Nr601 Week 2: COPD Case Study Part 2
Nr601 Week 2: COPD Case Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.Nr601 Week 2: COPD Case
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
- Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)
- Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Case Study – Part 2
You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA
CXR Result:
No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact.
Spirometry Results:
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Requirements/Questions:
- What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
- Identify the corresponding ICD-10 code.
- Provide a treatment plan for this patient’s primary diagnosis which includes:
- Medication*
- Any additional testing necessary for this particular diagnosis*
- Patient education
- Referral
- Follow up
- Provide an active problem list for this patient based on the information given in the case.
- Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based practice (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.
Example:
Amoxicillin 500 mg capsule
1 tab po BID q 10 days
Disp #20 no refills
Nr601 Week 2: COPD Case Answer
Final Diagnosis and Treatment Plan for Pulmonary Disorder
Diagnosis:
Upon careful analysis of the spirometer test, the leading diagnosis for the observed respiratory issues is Chronic Obstructive Pulmonary Disorder (COPD) coded as J44.9 in ICD-10. Notably, the spirometer test reveals a FEV1 (Forced Expiratory Volume in one second) less than 80% of the FVC (Forced Vital Capacity), a key indicator of potential respiratory concerns.
While a reduced FEV1/FVC ratio might suggest pneumonia, the proportional decline in both FEV1 and FVC leans more towards a restrictive lung disorder, characteristic of COPD (Postma & Rabe, 2015). The client’s manifestations, including breathlessness, fatigue, chronic cough, and prior pulmonary hypertension, align with COPD symptoms. Particularly, the inability to perform daily activities without excessive resting is a crucial indicator favoring COPD over pneumonia or heart disease (Postma & Rabe, 2015).Nr601 Week 2: COPD Case
Treatment Plan:
Medical Treatment:
First-Line Medication – 5-HT Reuptake Inhibitors:
For COPD management, 5-HT reuptake inhibitors emerge as the primary pharmaceutical intervention due to their demonstrated efficacy (Horita & Kaneko, 2015).
- Fluvoxamine Oral Tablets:
- Initial immediate-release tablet dose: 50 mg orally once daily at bedtime.
- Initial extended-release capsule dose: 100 mg orally once daily at bedtime.
Second-Line Medication – Bronchodilators:
In addition to 5-HT reuptake inhibitors, bronchodilators play a crucial role in alleviating COPD symptoms.
- Albuterol Inhaler:
- Two puffs every four to six hours as needed for bronchodilation.
Lifestyle Modification:
- Smoking Cessation: Encourage and support the patient in quitting smoking, a pivotal step in COPD management (COPD Foundation, 2021).
- Physical Activity: Prescribe a tailored exercise regimen to improve lung function and overall well-being (COPD Foundation, 2021).
Follow-Up:
Regular monitoring of respiratory function through spirometry, coupled with periodic clinical assessments, will guide adjustments to the treatment plan for optimal COPD management.Nr601 Week 2: COPD Case
Implementing this comprehensive treatment approach aims to enhance the patient’s pulmonary function and quality of life.
References: COPD Foundation. (2021). COPD Treatment. https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Treatment.aspx
Horita, N., & Kaneko, T. (2015). Role of serotonin in the pathophysiology of chronic obstructive pulmonary disease. Pulmonary Pharmacology & Therapeutics, 31, 1-6.
Postma, D. S., & Rabe, K. F. (2015). The Asthma–COPD Overlap Syndrome. New England Journal of Medicine, 373(13), 1241-1249.
