M.B. is a 65-year-old male who is being admitted from the emergency department to the cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD). M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg, heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 38.4 C, and SaO2 85%. He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest. Which assessments or actions should you take at this time? What do you know about his medications? M.B. is receiving ipratropium and albuterol (DuoNeb) in his nebulizer treatments. Identify the common side effects that might occur as a result of inhaled -adrenergic agonists and what information would you teach him about so he can give this medication to himself? What concerns do you have with his other assessment data? While continuing M.B.'s assessment, you recognize that sometimes it is difficult to distinguish COPD from asthma since clinical manifestations may be identical. However, there are some clinical features that are different. Select the appropriate column for each clinical feature to indicate whether each is specific to COPD or asthma. Clinical Features COPD Asthma Onset usually less than 40 Long history of smoking History of allergies Clinical symptoms intermittent Smoking not a cause Thick tenacious sputum Progressive worsening of disease Onset usually 40-50 years old Infrequently associated with allergies Dyspnea during exertion Stable disease course Infrequent sputum Slowly progressive clinical symptoms MD orders Activity as tolerated with assistance O2 at 2 L/nasal cannula IV of D5W in 0.45 NS at 50 ml/hr sputum C&S x3 CBC, ABGs, and electrolytes chest x-ray cefuroxime axetil (Ceftin) 1 g q8hr IVPB prednisone 40 mg PO bid ipratropium and albuterol (DuoNeb) nebulization What are the rationale for the MD orders? You also need to teach him about pursed lip breathing. Why is this helpful and how would you explain that to him?.

1. M.B. is a 65-year-old male who is being admitted from the emergency department to the
cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD).
M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for
control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg,
heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 38.4 C, and SaO2 85%. He
is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest. Which assessments or actions
should you take at this time? What do you know about his medications? M.B. is receiving
ipratropium and albuterol (DuoNeb) in his nebulizer treatments. Identify the common side
effects that might occur as a result of inhaled -adrenergic agonists and what information would
you teach him about so he can give this medication to himself? What concerns do you have with
his other assessment data? While continuing M.B.'s assessment, you recognize that sometimes it
is difficult to distinguish COPD from asthma since clinical manifestations may be identical.
However, there are some clinical features that are different. Select the appropriate column for
each clinical feature to indicate whether each is specific to COPD or asthma. Clinical Features
COPD Asthma Onset usually less than 40 Long history of smoking History of allergies Clinical
symptoms intermittent Smoking not a cause Thick tenacious sputum Progressive worsening of
disease Onset usually 40-50 years old Infrequently associated with allergies Dyspnea during
exertion Stable disease course Infrequent sputum Slowly progressive clinical symptoms MD
orders Activity as tolerated with assistance O2 at 2 L/nasal cannula IV of D5W in 0.45 NS at 50
ml/hr sputum C&S x3 CBC, ABGs, and electrolytes chest x-ray cefuroxime axetil (Ceftin) 1 g
q8hr IVPB prednisone 40 mg PO bid ipratropium and albuterol (DuoNeb) nebulization What are
the rationale for the MD orders? You also need to teach him about pursed lip breathing. Why is
this helpful and how would you explain that to him?