Case

Presentation
Group 7
Ablay-Andrade-Batario-Berbano-
Bibera-Borja-Borres-Burns-
Cabañero-Corsiga-Custodio-
Cuyegkeng
BRONCHIAL ASTHMA IN
ACUTE EXACERBATION

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
INTRODUCTION
 INTRODUCTION

COPD, or chronic obstructive pulmonary

disease, is a progressive disease that makes it hard
to breathe. "Progressive" means the disease gets
worse over time.
COPD can cause coughing that produces large
amounts of mucus, wheezing, shortness of breath,
chest tightness, and other symptoms.
Cigarette smoking is the leading cause of COPD.
Most people who have COPD smoke or used to
smoke. Most cases of COPD occur as a result of
long-term exposure to lung irritants that damage the
lungs and the airways.
 Breathing in secondhand smoke, air pollution,
and chemical fumes or dust from the environment or
workplace also can contribute to COPD.
(Secondhand smoke is smoke in the air from other
people smoking.)
In rare cases, a genetic condition called alpha-1
antitrypsin deficiency may play a role in causing
COPD. People who have this condition have low
levels of alpha-1 antitrypsin (AAT)-a protein made in
the liver.
 Having a low level of the AAT protein can lead to
lung damage and COPD if you're exposed to smoke
or other lung irritants. If you have this condition and
smoke, COPD can worsen very quickly.

COPD develops slowly. Symptoms often worsen

over time and can limit your ability to do routine
activities. Severe COPD may prevent you from
doing even basic activities like walking, cooking, or
taking care of yourself.
 Most of the time, COPD is diagnosed in middle-
aged or older people. The disease isn't passed from
person to person—you can't catch it from someone
else.

COPD has no cure yet, and doctors don't know

how to reverse the damage to the airways and
lungs. However, treatments and lifestyle changes
can help you feel better, stay more active, and slow
the progress of the disease.
CHRONIC BRONCHITIS
 
Lung damage and inflammation in the large
airways results in chronic bronchitis. Chronic
bronchitis is defined in clinical terms as a cough with
sputum production on most days for 3 months of a
year, for 2 consecutive years. In the airways of the
lung, the hallmark of chronic bronchitis is an
increased number (hyperplasia) and increased size
(hypertrophy) of the goblet cells and mucous glands
of the airway.
 As a result, there is more mucus than usual in the
airways, contributing to narrowing of the airways and causing
a cough with sputum. Microscopically there is infiltration of
the airway walls with inflammatory cells. Inflammation is
followed by scarring and remodeling that thickens the walls
and also results in narrowing of the airways. As chronic
bronchitis progresses, there is squamous metaplasia (an
abnormal change in the tissue lining the inside of the airway)
and fibrosis (further thickening and scarring of the airway
wall). The consequence of these changes is a limitation of
airflow.
 Patients with advanced COPD that have
primarily chronic bronchitis rather than emphysema
were commonly referred to as “blue bloaters”
because of the bluish color of the skin and lips
(cyanosis) seen in them. The hypoxia and fluid
retention leads to them being called “Blue Bloaters.
EMPHYSEMA
Emphysema is a chronic obstructive pulmonary
disease (COPD, as it is otherwise known, formerly
termed a chronic obstructive lung disease). It is
often caused by exposure to toxic chemicals,
including long-term exposure to tobacco smoke.
Emphysema is characterized by loss of elasticity
(increased pulmonary compliance) of the lung tissue
caused by destruction of structures feeding the
alveoli, owing to the action of alpha 1 antitrypsin
deficiency.
 This causes the small airways to collapse during
forced exhalation, as alveolar collapsibility has
decreased. As a result, airflow is impeded and air
becomes trapped in the lungs, in the same way as
other obstructive lung diseases. Symptoms include
shortness of breath on exertion, and an expanded
chest. However, the constriction of air passages isn’t
always immediately deadly, and treatment is
available.
ASTHMA
Asthma is a chronic lung disease that
inflames and narrows the airways. Asthma
causes recurring periods of wheezing,
chest tightness, shortness of breath, and
coughing. The coughing often occurs at
night or early in the morning. Asthma
affects people of all ages, but it most often
starts in childhood.
The airways are tubes that carry air into and out of
your lungs. People who have asthma have
inflamed airways. This makes the airways swollen
and very sensitive. They tend to react strongly to
certain substances that are breathed in.
When the airways react, the muscles around them
tighten. This causes the airways to narrow, and
less air flows to your lungs. The swelling also can
worsen, making the airways even narrower. Cells
in the airways may make more mucus than normal.
Mucus is a sticky, thick liquid that can further
narrow your airways.
When your asthma symptoms become worse
than usual, it's called an asthma attack. In a
severe asthma attack, the airways can close
so much that your vital organs do not get
enough oxygen. People can die from severe
asthma attacks.
Asthma is treated with two kinds of
medicines: quick-relief medicines to stop
asthma symptoms and long-term control
medicines to prevent symptoms.
NURSING
THEORIES
VIRGINIA HENDERSON
 NURSING THEORIES

Virginia Henderson
Henderson defined nursing in functional terms.
She stated, “The unique function of the nurse is to
assist the individual, sick or well, in the performance
of those activities contributing to health or its
recovery that he would perform unaided if he had
the necessary strength, will or knowledge.
 And to do this in such a way as to help him gain
independence as rapidly as possible.
Person (Patient)
Henderson viewed the patient as an individual
who requires assistance to achieve health and
independence or peaceful death. The mind and
body are inseparable. The patient and his or her
family are viewed as a unit.
 3 levels comprising the nurse patient
relationship
• 1. nurse as a substitute for the patient
• 2. nurse as a helper to the patient
• 3. nurse as a partner with the patient
 Henderson identified 14 basic needs of the
patient, which comprise the components of
nursing care. These include the following needs:
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes—dress and
undress
7. Maintain body temperature within normal
range by adjusting clothing and modifying
the environment
8. Keep the body clean and well groomed
and protect the integument
9. Avoid dangers in the environment and
avoid injuring others
11. Worship according to one’s faith
12. Work in such a way that there is a sense
of accomplishment
13. Play or participate in various forms of
recreation
14. Learn, discover, or satisfy the curiosity
that leads to normal development and
health and use the available health facilities
PERSONAL
DATA
 PERSONAL DATA

