3/2/2016 Case Study

Chronic Obstructive Pulmonary Disease

Submitted To:
MA GENEL GRACE M. VILLACASTIN

Submitted To:
MADONNA S. PALMES, RN, MAN
 I. VITAL INFORMATION
Name: RS
Age: 79 years old
Sex: Male
Civil Status: Widower
Date and Time Admitted: February 16, 2016
Chief Complaint: Difficulty of bbreathing
Ward: Male Medical Service Ward
Allergies: None to food, medications and other stimulants
Religious Affiliation: Roman Catholic
Impression/Diagnosis: COPD in AE CAP HR with Hypoxemia

II. CLINICAL ASSESSMENT

IIA. Nursing History

1. History of Present Illness

Chronologic Story
7 years prior to confinement (2009), RS was diagnosed with PTB

and was able to complete his treatment.

One week prior to confinement, patient experienced productive

cough with yellowish sputum, and experienced difficulty of breathing. He took a

rest and his daughter then nebulized him with salbutamol nebulization and relief

was noted but there was still persistence of difficulty of breathing. No other

medications were taken.

3 days prior to confinement, there was still persistence of cough

with yellowish sputum and associated with difficulty of breathing. He then

experienced loss of appetite. He just took a rest and settled with nebulization

and slight relief was noted.

5 hours prior to confinement, patient was not able to tolerate the

discomfort of difficulty in breathing. He then opted to seek medical attention in

the Out Patient Department of WVSU-MC. He was then referred to the

emergency room because of the worsening of his condition.

 Thus, this admission.

Disability Assessment
RS is very dependent on his daughter in performing ADLS
2. Past Health Problems/Status
Childhood Illness

The daughter of the patient was not able to answer the question.
Adult Illnesses
COPD, on maintenance salbutamol
(+) PTB treatment completed (2009)

Immunization
The daughter of the patient was not able to answer the question.

Allergies
None

Accidents and injuries

None

Operations

None

Hospitalization for serious illnesses

RS was hospitalized due to PTB and COPD exacerbations, but the

daughter failed to recall the exact dates.

Medications

Salbutamol 1 neb
Metformin 500 mg BID
Amlodipine 10 mg OD
Family History of Illness

(+) Hypertension- Maternal Side

(+) DM Paternal Side

TEXTBOOK DISCUSSION

Definition: Chronic Obstructive Pulmonary Disease

A preventable and treatable disease with some significant extrapulmonary effects

that may contribute to the severity in individual patients. Its pulmonary components is

characterized by airflow limitation that is not fully reversible. The airflow limitation is

usually progressive and associated with an abnormal inflammatory response of the lung

to noxious particles or gases.

 Types of COPD:

1. Chronic bronchitis- a disease of the airways, is a long-term, often irreversible

respiratory illness. Chronic bronchitis have a daily presence of cough and sputum

production for at least 3 months in each 2 consecutive years.

2. Emphysema- impaired oxygen and carbon dioxide exchange results from

destruction of the walls of overdistended alveoli.

The disease is increasingly common, affecting millions of Americans, and is fourth

leading cause of death in the U.S.

COPD is almost always caused by smoking. Tobacco smoke irritates the airways and

destroys the stretchy fibers in the lungs. Breathing chemical fumes, dust, air pollution

over a long period of time or secondhand smoke also may damage lungs. COPD is most

common in people who are older than 60 years old.

Stage A patients are at high risk for heart failure but have no structural heart

disease or symptoms of heart failure

Stage B patients have structural heart disease but have no symptoms of heart

failure
 Stage C patients have structural heart disease and have symptoms of heart

failure

Stage D patients have refractory heart failure requiring specialized interventions

Acute exacerbation

An event in the natural course of the disease characterized by an acute change

in the patients baseline dyspnea, cough or sputum production beyond the normal

day-to-day variations.

