Mr Thomas Brennan (69)

Case notes

Notes: You are a registered nurse on the respiratory ward of St Columba's Hospital.

Patient details
  Name:            Thomas Brennan
  DOB:             30/11/1955 (69 yrs)
  Address:         27 Harbour View, Port Ellis
  Admission date:  14/02/2025
  Discharge date:  21/02/2025
  Diagnosis:       Infective exacerbation of COPD (3rd admission in 12 months)

Social background
  - Lives with wife (Maureen, 67, has arthritis — limited ability to help)
  - Former dock worker; retired 2016
  - Ex-smoker — quit 2021 (50 pack-years)
  - Ground-floor flat; uses mobility scooter outdoors
  - Keen on fishing — stopped going out due to breathlessness

Medical history
  - COPD (2014), FEV1 42% predicted (2024)
  - Atrial fibrillation — apixaban 5 mg BD
  - Type 2 diabetes — diet-controlled
  - Depression (2023) — sertraline 50 mg daily

Nursing management and progress
  14/02  SOB at rest, SpO2 84% RA, productive cough green sputum. O2 via nasal prongs (target 88–92%)
         IV amoxicillin, oral prednisolone 30 mg, nebulised salbutamol 4-hrly
  16/02  Improving. Switched to oral antibiotics. Sputum clearing
  17/02  Inhaler technique observed — poor: does not exhale before MDI, no spacer
  18/02  Weaned off O2. SpO2 91% RA at rest, 86% on walking 20 m
  19/02  Pt says he "gives up" on exercise because breathlessness frightens him
         Wife reports he has been low in mood, rarely leaves the house
  20/02  Educated re spacer + technique — improved, needs reinforcement
         Discussed written COPD action plan — given copy, pt unsure when to start rescue pack

Discharge medications
  - Tiotropium/olodaterol inhaler 2 puffs daily
  - Salbutamol MDI with spacer PRN
  - Prednisolone 30 mg daily × 2 more days, then stop
  - Rescue pack (antibiotic + prednisolone) at home
  - Usual medications unchanged

Plan
  - Respiratory nurse specialist: home visit within 1 week — inhaler technique, action plan
  - Assess for pulmonary rehabilitation programme
  - GP to review mood

Writing task