Mr. R.B, a 50-year-old Filipino, male. He was

born Roman Catholic on August 13, 1959 and
resides in Mamatid, Cabuyao Laguna. His wife died
four years ago and now, he’s living with his 3
children. He earned his income being a tricycle
driver. Mr. R.B was admitted to the hospital last
June 29, 2010 because he experienced difficulty of
breathing and was diagnosed of having COPD
under the management of Dr. Cuadra
HISTORY
 NURSING HISTORY

Sources of History
- Mr. R.B.
- daughter of Mr. R.B. (unfortunately she only
knows a few about her father’s illness and
medications).
Reasons for Seeking Care
A few hours prior to admission, the patient
experienced dyspnea accompanied with a
productive cough.
Present Health or History of Present illness
Three days prior to admission (June 25, 2010),
Mr. R.B has been having an on and off productive
cough. Then a few hours before he was admitted
(June 28, 2010), he suffered from difficulty of
breathing that is why his relatives rushed him at the
ER of Calamba Doctors’ Hospital and admitted to
our institution. Patient manifested productive cough
greenish in color, with nasal canula connected to
oxygen tank at 2-3 liter per minute as ordered.
His initial vital signs were:

BP = 160/100 mmHg
RR = 36 cpm
PR = 138 bpm
Temp = 36.5 C

Diagnostic exams included Chest X-ray, CBC, BUN,

NA, K, Urinalysis, ABG.
Past Health History
Patient was known to be asthmatic since
childhood. His usual attacks are precipitated by dust
or smoke inhalation. He has maintenance
medication of Ventolin.
During his teenage years, He worked as a
farmer and was exposed to fertilizers and other
different chemicals used for the crops. According to
him, he often sweats himself in the field and doesn’t
bother to change his clothes which he concluded as
the source of his Pneumonia. No accidents or
injuries are noted.
 At 20 years old, he worked as a Construction
worker. He also worked in a Textile factory and
worked as a tricycle driver. During those days, he
was diagnosed with PTB. He had suffered dyspnea
and had hemoptysis. According to him, he had his
shots of Streptomycin in their health center.
Nebulization was done for about 3 times but
offered no relief of the said condition
 Last year, he suffered from difficulty of breathing
and he was admitted in Calamba Medical Center
with a diagnosis of COPD

At year 2010 of January, patient seeks

consultation and was then admitted in Calamba
Doctors Hospital and diagnosed him COPD.
Complaining of DOB accompanied by greenish
phlegm. Patient also started to complain of easy
fatigability. Patient was also unable to sleep at night
associated with wheezes, chest pain.
Patient History at the ICU
Patient sensorium is unpredictable and the GCS
is only 9 then the next day is 15. After several
minutes the patient was intubated, size of ET tube is
7.5 lip level is 21, and continuous ambubagging
was done prior the patient was connected to
mechanical ventilator with the setting of FIO2 100%,
TV -450 RR is 22, he has Nasogastric tube
 and after several minutes Foley Catheter is
inserted connected to urine bag with a minimal
Urine Output, on Physical Restrains. Patient is full
pulses 94 beats per minute, pulse oximeter O2
Saturation 98%. After 9 days, patient was extubated
and placed O2 face mask at 10LPM as ordered and
the next day he was transferred to medical ward
with same medications and with nasal canula
connected to oxygen tank at 5-6LPM and with
Indwelling Foley Catheter.
Family History
He is not Hypertensive and Diabetic but his brother is only known
for this disease.

Psychosocial History
The patient is a widow and has 3 children. His neighbors are
friendly and helpful. He is a high school graduate and work as a Tricycle
driver. He is a not an alcohol drinker and only an occasional smoker.

Whenever the patient has problems, he is usually supported by his

children and relatives. Everytime he gets hospitalized when he is having
an asthma attack, his family is worried about what might happen to him
and also with the expenses that they will have. Work and money was
considered as primary stressor and his ways of coping are laughing and
spending time with peers.
PHYSICAL
ASSESSMENT
 PHYSICAL ASSESSMENT

Integumentary
Mr. RB’s skin is cold when touched, cyanotic,
has no edema, no signs of dehydration, scar on the
left foot. Nail convex curvature, smooth in texture,
capillary refill is not normal. Hair is dark brown with
some gray in color, shiny and equally distributed.
Head and Neck
Skull is rounded, smooth contour, absence of nodules or
masses. Facial gestures are symmetric. Has sunken
eyeballs. Eyebrows are symmetrically aligned.
 Eyelashes are equally distributed and curled
slightly outward. Eyelids has no discharge,
discoloration, closes symmetrically. There is no
visible sclera above corneas, sclera appears white,
the conjunctiva is pink in color, and both eyes are
coordinated. Ears color are same with the facial
skin, the auricle is aligned with other canthus of the
eye, they are firm and not tender. His hearing is
tested by asking questions and he response to his
normal voice. The external nose are symmetric and
straight there are no discharge, and has flaring,
uniform in color, not tender and there are no lesions.
 Air movement is restricted in both nares and he has
nasal canula. His lips are dry, slightly pink in color.
Teeth are incomplete, tongue is pink in color, slightly
rough, there is no lesions, no tenderness and it moves
freely. Muscles neck are equal in size, head centered
with smooth movements with no discomfort.

