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Introduction a. Background of the study COPD or Chronic Obstructive Pulmonary disease chronic lung conditions that obstruct the airways in your lungs refers to obstruction caused by CHRONIC BRONCHITIS and EMPHYSEMA there is a blockage within the tubes and air sacs that make up the lungs which hinders the ability to exhale and even breath

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. Chronic Bronchitis is hallmarked by hyperplasia (increased in number) and hypertrophy (increased in size) of goblet cells (mucous gland) of the airway, resulting in an increase in secretion of mucous which contributes to the airway obstruction. Microscopically there is infiltration of the airway walls with inflammatory cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to metaplasia abnormal change in the tissue) and fibrosis (further thickening and scarring) of the lower airway. The consequences of these changes are limitation of airflow. Emphysema is defined histologically as the enlargement of the air spaces distal to the terminal bronchioles , with distruction of their walls. The enlarged air sacs (alveoli) of the lungs reduces the surface area available for the movement of the gases during respiration. This ultimately leads to dyspnea in severe cases. The exact mechanism for the development of emphysema is not understood although it is known to be linked with smoking and age. Types of Emphysema Paniobular (or panacinar) Emphysema This type of emphysema is characteristic of a weakening and inflammation of alveoli at the end of the bronchioles. When destruction is very severe the affected acinus disappears and the lungs appear “spider web-like” in x-rays. A mild version of this type of emphysema occurs as aging progresses. In younger people, this panlobular emphysema is caused by the body’s inability to produce sufficient amounts of alpha-1 antitypsin. Centrilobular (or centriacinar) Emphysema
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This type of emphysema affects single alveoli entering directly into the walls of terminal and respiratory bronchioles. Risk Factors: o Smoking o Exposure to occupational and environmental pollutants o Genetic factors o Allergies o Nutrition o Age, Gender Signs and Symptoms:
o

Cough: productive or non-productive

o Dyspnea o Wheezing
o

Chest pain

o Hemoptysis o Cyanosis o Swelling o Respiratory failure Diagnostic Test o Chest X-ray o CT Scan (computerized Tomography) o Arterial Blood Gas Surgery: o Bullectomy o Lung volume Reduction Surgery (LVRS)
2

o

Lung Transplant

Nursing Care: -

Eliminate or minimize exposure to all pulmonary irritant Clear airways with postural drainage, clapping or vibrating and suctioning as appropriate Administer oxygen at the prescribed percentage Encourage rest Assess for drug allergies especially to antibiotics before administering Also prescribed , administer bronchodilators, mucolytic agents and corticosteroid Provide client and family teaching , covering disease process and treatments, breathing restraining exercises, energy conservation, use of inhalers and nebulizers medication administration and the importance of compliance , prevention of complications and infections by receiving influenza and medications prescribed

Special Instructions: Demonstrate the use of bronchodilator nebulizers Teach and demonstrate to the patients and caregiver and adaptive breathing techniques : deep breathing exercise, coughing and techniques , pursed lip breathing, abdominal breathing and position for postural drainage Explain the need to avoid persons with infection like flu Instruct the patient and caregiver on cleaning of home respiratory equipments Instruct the patient and caregiver on cleaning of all home respiratory equipments Explain the need to avoid going out in cold temperatures which may cause bronchospasms Stress the importance of not smoking and avoiding second hand smoke Suggest avoiding clothing that restricts chest or abdominal expansion

-

-

For Activity: -

-

Advise the patient to exercise to tolerance and to avoid fatigue by planning rest periods during the day Instruct the patient to breathe deeply and slowly during the periods of a activity Instruct patients to avoid emotional stress

