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Assignment 12.2 Shadow health D. O Connor
Medical surgical (NURS 380)
Nevada State College
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Assignment 12: Shadow Health-Focused Exam: COPD and Anti-asthmatics Concept Lab Case Study Patient: Debbie O’Connor DOB: 10/05/ Height: 5’ Weight: 195lbs Allergy: NKDA Previous diagnosis: COPD Group B – chronic bronchitis Current diagnosis: COPD Class C – chronic bronchitis Scenario: Ms. O’Connor is a 55-year old Caucasian female who has come to the doctor’s office reporting worsening of COPD symptoms and a recent, frightening episode of bronchospasm. She is a long-term smoker (37 years) and would like assistance with smoking cessation. Home medications: Formoterol inhaler 12mcg single-use q12 hours Vitals: Temp 37C (Temporal), Blood pressure 129/79 (Automatic), Heart rate 90 (NSR), O2 sat 92% (room air), Respiratory rate 26. Assessment: Ms. O’Connor is in today stating she feels her lungs “are falling apart” due to worsening shortness of breath. She reports that three days ago she had an episode of bronchospasm causing a coughing fit that made her apprehensive about her pulmonary health. She has been a smoker since the age of 15 and has had trouble breathing for years being hospitalized for a COPD exacerbation two years ago. She complains of feeling very uncomfortable with breathing difficulty being a 6 out of 10. Patient states symptoms have progressed in the recent 4 months as she has been getting more fatigued with worsening shortness of breath on minimal exertion, and a productive cough expectorating phlegm. She
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describes the cough as a wheezing, crackling sound which happens a few times an hour throughout the day with worsening frequency after she smokes a cigarette. She reports feeling anxious about her health and when symptoms arise although she denies having an anxiety disorder. The patient describes the sputum as mostly clear with episodes of yellow, gray and dark-colored expectoration. She denies seeing any blood but does describe it as the texture being thick starting two weeks ago. Ms. O’Connor reports constant wheezing and a strong desire to stop smoking to reduce her breathing symptoms. She reports multiple attempts at quitting smoking with the longest being 10 years when she had her daughter. She has tried using gum, patches and lozenges being unsuccessful at most attempts due to lack of required compliance. Reports symptoms have made her less social with no desire to go out even affecting her activities of daily living. Denies oxygen use out of fear of igniting a fire. Lives with her daughter who is a nonsmoker and is supportive of her mother's decision to stop smoking. Ms. O’Connor states her daughter cooks most of her meals however when she is not around, the alternative is frozen meals. She reports a 30lb weight gain over the last couple of months. She uses Formoterol inhaler twice a day and denies the use of any other medications including vitamins. Denies alcohol and drug use. Denies having a fever, having contracted influenza recently. She admits to not having the flu shot in some time and was educated on the importance of being diligent about having the shot yearly as recommended by the CDC. Ms. O'Connor uses an incentive spirometer at home achieving an FEV1 reading of 1, which she states is approximately 49% of her goal therapy. She reports no exercise due to symptoms. Reports no major eyesight issues other than nearsightedness, no surgeries, one miscarriage at a young age. Reports yellow discoloration of the skin around the mouth, teeth, nails, and fingers. Denies any cyanosis. She is postmenopausal, not sexually active.
Patient education: Ms. O'Connor appears to be very motivated to make lifestyle changes. She was educated on the new medications she'll be using for her worsening COPD symptoms. While taking Budesonide/Formoterol she was instructed to continue using this drug as told by the healthcare provider, even if feeling better, do not use more than once every twelve hours, if a dose is missed, skip the dose and go back to your normal time and to not exceed directed doses. She was reminded to shake the container well before use and rinse her mouth well with water after each dose. She was instructed to discontinue medication and contact the healthcare provider if she experiences bronchospasm shortly after administering a dose. At last, she was instructed to discontinue the previous Formoterol monotherapy inhaler to avoid overdosing. Regarding albuterol/ipratropium bromide, she was told not to use it more than recommended by the healthcare provider as it can cause tachycardia and discomfort. Alike Budesonide/Formoterol, she should recap back after using the inhaler and prep it before first use. Ms. O'Connor was told to seek medical attention right away at the nearest emergency room if she is not able to get a breathing attack under control as this is an emergency and can lead to death. Common side effects include feeling nervous or excitable and tachycardia. Lastly, she was educated on Varenicline, her drug therapy to quit smoking. She was instructed to take missed doses as soon as possible, to take after meals with a full glass of water, not to take extra doses and to begin smoking cessation counseling also as it has a mental health aspect linked to it. Common side effects she may experience include GI problems, insomnia and she may still experience nicotine withdrawal symptoms in the begin which should subside with time. She was instructed to take medication after meals with a full glass of water and to contact
the healthcare provider immediately if she has mood or behavior problems, such as suicidal ideation or depression while on this drug. Learning outcome 1) What did you learn? I enjoyed this module because it allowed me to explore the pulmonary system on a deeper level looking at COPD and its pathophysiology. The first module was interesting because shadow health is excellent in providing visual explanations of the information it is trying to relay. I particularly found it interesting to move the dial and look at how certain receptors and drugs affect different systems in the body at the same time. I was very familiar with albuterol/ipratropium as I work with these medications often in cardiac recovery but the management of chronic COPD with anti-inflammatory therapy was very interesting to learn. One topic I went back researched more about was smoking cessation therapies and it was interesting to see the options available and what we know so far about these drugs. Varenicline (Chantix) was the drug used in the shadow health module however, prescribers also have the option of using bupropion as an option. Medicine still knows very little about the use of smoking cessation drug therapy and research is currently underway to establish the most effective treatment. We still don't know about the safety of using varenicline in conjunction with nicotine replacement therapy patches however, studies are starting to confirm that this dual therapy is well-tolerated and safe. More research is needed but the current studies are very promising (American Cancer Society, 2017, para. 13). Smoking is a psychiatric disorder that leads to many life-altering diseases such as lung cancer, COPD and even death thus, we must tackle every aspect of the disease process, not just the pathophysiology of lung disease.
shows that as providers, we must always do our due diligence and always reconcile medication lists and make sure there is no polypharmacy to avoid interactions that could be uncomfortable and/or life-threatening.
References American Cancer Society. (2017, January 12). Prescription drugs to help you quit tobacco. Retrieved from cancer/healthy/stay-away-from-tobacco/guide-quitting- smoking/prescription-drugs-to-help-you-quit-smoking RxList. (2018, September 11). DuoNeb. Retrieved from rxlist/duoneb- drug#description Woolston, C. (2019, January 1). Drug interactions. Retrieved from consumer.healthday/encyclopedia/drug-center-16/misc-drugs-news-218/drug- interactions-646388
Assignment 12.2 Shadow health D. O Connor
Course: Medical surgical (NURS 380)
University: Nevada State College
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