Respiratory Case Study - Chronic Bronchitis

Chapter 3 –Emphysema
Response 1:
O2 via NC at 2lpm
Breathing tx (Albuterol) q4h
CPT q4h
Postural Drainage of RLL
Monitor closely for respiratory failure
Response 2:
Recommend Intubation with mechanical ventilation
Order ABG in 30 minutes
Continue Albuterol q4h – Add Mucomyst q4h
CPT q4h

Patient has severe case of COPD with air trapping. Patient was diagnosed previous to this admission with Chronic Emphysema. Patient also suffers from pneumonia. I placed patient on nasal cannula to correct low oxygen level. The patient was given a bronchodilator and CPT q4h to move secretions. Patients ABG reading suggested pending respiratory failure so monitoring of the patient was crucial. 2 days later, patients ABG’s showed that his status was rapidly deteriorating. I suggested intubation and mechanical ventilation with continued bronchiohygiene treatments with added mucolytic (mucomyst) q4h. CPTs continued q4h.

Respiratory Protocol for patient with Chronic Bronchitis:
Plan 1
Nebulizer treatment with Albuterol q4h
CPT q.4h
Flutter/ Acapella q.4h
NC @ 2 L

Plan 2
BiPAP
Breathing treatment with Albuterol q4h
CPT q.4h
Flutter/Acapella q.4h

Plan 3
Suggest Intubation
Breathing Treatment with Xopenex q4h

Upon admittance the patient exhibits signs of COPD with pursed-lip breathing, barrel chest, etc. I gave the patient a breathing treatment with Albuterol to dilate the airways and allow the thick secretions to move. The CPT and Acapella will also act as inhibitors to move the patients secretions. Even though I believe the patient to be a COPD patient, his blood gases show that he is uncompensated so I put him on a nasal cannula at 2 lpm. The next day, the patient continued to worsen. His ABG showed an uncompensated high CO2 level. The patient was then put on a BiPAP to help blow off his CO2. He continued his treatment with Albuterol, CPTs and Acapella. Later that evening, the patient became hard to arouse, his vitals were deteriorating so I suggest intubating the patient and changing his breathing tx from Albuterol to Xopenex for the high blood pressure.