Chronic obstructive pulmonary disease (COPD) is a major health problem. In the United States, it is the 4th leading cause of death affecting more than 12 million people. As a nurse, it is important that you understand the treatments available for COPD and the adverse side effects of these medications. Read the case study below, and then respond to the questions:
You are an RN working in a family practice clinic. Mrs. D. is a 52-year-old woman who came into the office because of increased shortness of breath with symptoms are only partially relieved by her inhaler (1.25 mg of Albuterol) which she has been using up to three times daily over the past week. She also complains of a new cough that is productive with thick yellow sputum and a “pounding in my chest”. She reports she has been taking her medications as prescribed: HCTZ 50 mg daily and salmeterol (Serevent Diskus) one puff every 12 hours.
Her chart reveals a past medical history of hypertension for the past 12 years, a diagnosis of bronchitis yearly for the past two years, and a recent diagnosis of COPD. She began smoking at age 16 and claims she quit two years previously; however, you note a mild cigarette smell from her clothing. The physician orders prednisone 40 mg daily for 10 days, and Ciprofloxacin 500 mg twice daily for 14 days. Based on the case study, respond to the following:
• Reflect on what you know about the pharmacologic treatment of COPD, asthma, and hypertension. Identify two concerns about drug interactions the patient, Mrs. D, may experience.
• Identify other nursing concerns.
• What nursing interventions would you recommend?
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