vet case presentation(copd)
TRANSCRIPT
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INTRODUCTION
CASE STUDYCASE STUDY
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Chronic obstructive pulmonary disease (COPD) is a
chronic, progressive disease of the lungs that reducesairflow over time. It is characterized by symptomsthat include coughing, wheezing and shortness ofbreath. As the disease progresses, quality of life maybe severely compromised.
COPD is most commonly associated with smokingtobacco over a period of years. COPD involvesgradual, permanent damage caused to the lungs,which is why the condition is usually found in peopleover the age of 60. COPD often results from one oftwo conditions emphysema or chronic bronchitis though both conditions may coexist in an individualwith COPD.
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Emphysema is a condition in which the air sacs in the lungs(alveoli) are damaged, interfering with the normal
exchange of oxygen and carbon dioxide. Some of themeventually collapse. Thus, a single, large useless hole takesthe place of the many functional sacs (alveoli) that hadbeen supporting the airways (bronchioles). This makes itharder to exhale stale air from the lungs and inhale a fullbreath of clean air.
Emphysema is often the result of smoke that has triggeredthe immune system to produce more harmful enzymes.Although these harmful enzymes are normally preventedfrom causing any significant damage by a protective
protein, smoking reduces the proteins protective effect.Even if someone has plenty of the protein in their system,smoking generates certain substances that keep theprotective protein from doing its job.
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Many of the symptoms ofCOPD are similar to those ofasthma, although the two conditions are not related inany way. Asthma usually involves breathing difficultiesthat occur as a result of inflammation in the airpassageways, while COPD impedes breathing by
causing more permanent lung damage. COPD isgenerally considered more damaging to the lungs thanasthma.
The damage caused byCOPD cannot be reversed, butmany individuals can stop additional damage fromoccurring by quitting smoking, avoiding airborneirritants and using drug treatments such asbronchodilators
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COPD affects an estimated 17 million Americans and itsprevalence is rising. It affects more men than women
and more whites than blacks. It doesnt always producesymptoms and causes only minimal disability in manypatients. However, COPD tends to worsen with time.
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I. PERSONAL DATA
CASE STUDYCASE STUDY
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Name:Mr. FS
Address:Taguig CityAge: 56
Sex:Male
Civil Status:Married
Religion:Roman CatholicBirth Date: 01/01/1953
Room and BedNo.:Room 151 W15-138-04
Attending Physician: M.U.M., MD
Medical Diagnosis: (COPD) ChronicObstructivePulmonaryDisease
Chief Complaint: Difficulty of Breathing
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II. MEDICAL
HISTORY
CASE STUDYCASE STUDY
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A. History of Present Illness
3 days PTA, patient had shortness of breath
accompanied by productive cough withwhitish phlegm secretions, loss of appetite.Self- medicated with N-acetylcystane andsalbutamol nebulization, with unrecordeddose, Provided patient temporary relief.
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1 dayPTA, still with the persistence of above signs andsymptoms but associated with low grade fever,
undocumented no consultation was done self-medicated with biogesic with unrecorded dose.
Few hours PTA, patient still had the above signs and
symptoms, patient was brought to VMMC and patientwas diagnosed with HCAP. Hence, admitted.
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B. Past Medical History
Patient had asthma and developed COPD. He also had PTBand was diagnosed year 1959.
C. Family Medical History
Patients Mother was also diagnosed with PTB and she is alsosmoking.
(-)Cancer(-)Diabetes Mellitus(-) Asthma(-) Allergy
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D. Social History
The patient is smoking; he started at the age of 18 year 1971.He consumes 10-20 sticks per day. He smokes for 26 yearsand stop last 1997. He also drinks alcohol beverages but notto much as verbalized by the patient and wife.
E. Environmental History
The patient lives in Taguig City; their house is an apartmentstyle. There are two bedrooms for 8 of them which are thepatient itself, his wife, daughter and her family. Accordingto the wife they are to crowded in the house.
