Oxygenation & Perfusion Mr. King Case Study

Read the Case Study for Mr. King found in your PowerPoint from class. What lifestyle risk factors does Mr. King have that are associated with COPD? (select all that apply)

• Shortness of Breath

• History of smoking

• History of alcohol use/abuse

• general malaise

• Gardener

Answer explanation

Shortness of breath and general malaise are symptoms associated with COPD.

Lifestyle factors like smoking and alcohol use increase person's risk for COPD.

Mr. King is extremely anxious. Based on the information in this first encounter with Mr. King, what condition or symptom would the nurse suspect is the primary problem related to being extremely anxious?

• Hypoxia

• Withdraw from alcohol

• Watching too much TV

• Not being able to garden

• Coughing

Answer explanation

Hypoxia initially presents with restlessness. Patients may seem anxious. Hypoxia is decreased oxygen in tissues. A patient with respiratory distress, chronic cough, shortness of breath, and anxious is likely experiencing hypoxia.

You suspect Mr. King is experiencing hypoxia, what should you assess first?

• Respiration Rate

• Sputum Color

• Oxygen Saturation (SpO₂)

• Lung Sounds

Answer explanation

Measurement of peripheral oxygen saturation (SpO₂) is used to identify early hypoxia in patients and evaluate the effectiveness of oxygen therapy.

Respiration rate, sputum color, and lung sounds are important to assess, but hypoxia (or severity of hypoxia) is determined by their oxygen saturation.

Tags

NGSS.HS-LS1-3

NGSS.HS-LS1-7

Based on your assessment for Mr. King, what intervention would the nurse do first?

• Wait for the provider's orders for labs and antibiotics

• Have patient cough and deep breath

• Apply oxygen at 12 liters per min (L/min) via high flow nasal cannula

• Apply oxygen at 2 liters per min (L/min) via nasal cannula

Answer explanation

Applying 2 L/min oxygen via nasal cannula will help improve the Mr. King's SpO₂ of 82%. The patient has been coughing and it is struggling to breath. Taking a deep breath will not work a this moment.

High flow oxygen is contraindicated for a patient with COPD.

The patient is hypoxic and needs oxygen. Waiting for the provider's medication orders is causing more harm for your patient.

When auscultating Mr. King's lungs, the nurse notes expiratory wheezes, crackles, and diminished breath sounds over the right lower lobe. Based on the assessment findings, what might be the cause of the diminished breath sounds?

• Pneumonia

• Right sided heart failure

• Chronic cough

• History of smoking and alcohol abuse

• Reactive airway disease or Asthma

Answer explanation

Mr. King has a temperature of 102^oF and is sputum is thick, yellow-green. These are signs of infection. With pneumonia (an infection), you may hear may hear nothing because of lack of air exchange – as it is starts to clear you will hear crackles and wheezing on auscultation.

Mr. King does not have symptoms of right-sided heart failure.

History of alcohol abuse and smoking can contribute to COPD diagnosis, but does not directly cause diminished breath sounds.

Reactive airway disease presents with wheezing, not diminished breath sounds.

At 1415, the nurse applied oxygen at 2 L/min via nasal cannula to Mr. King. His SpO₂ increased to 84% with respiration rate of 34 bpm after 15 minutes.

At 1440, the respiratory therapist administered a bronchodilator nebulizer to Mr. King and kept his nasal cannula at 2 L/min.

30 minutes after receiving the nebulizer, Mr. King's respiration rate is 16 bpm and his SpO₂ is 98%. What should the nurse do next?

• Increase the oxygen flow to 3 L/min and recheck his SpO₂ in 15 and 30 minutes.

• Humidify the oxygen.

• Do nothing, 98% SpO₂ and 16 bpm respiration rate are within normal limits.

• Reduce the oxygen flow to 1 L/min and recheck his SpO₂ in 15 and 30 minutes.

Answer explanation

decrease Mr. King's oxygen flow. SpO₂ of 98% is too high for a patient with COPD who is receiving oxygen. Mr. King's SpO₂ should be maintained between 88% - 92%.

Increasing the oxygen to achieve SpO₂ > 92% can be dangerous in patients with COPD. Whengiven a high concentration of oxygen, their primary urge to breathe is removed and hypoventilation or apnea may occur. Doing nothing keeps his SpO₂ too high.

Humidifying the oxygen is not indicated unless administering 4 L/min or more. It also does not address our concern of Mr. King having an of SpO₂ 98%.

Tags

NGSS.HS-LS1-3