COPD

Republic of the Philippines
WESLEYAN UNIVERSITY-PHILIPPINES
COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES
3100 Sampaguita St. Cabanatuan City, Nueva Ecija
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
A Case Analysis
Presented to the Faculty of the
College of Nursing
In Partial Fulfillment of the Requirements

For the RLE Clinical Duty
Submitted By:
Elizabeth C. Bernardino
Submitted To:
Mrs. Josephine O. Samonte
Definition
A widespread, preventable, and curable chronic lung illness that affects both men and
women worldwide is chronic obstructive pulmonary disease (COPD). Airflow into and out of the
lungs is restricted as a result of abnormalities in the tiny airways of the lungs. The airways
constrict due to several factors. Parts of the lung may be destroyed, the airways may be
obstructed by mucus, and the lining of the airways may become inflamed and swollen. Chronic
bronchitis or emphysema are other names for COPD. Emphysema often refers to the lungs' small
air sacs at the end of airways being destroyed. A chronic cough that produces phlegm as a result
of airway irritation is referred to as chronic bronchitis. Coughing, wheezing, and breathing
difficulties are common symptoms of both COPD and asthma, and some people may have both
conditions.
Pathophysiology
COPD is an inflammatory disease that affects the pulmonary vasculature, lung

parenchyma, and airways. Protease-antiprotease imbalances and oxidative stress are considered
to play a role in the process. Emphysema is the name given to one of the structural alterations
associated with COPD, in which the lungs' gas-exchanging surfaces known as alveoli are
destroyed, causing obstructive physiology. Emphysema results from an inflammatory reaction to
an irritant (such as smoking). The recruitment of neutrophils and macrophages results in the
release of many inflammatory mediators. The air sacs are destroyed by oxidants and excessive
proteases. Airways collapse during expiration as a result of the lack of elastic recoil caused by
the protease-mediated degradation of elastin. An uncommon form of emphysema called alpha-1
antitrypsin deficiency is characterized by a deficit in antiproteases, which puts the lung
parenchyma at risk for damage caused by proteases. The mutant protein's misfolding, which can
build up in the liver, is what causes AATD. When COPD patients present with liver injury,
AATD should be taken into consideration. In contrast to emphysema brought on by smoking,
AATD predominantly affects the lower lobes. The forced expiratory volume (FEV1) is reduced
by the inflammatory response and airway blockage, while airflow restriction and decreased gas
exchange are brought on by tissue damage. Imaging examinations frequently reveal
hyperinflation of the lungs, which results from air becoming trapped when the airways collapse
during exhalation. Increases in carbon dioxide (CO2) levels are also brought on by the inability
to adequately exhale. A common symptom of illness progression is impairment of gas exchange.
CO2 retention is caused by a decrease in ventilation or an increase in physiologic dead space.
Hypoxemia-induced diffuse vasoconstriction may lead to pulmonary hypertension. COPD acute
exacerbations are frequent and typically brought on by a trigger (e.g., bacterial or viral
pneumonia, environmental irritants). An rise in inflammation and air embolism frequently need
corticosteroid and bronchodilator therapy.
Risk Factors
The main cause of chronic obstructive pulmonary disease (COPD), which includes emphysema
and chronic bronchitis, is smoking. You run a higher chance of getting COPD and passing away
from it. Smoking is a factor in 85 to 90 percent of COPD patients. Male smokers are about 12
times more likely than males to die from COPD, and female smokers are nearly 13 times more
likely to die from COPD than non-smokers. Exposure to air pollution, breathing in secondhand
smoking, working with chemicals, dust, and fumes, an inherited disorder called Alpha-1
deficiency, and a history of respiratory infections in infancy are additional risk factors for COPD.
Types of Chronic obstructive pulmonary
Chronic bronchitis
Long-term inflammation of the bronchi (lung breathing passageways) known as
chronic bronchitis leads to an increase in mucus production as well as other
abnormalities. Breathing difficulties, recurrent infections, coughing, and incapacity might
be the results of these alterations.
Emphysema
Alveoli, or the air sacs in the lungs, may be destroyed, retracted, collapsed,
stretched, or overinflated in those who have emphysema, a chronic lung illness.
Breathlessness and a decline in respiratory function may result from this. Permanent
"holes" in the lung tissue develop from damage to the air sacs, which is irreversible.
Signs & Symptoms
Many people don't become aware of COPD symptoms until the condition has progressed
significantly. Shortness of breath can be a significant sign of lung illness, but many individuals
mistakenly believe it to be a sign of "simply getting older" or that they are less able to carry out
their daily activities. If you have any of the following symptoms: a persistent cough, dyspnea
(shortness of breath during daily activities), recurrent respiratory infections, cyanosis (blueness
of the lips or nail beds), fatigue, or excessive mucus production (also known as phlegm or
sputum).
Diagnostic Test
They may use a stethoscope to examine your chest and listen to your breathing, inquire
about your smoking history, calculate your body mass index (BMI) using your height and
weight, and inquire about any lung conditions in your family. They may also perform or arrange
for you to undergo spirometry, along with other related tests of the lungs and airways, a chest x-
ray, and blood tests to help them diagnose COPD.
Medical Management.
 Albuterol
 Ampicillin
 Daliresp
Surgical Management
The major types of surgery for COPD are:
 bullectomy,
 lung volume reduction (LVRS)
 lung transplant
Discharge planning
Diet/Nutrition
Instruct the family and the patient that she has a diet she needs to follow:
• Keep simple carbs, such as those found in table sugar, candy, cake, and ordinary soft
drinks, to a minimum.
• Consume 20 to 30 grams of fiber daily, which may be found in foods like bread, pasta,
nuts, seeds, fruits, and vegetables. To assist maintain powerful respiratory muscles, consume a
decent supply of protein at least twice each day. Milk, eggs, cheese, meat, fish, poultry, almonds,
and dry beans or peas are all healthy options.
• Opt for mono- and polyunsaturated fats, which are cholesterol-free. These are plant-
based fats, such as canola, safflower, and maize oils, that are frequently liquid at room
temperature.
• Eat fewer foods that are high in saturated and trans fats. For instance, shortening,
hydrogenated vegetable oils, butter, lard, beef fat and skin, fried dishes, biscuits, crackers, and
pastries.
Health Teaching
 Stop smoking. One of the most crucial things you can do for your health is to stop using
nicotine. Each year, more than 3 million Americans give up smoking.
 Eat healthfully and exercise. The COPD-related breathlessness might make it
challenging to prepare a healthy diet. Maintaining and increasing your fitness level
requires both a good diet and exercise.
 Sleep well. Rest is crucial for general health, but having COPD can make it challenging
to sleep due to a number of factors.
 Take your prescription drugs as directed. The majority of COPD sufferers need
medication to treat both chronic and acute respiratory issues.
 Use oxygen sensibly. To help their bodies function correctly, some patients with COPD
require oxygen treatment. If used properly, oxygen treatment does not hurt your body or
lungs and enables you to be more active. You could require it for exercise, rest, and sleep.
 Work on breathing exercises. You may increase the amount of air that enters and leaves
your lungs by learning new breathing methods.
 Acquire skills for clearing mucous. Infection can result from mucus buildup in the
airways, which can make breathing challenging.
 Get to know COPD better. With COPD, you may have a healthy and fulfilling life. Learn
more about the illness. Talk with your provider and list any issues or places you wish to
see improved. You can take control of your life and live the way you want to live if you
understand how the condition might affect you and what you can do to prevent or correct
issues.
NURSING CARE PLAN 3100 Sampaguita St. Cabanatuan City, Nueva Ecija
ASSESSMENT DIAGNOSIS OUTCOME PLANNING NURSING INTERVENTION EVALUATION