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GORDONSPATTERNOF
FUNCTIONING
CASE STUDYCASE STUDY
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Before
Hospitalization
During
HospitalizationAnalysis
Health perception-HealthManagement pattern
Takes a bath twice a day.
Brushes teeth twice a day.
Sponge bath twice a day
done by wife.
Brushes teeth twice a day
Attributed to activity
intolerance related to
occurrence of
shortness of breathing.
Nutritional-Metabolic PatternConsumes 3 meals a day,
usually meat and rice; and 2
snacks; biscuit and juice.
Hypoallergenic Diet; 3
meals and 2 snacks a day.
To prevent episodes of
asthma attack.
Elimination Pattern
BM once a day
Urination- 7 to 10 times a
day.
BM every other day.
Urination 8 to times a day.
Decreased elimination
pattern related to
decreased peristaltic
movement due to
limited movement.
Activity-Exercise pattern Walking. Complete bed rest without
bathroom privileges.
Due to easy
fatigability.
Sleep-Rest Pattern
The patient is usually having
6 to 8 hours of sleep every
day.
Still 6 to 8 hours but
disturbed.
Disturbed sleeping
pattern is due to his
cough, uncomfortable
environment and
ortho nea.
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Before
Hospitalization
During
HospitalizationAnalysis
Sexuality Reproductive Pattern
Coping stress Tolerance Pattern
Values-Beliefs Pattern
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PHYSICALASSESSMENT
CASE STUDYCASE STUDY
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Date: July 28, 2009
General Survey:Oxygen is administered regulated in 2-3 L per minute to
provide adequate blood oxygenation. An increase inthe anteroposterior diameter of the chest was also
noted, an indication of expiratory muscles utilizationduring exhalation process.
Vital Signs:
Temperature = 36.1 oC
Pulse Rate = 81 beats per minute
RespiratoryRate = 20 breaths per minute
Blood Pressure = 130/80 mmHg
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
Head
Hair andscalp
Inspection andpalpation
Smooth andshiny, thick; Noinfection andinfestations
- Thick strandsof hair, black incolor, smoothand shiny;Normo-cephalic
NormalFindings
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
Eyes andvision
Inspection Normal
vision, and
no disease
in the eyes;
no masses
and nodules,smooth and
round head
white sclera
Pupil black,
briskly and
reactive,
sclera white,
position of
the eyes aresymmetrically
close to each
other, doesnt
wear
eyeglassesbut able to
read print
materials
without
difficulty
Normal
Findings
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
Ears and
hearing
Inspection Color same
as facial,symmetricalauriclealigned withoutercanthus, nodischarges,normalhearing
Color same
as facial,Normal setof ears, nodischarge,able to hearwith normaltone ofvoice
Normal
Findings
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
Nose Inspection Symmetric; nodischarge
Nodischarge,symmetric, color
same asfacial,with 02cannula
Patient has02 cannula2-3L asordered
due todifficulty inbreathing,patient
gasp for airw/oO2
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ASSESSMENT TECHNIQUES USED
NORMALFINDINGS
FINDINGS ANALYSIS
MOUTH ANDLIPS
NECK ANDNAPE
Inspection
Inspectionand palpation
Smooth enamelpink gums, soft
lips, no lesions
No discomfort;no mass andnodules,uniform incolor, lesions, notenderness
Smooth yellowenamel, dark
pink gums,blackish pinklips, no lesions
Uniform incolor; no mass,nodules andlesions. Neckveins areengorged.
Smoking causesyellow teeth as
the yellow-tinted nicotinepasses throughthe mouth, itstains the teeth;dark gums and
lips are alsoeffect ofnicotine.
Enlargement ofneck veins is onesign of corpulmonale; signof jugular veindistention.
