Clinical Analysis on a Patient

Case Study
Ms. Lester is a 58-year-old woman, admitted for an acute exacerbation of COPD (AECOPD) and is being referred to pulmonary rehabilitation with COPD GOLD Stage 2 following discharge.
Demographic Data
• Sex: Female
• Age: 58 years old
• Height: 65 inches
• Weight: 250 lbs
• BMI: 42 kg/m2
Past medical history (PMH)
• COPD with hospital admission 6 months ago
• Sleep apnea: wears continuous positive airway pressure (CPAP) device at night
• Hypertension
• Hyperlipidemia
• Type 2 Diabetes
• Heart failure: ECHO 6 months ago showed concentric left ventricular hypertrophy with borderline EF of 45% and dilated right ventricle without other valvular or structural abnormalities. Hospitalization in the last year for heart failure exacerbation complicated by COPD requiring bilevel positive pressure ventilation (BiPAP) and admission to the intensive care unit (ICU).
Social History
• 45 pack year history of smoking
• Drinks 1 alcoholic beverage each week
• Lives at home with her husband
Assessment
• PFTs: pre-post spirometry results revealed FEV1/FVC = 65%, FEV1 = 50%
• Timed Up and Go (TUG): 14 seconds.
• 6MWT: 690 feet (210m) and 2.0 METS. Patient experienced oxygen desaturation to 88% on room air toward the end of the 6MWT. Supplemental oxygen was not administered but rechecked after the test and resting for 1 minute and oxygen saturation was 92% on room air.
• mMRCLinks to an external site. (modified Medical Research Council) scale for dyspnea: 3
• BODE (BMI, airflow obstruction, dyspnea, and exercise capacity) index: 5
Medications
• Albuterol inhaler (2 puffs as needed)
• Furosemide
• Carvedilol
• Metformin
Other:
She indicated that she walks two days per week on a sidewalk with no incline for about 1000 steps tracked by her iPhone. She stated that she gets short of breath and has to stop a few times during the walk.
Resources to help with the case study:
Bode Index Table and Calculator
Charlson Comorbidity Table and Calculator
Discussion Questions
Assessment
• Based on the patient’s current AECOPD hospital admission and past medical history, what is the combined COPD assessment (airflow limitation + symptom burden and risk of exacerbation) using the ABCD tool in the 2022 GOLD COPD standardsLinks to an external site.?
• What does the BODE IndexLinks to an external site. and Charlson Comorbidity Index (CCI)Links to an external site. suggest about this patient’s risk of mortality? (Hint: you may have to do some additional research on the BODE and CCI)
Additional Assessment Recommendations
• What additional tests or laboratory values would you recommend for this patient? Be specific about why you are making the recommendation.
Pulmonary Rehabilitation Recommendations
• Use the FITT model to develop the exercise prescription. (Hint: review the Exercise in Cardiopulmonary Disease page for assessing functional exercise capacity to calculate baseline parameters).
• How will you measure success in achieving patient outcomes?
Medication Recommendations
• Review the patient’s current medication list and make recommendations for any changes based on the patient’s status. (Hint: chapter 10 in your textbook and 2022 GOLD COPD standards). Be sure to discuss any potential drug interactions and drug considerations (e.g., proper MDI use with spacer, minimal inspiratory flow rates for DPIs, etc.).
Post Pulmonary Rehabilitation Recommendations
• Make recommendations for post pulmonary rehabilitation for home-based exercise and disease self-management. Don’t forget to address all the patient’s medical conditions.

Instructions:
For this discussion case study, you will be divided into groups to present the recommended care for this patient addressing all of recommendation elements (assessment, additional assessment recommendations, pulmonary rehabilitation recommendations, medication recommendations, and post pulmonary rehabilitation recommendations). Each group will post their care recommendations, with one member of the group posting the initial response. Please list your group names in the discussion to identify which group is posting. You will need to review each group’s recommendations and select at least one group to compare your recommendations. One person from the group will post the compare/contrast response, preferably someone different than who posted the initial response. Each member of the group is responsible for participating in managing the thread.