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Case Study: Mrs. Brown’s COPD Exacerbation Mrs. Emily Brown, a 62-year-old female with a 20-year history of chronic obstructive pulmonary disease (COPD), presents to the emergency department with shortness of breath, increased sputum production, and fatigue over the past two days. She has a history of smoking (1 pack per day for 30 years) but quit five years ago. Mrs. Brown reports that her sputum has turned yellowish-green, and she has been using her rescue inhaler (albuterol) more frequently, with limited relief. Upon arrival, her vital signs are as follows: Temperature: 38.1°C Heart rate: 102 bpm Respiratory rate: 26 breaths per minute Blood pressure: 142/88 mmHg Oxygen saturation: 88% on room air Physical examination reveals diminished breath sounds with expiratory wheezing and crackles in both lower lung fields. Mrs. Brown is visibly anxious and using accessory muscles to breathe. She is placed on 2 L/min of oxygen via nasal cannula, which improves her oxygen saturation to 92%. Her current medications include: Salbutamol (albuterol) inhaler as needed Tiotropium (Spiriva) once daily Fluticasone/salmeterol inhaler twice daily Metoprolol 50 mg once daily Short Answer Questions Oxygen Therapy: Why is it important to carefully monitor oxygen therapy in a patient with COPD like Mrs. Brown, and what complications can arise from improper oxygen administration? Inhaler Use: Describe the correct technique for using a metered-dose inhaler (MDI) with a spacer, and explain how it improves drug delivery for patients with COPD. Anxiety Management: What are two nursing interventions that can help reduce Mrs. Brown’s anxiety during this episode of acute shortness of breath? Medication Review: Why is Mrs. Brown prescribed both a long-acting bronchodilator (tiotropium) and an inhaled corticosteroid/long-acting beta-agonist (fluticasone/salmeterol) combination? Patient Education: What are two key self-management strategies you would teach Mrs. Brown to help prevent future COPD exacerbations?

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