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
UPPER
EXTREMETIES
Inspection Uniform skin
color,NormalROM, Left andRight upperextremities aresymmetric,complete
fingers, nailbeds pink,capillary refillof
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ASSESSMENT TECHNIQUESUSED
NORMALFINDINGS
FINDINGS ANALYSIS
CHEST ANDAC
Ins ecti n,sc ltati n,
al ati n
oiscolorationof
s in, no lesion,nor al
ia eter ofc est- reastandni le aresy etric; no
ass or nodule,nor alres irationrate; Nor al
reat sounds;nor al eart
eat; nodefor ities ofs ine
Increasedantero-
osteriordia eter ofc est ( arrelc est);
resenceofeezes;
Pulse rate 2
arrel c estdevelopeddue
to t eutilizationoft e accessoryusclesof
reat ing fort e purpose of
expiration.
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ASSESSMENT TECHNIQUES USED
NORMALFINDINGS
FINDINGS ANALYSIS
ABDOMEN Inspectionand
Ausculta-tion
Uniform color,no lesions, notenderness;Bowelmovement
(Normo-active)
Active BowelMovement
- NormalFindings.
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ASSESSMENT TECHNIQUES USED
NORMALFINDINGS
FINDINGS ANALYSIS
GEN
ITALS /RECTUM
LOWEREXTREMITIES
Inspection
Inspection
No foul Smelldischarges, nolesions in theskin, Nohemorrhoids
Uniform skincolor, normalROM,complete toes,
nail bedspink, canmaintainbalance andnormal gait
N/A
Normal
Patientrefuses to beassessed
- NormalFindings.
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LABORATORYRESULTS
CASE STUDYCASE STUDY
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RESULT NORAMAL
RANGE
ANALYSIS INTERPRETATI
ON
WBC COUNT 11.2 5-10 x 10 / L ABNORMAL INCREASEDWBC ISAN INDICATION OFPRESENCE OFINFECTION.
SEGMENTER 0.79 0.60 0.70 ABNORMALINCREASED
SEGMENTERIS AN
INDICATIONOF
INFECTION.
LYMPHOCYTE 0.20 0.20 0.40 NORMAL
MO LO N
4 M-
40
80 g/ NORMAL
MATOCR T 0.50 M- 0.40 0.54 NORMAL
MATOLO Y S CT ON
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RESULT NORMAL
RANGE
ANALYSIS INTERPRET
ATION
CREATININE 160 53 -133 ABNORMAL INCREASEDCREATININE IS
ANINDICATION
OF INFECTION
POTASSIUM 4.9 3.9 ABNORMAL BRONCHODILATORS ONE SIDEEFFECTIS
INCREASEDIN
POTASSIUM
CHEMISTRY SECTION
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PATHOPHYSIOLOGY
CASE STUDYCASE STUDY
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DRUG STUDY
CASE STUDYCASE STUDY
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Generic
name
Brandname
Dosage Mechanismof Action
Indication Contraindi-cation
Adversereaction
NursingResponsi-bilities
Levo-flixaci
n
Floxel AdultTab250-500 m once daily. IV
500 m administeredby slowinfusion over60 min every24 hr or 750m administeredby slow
infusion over90 min every24 hr. 750-mg tabAcutebacterialsinusitis,community-aquired
pneumonia750 m for 5days.Nosocomialpneumonia,complicatedskin & skinstructureinfection
750 m
for7-14 days.
Antacids,sucralfate, metalcations &
multivit prepcontainin Znmay interfere w/absorption.Concomitantadministration oftheophylline,fenbufen orsimilar NSAID
may increasethe risk ofCNSstimulation &convulsiveseizures.Disturbances ofblood lucosereported inpatients treated
concomitantlyw/ quinolones &an antidiabetica ent. IVDo notco-administer w/soln containin
multivalentcations e
throu
h the
same IV line.Warfarin.
Treatment ofadults 1 yr w/mild, moderate &
severe infectionscaused bysusceptiblestrains ofmicroor
anismsin the followin
conditions:Community-acquired
pneumonia,acute bacterialexacerbation ofchronicbronchitis, acutemaxillarysinusitis,complicated &uncomplicated
skin & skinstructureinfections, acutepyelonephritis,complicated &uncomplicatedUTI, nosocomialpneumonia,chronic bacterial
prostatitis.
