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Valesia Mason
June 7, 2024
Bio Medical Ethics & Values
Professor Dallas Pitts
Segment one on the analysis of medical indications and patient preferences
A seventy-year-old male.
Presenting problem: the patient has presented a severe case of COPD disease with a pneumonia complication.
Medical history:
Nine years ago, he was diagnosed with COPD.
He is a long-term smoker.
Medicine is used to manage his hypertension.
Has been diagnosed with type II diabetes, managed through medication and nutrition.
Signs/Symptoms (S/S) on admission:
Coughing and producing purulent sputum.
Wheezing sound.
Shortness of breath.
Fatigue.
Elevated respiratory rates. (Agustí et al. 2020).
Diagnoses:
Increased COPD.
May be suffering from bacterial pneumonia.
Characterization of condition(s):
Due to periodic exacerbations, the COPD is progressive.
The condition has been complicated by pneumonia, leading to respiratory failure.
The lengthy smoking duration may increase other comorbidities. (Venkatesan, 2024).
Initial goal(s) of care
Improve the patient’s management of COPD and breathing rates.
Use antibiotics to treat the bacterial pneumonia.
Improve oxygenation to relieve the dyspnea or shortness of breath.
Reduce the possibility of other complications like acute respiratory distress.
After three days:
New Signs/Symptoms (S/S):
Although treatment was administered, shortness of breath increased.
The patient requires more oxygen supply.
Not being conscious of their environment.
Increased fever.
New Diagnosis:
An acute respiratory failure.
Pneumonia has caused secondary sepsis.
After transfer from the ICU to the step-down unit:
New Signs/Symptoms:
Increased fatigue.
Oxygenation has improved.
Signs and Symptoms over several days:
Reduced output of urine.
Disorientation episodes noted.
After auscultation, the wheezing proceeded.
The blood pressure level has increased.
The peripheral edema is swollen.
New Diagnosis:
The sepsis may have caused potential kidney injury.
Due to fluid overload, heart failure has occurred.
Prognosis:
The patient is at risk for more complications and health deterioration.
There may be no full recovery of the patient since long-term oxygen therapy is needed.
Goals of treatment
Stabilize the symptoms through optimization of fluid management to improve kidney function and reduce heart failure.
The treatment should focus on improving fatigue and dyspnea to ensure patient comfort and reduce suffering.
Sensitization for the patient and family on severity of the condition is and the palliative care.
References
Agustí, A., Vogelmeier, C., & Faner, R. (2020). COPD 2020: changes and challenges. American Journal of Physiology-Lung Cellular and Molecular Physiology, 319(5), L879-L883.
Venkatesan, P. (2024). GOLD COPD report: 2024 update. The Lancet Respiratory Medicine, 12(1), 15-16.