Types of Exercises for COPD
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This type of exercise works your heart and lungs. 2. Relax your neck and shoulder muscles. Strengthening exercises Involve tightening muscles repeatedly to the point of fatigue. (Your belly and lower ribs should rise. Breathe in for two seconds through your nose. can improve your breathing. simply breathe out twice as long as you breathe in. Diaphragmatic breathing: 1. Inhale deeply through your nose for a count of 3. first try slowing your rate of breathing and focus on breathing out through pursed lips. increasing your flexibility. 1. Place the other hand on your chest. 2. Pursed lip breathing: 1. 4. but your chest should remain still. improving their endurance by working your respiratory muscles. When you do this for the upper body. You can put a pillow under your knees for support. with time. Helps you strengthen breathing muscles. Stretching can also help prepare your muscles for other types of exercise. and breathe with less effort. it can help increase the strength of your breathing muscles. Lie on your back with knees bent. Tighten your stomach muscles and exhale for a count of 6 through slightly puckered lips. If you experience shortness of breath. If this is too long for you. 3. How much you focus on each type of exercise may depend upon the COPD exercise program your health care providers suggests for you. Walking and using a stationary bike are two good choices of aerobic exercise if you have COPD. 3. Stretching exercises Lengthen your muscles.) 4. 4 .These four types of exercises can help you if you have COPD. Breathing exercises for COPD Use pursed-lip breathing while exercising. Here are two examples of breathing exercises you can begin doing for five to 10 minutes. 2. get more oxygen. Place one hand on your belly below your rib cage. rhythmic pace. three to four times a day. keeping your mouth closed. Aerobic exercises Use large muscle groups to move at a steady. Breathe out for four seconds through pursed lips. 3. This helps your body use oxygen more efficiently and. decreasing your chance of injury.

to understand better about Chronic Obstructive Pulmonary Disease and will explain the different risk factors developing the disease process like smoking. actual result from the client. 5 . c. and its interpretation. frequent meals to avoid abdominal distention Avoid gas-producing foods b. students. To obtain the developmental history of the client. To show the laboratory examination results with the corresponding normal values. pollutants/irritants and environment. To perform physical assessment and to obtain Gordon’s patterns of functioning.Diet: Explain the need to maintain high-calorie diet as indicated Encourage fluid intake at 2000-3000 mL/day to keep secretions clean Suggest small. Specific objective o o o o o o To gather and determine the past and present clinical history of the client. Also this study can help us to have enough knowledge on how to help patients to control. To trace and understand the pathophysiology of Chronic Obstructive Pulmonary Disease. To understand the anatomy and physiology of Respiratory System. Objectives General objective This study aims to fully understand the underlying disease process of COPD. lessen and/or eradicate this kind of disease. Significance of the study This study will enable us.

To use the nursing process to identify nursing problems from the client and provide the appropriate nursing care plan. To understand the pharmacological management set on the client and provide nursing interventions.o o o To learn the basic principle of medical management of Chronic Obstructive Pulmonary Disease. 6 .

Warmth. She believed that "Healthy surroundings were necessary for proper nursing care.concepts of ventilation. Her nursing interventions focus on proper handling and disposal of bodily secretions and sewage. 3. cleanliness 5. She focus o the physical aspect of environment. etc. opening the windows and repositioning the room seasonally. diet. She introduce the manipulation of the environment for patient's adaptation such as fire. efficient drainage 4. Theoretical Framework The Nightingale’s Environmental Theory Environment . 7. 2.d. clean clothing and hand washing. 5. Dietary intake. Her nursing intervention includes direct exposure to sunlight. no 7 . frequent bathing for patients and nurses. pure air 2. Unnecessary noise is not healthy for recuperating patients. She assumes that dirty environment was the source of infection and rejected the "germ theory". 4. Petty management proposed the avoidance of psychological harm. Proper ventilation focus on the architectural aspect of the hospital. quiet and diet environment. 6. pure water 3." 5 essential components of healthy environment: 1. light Concerns of Environmental Theory 1. light. cleanliness and noise. Cleanliness and sanitation. warmth. Light has quite as real and tangible effects to the body.

Nursing Metaparadigm Nursing Nursing is very essential for everybody's well-being. A healthy body can recuperate and undergo reparative process. Disease control 2. The nurse should perform the task for the patient and control environment for easy recovery. Health Health is the being well and using every power that the person has to the fullest extent. Environment People would benefit form the environment.upsetting news. 4. She includes the use of small pets of psychological therapy. Sanitation and water treatment 3. Importance of Environmental Theory 1. Notes on nursing focus on the implementation and rendering efficient and effective nursing care. She practice nurse-patient passive relationship. Utilized by modern architecture in the prevention of "sick building syndrome" applying the principles of ventilation and good lighting. Strictly war issues and concerns should not be discussed inside the hospital. Environmental control uplifts maintenance of health. Person The patient is the focus of the environmental theory. Control of room temperature. Noise management 8 . 6. Waste disposal 5.