IDENTIFICATION
Subjective: Short term:
Ineffective airway 1.Assist the client to an upright position.
“Nahihirapan akong clearance related to After 4 hours of nursing intervention,
huminga lalo na kapag gray sputum the client will be able to learn the
nakahiga, tapos kapag released when optimal position for a maximum lung Rationale: This position will allow for After 4 days of Nursing
iihitin na ako ng ubo nag coughing but After 4 days of Nursing expansion. Also, the client will be able maximum lung expansion. intervention, the client has
sisimula na akong accompanied with intervention, the patientto induce coughing and deep improved effective airway
mahirapan huminga kasi will be able to improve 2.Encourage the patient to induced cough clearance by sitting in an
shortness of breath breathing.
nararamdaman ko yung airway clearance and will
as manifested by and deep breathing. Instruct the patient to upright position, inducing
plema na nakabara. demonstrate the
rapid, shallow take a deep breath in and hold for several cough and deep breathing,
Minsan para akong effective ways in
breathing and a Long term: seconds. Cough two- or three-times during taking prescribed
hirap na hirap. “ removing secretions.
wheezing sound exhalation. medication and increase in
As stated by the patient with a respiratory After 4 days of nursing intervention, fluid intake. Therefore, the
rate of 35 bpm. the client will be able to continue Rationale: Improve clearing secretions. goal was met.
Objective: inducing cough and deep breathing to
improve clearing secretions. 3.Administered medication as ordered
•Shortness of breath
along with rapid, shallow Rationale: Medications treat infections to
breathing; a respiratory help improve breathing by reducing airway
rate of 34 bpm. resistance.
•Gray sputum release
upon coughing. 4.Increase fluid intake
•Wheezing sound upon
Lung auscultation. Rationale: May help in thinning of the
•Vital Signs
mucus.
RR-35 bpm
BP:158/86 mmHg
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS OUTCOME PLANNING NURSING INTERVENTION EVALUATION
IDENTIFICATION
Subjective: 1.Apply tepid sponge bath.
Slightly elevated Short term:
Subjective: body temperature Rationale: A tepid sponge bath is a non-pharmacological measure to allow evaporative
in connection to After 6 hrs of cooling.
“Nanghihina talaga retained sputum continuous nursing
ako, parang as evidence by a After 4 days of care, the client’s 2.. Encourage adequate fluid intake After 4 days of
nanlalata tapos ang temperature of nursing intervention, body temperature nursing intervention,
init ng pakiramdam 37.8 which is the client will be will be within the Rationale: If the client is alert enough to swallow, provide cool liquids to help lower the the client has kept
ko.” as stated by the considered as a able to keep up his normal range 36.1° up a normal body
body temperature.
client. low-grade fever, temperature in C – 37.2°C. temperature and
discomfort, normal range and for retained sputum has
3.Adjust and monitor environmental factors like room temperature and bed linens as
exhaustion , the retained sputum Long term: been controlled.
Objective: indicated.
Fatigue and a to be controlled.
need for little After 4 days of
assistance in nursing Rationale: Room temperature may be accustomed to near normal body temperature,
 Discomposure walking. intervention, retain and blankets and linens may be adjusted as indicated to regulate the patient’s
Exhausted sputum that acts as temperature
 Need a little a way for bacterial
assistance in growth will be 3. Loosen or remove excess clothing and covers.
walking controlled.
 The body is Rationale: Exposing skin to room air decreases heat and increases evaporative cooling.
slightly warm to
touch 4. Monitor the client’s vital signs at least q4hrs or as ordered by the physician.
 A secretion of
gray sputum Rationale: An assessment provides baseline information for monitoring changes and
due to lung evaluating the effectiveness of the therapy.
infiltrates
through 5.Apply ice packs to the patient.
Sputum gram
stain. Rationale: Surface cooling by placing ice packs in the groin area, axillae, neck, and torso
is an effective way of cooling the core temperature.
Vital Signs:
Name of Patient: Riley Montefalco

