Assignent Solutionnurs

please respond to the case study post bellow:
1.The primary diagnosis is COPD.
Positives- former smoker, persistent cough x 6mos, worse in AM, productive cough with whitish-yellow phlegm, dyspnea, SOB with activity, faint bilateral expiratory wheeze, Robitussin did not help
Negatives- unlabored breathing, O2 94%, R-20
2.J44.9
3.The patient COPD severity is GOLD 2 moderate almost severe based on the FEV1/FV of 52%. Initial treatment will include LABA BID and SABA as needed (GOLD, 2022).  The patient should be up to date on immunizations such as Influenza, Covid, Pneumoncocal, and Tdap (GOLD, 2022). I would order pulse oximetry to elevate need for supplemental O2 with the goal to keep O2 sat above 90% (Gold, 2022). Patient education would include COPD diagnosis, signs and symptoms of exacerbation, and how to use an inhaler (GOLD, 2022). I would refer to pulmonary rehab to increase exercise stamina, teach breathing techniques, and decrease hospital admissions (GOLD, 2022). GOLD recommends follow up in 1-4 weeks (2022). I would like to follow up in 1 week to evaluate inhaler use and symptoms.
Salmeterol DPI 50mcg/actuation
1 inhalation every 12 hours
Disp: 1 with 1 refill
Albuterol MDI 90mcg/actuation
2 puffs inhaled every 4-6 hours as needed for shortness of breath
Disp: 1 with 1 refill
4.Problem list
COPD
Cough
Dyspnea with activity
HTN
Former smoker
Obesity
I would not make changes to his B/P meds at this time. He is very close to goal. I would have patient monitor his B/P at home, adjust diet, and hopefully he will be able to increase activity after COPD treatment started. According to JNC goal for this patient is 150/90 (James et al., 2014).
References
Global Initiative for Chronic Obstructive Lung Disease. (2022). Pocket guide to copd diagnosis, management, and prevention. https://goldcopd.org/2022-gold-reports-2/ (Links to an external site.)
James, P., Oparil, S., Carter, B., Cushman, W., Dennison, Handler, J., Lackland, D., LeFevre, M., MacKenzie, T., Ogedegbe, O., Smith, S., Svetkey, L., Taler, S., Townsend, R., Wright, J., Narva, A., &Ortiz, E. (2014).  Evidence-based Guideline for the Management of High Blood Pressure in Adults: (JNC8).  Journal of the American Medical Association, 311(5), 507-20. https://web-p-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=c0583b87-4205-42d4-aa70-8c30c7ed97d0%40redis