Question

Chief Complaint: Severe productive cough
Admitting Diagnosis: COPD

History of Present Illness
A 56-year-old man with a history of smoking rush to ER with shortness of breath and cough for several days. His symptoms began 3 days ago with runny nose. He reportsachronicmorning cough productive of white sputum, which has increased over the past 2 daysPast Medical History
He has had similar episodes each time of raining season for the past 4 years. He always experiences fatigue, worsening cough, increased breathlessness and waking up in the morning with headache.
Family History
(+) Tuberculosis
(+) Hypertension
(-) Cancer

Personal and Social History
He has smoked 1 to 2 packs of cigarettes per day for 40 years and continues tosmoke. He denies hemoptysis, chills, or weight loss and has not received any relief fromover-the-countercough preparations.

Admission Order:
NPO temporarily. Start IVF, PNSS 1L x KVO. Hook to O2 therapy via nasal cannulaat 2-3LPM.Nebulization of Salbutamol + Ipratropium now, then every 6 hours. Acetylcysteine(Fluimucil)400mg 1 sachet dissolved 1/2 of H2O every 6 hours, can be started tomorrowmorning. Tazobac(Piperacillin sodium) 4.5 g thru soluset dissolved in PNSS 90 cc x 1hr ODANST( ).

For Chestx-ray,CBC, FBS, ECG, Urinalysis and ABG. Please do spirometry and monitor for disease progress. Chest x-ray shows hyperinflation and right lobe pneumonia. ABGresults wasPh7.24,PO2-35 mmHg, PCO2 60mmHg, HCO3 30, O2 sat - 85%. Spirometry with FEVI 35%predictedthat does not change significantly after inhaled bronchodilators. ECG was ordered.

Physical Examination:
Took vital signs which are: BP: 130/80, T: 37.5 Celsius, PR:89, RR:30.

Examination displayed tachypnea, respiratory distress, use of accessory muscles, and intercostal retraction. Barrel
chest is a common observation

1.Conceptualize the pathophysiological alterations distinct to the case. (flow chart}l
- Establish the pathophysiological triad of Non modifiable risk factors– Patient –Modifiable Risk Factors specific to the case.
- Trace the pathophysiological changes and highlight problems that are experienced by the client.
- Connect the pertinent nursing care and medical – surgical management to the various signs and symptoms presented by the client.

Answer 1

COPD

Chronic Obstructive Pulmonary Disease ( COPD) : Any of group of respiratory diseases charecterised by the pathological limitation of airflow in the airway that is not fully reversible . Emphysema and Chronic bronchitis are the common conditions that precipitate COPD. Refractory Asthma also worsens the condition.

Chronic Obstructive Pulmonary Disease

?   

? Etiology  

↘ Chronic Infections

↘Reactive airways

↘Congenital diseases

Eg: Cystic fibrosis

↘Smoking   

Triad ?

➡ Modifiable risk factors : Exposure to air pollution, Smoking and passive smoking, infections

➡Non modifiable risk factor : Congenital disorders ( Cystic fibrosis) genetic condition Alfa 1 deficiency,

➡ Patient: Age ( 65 or older) A history of childhood respiratory infection  , congenital disorders like Cystic fibrosis , occupation( exposure to chemicals or fumes )

Pathophysiology

Due to etiological factors such as allergy, smoking, chronic infection etc

? (leads to)

Inflammatiory reactions  on the bronchial mucosa

?

Swelling, mucous production in the airways

?

Continous irritation and inflammation causes damage to the Airways and movement of the cilia ?

Damage to the cilia results in the inability to expell out the mucous

?

Swelling and mucous build up makes breathing difficult accompanied with inflammation of the bronchial tubes ➡ Chronic bronchitis

?

Damage to the airsacs due to the chronic infection , inflammation and mucous accumulation ?

Air sacs looses its stretchiness and air gets trapped inside the airsacs ➡

➡ Emphysema

?

↘Shortness of breath

↘Inadequate exchange of gases,

↘ tachypnoea

↘ respiratory distress

↘fatigue

↘ Barrel Chest

Medical surgical management  

* Medications such as ,  Bronchodilators , Glucocorticosteroids

* Provide adequate rest

* Give up smoking

* Oxygen supplementation appropriately

Nursing care:

* Monitor vital signs and check the abnormal breath sounds

* provide a semi sitting position that ease breathing

* Assist the nutritional needs

* Administer medications as per physician's order

* Educate the importance of avoiding smoking and environmental triggers

* Assist in steam inhalation

* Check oxygen saturation in regular intervals