Dalupang/Babaran Chief Complaint: difficulty of breathing ii. History of present illness Two days prior to admission. Due to persistence of symptoms. he also complained difficulty of breathing. patient was noted to have productive cough with whitish phlegm.II. No fever. patient sought consult at the emergency room and was subsequently admitted. Age: 63 y/o Sex: Male Civil Status: Married Religion: Roman Catholic Nationality: Filipino Room No. Patient took maintenance medication which afforded temporary relief.J. Patient’s profile Name: G.: 555 Hospital: CMC Hospital #: 555555 Attending Physician: Dr. and orthopnea.V. Medical history i. shortness of breath on exertion and easy fatigability. 9 . chest pain.

paternal side v. Past medical history o Hospitalization due to:   o Aortic Aneurysm S/P Cataract Surgery No known allergies on foods and medications o Known hypertensive   Highest BP: 150/80 Lowest BP: 110/70 iv.iii. Social and Environmental history o Environment: urban o o Type of housing: owned house Living arrangement: living with his wife and children o Drinks mineral water o Occasional alcoholic beverage drinker o o Smoker since 16 y/o and stopped smoking 20 yrs ago Consumes 2 ½ pack of cigarette a day 10 . none o Hypertension. Family history o Diabetes Mellitus.

-He seldom eats fruits and vegetable. 11 Analysis / Interpretation Compliance with the diagnostic procedures. beef and chicken. Low salt low fat is the diet of choice for . complies with the diagnostic procedures. -He drinks 8 glasses of water a day. Nutritional/ Metabolic Pattern -The patient is on regular diet. During Hospitalization -prefers medical assistance -listens and follows instruction. The patient is on low salt His nutritional and low fat diet. -He always eats pork. pharmacologic management and therapeutic regimen leads to prognosis and wellness. Gordon’s pattern of functioning Pattern of Functioning Health Perception/ Health Management Before Hospitalization -takes maintenance medication and if signs and symptoms worsen. metabolic status has been changed from regular diet to low salt low fat diet because he is known hypertensive. pharmacologic management and therapeutic regimen.a. they tend to seek for medical assistance.

-He drinks alcohol beverages occasionally. children. Pharmacological management and enough rest help alleviate difficulty on breathing. he experienced difficulty of and no difficulty of Coping Stress Pattern -the patient can handle stress or problem with the help of his available support systems. hypertensive patients. The patient usually sleeps 8-10 hours a day. wife. friends and relatives. Sleep and Rest Pattern The patient usually sleeps 6-8 hours a day. The length of his sleep and rest pattern has increased. shortness of breath on exertion and easy fatigability. The patient performs activities of daily living breathing. friends and relatives. Stress or problems can be handled with the assistance and advice of your family members. friends and relatives. wife. -the patient can handle stress with the help of his available support systems. children. 12 . shortness of breath on exertion and easy fatigability noted. -the patient has the ability to control or manage situations. Exercise/ Activity Pattern The patient can perform activities of daily living but breathing.

Cognitive The patient is conscious and coherent. People make the patient feel special and loved. of Agrarian Reform.The patient has a good relationship with his wife. The patient feels special because of people showing care to him especially his wife.Elimination Pattern The patient urinates 5-7 times and defecates once a day. children. Role and relationship . The patient is alert and responsive. friends and relatives. The patient urinates 5-7 times and defecates once a day. . .The patient can’t works as engineering aide at Dept. The patient was unable to perform his role as engineering aide because of his hospitalization. friends and relatives. There was no change in his elimination pattern. children. . Self perception The patient feels nothing unusual. 13 .The patient works as engineering aide at Dept.The patient has a good relationship with his wife. of Agrarian Reform. The patient is conscious and coherent.

14 .Value beliefs The patient is a religious Roman Catholic and attends mass every Sunday at the church. The patient can’t make it to the mass at the church due to his hospitalization. The patient can’t attend mass at the church but he is aware that he can go to chapel for his spiritual needs.

2°c o PR 76 o RR 23 o BP 90/60 15 .b. Physical Assessment General Health • • • • • • • • Conscious and Coherent Alert Comfortable Responsive No weight gain noted No weight loss noted No weakness noted Afebrile V/S o Temp: 36.

