Reference no: EM133461546

Assignment:

Case Study, Management of Patients with Chronic Pulmonary Disease

1. Howard Long, 50 years of age, is a male patient diagnosed with bronchiectasis. He has smoked one pack per day of cigarettes for 35 years. He has a long history of recurrent bronchial infections. He has a chronic productive cough with copious amounts of purulent sputum. The patient complains that he is short of breath even at rest. He has clubbing of his fingers. The chest CT scan reveals bronchial dilation. (Learning Outcomes 1 and 3)

a. How should the nurse explain to the patient and family the pathophysiology of bronchiectasis as it relates to the symptoms the patient is experiencing?

b. How should the nurse explain to the patient and family the goals of medical management that may be used to treat the bronchiectasis?

c. What does the nursing management for bronchiectasis entail?

• Use albuterol: two to four puffs every 20 minutes for up to 1 hour as a rescue inhaler. If symptoms improve, then take the inhaler every 4 hours for 1 to 2 days. If no improvement after 2 days, call the primary provider.

2. Sallie Thorp, a 21-year-old patient, presents to the primary provider's office with an asthma action plan form she acquired from a literature search on the World Wide Web. She states that she would like to develop the plan with the nurse and the primary provider's help and review it at each appointment to keep it current. She has had moderate persistent asthma for 5 years, and she has visited the emergency department several times in the past year with severe asthma attacks. She stated that she forgets to take her medications because they are due at the times that the hospital provided the inhalers (noon and midnight). She gets confused on which inhalers are the long-acting ones and which inhaler is the short-acting rescue inhaler that she is supposed to use when she has an exacerbation. She states that she would like to take the inhalers at 8 am and again at 8 pm, if she could. The patient states that she has a flow meter and that a respiratory therapist at the hospital taught her how to use it in the past, and he wrote down her personal best peak flow, which is 400 L/sec. The nurse reviews the patient's medical chart and discovers that she has been prescribed the following from today's visit:

• Salmeterol: 50 mcg every 12 hours
• Fluticasone: 88 mcg or two puffs every 12 hours
• Cromolyn sodium: one spray to each nostril daily and before being exposed to known asthma triggers. You may use the spray up to every 4 hours
• Measure peak flow meter every morning before using inhalers and record. Use peak flow meter, as needed, if you develop symptoms, such as cough, shortness of breath, wheezing, or chest tightness; use of neck and chest muscles to breathe; or problems talking or walking because of extreme shortness of breath
• Follow-up in 3 months
• Have the nurse provide education on asthma self-management and fill out the action plan that the patient brought with her today and have the primary provider review it and sign it

The nurse also notes that the medications have not changed since the last visit. (Learning Outcome 6)

• Explain the medications to the patient and practice filling in the asthma action plan.
• Explain ways to evaluate the patient's mastery of the content?