B. Signs and Symptoms

Signs and Symptoms According to the Signs and Symptoms Manifested by the

Textbook Patient

COPD

Shortness of breath, especially during (+)

physical activities (dyspnea)

Wheezing

Chest Tightness

Chronic cough

Sputum production

Blueness of the lips or fingernail beds

(cyanosis)

(+)

Fatigue

Weight loss

Barrel chest
D. Management

Chronic Obstructive Pulmonary Disease

The goals of effective COPD management are to:

Prevent disease progression

Relieve symptoms

Improve exercise tolerance

Improve health status

Prevent and treat complications

Prevent and treat exacerbations

Reduce mortality

Nursing Management

Administer prescribed medications, which may include antibiotics,

bronchodilators, mucolytic agents and corticosteroids.

 Administer oxygen.

Provide education in prescribed medications, covering proper use of inhaled

drugs (including spacers if indicated), proper sequence for taking medications to

maximize their effects, and adverse effects.

Make sure patients know how to determine the amount of inhaled medications

left so they can avoid running out.

Teach patients to observe their usual symptoms and to contact their healthcare

provider when symptoms worsen.

Clear airways with postural drainage, percussion or vibrating and suctioning as

appropriate.

Reinforce the importance of good infection control, such as frequent hand

washing and avoiding crowds when upper respiratory infections are prevalent.

To help patients manage dyspnea, teach them activities that reduce or control it

like:

-Breathing techniques. Techniques such as pursed-lip breathing help reduce

respirations while improving the expiratory phase (by increasing laminar flow of

expired air).

-Proper positioning. Explain that the tripod position, in which the patient sits or

stands leaning forward with the arms supported, forces the diaphragm down

and forward and stabilizes the chest while reducing the work of breathing.
 -Energy-conservation techniques. Advise patients to pace activities, take

frequent rest, use assistive device, and break activities into smaller tasks to help

reduce dyspnea development.

Tell patient to avoid environmental triggers of dyspnea, including temperature

extremes and exposure to air pollution, pollen, cigarette smoke, chemical

fragrance and dust.

Discuss the importance of smoking cessation and avoiding second-hand smoke.

Discuss ways to quit smoking and make appropriate referrals.

Medical Management

Bronchodilators and Anti-inflammatory Agents

Mucolytics- break up and allow mucus to be cleared more effectively from the

airways.

Antibiotics- are used only for acute exacerbations.

Oxygen- is the only treatment that has been shown to improve survival.

Surgical Management
 Lung volume reduction surgery- removes part of one or both lungs, making room

for the rest of the lung to work better. It is used only for some types of severe

emphysema.

Lung transplant- replaces a sick lung with a healthy lung from a person who has

just died.

Bullectomy- removes the part of the lung that has been damaged by the

formation of large, air-filled sacs called bullae. This surgery is rarely done.

Discharge Plans:

COPD

Instruct to call the doctor if :

- Trouble talking or walking because of shortness of breath

 - Bluish or gray color of your lips or fingernails

- Trouble breathing that does not get easier with medicine

- Fast breathing or trouble catching your breath

- Feeling like you are going to die

- Chest discomfort (pressure, fullness, squeezing or pain) that lasts more than

a few minutes or goes away and comes back or chest discomfort that goes to

your arms, neck, jaw or back

Advise her to take her medicines exactly as your provider tells you to.

Follow your provider's instructions for follow-up appointments.

Get plenty of rest while youre recovering. Try to get at least 7 to 9 hours of

sleep each night.

Eat a healthy diet.

Drink enough fluids to keep your urine light yellow in color, unless you are told

to limit fluids.

Exercise as your provider recommends.

Don't smoke. Smoking can worsen lung disease.

 Avoid secondhand smoke, air pollution, and extreme changes in temperature and

humidity.

Ask about getting flu and pneumonia vaccinations to help prevent lung

infections.

Avoid close contact with people who have colds or the flu.

If you plan to travel, discuss your plans with your healthcare provider.

You may need to continue a rehabilitation program after you leave the hospital

to help you adjust to life with COPD. A pulmonary rehabilitation program can

help you learn how to live and feel better with COPD. The program will give you

information about exercise and a healthy diet. It can help you learn how your

lungs work and how to care for your COPD.

Find ways to make your life less stressful.