Thorax/ Lungs/ Heart

- thorax is barrel, it is decreased in vibratory sensation,
asymmetric thoracic expansion and he has abnormal
breathing pattern, his respiratory rate is 32 breaths per
minute and his lips are pursed.
 His left lung has dubbing sounds when it is
auscultated and palpated. He has persistent cough
which is productive; green in color. Heart rate is 105
beats per minute and irregular.

Abdomen
- abdomen is soft, free of tenderness, no pain on light
palpation.

Peripheral Vascular
- pulses equal in both arms, pulses equal in both legs.
No edema present.
Musculoskeletal
- normal spinal curves. No joint deformities,
tenderness, full active range of motion in all joints.
Muscle strength equal bilaterally, there are no
contractures, tremors.

Neurologic
- facial expressions appropriate. Speech is not clear,
he has husky voice. He has muscle strength to hold
and grasp things. He is non alcoholic, feels pain on
his head part.
NURSING
ASSESSMENT
14 Fundamental Needs
Nursing Assessment (14 fundamental
needs)
Breathe normally
During admission, his RR=20 and his chief
complain is DOB.
ICU Days, he is intubation
because of DOB and the result of pulse
oximetry is 38- 40%.
Post ICU, he is negative in DOB but there is still
oxygen
• Eat and Drink adequately
his usual eating pattern is 5 meals a
day with meriendas.
“magana naman akong kumain” as stated
• Eliminate body waste
Before hospitalization, his usual BM is every
morning.now, when he is in the hospital he
did not bowel for 3 days.
• “hndi pa ako dumudumi ilang araw na” as
stated.
On July 2,there is an insertion of foley cathether
because of uncontrolled urination.he had
bladder training on July 8 and because
there’s an urge of urination it was removed on
July 9 early AM.his urinary frequency in now
normal.
Move and Maintain desirable posture
He works as a tricycle driver and did not usually
participate in activities like exercise because he
has asthma.
“ madali ako hapuin”- as stated.
Sleep and Rest
ICU days, he has difficulty of sleeping and resting
because of severe productive cough. But after
intubation, he slept and rest well.
Select suitable clothes- dress and undress
before hospitalization, he wears his usual comfy
clothes. Now, he is wearing a standard gown for
patient.

Maintain body temperature

before he did not change clothes even if it is wet.
Now, he’s been hospitalized he wears socks and
uses blanket whenever he feels cold.
Keep the body clean and well groomed and protect
the integument.
before he takes a bath regularly. Now, he needs
assistance on going to CR. He had sponge bath
every morning with the assistance of the nurse and
relatives.

Avoid dangers in the environment and avoid injuring

others
he doesn’t know where he got TB. And he is
 aware that might infect his family.
Communicate with others in expressing emotions,
needs, fears/ opinions
he is the bread winner of his family and his
children’s family.
ICU days, he can’t talk because of intubation.
after extubation, he can talk and express feelings
even though his voice is husky
Worship according to one’s faith
he is Roman Catholic and believes in God but
he doesn’t always pray and goes to church.

Play or Participate in various forms of recreation

he doesn’t have vices and recreational
activities. Now, he is in the hospital he
watches TV, sleeps, and sometimes makes
joke with his family to eliminate his boredom.
Learn, Discover or Satisfy the curiosity that leads to
normal development and Health and use the
available Health Facilities.
he is aware and understands his illness. He
gave information about the history of his illness and
he complies on therapeutic regimen but due
financial problem, his family sometimes
 DRUG STUDIES

DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICATI NURSING

& ACTION REACTION / SIDE ON CONSIDERATION
EFFECTS
ACETYLCYSTEIN Miscellaneous - for abnormal CNS: fever, Contraindicated to - drug smells
E respiratory tract viscid thickened drowsiness, gait patients with strongly of sulfur.
(fluimucil) drugs mucous secretions disturbances hypersensitive to Mixing oral form
Dosages: Mucolytic that CV: tachycardia, drug. with juice or cola
Inhalation solution: reduces the hypotension, Use cautiously in improves its taste
10%, 20% viscosity of hypertension, elderly patients - drug delivered to
I.V. injection: 20% pulmonary flushing, chest with severe nasogastric tube
solution secretions by tightness respiratory maybe diluted with
(200mg/ml) splitting disulfide GI: stomatitis, insufficiency. Use water.
linkages between nausea, vomiting I.V. formulation in - monitor cough
mucoprotein RESPI: patients with type and frequency
molecular bronchospasm, asthma or history - monitor patient for
complexes. dyspnea, cough of bronchospasm. bronchospasm,
SKIN: rash, specially if he has
diaphoresis asthma
OTHER: chills - facial erythema
may occur within
30-60 mins. Of
start of IV infusion
and usually
resolves without
stopping infusion.
DRUG
STUDIES
 DRUG NAME CLASSIFICATION & INDICATION ADVERSE CONTRAINDICATIO NURSING
ACTION REACTION / SIDE N CONSIDERATION
EFFECTS
AMBROXOL Mucolytic acute and chronic Mild upper gastro- should not be used -should be taken
(Mucosolvan) It enhances bronchopulmonary intestinal side effects in patients known to with food
Dosage: pulmonary surfactant diseases associated (primarily pyrosis, be hypersensitive to - monitor S/SX of
Tablet: 75mg, 30 production and with abnormal dyspepsia, and ambroxol or other aspiration of excess
mg, 50mg stimulates ciliary mucus secretion and occasionally nausea, components of the secretions and
Mucosolvan Liquid 3 activity. These impaired mucus vomiting) have been formulation. bronchospasms, if
0 mg, 60ml actions result in transport. reported, principally occurred notify
   improved mucus flow following parenteral physician
and transport ( administration. - have suction
mucociliary Allergic reactions apparatus
clearance). have occurred rarely, immediately
Enhancement of fluid primarily skin rashes. available.
secretion and There have been - tell the patient or
mucociliary extremely rare case family to report any
clearance facilitates reports of severe difficulty clearing the
expectoration and acute anaphylactic- airway or any other
eases cough. type reactions but repi distress.
their relationship to
ambroxol is
uncertain. Some of
these patients have
also shown allergic
reactions to other
substances.
 DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICATI NURSING
& ACTION REACTION / SIDE ON CONSIDERATION
EFFECTS
DOXOFYLLINE Antiasthmatic Bronchial asthma After xanthine Individuals who -maybe taken with or
administration, without food
(ansimar) Bronchodilator & have shown
nausea, vomiting, - assess lung
    pulmonary disease hypersensitivity to
epigastric pain, sounds, BP before
Dosage: its mechanism of w/ spastic Ansimar and its administration and
  action is related to bronchial cephalalgia, components. during peak of
Tab Adult 1 tab the inhibition of component irritability, Patients with acute medication. Note
bid-tid. Syr Childn phosphodiesteras insomnia, myocardial amount, character,
>12 yr 10 mL e activities, tachycardia, infarction and and color sputum
once-tid, <12 yr 6- resulting in extrasystole, hypotension. produced.
9 mg/kg bid. bronchodilating tachypnea and Use in lactation: - monitor pulmonary
effects. occasionally, Doxofylline is function test before
hyperglycemia and contraindicated in initiating therapy and
albuminuria, may during therapy to
nursing mothers.
occur. If a potential determine
oral overdose is effectiveness of
medication.
established, the
- observe for
patient may
paradoxial
present with severe bronchospasm
arrhythmias and ( wheezing ). If
seizure; these occurred, withhold
symptoms could be medication and notify
the 1st sign of an physician.
intoxication.
 DRUG NAME CLASSIFICATION & INDICATION ADVERSE REACTION CONTRAINDICATION NURSING
ACTION / SIDE EFFECTS CONSIDERATION
COMBIVENT Antiasthmatic chronic obstructive edema, fatigue, COMBIVENT Inhalation -do not use more than
(albuterol) Bronchodilator pulmonary disease hypertension, dizziness Aerosol is also 12 inhalations in a 24-
Dosage: expected to maximize (COPD) on a regular , nervousness, contraindicated in hour period. Doing so
the response to aerosol bronchodilator paresthesia, tremor, patients hypersensitive may increase the risk
Each Combivent treatment in patients who continue to have dysphonia, insomnia, to any other of serious side effects.
inhaler is good for 200 with chronic obstructive evidence of diarrhea, dry mouth, components of the drug - Extreme heat can
"sprays" (pumps). pulmonary disease bronchospasm and dyspepsia, vomiting, product or to atropine cause the medicine
(COPD) by reducing who require a second arrhythmia, palpitation, or its derivatives. canister to burst. Do
bronchospasm through bronchodilator. tachycardia, arthralgia, not store your inhaler in
two distinctly different angina, increased your car on hot days.
mechanisms, sputum, taste Do not throw an empty
anticholinergic perversion, and urinary canister into open
(parasympatholytic) tract infection/dysuria. flame.
and sympathomimetic. - Exhale deeply through
your mouth, then close
your lips around the
mouthpiece. Keep your
eyes closed to protect
them against an
accidental spray.
Inhale slowly through
the mouth, and at the
same time press down
once on the canister's
base. Hold your breath
for 10 seconds, then
remove the mouthpiece
from your lips and
exhale slowly.
Wait 2 minutes, shake
the canister again, and
repeat.
 DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICATI NURSING
& ACTION REACTION / SIDE ON CONSIDERATION
EFFECTS
HYDROCORTISO Corticosteroids - severe CNS: insomnia, Contraindicated to -give oral dose with
NE SODIUM Not clearly defined. inflammation psychotic behavior, patients food when
SUCCINATE Suppresses - shock vertigo, headache, hypersensitive to possible. Patient
(solu-cortef) immune response, - treatment for seizures drugs and in those may need another
Dosage: stimulates bone ulcerative colitis CV: heart failure, with systematic drug for GI irritation
Injection: 100mg marrow and hypertension, fungal infections. - monitor patient’s
vial, 250mg vial, influences protein, arrythmias, weight, BP and
500mg vial, fat and thrombophlebitis, electrolyte level
1,000mg vial carbohydrate thromboembolism - watch for
metabolism GI: peptic depression or
ulceration, GI psychotic episodes
irritation, increased especially during
appetite, nausea, high dose therapy
vomiting - warn patient
HEMATOLOGIC: about easy
easy bruising bruising
SKIN: delayed - unless
wound healing contraindicated,
MUCOSKELETAL: give a low sodium
muscle weakness, diet that is high in
osteoporosis potassium and
METABOLIC: protein. Give
hypokalemia, potassium
hyperglycemia, suplements
carbo intolerance,
hypocalcemia
 DRUG NAME CLASSIFICATIO INDICATION ADVERSE CONTRAINDICA NURSING
N & ACTION REACTION / TION CONSIDERATIO
SIDE EFFECTS N
RANITIDINE Antiulcer drugs - active CNS: headache, Contraindicated - assess patient
HCL Competitively duodenal and vertigo, malaise to patients for abdominal
(zantac) inhibits action of gastric ulcer HEPATIC: hypersensitive pain. Note
Dosage: histamine on the - GERD jaundice to drugs. presence of
Injection: H2 receptor sites - heartburn OTHER: burning blood in emesis,
25mg/ml of parietal cells and itching at stool or gastric
Syrup: 15mg/ml decreasing the injection site aspirate.
Tablets: 75mg, gastric acid - drug maybe
150mg, 300mg secretion. added to TPN
- instruct patient
to take without
regard to meals
because
absorption isn’t
affected by food
- urge patient to
avoid smoking
because this
may increase
gastric acid
secretion and
worsen disease.
 DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICATI NURSING
