15% pneumothorax (Day 3): Iatrogenic or from alveolar rupture in COPD

Cr 1.7 / BUN 48: Possible prerenal AKI from hypoperfusion/dehydration

Troponin 2.4 ng/mL: Indicates myocardial strain, possibly demand ischemia

BNP 242 pg/mL: Confirms fluid overload and pressure elevation → HF diagnosis

Reflects COPD retention of CO₂, worsened by fatigue and poor oxygenation

HR 126, irregular: A-fib with RVR → ↓ preload and CO → worsens systemic perfusion

BP 102/50, MAP 67: Marginal perfusion pressure → puts kidneys and brain at risk

-Coughing up thick pink mucus Stated in case intro → "Coughing up thick pink mucus" → Commonly reported by patient but also visible → borderline subjective/objective

-Leg pain Day 7: "Jessie complained of right leg pain" → This is a clear subjective statement (patient complaint)

Crackles in posterior lungs Lung auscultation findings

CXR: RUL infiltrate, later 15% pneumothorax Imaging

ABG: pH 7.31, PaCO₂ 52, PaO₂ 64 Day 1

WBC 19.8, Troponin 2.4, BNP 242, Glucose 235, Cr 1.7, BUN 48 Lab values

Swollen right leg Day 7 physical exam

Doppler confirms DVT Day 7 diagnostic

Thick pink sputum Observable (could be subjective if reported, but it’s visible here)

Trach collar at 28% FiO₂ Objective respiratory intervention

Tube feeding at goal rate Documented nutrition status

Bed-bound, weak Functional status observation

DVT: Venous stasis from low perfusion and immobility

Kidney function: Hyperglycemia can worsen nephropathy (↑ BUN/Cr)

Atherosclerosis → ↓ coronary perfusion → CAD

CAD + A-fib → ↑ risk of demand ischemia and heart failure

Exacerbated during decompensation with hypoxia and arrhythmia

Also onnected to:

HF: CAD worsens heart function

HTN: Works synergistically to increase cardiac stress