MS 1 COMPETENCY APPRAISAL

Care of Client with COPD, Acute Respiratory Failure, Acute Coronary Syndrome
and Acute Renal Failure

Mr. RRJ 62-year-old male, with 20 years history of COPD suddenly develop intermittent
moderate to severe hemoptysis accompanied with abdominal pain, tachycardia and indigestion.
He was brought to the E.R. He is alert, coherent and appears anxious. Health history was
taken.

Family History:
(+) COPD/HPN Father
(+) Uterine CA Mother
Personal History:
(+) Cigarette Smoker 30 pack years
(+) Alcoholic Beverages Drinker 30 years
Surgery Done:
2011 - Left Coronary Angiogram and Stenting

Physical Assessment:
BP: 170/100, HR: 133 bpm, Temp: 37.8, O2 sat: 89%
Awake, conscious, coherent.
Pink palpebral conjunctiva, anicteric sclera
Symmetrical chest expansion, with rales and crackles
Adynamic precordium, tachycardic, irregular rhythm
(-) cyanosis, (-) jaundice

The physician ordered for rapid administration of NSS. The patients O2 saturation
continues to drop at 78%. Patient was intubated and hooked to mechanical ventilation. ABG
taken as follows: pH: 7.25, paCO2: 49.50, paHCO3: 26. Intermittent moderate to severe
hemoptysis continued. Bronchoscopy was planned.

The pulmonologist suggested for Bronchial Artery Embolization.

After 3 days hospital stay at the ICU, the patient experienced shortness of breath. ECG was
taken and yield to the following result:

Urine output: 240 ml/24 hours. Troponin I: 4.0 ng/ml, Troponin T: 3.0 ng/ml.
 5 days later in the ICU, the patient develops dryness of the skin and oral mucosa. BUN:
12.5 mmol/L, creatinine 4.0mg/dl, uric acid: 6 mmol/L.