal 2 Evaluation (8 hours post-intervention):** Patient successfully using huff coughing technique, expectorating moderate amounts of mucopurulent sputum. Wheezes decreased in intensity. **Goal PARTIALLY MET** — will continue pulmonary hygiene every 4 hours. **Goal 3 Evaluation (2 hours post-intervention):** Patient using pursed-lip breathing independently, SpO₂ improving. Anxiety score decreased from 8/10 to 4/10. **Goal MET.** --- ## References - Vogelmeier, C. F., Criner, G. J., Martinez, F. J., Anzueto, A., Barnes, P. J., Bourbeau, J., ... & Agusti, A. (2023). *Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD 2023 Report.* GOLD. - Harding, M., Kwong, J., Roberts, D., Reinisch, C., & Hagler, D. (2023). *Lewis's medical-surgical nursing* (12th ed.). Elsevier. - Chamberlain University. (2024). *NR-341 course case study guidelines.* Chamberlain College of Nursing. - American Nurses Association. (2021). *Nursing: Scope and standards of practice* (4th ed.). ANA. --- ## Get Expert Help With NR 341 Pneumonia-COPD Case Study Solutions Struggling with this assignment? 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