& ACTION REACTION / SIDE ON CONSIDERATION
EFFECTS
CEFUROXIME for Antibacterial Lower Respiratory Diarrhea; Cefuroxime for - Determine history
injection USP inhibits synthesis of Tract Infections headache; loose Injection USP and of hypersensitivity
Dosage: bacterial cell wall, Urinary Tract stools; nausea; Dextrose Injection reactions to
I.V. administration: causing cell death. Infections vomiting. Severe USP is cephalosporins,
250mg,500mg,750 Skin and Skin- allergic reactions contraindicated in penicillins, and
mg,1 gm Structure Infections (rash; hives; patients with known history of allergies,
Bone and Joint itching; difficulty allergy to the particularly to
Infections breathing; tightness cephalosporin drugs, before
Meningitis in the chest; group of antibiotics. therapy is initiated
swelling of the - Inspect IM and IV
mouth, face, lips, or injection sites
tongue); bloody frequently for signs
stools; change in of phlebitis.
the amount of - Monitor for
urine; dark urine; manifestations of
easy bruising or hypersensitivity
bleeding; fatigue; Discontinue drug
fever; seizures; and report their
severe diarrhea; appearance
stomach promptly.
cramps/pain; -Monitor I&O rates
vaginal irritation or and pattern:
discharge Especially
important in
severely ill patients
receiving high
doses. Report any
significant changes.
- Report onset of
loose stools or
diarrhea.
 DRUG NAME CLASSIFICATIO INDICATION ADVERSE CONTRAINDICA NURSING
N & ACTION REACTION / TION CONSIDERATIO
SIDE EFFECTS N
CEFTAZIDIME Antibiotic, Lower CNS: Headache, Patients with -Monitor
(Zeptrigen) Cephalosphorin Respiratory dizziness, allergies to prothrombin
Dosage: (3rd Generation) Tract Infections, lethargies, penicillins, time in patients
Powder for inhibits Skin and Skin- paresthesias, cepahlosporins. w/ renal or
injection: mucopeptide Structure malaise, fatigue, hepatic
synthesis in the Infections , vertigo, impairment, in a
500 mg bacterial cell wall, Urinary Tract confusion, poor nutritional
making it Infections , Intra- precipitation of state or are on
1 gram defective and abdominal seizures, prolonged
osmotically Infections, (especially therapy.
2 grams unstable. The Central Nervous inclients with - Have Vit. K
drug is usually System impaired renal available in case
6 grams bactericidal. It is Infections function) hypoprothrombine
more effective GI: nausea, mia occurs.
against rapidly vomiting, - Do not mix
growing with
diarrhea, glossitis,
organisms aminoglycoside
forming cell walls. abdominal solutions,
cramps or pain, administer these
dyspepsia, drugs separately.
anorexia,
flatulence,
cholestasis,
pseudomembrano
us colitis
Local: Pain,
abscess at
injection site,
phlebitis,
inflammation at IV
site
 DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICATI NURSING
& ACTION REACTION / SIDE ON CONSIDERATION
EFFECTS
DILTIAZEM HCL Antianginals - angina pectoris CNS: headache, Contraindicated - monitor blood
(dilzem) A calcium - HPN dizziness, to patients with pressure and
Dosage: channel blocker somnolence hypersensitive heart rate
Tablet: 30mg, that inhibits CV: edema, to drug and in before, when
60mg, 90mg, calcium ion arrythmias, those with starting therapy
120mg across cardiac flushing, systolic blood and during
Injections: and smooth bradycardia, pressure below dosage
5mg/ml (25mg & muscle cells, hypotension, 90mm Hg. adjustments.
50mg) decreasing heart failure, AV Use cautiously - if systolic blood
myocardial block in elderly pressure is
contractility and GI: nausea, patients and in below 90 or
oxygen demand. constipation, those with heart heart rate is
Also dilates abnormal failure or below 60 bpm,
coronary discomfort impaired hepatic withhold dose
arteries and SKIN: rash or renal function. and notify
arterioles. physician.
- tell patient to
swallow
extended
release
capsules whole,
and not to open,
crush or shew
them.
DRUG NAME CLASSIFICA INDICATION ADVERSE CONTRAINDI NURSING
TION & REACTION / CATION CONSIDERA
ACTION SIDE TION
EFFECTS
NITROGLYCE Antianginals - to prevent CNS: Contraindicate - closely
RIN PATCH Reduces chronic headache, d to patients monitor VS
(deponit) cardiac anginal attack dizziness, with early MI particulary the
Dosage: oxygen - acute angina weakness orthostatic BP
Transdermal: demand by pectoris CV: hypotension, - apply to a
0.1mg/ hour, decreasing left - HPN orthostatic allergy to non hairy part
0.2mg/hour, ventricular hypotension, adhesives. of the skin
0.3mg/hour, end- diastolic tachycardia, Use cautiously except distal
0.4mg/hour, pressure flushing, to patients part of the
0.6mg/hour, (preload) and palpitation, with arms and
0.8mg/hour to a lesser fainting hypotension. legs.
extent, GI: nausea, - remove
systemic vomiting patch before
vascular SKIN: rash defibrillation.
resistance
(afterload).
Also increases
blood flow
through
coronary
vessels.
DRUG NAME CLASSIFICATI INDICATION ADVERSE CONTRAINDI NURSING
ON & ACTION REACTION / CATION CONSIDERATI
SIDE ON
EFFECTS
AZITHROMYCI Anti – - acute CNS: Contraindicate - give meds 1
N infectives bacterial dizziness, d to patients hour before or
(zithromax) Binds to the worsening of vertigo, with 2 hours after
Dosages 50S subunit of COPD headache, hypersensitivity meals
Powder for oral bacterial - community fatigue, to - do not give
suspension: ribosomes, acquired somnolence erythromycin. with antacids
100mg/5ml, blocking pneumonia CV: chest pain, Use cautiously - monitor
200mg/5ml protein - patients with palpitation in patients with patients with
Tablets: synthesis; advanced HIV GI: nausea, impaired super
250mg, bacteriostatic infections vomiting, hepatic infections.
500mg, 600 or bactericidal, diarrhea, function. Drug may
mg depending on abdominal cause
concentration. pain,, overgrowth of
flatulence no susceptible
SKIN: bacteria or
photosensitivity fungi.
, rash - advise patient
to avoid
excessive
sunlight and to
wear protective
clothing and
use sunscreen
when outside.
 DRUG NAME CLASSIFICATION INDICATION ADVERSE CONTRAINDICAT NURSING
& ACTION REACTION / SIDE ION CONSIDERATION
EFFECTS
DIAZEPAM Anxiolytics - anxiety CNS: drowsiness, Contraindicated to - inject deeply into
(valium) A benzodiazepine - acute alcohol slurred speech, patients a large muscle.
Dosage: that depresses the withdrawal fatigue, headache, hypersensitive to - if patient takes
Capsules: 15mg CNS, and - muscle spasm insomnia, drugs and patients other CNS drugs
Injection: 5mg/ml suppresses the - preop sedation hallucinations experiencing observed for over
Tablets: 2mg, 5mg, spread of seizure - severe recurrent CV: hypotension, shock, coma or sedation
10mg activity. seizure bradycardia acute alcohol - warn patient to
Oral solution: GI: nausea, intoxication . avoid hazardous
5mg/5ml, 5mg/ml constipation, activities that
diarrhea require alertness
URINARY: and good
retention and coordination until
incontinence effects of drug are
HEPATIC: known.
jaundice - advise patient to
RESPIRATORY: use sugarless hard
respi depression, candy or gum to
apnea relieve dry mouth.
SKIN: rash
OTHERS: altered
libido, physical or
psychological
dependence
PATHOPHYSIOLO
GY
NURSING CARE PLAN
 NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objectives: After a week, the •Give expectorant • For immediate Client still have
-Positive wheezes
Ineffective client will or recovery, productive cough
sound in both airway maintain airway bronchodilators broncho airway but he can
lungs clearance patency as ordered. resistance already
-Positive secondary to expectorate it
related to bronchoconstricti
productive cough • Administer on
-Positive sputum, secretions oxygen as • Oxygen has
greenish in color in the ordered been shown to
correct
-RR 39
bronchi hypoxemia, which
-With et tube
connected to can be caused by
retained
ventilator
respiratory
• Suction prn secretions
• To clear airway
when secretions
are blocking
airway
• Position client to
optimize • Upright position
respiration (head allows for
of bed elevated maximal air
45 degree) exchange and
lung expansion.
And also will be
easy to
expectorate the
sputum
Assessment Diagnosis Planning Intervention Rationale Evaluation

