Dx: Impaired gas exchange r/taltered oxygen supply(obstruction of airways bysecrections, bronchospasm: air-trapping) as evidenced bydyspnea, confusion, inability tomove signs, and reducedtolerance for activity.

Goal: Improve ventilation andoxygenation of tissues by use ofoxygen therapy beforedischarge.Goal met: patient receivedoxygen per nasal cannulathroughout hospital stay andwill be receiving home oxygentherapy.

Dx: Ineffective airwayclearance r/t increasedproduction of secretions asevidenced by persistent coughtwith sputum production.

Goal:Maintaing airway patencywith breath soundsclear/clearing throughout stayand before discharge.Goal met:patient's airwayremained patent throughouthospital stay.

Interventions:1. Auscultate breath sounds. Noteadventitious breath sounds(wheezes, crackles, rkonchi).2. Note presence and degree ofdyspnea as for restlessness, anxiety,respiratory muscles.3. Assist parient to assume postitionof comfort (elevate head of bed,have patient lean on overbed tableor sit on edge of bed.

Goal: Identify interventions toprevent/reduce risk ofinfection before discharge.Goal met: patient indentifiedways to prevent and reducerisk of infection as well asstayed free of infection duringhospital stay.

Dx: Risk for infection r/tinadequate primary defenses(decreased ciliary action, Stasisof secretions), inadequateacquired immunity (tissuedestruction, increasedenvironmental exposure),"chronic disease process, andmalnutrition as evidenced byCOPD diagnosis.

Allergies:-Codeine-Corticosteroids-demerol (Meperidine)-morphine-talwin compound

Interventions:1. Monitor temperature.2. Review importance ofbreathing exercises,effective cough, frequentposition changes, andadequate fluid intake,3. Observe color,character, odor ofsputum.4. Demonstrate and assistpatient in disposal oftissues and sputum.Stress properhandwashing (nurse andpatient), and use gloveswhen handing ordisposing of tissues,sputum containers.5. Encourage balancebetween activity and rest.6. Discuss need foradequate nutritionalintake.7. Administerantimicrobials as needed.

Interventions:1. Encourage deep-slow pr pursed-lip breathing as individuallyneeded or tolerated.2. Assess and routinely monitor skin and mucous membrance color.3. Encourage expectoration of sputum; suction when indicated4. Monitor level of consciousness and mental statue. Investigetechanges.

Pertinent information:-Chest X-Ray on 10/10 showedmild progressive bibasilarinfiltrates or atelectasis -Patient is NPO at this time andis not reveiving any IV fluids -Patient had a fall proior to admitand her main complaints in theER were abdominal pain, N/V,and constipation -Patient has a history of COPD,sleep apanea, thyroid disease,stroke, seizures, dementia,pneumonia, hypertension, heartattack, GERD, depression,anxiety, CHF, chronic back pain,CAD, and asthmaghtwith sputum production.

Medications:-albuterol-ipratropium (Duo-Neb) 3mL4x/day nebulizer-aspirin tablet 325mg PO daily withmeal-atorvastatin (Lipitor) tablet 10mg POnightly-carvedilol (Coreg) tablet 10mg POnightly-Docusate sodium (colace) capsule25mg PO 2x/day-fluoxetine (Prozac) capsule 20mg POdaily-levothyroxine (Synthroid) tablet175mcg PO daily early AM-tiotropium bromide (SpirivaRespimat) inhalation solution 2 puffdaily AM

Vitals:-0748Temp - 98.3pulse -79Resp - 23BP - 207/129O2 sat-95%pain - 0 Reported toincreased B/P andrespirations toprimary nurse

Labs:CBC 10/10/18 1244WBC _ 8.8RBC - 3.38Hgb - 9.7Hct - 29.2Platelets -216BMP 10/10/18 1308Sodium -4.6chloride -104Tatal co2 - 23Anion gap -Calcum - 8.9Glucose - 112BUN - 5Creatinine - 0.46Magnesium - 0.9