Diagnosis: Chronic Obstructive Pulmonary Disease
DRUG STUDY
Name of
Action/ Nursing
Medication Generic Classification/ Shape & Color of the Medication Card to
Contraindication/Side Implications/Nursing
(Brand Name Dosage/Route be Used
Effects Responsibilities
Name)
Proventil Albuterol Classification  Albuterol acts on  The color of the medication card is yellow  Follow the 12 rights of
Bronchodilators beta-2 adrenergic since it is 2 times a day . medication administration.
receptors to relax the  Twice a day which starts at 8 am and 6pm.
Dosage bronchial smooth  The shape is Spike as it is given.  Monitor respiratory rate,
• 2.5 mg, BID, muscle. It also oxygen saturation, and lungs
Nebulizer inhibits the release of sounds before and after
immediate administration. If more than
hypersensitivity medi one inhalation is ordered, wait
ators from cells, at least 2 minutes between
especially mast cells. inhalations. Use a spacer device
Although albuterol to improve drug delivery, if
also affects beta-1 appropriate.
adrenergic receptors,
this is minimal and  Patients should remain
has little effect on the compliant with the medication
heart rate. In at least dosing regimen. Individuals
one specific study should contact their healthcare
that used provider if they experience

immunoliposomes to ongoing shortness of breath
deliver albuterol to unrelieved with medication
oxytocin receptors. therapy. If using an inhaler, the
patient should be sure to prime
Contraindications the inhaler prior to
 Hypersensitivity is a administering the dose of
contraindication for medication. The medication
albuterol. Also, if a can cause an unusual taste in
patient is severely the mouth, so patients should
hypersensitive to rinse their mouth with water
milk protein, it is after each use.
advised to avoid the
use of albuterol..
Side Effects
 fast or irregular
heart rate
 chest pain
 shakiness
 nervousness
 headache
 nausea
 vomiting
 dizziness
 sore throat
 runny nose

