Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words at least.
This week, one of the patients I saw was an elderly male who had a medical history of COPD and hypertension. This presentation led to conducting a comprehensive assessment so that the patient could get a treatment plan designed to cater to his respiratory and cardiovascular issues. Dealing with the acute COPD episode as well as considering the patient’s hypertension was in itself a complicated task. Petrosyan et al. (2020) noted that in such cases, the challenge lies in managing both the chronic conditions collectively instead of focusing on the treatment of a single disease. This case called for the need to refer to proven clinical guidelines in order to put together an effective care plan for the patient. Success was achieved through thorough assessment and the integration of evidence-based practice.
P.J, a 71-year-old Caucasian male patient, was brought to the outpatient clinic with complaints of chest pain. He reported that the pain was sudden in onset, radiating to his neck, back, and upper arms, and had progressively gotten worse with no relieving or aggravating factors. He also admitted experiencing progressive shortness of breath with hemoptysis, productive cough, mild fatigue, intermittent wheezing, and night sweats. Nevertheless, the patient denied any other infectious or gastrointestinal symptoms, including rigours, recent weight loss, chills, fever, abdominal pain, diarrhea, vomiting, or nausea. There was no history of recent dyspnea on exertion or COPD exacerbation. Social history was positive for a 30-pack-year smoking history, but quit 4 years, with tuberculosis exposure, illicit drug use, or recent travel. Family and surgical history were unremarkable.
On initial examination, J.P was afebrile through tachycardiac, with audible wheezing and no respiratory status distress at the moment. His current vital signs include a BP of 120/70 mmHg, HR of 102/min, RR of 20/min, temp of 97.8oF, O2 saturation of 96% (breathing ambient air), BMI of 23.8, and pain of 0/10. Lung/chest exam revealed mild expiratory wheezing and diminished breath sounds at the right lung. All the other physical exams were unremarkable. Lab tests, including CBC, CMP, ECG, and coagulation profile, were largely unremarkable, except for mild anemia with hemoglobin of 11.8g/dL and mild leukocytosis with WBC count of 14,400/ L. Chest radiograph revealed right upper lobe bullae, emphysematous lung, and adjacent opacification.
The doctor made a presumed diagnosis of pneumonia and acute COPD exacerbation, and the patient received empirical antibiotics with ceftriaxone and azithromycin with oral prednisone. According to Al-Salloum et al. (2021), a combination empirical antibiotic therapy with ceftriaxone and azithromycin is one of the most common regimens that have proved effective in the treatment of CAP. This therapy was expected to significantly improve the prognosis of the patient. Bronchoscopy was also planned because of the worsening hemoptysis on presentation (Deshwal, Sinha & Mehta, 2021). Further diagnostic workups for vasculitis, mycobacterium disease, and invasive fungal infections were ordered, and the patient was advised to return to the clinic the following week.
During this weeks clinical experience, I obtained a deep understanding of the nursing complexities related to the management of respiratory and cardiovascular conditions in elderly patients. I got the understanding of the significance of extensive evaluation, differential diagnosis, and interdisciplinary collaboration for the provision of personalized care which would be unique for each patient. The health promotion intervention we addressed with the patient is the development of an individualized pulmonary rehabilitation plan that could help him improve his lung function, increase exercise tolerance, and promote self-care skills.
