Chronic Obstructive Pulmonary Disease

What plan would you outline for this patient that seems to present with  Chronic Obstructive Pulmonary Disease?  What medications (name, dosage, route, frequency, and duration (if applicable like antibiotics), education on medication/ adverse effects, etc.?

-What Diagnostic testing and reasoning (why are you ordering it, what are you looking for? with reference)

-What is symptom management for a patient with COPD?

-What patient education would you give to a patient with COPD? (med, testing, diet, social, reasons for emergent evaluation?)

-Does this patient need a referral for further consultation with another specialist?

-When will the patient follow up with you and/or another specialist?

(All details of the plan should include a rationale that is supported with references from the healthcare literature)

Chief Complaint

A 58 y.o. female presents with fatigue and difficulty catching her breath. Although she has frequently coughed for months, the fatigue and shortness of breath have come on over the past 2 months. She has been treated twice in the past year for bronchitis, which included a severe cough with yellow sputum, shortness of breath, and fever. Once treated, the shortness of breath resolved until recently. She is a former smoker, describing a 40-pack-a-year history and finally quitting successfully on her 58th birthday.

Past Medical History

• Negative for asthma and other respiratory conditions
• Type 2 diabetes, hypertension, and increased lipids
• Surgeries: hysterectomy at age 55; an appendectomy in her teens; cataract removals earlier this year

Current Meds

• Metformin 500 mg BID
• HCTZ 25 mg daily
• Atenolol 25 mg daily
• Atorvastatin 10 mg daily

Psychosocial History

Works 2 days a week as a sales associate in the local department store and volunteers 1 day a week at the local library. Has recently taken a leave from her volunteer role and has decreased from 8-hour to 4-hour work days at the store because of the fatigue. Used to walk daily but has quit this lately, as she says, “It is all I can do to make the bed some days!”

Physical Examination

• Vital signs: T 98, BP 138/86, HR 92, RR 34, HT 64, WT 155 lbs.
• General: Appearance in no acute distress. Alert and oriented. Well groomed. Articulate and seems to be a good historian. Fluid movements.
• HEENT: Normal.
• CV: RR&R. S1/S2 without audible extra sounds or murmurs.
• Respiratory: Initially some crackles, which cleared with forceful cough. Decreased breath sounds, slight wheeze noted. Slight increased AP ratio.
• Skin: Intact, pink, resilient. No rashes or lesions noted.
• MS: Full ROM, non-pitting edema ankles/feet bilaterally. Pulses 2+ bilaterally.