Hair Inspection The patient’s hair was normal for his age.No dryness noted Scalp Inspection -No scars noted -Free from lice and dandruff The patient’s scalp was normal. -Maybe thick or thin.Body Part Skin Normal Findings Method used Actual Findings Analysis/Interpre tation -Sus-tanned areas -Pinched-up skin returns immediately -Smooth and soft -Evenly distributed and covers the whole scalp Inspection -Sus-tanned areas -Pinched-up skin returns immediately -Smooth and soft . nits and dandruff -No lesions noted -No lesions should be noted Face No wound Inspection No wound noted The patient’s face .Thin The patient’s skin is normal.Grayish Hair . coarse or smooth -Neither brittle nor dry -No scars noted -Free from lice. .

The patient’s nose is normal. Eyes -Pink palpebral.was normal. dark gums and lips are also some effect of nicotine. anicteric sclera -No nasal discharge -Both nares are patent -Nasal septum is in the midline -Dark-pink in color gums Smoking causes yellow teeth as the yellow-tinted nicotine passes through the mouth. it stains the teeth. lesions -No dentures -White color teeth Thorax -quiet. rhythmic and Inspection . . The patient’s eye was normal.Blackish lips -With visible margin -No sore and lesions -No dentures -Yellowish teeth -occasional wheezes noted Wheezes are significant as they midline -Pinkish in color gums Inspection Inspection Inspection -Pink palpebral. anicteric sclera Nose -No discharges -Both nares are patent -Nasal septum is in the Mouth and lips -Moist lips -With visible margin -No sore.

no lesions -No venous engorgement -Flabby abdomen The patient’s abdomen is normal. imply decreased airway lumen diameter either due to thickening of reactive airway walls or collapse of airways due to pressure from surrounding pulmonary disease.and Lungs effortless respiration Auscultatio n Wheezes are continuous musical tones that are most commonly heard at end inspiration or early expiration. They result as a collapsed airway lumen gradually opens during inspiration or gradually closes during expiration. no lesions -No venous engorgement -Contour maybe flat or rounded Inspection -Skin color is uniform. Abdomen -Skin color is uniform. Upper Extremiti es -Symmetrical -Equal color and no Inspection Palpation -Symmetrical -Equal color and no The patient’s upper extremities are symmetrical and no .

Lower Extremiti es Inspection Palpation The patient’s lower extremities are no tenderness and no edema. .discoloration -No tenderness noted -Symmetrical -Equal color and no discoloration -No edema -No tenderness noted discoloration -No tenderness -Symmetrical -Equal color and no discoloration -No edema -No tenderness noted tenderness.

Bronchitic changes occurred as a result of the disease process wherein progressive narrowing of the bronchial tree happened. . representing pulmonary fibrosis >No new active parenchymal infiltrates are identified in either lungs >Pulmonary vascularity within normal limits >Blunting of right costophrenic sulcus is now appreciated.c. Laboratory. which may due to interval development of minimal pleural fluid >Left costophrenic sulcus remain intact Analysis: Pulmonary Fibrosis indicates chronic obstructive pulmonary disease. diagnostic procedures Chest Physical Assessment >Comparison is made with the prior chest x-ray dated 04/01/2010 >Present exam shows stable cardiomegaly and aneurismal dilation of descending thoracic aorta >Both lungs are again hyperaerated and shows unchanged appearance of the previous seen chronic interstitial changes in the left lower lung. Pulmonary hyperaeration is attributed to distention of alveoli due to its altered function to recoil and deflate leading to retention of carbon dioxide and thus crowding of C02 and 02 in the alveoli occurs.

5 mmHg 75 – 100 mmHg Low 28.45 Low (Acidosis) 47.100% Low Analysis: Compensated Respiratory Acidosis ECG >Atrial Fibrilation with rapid ventricular response .45 mmHg High (Acidosis) 67.2% 95 .Arterial Blood Gas Actual Result pH (Acid – Base Balance) PaCO2 ( Partial pressure of Arterial Carbon Dioxide) PaO2 ( Partial pressure of Arterial Oxygen) HCO3 ( Bicarbonate ion) SaO2 (Arterial oxgen saturation) 7.35 – 7.394 Normal Range 7.9 mmHg 35 .6 mmol/L 22 – 26 mmol/L High (Alkalosis) 93.

