D. Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history (PMH) of hypertension (HTN), which has been well controlled by enalapril (Vasotec) for the past 6 years, and a diagnosis (Dx) of pneumonia yearly for the past 3 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D. Z. seems irritable and anxious when he tells you that he has been a 2-pack-a-day smoker for 38 years. He complains of (C/O) sleeping poorly and lately feels tired most of the time.

His vital signs (VS) are 162/84, 124, 36, 102°F, Sao2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation, etiology to be determined.

His admitting orders are as follows: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain Sao2 of 90%; maintenance IV of D5W at 50 ml/hr; intake and output (I&O); arterial blood gases (ABGs) in am; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h × 10 days, azithromycin 500 mg IV piggyback (IVPB) q24h ×2 days then 500 mg PO × 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q am.

1) Identify the expected findings in patients with COPD.
2) Identify three measures you could try to improve oxygenation status.
3) Explain the priority nursing care needed for patients with COPD.
4) What are two of the most common side effects of bronchodilators?
5) Identify the acid-base imbalance expected for patients with COPD.
6) Identify the expected arterial blood gas value results commonly seen in patients with COPD.