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Gas Exchange Case Study
Human Pathophysiology (NUR 252)
Creighton University
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Gas Exchange Case Study
Case Presentation
Jimmy Bley, an 84-year-old male, is a retired veteran who served as an electronics technician in the Army for his entire career. Since retiring 20 years ago, Mr. Bley has been increasingly struggling with emphysema and hearing loss. He is able to do most things around the house, but he needs to pace himself. He does not perceive that his breathing problems are all that bad. Mr. Bley is still a smoker, and he uses an inhaler when absolutely necessary, but he is not oxygen-dependent. He has made several unsuccessful attempts to quit smoking.
- What risk factors for impaired gas exchange does Mr. Bley have?
The nurse should ask Mr. Bley how many cigarettes per day he currently smokes and offer assistance in reducing or stopping smoking. Age is another risk factor
Mr. Bley has begun waking in the middle of the night with a persistent, productive cough. He finds himself needing his inhaler as soon as he is awake. Mr. Bley believes that he just has a bad cold. To help him sleep, he props himself up on several pillows. His wife sets up a humidifier in the room at night, which seems to help. For several days, Mr. Bley spends most of the day resting and taking over-the- counter antitussive medicine in an effort to treat this worsening cough and “cold.” He is resistant to his wife’s suggestion that he schedule an appointment with his healthcare provider. “It is just a cold,” Mr. Bley tells her. However, after a week, Mr. Bley’s condition worsens to such a degree that he is unable to walk to the bathroom because of dyspnea. Despite the use of antitussive medication, he is coughing up copious amounts of thick, yellow mucus, and he admits to feeling chilled. At his wife’s insistence, he agrees to seek medical treatment. Although he refuses her request to call an ambulance, he allows her to drive him to the emergency department.
- What facts indicate that Mr. Bley does not have a cold?
Mr. Bley’s condition has worsened over the course of a week. With colds, the symptoms often begin to dissipate after this amount of time. The increasing sputum production and cough despite antitussive medications and the newer symptom of chills reflect a worsening of symptoms.
- According to the GOLD classification system, what degree of severity is Mr. Bley’s COPD?
Mr. Bley’s symptoms reflect moderate COPD (GOLD 2) based on increasing shortness of breath on exertion and sputum production. This is typically when medical care is sought.
- What is the significance of Mr. Bley’s report of feeling chilled?
Mr. Bley’s report of feeling chilled may reflect increasing body temperature in response to a respiratory infection secondary to the COPD.
Upon arrival at the hospital emergency department, Mr. Bley is pale and sweating profusely, with labored respirations. His oxygen saturation is 83% on room air. His oral temperature is 101°F. He is rapidly triaged and admitted to the hospital. Initial treatment includes immediate administration of a nebulized inhaled beta-2 agonist and insertion of an intravenous access device for fluid administration. When asked about his recent intake of food and fluid, Mr. Bley tells the healthcare provider, “I haven’t been eating or drinking much since I caught this cold. It’s too much work to eat a meal.” Laboratory tests include a chest x-ray, which reveals pneumonia. Mr. Bley’s white blood cell count is elevated, indicating the presence of infection. Arterial blood gases reveal hypercapnia and respiratory acidosis. Blood samples are sent to the laboratory for culture and sensitivity (C&S) testing. While awaiting the C&S results, the healthcare provider orders intravenous administration of a broad-spectrum antibiotic for immediate treatment of Mr. Bley’s pneumonia. Following 5 days of treatment for bacterial pneumonia, Mr. Bley’s condition improves to the point at which he can be discharged to his home. Mr. Bley’s discharge instructions include a course of oral antibiotics, scheduled use of his beta-2 agonist inhaler, and smoking cessation. In addition, the healthcare provider advises Mr. Bley to immediately discontinue use of any over-the-counter antitussive medication, as this class of medication inhibits the ability to expectorate mucus secretions and may lead to formation of a mucus plug, which can cause airway obstruction.
- What immunizations would be beneficial to Mr. Bley?
Mr. Bley would benefit from annual influenza vaccines and a pneumonia vaccine.
- What actions should be taken, given Mr. Bley’s statement that “it’s too much work to eat”?
Mr. Bley needs small, frequent meals that are nutritionally sound. He may benefit from a protein supplement between meals to ensure adequate protein intake.
- What information about the oral antibiotics should Mr. Bley receive at discharge?
Mr. Bley should be told to take the entire course of antibiotics as prescribed.
Gas Exchange Case Study
Course: Human Pathophysiology (NUR 252)
University: Creighton University
