A COPD Case Study: Susan M.
Posted on December 05, 2017 |
Meet Susan M! Share your impressions in our latest COPD case study.
Summary of in-patient admission: Susan M. is being discharged today following a 6-day ICU and step-down admission for acute exacerbation of COPD with bacterial pneumonia requiring intubation and mechanical ventilation for a period of 32 hours. Subsequent to her extubation and transfer to the step down unit she was treated with oral antibiotics and Albuterol and Ipratropium nebulizer q 4 hrs. and prn at noc.
Past utilization: Susan was admitted to the hospital for eight days last winter for acute exacerbation of COPD with bacterial pneumonia requiring 48-hour intubation and mechanical ventilation. Since then she has been seen in the ER x 2 for extreme shortness of breath with anxiety with no evidence of infection. On both occasions her shortness of breath subsided with nebulizer treatments, low flow O2, and coaching in relaxation techniques. On one of those visits Susan reported that her shortness of breath “ramped up” when she was unable to contact her daughter who, at the time, was driving alone, long-distance. “I worry a lot. I try to tell myself not to worry, but I just can’t help it.”
Medical history: COPD, systemic hypertension, hip replacement 5 years ago. FEV1 is 50% normal predicted. 35-pack year cigarette history, quit at age 50. Bone density: T score: -2 (low bone density possibly leading to osteoporosis).
Family history: Father died of stroke at age 80, mother died of injuries due to a MVA at age 75. Has three adult children with no known medical problems.
CXR at discharge: Mild hyperinflation, no pneumonia.
Pulse oximetry: Room air 95%.
Height: 65” Weight: 130 lbs. Susan has lost 5 lbs. within the last year with no intention of losing weight.
Psych/Social: Widowed. Lives alone. Husband died of internal injuries following a MVA 2 years ago. Spends meal times alone. “I used to make big meals when everybody was here but now, why make a big deal out of cooking when I’m the only one?” Our youngest son and his family live 15 miles away. “They’re so busy, I hate to bother them.” Susan drives her car only during the day and when “absolutely necessary,” sometime not leaving the house for up to 6 days at a time.
Here are a few questions for your consideration.
- What are your impressions?
- What are your post-acute recommendations for this patient?
- What follow up would you conduct with this patient and within what time frame?
- What education would you ensure this patient has at discharge?
- Would you recommend any consults in addition to nutrition and behavioral health?
Share your thoughts in the comments below!