•Performed • Chest Physical

back tapping Therapy help
mobilizes
bronchial
secretions
Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Nutritional The patient will •Evaluated •To have primary Client has
imbalanced less display basis, because increased
Loss of weight weight and copd patient appetite
than body progressive
From 70 kgs – 55 requirements weight gain body size habitually eat
kgs)   poorly
toward goal as
Less of muscle
mass appropriate at  
Poor muscle tone least half kilo per  
Altered taste week. •Provide •Enhance
sensation appetite
Aversion to good oral  
eating hygiene
 
 
• Auscultated •Hypo active
bowel sounds may
reflect decrease
sounds gastric motility
and constipation

• Helps reduce
•Provide fatigue during
frequent mealtime and
small feeding provide
opportunity to
increase total
  caloric intake or
  decrease desire
to vomit
Assessment Diagnosis Planning Intervention Rationale Evaluation

•Encourage •Can produce

patient to avoid abdominal
drinking distention or
carbonated increase dyspnea
beverage
• Extreme in
• Encourage temperature can
patient to avoid precipitate or
very hot and very aggravate cough
cold foods system
 
• Encourage to • To meet the
eat nutritious total weight gain
foods needs
Assessment Diagnosis Planning Intervention •Rationale Evaluation
Objective: Impaired gas Client will be able • Elevate head of • Correct
(+) DOB exchange related to demonstrate bed or position positioning will
RR= 36 to alveolar improved the client maintain airway
(+) productive capillary ventilation and approximately patency and
cough with green adequate (Moderate High promote drainage
membrane
in color sputum oxygenation of back Rest) secretions
secretion changes (COPD) provide airway
tissues by ABG’s
Contraction of within client’s adjuncys and
abdominal normal limits and suction as
muscles during absence of indicated
inspiration symptom of
• Auscultate • To identify the
Restlessness respiratory
chest and check presence of
With pulse for breath sounds secretions
distress after
oximeter
With mechanical • Performed back • To easily
ventilator tapping after the remove the
ABG’s result nebulization secretion

Ph= 7.285 (+) • Assesslevel of

decreased consciousness • To know if the
  and mentation patient can
Pco2= 93.4 (+) changes response to the
 increased motor, eye
Pco2= 63 (+) opening and
 decreased • Evaluate pulse verbal
Hco3= 43.9 (+) oximetry to • To assess
increased determine respiratory
oxygenation insufficiency
• Suction PRN as
ordered •To clear airway
when secretions
are blocking
airway
Assessment Diagnosis Planning Intervention •Rationale Evaluation

Objective: Impaired After the • Assessed • to measure the client

• dyspneic Spontaneous nursing spontaneous the work of
•Restlessness Ventilation intervention, the respiratory breathing maintain
•Increased use related to client will: pattern, noting effectivenes
of accessory problem with rate, depth, s
muscle secretion • maintain rhythm,
• uncooperative management effective pattern symmetry of respiratory
• with ET tube via ventilator chest pattern via
connected to with absence of movement and ventilator
ventilator retractions or use of
machine use of accessory
• unstable accessory muscles
cardiac rate muscles within • to synchronize
• pursed lip acceptable • Administered respirations and
breathing range. sedative drugs reduce work of
• wheezes as required breathing(to
• lethargic relax the
• increased patient prior to
RR(39 bpms) • Verified intubation as
• clients order)
respirations are
in phase with • to decrease
the ventilator work of
breathing
maximizes
Oxygen delivery
Assessment Diagnosis Planning Intervention Rationale Evaluation

• Checked cuff • to prevent risk

inflation at time associated with
whenever cuff is under or over
deflated or inflation
reinflated.