Hypersensitivity toquinolones. IV
Epilepsy,history oftendondisordersrelated tofluoroquinolonetherapy.Childn,pre
nancy &
lactation.
Diarrhea,abdominaldiscomfort,
nausea,anorexia,abdominalpain,vomitin
,stomatitis &heartburn;insomnia,headache &
dizziness;rash, pruritus& eczema;muscle &
joint pain;bone marrowdepression.Increasedliver
enzymes.Pain,reddenin
atthe inj site,phlebitis.
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Genericname
Brandname
dosage Mechanismof Action
Indication Contraindication
Adversereaction
Nursingresponsibilities
Isosorbide-5-mononitrate
Angistad
Tab 40 m
once daily,
may beincreasedto 40 m
bid. SR cap1 cap daily.
Antihypertensive a
ents, e
-
blockers, Caanta
onists &vasodilators;neuroleptics ortricyclicantidepressants, alcohol,dihydroer
otamine; NSAIDs;
sildenafil,tadalafil &vardenafil.Isosorbidemononitrate ;Belon
s to theclass of or
anicnitratevasodilators.Used in thetreatment ofcardiac disease.
Lon
-termtreatment of
ischaemic heartdisease. Preventionof an
ina attacks.Follow-uptreatment of heartattacks whensymptoms ofan
ina persist.Pulmonary
hypertension.Treatment ofchronic cardiacfailure, incombination w/cardiac
lycosides&/or diuretics.
Acute I w/ low-fillin
pressures,
left heart failurew/ low-fillin
pressures,shock, very lowBP, hypertrophicobstructivecardiomyopathy,constrictivepericarditis,
pericardialtamponade,aortic stenosis,mitral stenosis,markedanemias, headtrauma, cerebralhemorrha
e,closed-an
le
laucoma,hyperthyroidism,concomitanttherapy w/sildenafil,tadalafil &vardenafil.
Headachesat the
be
innin
oftreatment,fall in BP,nausea,vomitin
,transientskindisorders
(flushin
)& aller
icskinreactions.Rarely,paradoxicalnitrateeffects&/ormarkedparadoxicalbradycardia.
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Generic
name
Brandname
dosage Mechanismof Action
Indication Contraindication
Adversereaction
Nursingresponsibilities
losar
tan
Acet Acet/Acet-MS/Acet-ES
tabAdult &childn >12yr325-1000m 4-6 hrly.Childn 10-20 m /k 4-6 hrly. ax:4 /day.Acet syr
Adult &childn >12yr2-4 tsp,childn 6-12yr1-2 tsp,1-5 yr-1tsp.Infant3 mth-
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Genericname
Brandname
dosage Mechanism ofAction
Indication Contraindication
Adversereaction
Nursingresponsibilities
Bude-sonide
Symbicort
SYMBICORT should beadministered by the
orallyinhaledroute inpatientswithasthma 12years ofa e andolder.
SYMBICORT shouldnot be usedfortransferrin patientsfromsystemiccorticostero
id therapy.
Budesonide is ananti-inflammatorycorticosteroid thatexhibits potent lucocorticoidactivity and weakmineralocorticoidactivity. In standardin vitro and animalmodels, budesonidehas approximatelya 200-fold hi heraffinity for the
lucocorticoidreceptor and a1000-fold hi hertopical anti-inflammatorypotency thancortisol (rat crotonoil ear edemaassay). As a
measure ofsystemic activity,budesonide is 40times more potentthan cortisol whenadministeredsubcutaneously and25 times morepotent whenadministered orallyin the rat thymusinvolution assa .
