CLINICAL REASONING REPORT: An elderly man (76 years old) with chronic obstructive pulmonary disease

PATIENT SITUATION:

Mr. A a 76-year old and has regular visits from the community nurse. Mr. A has COPD and has been on home oxygen for several years. The extent of his disease means that he is unable to walk short distances without the aid of oxygen. Despite his disease progression, Mr. A wishes to stay in his own home and maintain his independence with the aid of community nurses. Mr. A’s target O2 of > 89% using the home oxygen concentrator. However, his usual machine required servicing and a replacement medical oxygen cylinder was supplied. Mr. A was educated on the appropriate use of medical oxygen. When you attend his residence, Mr. A is propped up in his recliner with his nasal prongs in place and the oxygen on.

You notice a packet of cigarettes and lighter on the table beside him. He is observed to be distressed and has difficulty breathing (not unusual for him though).

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Review the existing documentation; Past History

Mr. A a 75 year old gentleman who is in considerable poor health. He has an extensive medical history including diabetes, peripheral vascular disease and COPD. Despite his ill health, Mr. A continues to smoke a packet of cigarettes a day for which he has a 60 year history when he commenced smoking at the age of 15. He has a poor diet, limited social network and relies on community services such as Meal on Wheels. Due to his poor health, Mr. A rarely leaves his apartment.

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