• to prevent risk
• Checked tubing associated with
for obstruction under or over
inflation

• to clear the
• Suctioning secretion
provided

• to liquefy
• Noted inspired secretions
humidity and facilitating
temperature, removal
maintain
hydration
Assessment Diagnosis Planning Intervention Rationale Evaluation

• Noted changes • may indicate

in chest improper
symmetry placement of ET
tube

• Elevated the
head part of the • to facilitate
bed in 45 degree oxygen
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective data:
Anxiety Will appear •Encourage •To ease
  client to anxiety
“Natatakot ako sa R/T relaxed and acknowledge  
kung anu man
ang pwedeng
changes in report and to express  
mangyari sa akin” health anxiety is feelings of  
as stated.
status reduced to sadness, fear  
  or anger.  
Objective data: a    
 
Poor eye contact
manageabl  
Tearfulness e level •Be available
Elevated Blood to client for  
pressure listening and •To establish
150/100 talking. therapeutic
Restlessness   relationship/
With body
  communication
weakness
Slightly irritable  
Pale  
     
•Provide  
accurate •Helps client to
information identify what is
about the reality based
situation.
 
Assessment Diagnosis Planning Intervention Rationale Evaluation

•Provide quiet •To be able the

and calm pt. to relax and
environment. relieve anxiety.
   
   
   
   
 
 
•Encourage SO •In order for pt. to
not to leave the have someone if
patient alone. he needs a
  should to lean on
   
   
   
 
 
•Use comfort  
measures. •In order for
( Clean patient to relax
linen,siderails) and be
  comfortable.
 
•Encourage to  
use diversional •To divert
activities. anxiety.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Self Care After nursing •Plan time for •To discover Client now
•Weak in intervention, the listening to the barriers to perform easy
appearance. Deficit client will be client feelings participation in activity of daily
•Inability to related to able to: and concern regimen and to living but still
ingest food weakness Perform self-   work on with supervision
safely. care activities   problem solution
•Inability to within level of    
chew or swallow own ability  
food.  
•Inability to used •Identify energy •To avoid
bathroom. saving behavior fatigue
•With foley    
catheter. •Implement  
•With diaper bowel or •  adaptive
•(+) pain bladder training devices promote
•Uncooperative as indicated independence
  and safety 
   
•Assist with  
necessary •To encouraged
adaptations to client and build
accomplish on
ADL’s, begin
with familiar

•Help client into

sitting position • Gravity assist
with swallowing
and spiration
with decreased
when sitting
upright
Intervention rationale

• Advise S.O. •Functional

to prepare feeding can
small portion be improved
of favorite by altering
foods that physical
acoording to context of the
clients diet meal to
appeal to the
client

• advise S.O. • finger foods

to provide can be
finger foods nutritious as
well as
allowing
independenc
e and the
choice of
what and
when to eat
LABORATORY
 COMPLETE BLOOD COUNT and
PLATELET COUNT
JUNE 29, 2010

PARAMETER RESULTS UNITS NORMAL VALUES

Hemoglobin 16.30 g/L (13-17)
Hematocrit 0.50 (0.4-0.5)
Red Cell Count 5.47 (4.5-5.5)
White Cell Count 8.40 10^9/L (5-10)
Neuthophils 0.920 (0.55-0.65)
Lymphocytes 0.80 (0.25-0.35)
Eosinophils 0 (0.02-0.04)
Basophils 0 (0-0.05)
Platelet 266.00 10^9/L (140-340)
MCV 90.90 fL (86-100)
MCH 29.80 Pg (26-31)
MCHC 32.80 g/dL (31-37)
 BLOOD CHEMISTRY

JUNE 28, 2010

TEST NAME RESULT UNITS REFERENCE

VALUES.
Blood Urea 12 mg/dL 9-20
Nitrogen
Creatinine 0.8 mg/dL 0.66-1.25
Sodium 133 mmol/L 137-145
Potassium 4.7 mmol/L 3.5-5.1
URINALYSIS
JUNE 29, 2010
MACROSCOPIC
Color Yellow
Transparency Clear
Reaction 5.5
Specific Gravity 1.020
Albumin Negative
Sugar Negative
MICROSCOPIC
WBC 2.5
RBC None seen
Bacteria Moderate
E.cells Rare
Amorphous Urates
Mucuos Treads Few
Cast
Crystals
 X-RAY REPORT

EXAMINATION: CXR-PA
6/28/10
FINDINGS:
There are fibrotic and coarse reticular densities
in both upper lodes, consistent with fibroexudate
and atelectatic PTB. Pleura- parenchymal
adhensions seen in both lung bases. The heart and
the rest of the visualized chest structures are
unremarkable.
ARTERIAL BLOOD GASES
(JUNE 29, 2010)

RESULT NORMAL VALUES

Ph 7.285 7.35-7.45
PC02 93.4 35-45 mmHg
P02 63 80-100 mmHg
HC03 43.9 22-28 meq/l
BE 17 (+-)2
02 sat 85 80-100%
Temp. 37.8
FI02 32%
RR 28bpm
site RBA
ARTERIAL BLOOD GASES
(JULY 1, 2010)
RESULT NORMAL VALUES
Ph 7.328 7.35-7.45
PC02 96.7 35-45 mmHg
P02 54 80-100 mmHg
HC03 51.3 22-28 meq/l
BE 25 (+-)2
02 sat 83 80-100%
Temp. 36.2
FI02 44%
RR
site RBA
ARTERIAL BLOOD GASES
(JULY 2, 2010)
RESULT NORMAL VALUES
Ph 7.31 7.35-7.45
PC02 79.7 35-45 mmHg
P02 57 80-100 mmHg
HC03 40.4 22-28 meq/l
BE -14 (+-)2
02 sat 85% 80-100%
Temp. 36.8
FI02 70% MV
RR 22
site LBA
JOURNAL
 JOURNAL

