Nursing – Case Study – Nursing Assignment Help
Mr. George Kostas is a 68-year-old retired mechanical engineer with a past medical history of smoking two packs of cigarettes per day for 30 years (75 pack years), chronic bronchitis and cor pulmonale. George was on holidays with his wife at Mt Hotham, Victoria when he became extremely short of breath. Upon presentation to the Emergency Department (ED), George was agitated and dyspnoeic at rest and had a Glasgow Coma Scale (GCS) of 15. His physical examination revealed the following: loud wheeze in the mid-lung fields, a temperature of 38.8 ºC, SpO2 90% on room air and a respiratory rate of 25 breaths/min. George’s lips were cyanotic, and during the past three days, George has had a productive cough expectorating thick, tenacious, green sputum in the morning on waking up.
Dr. Jones ordered a preliminary blood test and chest X-ray which revealed:
Blood test – moderate elevation of total white blood cell count (13.0 x 109/L)
Chest X-ray – hyperinflation with flattened diaphragm, large anteroposterior diameter, no infiltrates or effusions
Based on the preliminary test results Dr. Jones suspects an infective exacerbation of George’s chronic bronchitis and orders two additional tests, arterial blood gas analysis and pulmonary function test. Arterial blood gas analysis revealed pH of 7.32, PaCO2 of 54 mmHg and PaO2 of 65 mmHg. Pulmonary function test showed FEV1 = 1.67 L (45% of expected) and FVC = 4.1 L (85% of expected). FEV1= forced expiratory volume in 1 second; FVC = forced vital capacity.
George was admitted to the medical ward in the Royal Base Hospital and prescribed pharmacological therapy consisting of intravenous piperacillin with tazobactam, inhaled salmeterol and inhaled tiotropium.