Case Analysis: 2000 words

Mr Sam Jacobs, a 75?year?old male presented to hospital with increasing shortness of breath which is worse at night. He reports a three?day history of sudden onset of flu?like symptoms including fever, productive cough, and lethargy.
His past medical history includes hypertension, myocardial infarction and chronic obstructive pulmonary disease (COPD). He requires supplemental oxygen, 2L via nasal prongs (NP).
Mr Jacobs lives alone and continues to smoke a pack of cigarettes/day for 50 years. He was admitted to the ward for exacerbation of COPD.
Mr Jacobs is treated with short acting bronchodilator ? VENTOLIN/ATROVENT, prednisolone, humidified high flow nasal cannula (HHFNC). In view of his diagnosis and presentation, clarify the following components of Mr Jacobs clinical status
(1000 words):
• explain the causes and pathophysiology related to Mr Jacob’s exacerbation of COPD
• review actions, dose, efficacy and nursing management related to the administration of these drugs
• rationalise the appropriate use of oxygen during COPD exacerbations and strategies needed to optimise ventilatory support.
On admission to the ward you notice that Mr. Jacobs is very breathless, with frequent coughing and increased work of breathing. He shows you a tissue with frothy blood?tinged sputum.
On assessment ? Mr Jacobs is anxious and feels exhausted. He states that he has not taken his regular medications for past three days.
His vital signs are:
• temperature – 37.6C
• heart rate – 120 beats/min and irregular
• respiratory rate – 36 breaths/min
• blood pressure ? 100/58
• oxygen saturation – 85% on HHFNC delivering 35% FiO2.
Chest auscultation reveals bilateral lung crackles and decreased breath sounds.
Mr Jacobs denies having any pain and his ECG showed atrial fibrillation. You initiate a rapid response call.
Mr Jacobs is diagnosed with left ventricular heart failure and the following medications were prescribed and administered:
1 IV frusemide 40 mg (LASIX)
2 ENALAPRIL 5 mg tablets
3. Metoprolol 50 mg tablets (BETALOC)
4. IV morphine sulphate 2.5 mg (morphine).
Discuss the components of Mr Jacobs deterioration, clinical history and ECG findings. Consider these components and structure your discussion to (1000 words):
• analyse the relationship between COPD and cardiovascular disease – common risk factors, clinical manifestations, pathophysiological links
• explain the actions of these medication and their cardiopulmonary effect
• discuss clinical nursing care of heart failure patient.
The evidence in your discussion should relate to current literature and best practice guidelines.

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