SYMBICORTshould only beused forpatients not
adequatelycontrolled onother asthma-controllermedications(e. ., low- tomedium-doseinhaledcorticosteroids)
or whosedisease severityclearly warrantsinitiation oftreatment withtwomaintenancetherapies.SYMBICORT is
not indicated inpatients whoseasthma can besuccessfullymana ed byinhaledcorticosteroidsalon withoccasional useof inhaled,short-actin beta2-a onists.
SYMBICORT iscontraindicatedin the primarytreatment of
statusasthmaticus orother acuteepisodes ofasthma whereintensivemeasures arerequired.Hypersensitivit
y to any of thein redients inSYMBICORTcontraindicatesits use.
Lon -actin beta2-adrener ica onists may
increase therisk ofasthma-related death
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MEDICAL-SURGICALINTERVENTION
CASE STUDYCASE STUDY
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y The main goal of treatment is to relieve symptoms and
prevent complications. Bronchodilators can helpalleviate bronchospasm and and enhance mucociliaryclearance of secretions. Effective coughing, posturaldrainage, and chest physiotherapy can help mobilize
secretions
yAdministration of low concentrations of oxygen helpsrelieve symptoms; arterial blood gas analysis
determines oxygen need and helps to avoid carbondioxide narcosis.
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Antibiotics help treat respiratory tract infections.Pneumococcal vaccination and annual influenza
vaccinations are important preventive measures.
Some patients benefit from inhaled corticosteroids asmaintenance therapy. Oral corticosteroids are
occasionally needed for acute exacerbations
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NURSINGCAREPLAN
CASE STUDYCASE STUDY
Cues Nursing Analysis Objectives Interventions Rationale Evaluation
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Cues NursingDiagnosis
Analysis Objectives Interventions Rationale Evaluation
Snahihirapanako
humin a asverbalizedby thepatient.Odyspneaproductivecou hV/S taken as
follows:BP: 130/ 0PR: 1RR: 26TEMP: 36.1
Ineffectiveairway
clearance
related toincrease
productionof
secretions.
ChronicObstructionPulmonary
Disease(COPD) is a
diseasecharacterized
by airflowlimitationsthat is not
fullyreversible. Air
flowlimitations are
usuallypro ressive
andassociated
with aninflammatoryresponse in
the lun
sstimulated byirritants.Commoncause ofCOPD is
ci arette, airpollution,
aller ens andinfection thatmay also actas irritants.
After 4 hoursof nursin
interventions,
the client willdemonstratebehaviors to
improveairway
clearance.Example:
cou heffective and
expectoratesecretions
Monitor vital si
ns
Assist patient toassume positionof comfort.Example elevateshead of bed,encoura
e patientto lean on overbed table or sit on
the ed
e of thebed.
Keepenvironmentalpollution to aminimum.Example dust,smoke and
feather pillows,accordin
toindividualsituation
To have abaseline data.
Elevate of thehead of the bedfacilitatesrespiratoryfunction by useof
ravity.
Precipitator ofaller
ic type orrespiratoryreactions thatcan tri
er or
exacerbateonset of acuteonset.
After four hoursof nursin
interventions, the
patient was ableto demonstrate
behaviors toimprove airway
clearance.Example cou
heffective andexpectoratesecretions
Cues Nursing Analysis Objectives Interventions Rationale Evaluation
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Cues NursingDiagnosis
Analysis Objectives Interventions Rationale Evaluation
Encoura
e deepbreathin
exercise.
Observecharacteristic ofcou
h. Assist withmeasures toimproveeffectiveness orcou
h effort.
Administermedications asprescribed by thephysician.
Providesupplementalhumidification likenebulizer.
Provides patientwith somemeans to copeor control
dyspnea.
Cou
hin
is themost effectivein an upri
htposition or headdown position.
A variety ofmedicationsmay be used todecrease mucusand to improverepiration.
Humidity helpsreduce viscosityof secretions,facilitatin
expectorationand may reduceor preventformation ofthick mucusplu
s in
After four hoursof nursin
interventions, thepatient was able
to demonstratebehaviors to
improve airwayclearance.
Example cou
heffective andexpectoratesecretions