Mrs. Virginia Wade is a 74-year-old African

Mrs. Virginia Wade is a 74-year-old African American woman with a 22-year history of Chronic Obstructive Pulmonary Disease (COPD). She has been admitted to a medical unit for an acute onset episode of her disease. Her social history includes being married with one son who visits weekly and several siblings who visit her annually. Mrs. Wade is retired from a plastics factory. She lives with her spouse in a third-floor apartment located in an urban setting. Mrs. Wade no longer smokes but had a 42-pack-year history. There is no use of alcohol or illegal drugs. It is her third admission in the past eight months. Her medications while hospitalized are as follows: D51/2 NS at 125mL/hr Solumedrol (methylprednisolone sodium succinate) 125 milligram IV every six hours Ipratropium bromide and Combivent (albuterol sulfate) inhalation aerosol every four hours as needed for shortness of breath Spiriva handihaler (tiotropium) 18 mcg inhaled daily Fluticasone propionate 250mcg and Advair 250/50 (salmeterol 50 mcg) one inhalation twice a day Humibid (guaifenesin) 300 mg orally daily Prinivil (lisinopril) 20 mg daily Lasix (furosemide) 40 mg, oral twice a day Novolin R insulin coverage, subcutaneous every six hours according to sliding scale Prilosec (omeprazole) 40 mg tablet orally daily Xanax (alprazolam) 0.25 mg, oral every six hours as needed for anxiety Mrs. Wade’s vital signs are: temperature 37.2oC, respiration 27, blood pressure 132/74 mmHg. Chest film is clear with evidence of hyperinflation and enlarged right ventricle. Urine output is adequate with greater than 400 mL per shift. Mrs. Wade states she routinely drinks 5 to 6 glasses of water or juice daily. No significant weight loss has occurred over the past month (she is 5 feet 4 inches tall and weighs 172 lbs. Her lab tests were predominantly within normal range. Questions: 1. What are Mrs. Wade’s verse factors for developing COPD? 2. What expected age-related changes have contributed to the COPD? 3. What are three psychosocial-oriented nursing diagnosis Mrs. Wade might be experiencing? Provide a care plan (ADPIE). 4. Mr. Wade is worried about taking his spouse home and wants to know what preparations he should make. There is portable oxygen available at home with 50 feet of tubing. What safety precautions can you discuss with Mr. Wade? 5. Mrs. Wade says she does not have diabetes and wonders why she’s getting insulin as needed, based on glucometer assessments. How do you explain this to her? 6. You ask all paid Mrs. Wade’s lungs. What do you expect to hear? 7. What findings in this case study would require that it collaborate with the other members of the health care team? 8. Once Mrs. Wade is discharged from the hospital, list some leadership roles you may have when working with HealthCare Assistants.

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