Albert Long is 52 years old Type 2 diabetic and is admitted to the Hospital with an exacerbation
of his COPD following an episode of pneumonia. He states he is having difficulty breathing and
has a productive cough of large amounts of thick yellowish-green sputum. His gasps at the end of
the coughing spell. States "I don't smoke anymore, but I used to smoke like a chimney.”
Social History: Retired factory worker. Married with 4 children who live in town. States he is
always tired and can’t get around and play with his grandchildren like he would like to.
Medications: ipratropium (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril)
metereddose inhalers for control of his symptoms. Metformin 1000 mg PO BID. Hyzar 50 mg
PO daily.
Admission data: BP 158/86 mm Hg, heart rate 118 beat/min, respiratory rate 34 breaths/min,
temperature 98.4° F and SaO2 85%. He is 5 ft 9 inches tall, weighs 215 lb, and has a marked
barrel chest and bilateral breath sounds with expiratory wheezes. Clubbed nail beds. States he
eats whatever his wife cooks. His skin is thin and fragile with poor turgor. Neck veins flat. No
peripheral edema. There is a quarter size, Stage 2 wound on left heel. States he can’t bend over
long enough to wash his feet well. Voided 100 ml dark amber cloudy urine. States it burns when
he urinates
Orders: diet as tolerated; OOB with assistance; O2 at 2 L/min NC; IV of D5W at 75 ml/hr;
sputum C&S x3; chest x-ray; cefuroxime axetil (Ceftin) 1 g q8hr IVPB; prednisone 60 mg PO
bid; albuterol nebulization 2.5 mg (0.5 ml) in 3 ml NS with room air q4hr and PRN; chest
physiotherapy bid as tolerated.
Lab values: • complete blood count (CBC)= H&H normal; WBCs= 12,500 • arterial blood gases
(ABGs)= partially compensated respiratory acidosis • Electrolytes/BUN= WNL, BUN=22

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