[Solved]: CASE STUDY: Chronic Obstructive Pulmonary Disease…

CASE STUDY: Chronic Obstructive Pulmonary Disease (COPD) Client Narrative Mr. Thomas J. (75), retired factory worker, presents with progressive anxiety, chronic morning cough, and dyspnea. COPD x12 years; uses home O2 2 L/min NC. Quit smoking 5 years ago after ~40 pack-years. Lives with wife Hella, who assists with meds/O2 but struggles with equipment and polypharmacy. Reports poor appetite, weight loss, fatigue, and fear of breathlessness (“It’s scary when I can’t catch my breath”). Avoids social events due to embarrassment about the O2 tank; anxious and sleep-disturbed; feels like a burden. Key issues Anxiety r/t dyspnea/fear of exacerbations Dyspnea r/t impaired gas exchange Decreased appetite/weight loss r/t fatigue and increased work of breathing Chart Data (Essential) Biographical: Thomas Johnson, male, married, retired factory worker. Health history: COPD (12 yrs); HTN controlled; 2 prior COPD hospitalizations; home O2 2 L/min. Family: Father lung cancer; mother type 2 DM. Allergies: None. Risk factors: Former smoker (40 pack-years); long-term dust/fume exposure; limited activity. Physical assessment Objective: RR 28, HR 99, SpO2 88% RA, barrel chest, prolonged exhalation, ↓ breath sounds, accessory muscle use, productive cough. Subjective: “SOB even walking to the bathroom.” Emotional Objective: Anxious, restless, poor sleep. Subjective: “I feel like I can’t breathe. It’s scary.” Psychosocial Lives with wife; reduces socializing; upset about loss of independence. Diagnostics/Labs CXR: hyperinflation, flat diaphragm. PFT: FEV1/FVC 0.58. ABG: pH 7.33, PaCO2 52 mmHg, PaO2 60 mmHg, HCO3 30 mmol/L. SpO2: 88%. Medications Ventolin PRN, Spiriva daily, Advair BID. Acetylcysteine for mucus; O2 2 L/min NC. Lorazepam PRN anxiety (if ordered). Current Plans Nursing: Upright positioning; pursed-lip breathing; monitor resp status/SpO2; schedule rest periods; small, frequent meals; fluids; vaccinations. Collaborative: Pulmonary rehab; dietitian; breathing exercises. Medical: Bronchodilators, ICS, antibiotics PRN, oxygen therapy; frequent reassessment. Alternative: Relaxation/mindfulness breathing for anxiety. Potential Complications Respiratory failure, cor pulmonale, frequent exacerbations, anxiety, malnutrition. Cultural/Preference Considerations Spouse caregiver; English-speaking; adherent to medical advice; open to herbal tea for comfort; prefer home-based care; receptive to O2 safety and infection-control teaching. Assignment Description (Advocacy Paper) Canadian health care is acute/episodic and may not meet complex chronic needs. Nurses advocate for social justice, patient rights, equity, and access. Per CNO Entry-to-Practice Competencies (2023): ETPC 26: Advocate for equitable access/treatment/resources, especially for vulnerable clients. ETPC 27: Advocate for clients unable to advocate for themselves. Task: Write an individual academic paper advocating for a vulnerable client with a chronic condition (Mr. T