A PRAXIS Case Study: Paul S.
Posted on February 25, 2020 |
This post was authored by Stephanie Williams, BS, RRT, COPD Foundation Director of Community Programs.
Current Visit: Paul S. is a 60-year-old man with a diagnosis of COPD. He is being seen by his pulmonologist as a sick-visit due to a “cold” he has been unable to recover from for two weeks. Symptoms from this illness have become progressively worse, with increased green sputum production, and increased breathlessness at the time of this visit. Paul has had to take off work for the past three days due to impact of these symptoms and is worried about how much longer it will take him to feel well enough to return to work. This is a big concern for him because he is self-employed as a stone mason and no work means no income.
Past Utilization: Similar episodes have occurred every few months for the past seven years and have been routinely treated by his PCP. It was during of one of these episodes that he was diagnosed with COPD five years ago and was placed on a short acting beta agonist (SABA) to help with his daily symptoms. Paul was referred to a pulmonologist about two years ago to help manage the COPD symptoms since he also now deals with other chronic conditions including hypertension and diabetes.
Medical History: COPD, HTN, DM2, and arthritic joints in his hands. Last spirometry (1 year ago) FEV1= 56% of predicted. 60-pack-year cigarette history, still smoking. Negative for Alpha-1 Antitrypsin Deficiency.
Respiratory Medications: Albuterol PRN for symptom control
Family History: Father, age 80, with hypertension,hyperlipidemia, and prostate cancer. Mother, age 78, treated for diabetes, emphysema, atrial fibrillation, and depression. Paul has one sibling, a sister age 55 who has diabetes and hypertension.
- CXR: Severe hyperinflation, negative for pneumonia.
- Pulse oximetry: Room air 90%.
- Respirations: 18 breaths/minute
- Heart rate: 105 Beats/minute
- Breath sounds: rhonchi, clears with forceful cough
- What are your impressions?
- How would you manage his current problem?
- What additional steps would you recommend for future disease management?
- Do you think non-pharmacological interventions are appropriate at this time? If so, what would you suggest? If no, why not?
- What education would you provide to Paul at this visit?