Case Study ISBAR Handover: Chronic Obstructive Pulmonary Disease Introduction-David Nazzal

Case Study ISBAR Handover: Chronic Obstructive Pulmonary Disease Introduction-David Nazzal a 62-year-old male with no known allergies (NKA) Introduction-David Nazzal a 62-year-old male with no known allergies (NKA) Situation- David presented to the Emergency Department at 2200 hrs. Upon assessment he was sitting in a tripod position and found to have a barrel chest. David presents with fever, sore throat, productive cough, yellow phlegm and dyspnoea. Background- David tested positive for COVID-19 three days ago through a rapid antigen test. Wife Linda indicated symptoms had progressively worsened with no relieving factors noted. David had similar episode a year ago with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring hospitalisation. David has an increasing amount of purulent mucus which appears as yellow phlegm. He self-medicated with a Ventolin inhaler prior to admission but this had not resolved his symptoms Past Medical History- COPD, hypertension, hyperlipidaemia. He was a previous smoker for 30 years however he quit when he was diagnosed with COPD 10 years ago. Current Regular Medications taken: Ipratropium (Atrovent) via nebulizer once a day Salbutamol (Ventolin) puffer PRN Lipitor 40mg daily Not up to date on his annual pneumococcal and influenza vaccinations A to G Assessment Airway- Patent, own Breathing- RR-30 b/min, SPO2 78% on room air, Increased Shortness Of Breath (SOB) Auscultation: Diminished breath sounds bilaterally, with wheezing and crackles in the lung bases. Using accessory muscles of respiration ++. Circulation- Heart Rate (HR) Regular- 128 b/min-Sinus tachycardia. BP- 168/85 mmHg. Capillary Refill Time 3 sec, peripherally cool, heart sounds dual no murmur. Disability- GCS-14/15 E4V4M6, confused and distressed + Exposure- Febrile, skin intact, IV cannula right cubital fossa Abdo: bowel sounds present in all four quadrants with a soft, nontender abdomen Fluid- IVF fluids in progress TKVO, Nil by mouth Glucose- BSL- 5.8 mmol/L Imaging: Chest X-ray showing hyperinflated lungs with increased interstitial markings consistent with COPD exacerbation. Lab tests CBC Result Reference Range Haemoglobin 153 g/L 120-140 g/L White blood cells 15.0×10^9/L 4.0-11.0×10^9/L Neutrophils 11.0×10^9/L 2.0-7.5×10^9/L Platelets 200×10^9/L 150-400×10^9/L C Reactive Protein (CRP) 25 mg/L <3mg/L 2- COVID-19 PCR Test: Positive ABG on room air (at 2200hrs) Result Reference Range pH 7.30 7.35-7.45 PaO2 55 mmHg 80-100 mmHg PaCO2 60 mmHg 35-45 mmHg HCO3- 28 mmol/L 22-26 mmol/L SpO2 78% (88-92% COPD) BE -4 mmol/L -2 to +2 mmol/L Clinical Impression: Infective Exacerbation of COPD COVID 19 +ve Recommendations Continuous monitoring of vital signs- Transfer to High Dependency Unit COVID-19 Management: Isolate the patient in a negative pressure room, implement infection control precautions, and monitor for progression of COVID-19 symptoms Controlled oxygen therapy -Continuous pulse oximetry, to keep O2 between 88% to 92% Sit patient in high fowlers position 4/24 ABGs Salbutamol (Ventolin) nebuliser 2/24 Ipratroprium (Atrovent) via nebuliser 6/24 Prednisolone (40-50 mg daily) 12- lead ECG 6th hourly Blood troponin Sputum culture IV Azithromycin (Zithromax) 500 mg on day 1 , followed by 250 mg once daily for the next four days. 300 mg nirmatrelvir with ritonavir 100 mg taken together orally every 12 hours for 5 days. Pulmonary function tests Spirometry when patient is stable Q1. Discuss the A to E (Airway, Breathing, Circulation, Disability, Exposure) assessment approach for Mr. David Nazzal, who is experiencing an exacerbation of COPD. In your discussion, integrate relevant vital signs and explain how they inform your clinical decision-making. Q2. List four high priority nursing interventions for managing Mr David Nazzal's exacerbation of COPD and briefly discuss your rationales for each. Q3. Discuss the nursing considerations (i.e., Assessment, Administration and Side Effects) when administering the following therapies and medications to Mr Nazzal. Oxygen therapy Salbutamol (Ventolin) Ipratroprium (Atrovent)- Prednisolone Azithromycin (Zithromax) Nirmatrelvir and Ritonavir. Please provide APA 7 reference list and in text citataion and doi number of artices or ressources used for better understanding from Australia

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