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Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF) exacerbation

Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF) exacerbation (worsening)

Patient, Mr. P is 71 years old and has a long term diagnosis of CHF and COPD.  He had a visit from his grandchildren and his great grandchild.  The family came into town and his great grandson had an upper respiratory infection and they also brought their dog.  During their weekend visit Mr. P began having some Shortness Of Breath (SOB) that he thought was related to the his allergies to dogs.  On Monday, he visited his MD because he was out of his inhalers that he uses as needed (prn).  His doctor noted that he had wheezing and lots of congestion.  His doctor ordered Mr. P to stay home over the next 2-3 weeks and made a referral for home health.

Nursing went out to evaluate the following morning and found Mr. P with increased SOB and wheezing. He also had swelling (edema) to both of his lower legs  He had not filled his prescriptions.  The nurse noted a lot of dog hair on the furniture.  She also noted that Mr. P had Chinese take-out containers on the counter.  When asked the patient stated he felt so weak and tired from the MD visit, he just didn’t feel like cooking and ordered the food delivered.  The nurse set a care plan for a Home Health Aide (HHA) to come out and clean Mr. P’s house to rid of all remaining dog hair.  She also instructed HHA to pre-cook some meals low in sodium for Mr. P that he could re-heat.  The nurse called the pharmacy to ensure medications were ready for pickup and went to the pharmacy to get them.  She then reviewed all of Mr. P’s medications.  He had many expired medications and some of his new medications conflicted with his old medications.  She called his MD reported this and verified what Mr. P should be taking.  She assisted MR. P with removing all medications he should not take from where he kept current medications.  She taught Mr. P about the importance of eating a low sodium diet, especially during this exacerbation.  She taught how CHF and COPD affect his heart and his breathing and his body.  She described how his medications helped him and discussed triggers to his worsening symptoms, ie. Chinese take-out, allergy triggers, etc.

On Day Two, the nurse found Mr. P, with much less edema to his lower legs due to the change in diet and taking the appropriate medications.  His SOB, wheezing and congestion had worsened and he had developed a low grade temperature.  She contacted Mr. P’s MD and obtained an order for antibiotics, she instructed on use and called the HHA to pick up on her way to see patient in the AM.

Nursing and HHA continued for the next 3 weeks to visit patient.  Due to the MD and the home health care this patient’s condition improved without hospitalization.