Final answer:
In this case, the emergency orders for a patient with a history of smoking and COPD experiencing worsening symptoms of shortness of breath and wheezing would include assessing oxygen saturation, administering supplemental oxygen if needed, ordering a chest X-ray, starting inhaled bronchodilators, and considering systemic corticosteroids. The physical exam would involve assessing vital signs, listening to lung sounds, and observing the patient's appearance. Diagnostic tests would include a complete blood count, sputum culture, and arterial blood gas analysis. Therapy would involve supplemental oxygen, bronchodilators, corticosteroids, and smoking cessation. The patient would likely be admitted to a medical or respiratory care unit, and the final order would include continued oxygen therapy, adjustment of bronchodilator therapy, and patient education. The diagnosis is consistent with a COPD exacerbation.
Step-by-step explanation:
Emergency Orders:
Assess the patient's oxygen saturation level using a pulse oximeter.
Administer supplemental oxygen if the oxygen saturation level is low.
Order a chest X-ray to evaluate the extent of lung involvement.
Start the patient on inhaled bronchodilators, such as albuterol, to relieve bronchospasm.
Consider starting systemic corticosteroids to reduce inflammation in the airways.
Physical Exam:
Assess the patient's vital signs, including heart rate, respiratory rate, and blood pressure.
Listen to the patient's lungs using a stethoscope to identify any abnormal breath sounds.
Observe the patient's overall appearance, including signs of respiratory distress.
Diagnostic Tests:
Perform a complete blood count (CBC) to check for signs of infection.
Collect a sputum sample for culture and sensitivity testing.
Order arterial blood gas (ABG) analysis to assess oxygen and carbon dioxide levels in the blood.
Therapy:
Administer supplemental oxygen to maintain oxygen saturation above 90%.
Start inhaled bronchodilators for immediate symptom relief.
Consider systemic corticosteroids to reduce airway inflammation.
Encourage smoking cessation to slow down the progression of COPD.
Location:
Admit the patient to a medical unit or respiratory care unit for further management.
Consider transferring the patient to an intensive care unit (ICU) if there are signs of severe respiratory distress.
Final Order:
Continue supplemental oxygen to maintain oxygen saturation within target range.
Adjust bronchodilator therapy based on the patient's response.
Provide patient education on COPD management and smoking cessation.
Dx:
The patient's symptoms, history of smoking, and physical exam findings are consistent with a COPD exacerbation. Further diagnostic tests, such as chest X-ray and sputum culture, may help confirm the diagnosis.