According to a new study, published in the

American Journal of Respiratory and Critical Care
Medicine (American Thoracic Society), patients
with severe Chronic Obstructive Pulmonary
Disease (COPD) may benefit from a new treatment
that includes the use of two drugs: salmeterol and
fluticasone. This new treatment may be a better
alternative than the standard treatment already in
use (treatment with the drug tiotropium).
 The new study used a multi-center approach to test
the efficacy and safety of the new 2 drug treatment as
compared to the traditional used. Dr. Jadwiga
Wedzicha, from the Royal Free & University College
Medical School in London, led the study.

Researchers were able to enrol more than 1300

patients with severe COPD and divided them in two
groups (randomly).One of the group received the
standard treatment with tiotropium and the other group
received the new treatment. The treatment lasted for 2
years. During this time patients enrolled in both groups
were closely followed as to evaluate the efficacy of the
new treatment as compared to the old one.
 They looked for exacerbation (number and type). They
also used a standardized questionnaire which evaluates the
overall respiratory condition of the patients (St. George's
Respiratory Questionnaire (SGRQ), the lung function and
how long people remained in the study.

A Healthy Diet as a Remedy for COPD:

A plant-based diet, like the one Dr. Joel Furhman
recommends, is instrumental in helping COPD sufferers
recover. The plant-based diet rids the body of foods that
create mucus, like milk and cheese. The diet promotes the
consumption of organic fruits and vegetables. Many natural
hygienists also recommend avoiding animal products,
including eggs. Many studies indicate that adding broccoli to
the diet greatly improves the symptoms of COPD patients.
 Omega-3 oils are also beneficial to COPD patients.
Omega-3 oils are found in fish oil supplements and in
foods like fish, flax seeds and walnuts. "Fatty" fish like
mackerel, lake trout, herring, sardines, albacore tuna
and salmon are high in omega-3 fatty acids. Natural
remedies and a strict diet can improve COPD
symptoms.

7 Tips to Avoiding Shortness of Breath When Eating

While shortness of breath may be your constant
companion if you have COPD, experiencing it while
eating can be very frustrating. It can also lead to
malnutrition, a common complication of COPD.
If you are finding it difficult to complete a meal, try these 7 tips
to help you manage shortness of breath during mealtimes:

1. Clear Your Airways before Eating

Before you eat, make sure you attempt to clear your airways
of mucus. This will help you breathe better while eating.
2. Eat and Chew Your Food Slowly
Take small bites and chew your food slowly. Be sure to
breathe while you are eating. Put your utensils down
between bites to ensure that you eat slower. This will help
you retain energy, making it easier to breathe.
3. Eat Foods That Are Easy To Chew
Eating foods that are easy to chew will help you conserve
energy so you have more for breathing.
4. Eat Smaller, More Frequent Meals
Instead of eating 3 larger meals, try eating 6 smaller
meals. This will keep your stomach from feeling too
full and make it easier to breathe.
5. Save Beverages Until After Your Eat
When you drink liquids during your meals, you may
have a tendency to fill up quicker causing you to
feel full or bloated. This can cause difficulty
breathing. Try waiting until the end of your meal to
drink your beverages. But, of course, if you need to,
sip water while you eat to make the food go down
easier.
6. Eat While Sitting Upright
Lying down or slumping while eating can cause
pressure on your diaphragm. Sitting in an upright
position while eating can help reduce pressure and
allow you to breathe better.
7. Use Pursed-Lip Breathing
While eating, if it becomes difficult to breathe, try
using pursed-lip breathing until you catch your
breath.
Supplements for the Treatment of COPD:
1. Vitamin C and Magnesium - Research conducted at
the University of Maryland revealed that Vitamin C and
Magnesium aid in the treatment of COPD. People with
COPD often have low levels of magnesium due to poor
nutrition. Magnesium promotes healthy lung function,
thereby making it vital for COPD patients.
2. Carnitine - Research has also revealed that
supplements like Carnitine is beneficial for COPD
patients, who experienced improved breathing and
fewer COPD symptoms.
Herbal Treatments for COPD:
1. Olive leaf - Olive leaf is one herb that eases symptoms of
COPD. Olive leaf reduces inflammation and aids in the
treatment of COPD-related infection. Olive leaf is a natural
antibiotic with anti-inflammatory, anti-viral and anti-bacterial
properties.

2. Serrapeptase - Research suggests that Serrapeptase is

also helpful. There are many success stories using this
miracle natural enzyme. According to Robert
Redfern ."Serrapeptase is a naturally occurring, physiological
agent with no inhibitory effects on prostaglandins and is
devoid of gastrointestinal side effects."
3. Cayenne - Cayenne is used because it has the
ability to increase circulation and improve breathing.
A recipe for blood clearance: 1 cup of water, 1/4
teaspoon of cayenne, 1 tablespoon of apple vinegar
and 2 teaspoons of honey. Drink this slowly
throughout the day.

4. Other herbs that help ease COPD symptoms

include astragalus, enchinacea, ginseng, quercetin,
thyme, milk thistle, eucalyptus and lobelia.
REFLECTION

Our group was able to handle the case of

Mr. R.B when we were assigned at Calamba
Doctors’ Hospital for our Related Learning
Experience last July 1 2010. After we were
given consent by his family, we decided to
take Mr. R.B’s case as a subject for study in
order to expand our knowledge regarding his
disease and be able to collect additional data
that we seem necessary for us to progress in
our quest to become effective nurses in the
future.
THANK YOU
SO MUCH!!

GROUP 7
RLE