1. Identify relevant past medical history information for a patient with COPD.
2. Identify key components of the respiratory physical assessment for the patient with COPD.
3. Discuss clinical manifestations of COPD.
4. Develop a problems list and prioritize nursing interventions based on patient care needs
CASE STUDY
George Burney, a 67-year-old Caucasian man diagnosed by a physician with emphesema 4 years ago, reports that he has had a fever and
has chest pain when he takes a deep breath or coughs. He presents to the free walk-in clinic today for an evaluation. The nurse interviews
Mr. Burney using specific probing questions. The client reports that he experiences chest pain when coughing and taking a deep breath.
He also reports development of fever. The nurse explores Mr. Burney’s health concerns using the OLDCARTS memonic. After exploring
Mr. Burney’s report of chest pain, cough, and fever, and long-term tobacco use, the nurse continues with the health history. Mr. Burney
reports a history of shortness of breath due to emphysema first diagnosed 4 years ago and an episode of pneumonia 2 years ago. Denies
having had any thoracic surgery. Mr. Burney’s medication history includes: Mucinex 600 mg every AM and Combivent, 2 puffs 4 times
daily. He denies medication, food, environmental, or insect allergies. Mr. Burney reports having had a chest x-ray 2 years ago that showed
pneumonia and emphysema. Receives influenza vaccine annually and has had one this year. Received pneumococcal vaccine 2 years ago
at age 65. Denies having had a TB skin test. Denies having had formal pulmonary function testing. Denies travel outside of the United
States.
Mr. Burney’s father, a smoker, suffered from emphysema and died due to lung cancer at age 67. His mother died at 74 years of age due to
congestive heart failure. Mr. Burney has two younger brothers who neither smoke nor have any significant health problems. His paternal
grandfather died in his 80s; the cause of death is unknown to client. His paternal grandmother died at age 85 due to “old age.” Mr.
Burney’s maternal grandfather died at age 65 due to stomach cancer and his maternal grandmother died at age 70 due to breast cancer.
Client exposed to second-hand smoke since birth. Denies any family history of asthma.
The nurse explores Mr. Burney’s nutritional history. His 24-hour diet recall consists of: Breakfast—four 8-ounce cups of coffee, two glazed
donuts; lunch—half of ham sandwich, 8-ounce cup of coffee; afternoon snack—chocolate chip cookies and cup of coffee; dinner—few
bites of meatloaf, mashed potatoes and gravy, cup of coffee.
Mr. Burney has smoked at least one pack of cigarettes per day since he was 16 years of age (51 pack years). He has tried unsuccessfully to
quit smoking a few times and states, “I like to smoke too much to quit.” He reports always smoking a cigarette upon getting out of bed,
after every meal, and when driving. He says that he smokes intermittently throughout the day. Denies exposure to environmental
inhalants. Mr. Burney is a retired supervisor in the auto industry and worked in an office. He lives with his wife, who is a nonsmoker. He is
usually able to perform ADLs with little or no difficulty. However, he reports that he has noticed having to “slow down to catch my breath”
when gardening or doing yard work recently. Denies any stressors at this time. He denies use of herbal medicines or alternative therapies
to manage respiratory problems.
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