M.B. is a 65-year-old male who is being admitted from the emergency department to the
cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD).
M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for
control of his symptoms.
His admission vital signs are as follows: blood pressure 158/86 mm Hg,
heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 38.4° C, and SaO2 85%.
He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest.
1. Which assessments or actions should you take at this time?
2. What do you know about his medications? M.B. is receiving ipratropium and albuterol
(DuoNeb) in his nebulizer treatments. Identify the common side effects that might occur
as a result of inhaled β-adrenergic agonists and what information would you teach him
about so he can give this medication to himself?
3. What concerns do you have with his other assessment data?
4. While continuing M.B.’s assessment, you recognize that sometimes it is difficult to
distinguish COPD from asthma since clinical manifestations may be identical. However,
there are some clinical features that are different. Select the appropriate for
each clinical feature to indicate whether each is specific to COPD or asthma.
Clinical Features COPD Asthma
Onset usually less than 40
Long history of smoking
History of allergies
Clinical symptoms intermittent
Smoking not a cause
Thick tenacious sputum
Progressive worsening of disease
Onset usually 40-50 years old
Infrequently associated with allergies
Dyspnea during exertion
Stable disease course
M.B., a 65-year-old male, is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). In this scenario, we will discuss the immediate assessments and actions needed, understanding the medications he’s receiving, concerns from the assessment data, and differentiating between COPD and asthma based on clinical features.
Administer supplemental oxygen to improve oxygen saturation (SaO2) of 85%. Start at a low flow rate and titrate to maintain SaO2 > 90%.
Monitor M.B.’s respiratory rate and pattern for signs of distress, such as retractions or the use of accessory muscles.
Check his blood pressure and heart rate regularly, as the high respiratory rate may lead to increased heart rate and blood pressure.
Assess his lung sounds for adventitious sounds like wheezing, crackles, or decreased breath sounds in different lung fields.
Evaluate his mental status for signs of confusion or restlessness, which may indicate hypoxia.
M.B. is receiving a combination of ipratropium and albuterol (DuoNeb) in his nebulizer treatments. Common side effects include:
Tachycardia
Tremors
Nervousness
Palpitations
Dry mouth
Patient Education:
Instruct M.B. to rinse his mouth after inhalation to reduce dry mouth.
Teach him to monitor his heart rate and report any significant changes.
Advise him to use the nebulizer in a well-ventilated area.
Emphasize the importance of regular, scheduled use to manage COPD effectively.
The elevated respiratory rate (36 breaths/min) suggests increased work of breathing and possible respiratory distress.
Fever (38.4°C) indicates a potential infection, which could worsen his COPD symptoms.
SaO2 of 85% is concerning as it suggests significant hypoxemia, which should be addressed immediately.
| Clinical Features | COPD | Asthma |
|---|---|---|
| Onset | Usually > 40 years old | Usually < 40 years old |
| Long history of smoking | Common | Infrequent |
| History of allergies | Infrequent | Common |
| Clinical symptoms | Persistent and chronic | Intermittent, episodic |
| Smoking not a cause | Possible trigger | Not a cause |
| Thick tenacious sputum | Common | Rare |
| Progressive worsening | Common | Stable disease course |
| Dyspnea during exertion | Common | Common |
Assessing and managing COPD exacerbations requires immediate attention to the patient’s vital signs and oxygenation. Understanding the side effects of inhaled medications and educating the patient is crucial. The assessment data and clinical features help distinguish COPD from asthma, aiding in appropriate care and treatment decisions. Proper management, education, and differentiation ensure the best outcomes for patients like M.B. with COPD exacerbations.
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