DRUG STUDY
Name of
Classification Action/ Nursing
Medication Generic Shape & Color of the Medication Card to
/Dosage/ Contraindication/Side Implications/Nursing
(Brand Name be Used
Route Effects Responsibilities
Name)
Omnipen ampicillin Classification  Bactericidal action  The color of the medication card is Blue  Follow the 12 rights of
Aminopenicillin against sensitive since it is every 6 hours. medication administration.
s organisms; inhibits  Every 6 hours which starts at 12 mn 6 am
synthesis of 12 nn 6 pm  Check the doctor’s order .
Dosage bacterial cell walls,  The shape is rectangle as it is given orally.
 Monitor the client’s vital signs.
250-500mg, causing cell death.
Q6,PO  Assess for allergies to
Contraindications War
11-20-22
Riley Montefalco penicillins or other allergens
 A history of
Ampicillin
hypersensitivity to  Assess for renal disorders,
any penicillin is a 250-500mg, Q6,PO
lactation
contraindication 12 mn 6 am 12 nn 6 pm
Infectious  Culture infected area; skin
mononucleosis color, lesion; adventitious
patient develop a sounds
rash, and therefore  Monitor renal function tests of

use is avoided Renal the patient
and hepatic function
should be  Administer the right drug in the
monitored. right route and dosage at the
right time
Side Effects
 Nausea, Elizabeth C. Beranardino, WUP SN’24/ C.I  Check the patency of the IV
 vomiting, site and IV line
 diarrhea  Explain the purpose and
 mouth sores may Signature
importance of the drug to the
occur patient.
 This antibiotic is specific to
your problem and should not be
used to self-treat other
infections.
 Instruct the patient not to stop
taking the drug if she feel better
 Check IV site carefully for
signs of thrombosis or drug
reaction
 Report pain or discomfort at
sites, unusual bleeding or
bruising, mouth sores, rash,
hives, fever, itching, severe
diarrhea, difficulty breathing

 After 35-40 minutes, check the
patient for assessment
 Document and record.
.


DRUG STUDY
Name of
Classification Action/ Nursing
Medication Generic Shape & Color of the Medication Card to
/Dosage/ Contraindication/Side Implications/Nursing
(Brand Name be Used
Route Effects Responsibilities
Name)
Daliresp Classification  Daliresp (roflumilast) is  The color of the medication card is White  Follow the 12 rights of
roflumilast hosphodiesterase a selective since it is Once a day. medication administration.
-4 Enzyme phosphodiesterase 4  The time is 8am
Inhibitors (PDE4) inhibitor.  The shape is rectangle as it is given orally.  Advise patient to not exceed
Dosage Inhibition of PDE4 the recommended dose or
500 micrograms activity leads to frequency of administration.
(mcg), Once a accumulation of Contact physician if COPD
day , PO intracellular cyclic exacerbations are not
AMP. While the specific adequately controlled by the
mechanism(s) by which current medication regimen, or
Daliresp exerts its if respiratory symptoms
therapeutic action in continue to worsen.
COPD patients is not
well defined, it is
 Instruct patient and
thought to be related to
family/caregivers to report
the effects of increased
other troublesome side effects,
intracellular cyclic AMP
including severe or prolonged
in lung cells.
headache, sleep loss, or GI
problems (nausea, vomiting,
Contraindications diarrhea, indigestion,
 Hypersensitivity to the abdominal pain, decreased

active substance or to appetite).
any of the excipients
listed in section.
Moderate or severe Elizabeth C, Bernardino , WUP SN’24/ C.I
hepatic impairment
(Child-Pugh B or C).
Side Effects
 nausea, diarrhea;
 loss of appetite,
minor weight loss;
 headache, dizziness;
 occasional sleep
problems;
 back pain; or
 flu symptoms.

COPD

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COPD

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Republic of the Philippines

In Partial Fulfillment of the Requirements

COPD is an inflammatory disease that affects the pulmonary vasculature, lung

Types of Chronic obstructive pulmonary

Signs & Symptoms

The major types of surgery for COPD are:

ASSESSMENT DIAGNOSIS OUTCOME PLANNING NURSING INTERVENTION EVALUATION

Name of Patient: Riley Montefalco

that used provider if they experience

Name of Patient: Riley Montefalco

rash, and therefore  Monitor renal function tests of

diarrhea, difficulty breathing

Name of Patient: Riley Montefalco

Diagnosis: Chronic Obstructive Pulmonary Disease

 Hypersensitivity to the abdominal pain, decreased

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