Human lungs are located in two cavities on either side of the heart. The bronchial tree continues branching until it reaches the level of terminal bronchioles.III. Clinical discussion a. and it is here that gas exchange actually occurs. and after multiple divisions give rise to bronchioles. Both are separated into lobes on the right and two on the left. the two are not identical. Alveolar sacs are made up of clusters of alveoli. which lead to alveolar sacks. Anatomy and physiology In humans it is the two main bronchi that enter the roots of the lungs. The individual alveoli are tightly wrapped in blood vessels. The bronchi continue to divide within the lung. The oxygen-rich blood returns to the heart via pulmonary veins to be pumped back into systemic circulation. Though similar in appearance. The lobes are further divided into . where oxygen in the hemoglobin of the erythrocytes. Deoxygenated blood lungs. like individual grapes within an inch.

lobules hexagonal divisions of the lungs that are the smallest subdivision visible to the naked eye. The medial border of the right lung is nearly vertical. The cardiac notch is a concave impression molded to accommodate the shape of the heart. Pathophysiology . while the left lung contains a cardiac notch. in situations like these only a small portion of the lungs are actually perfuse with blood for gas exchange. a greater volume if the lung is perfuse allowing the body to match its CO2/o2 exchange requirements b. As oxygen requirements increased due to exercise. This is the reason that individuals can smoke for years without having a noticeable decreased in lung function while still or moving slowly. Lungs are to a certain extent overbuilt and have a tremendous reserve volume as compared to the oxygen exchange requirements when at rest. The connective tissue that divides tubules is often blackened in smokers and city dwellers.

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hydrochlorothiazide Brand name: -micardis plus Doctor’s order: -40mg 1tab OD INDICATION essential hypertension ACTION -blocks the vasoconstrictive and aldosteronesecreting effects of angotensin II by binding angiotensin II to the AT I receptor in many tissue. produces relaxation of coronary arteries.IV. Drug Study DRUG Drug name: -telmisartan. slows SA/AV node CONTRAINDICATI ON -hypersensitivity to the drug -2 and 3 trimester of pregnancy nd rd ADVERSE REACTION -diarrhea -anorexia -loss of appetite -gastric irritation -constipation NURSING CONSIDERATIONS -special precaution in patients with impaired hepatic and renal impairment -special precaution with volume and/or Nadepleted patients -lactation Drug name: -diltiazem Brand name: -cordazem Doctor’s order: -90mg 1tab BID -sick-sinus syndrome -2nd and 3rd AV block -severe hypotension -pregnancy -nausea -swelling/edema -arrhythmia -headache -rash -fatigue -monitor v/s especially the BP -should be administered with food or after eating . -angina pectoris ACTION-inhibits ca ion influx across cell membrane during cardiac depolarization.

and stimulates guanylate cyclase causing venous vasodilatation.Nicorandil dilates arterioles and large coronary arteries by opening the potassium channels. It therefore reduces preload and afterload. DRUG Drug name: -nicorandil Brand name: -aprior Doctor’s order: -10mg/tab. -reduction of elevated total cholesterol & LDL CONTRAINDICATI ON -cardiogenic shock -hypotension -left ventricular failure with low filling pressure -lactation ADVERSE REACTION -headache -flushing dizziness -n&v -weakness -hypotension NURSING CONSIDERATIONS -may be taken with or without food -monitor v/s especially the BP -may impair ability to drive or operate machineries Drug name: -atorvastatin -active liver disease -pregnancy -Gi disturbance -headache -avoid intake of alcohol -monitor creatinine phosphokinase and .conduction times. 1tab BID INDICATION -angina pectoris ACTION. and improves coronary blood flow. dilates peripheral arteries.

a precursor of sterols. -lowers cholesterol & lipoprotein levels -myalgia -insomnia -pruritus -muscle cramps transaminase elevation -history of liver disease -monitor v/s especially the BP -should be administered with food or after eating DRUG Drug name: -amlodipine Brand name: -vasalat Doctor’s order: -5mg 1tab OD INDICATION -hypertension ACTION -inhibits influx of calcium ion across cell membranes to produce relaxation of coronary vascular smooth muscle. decrease peripheral vascular resistance of smooth muscle (↓BP) CONTRAINDICATI ON -low BP -CHF -hypersensitivity -hepatic impairment ADVERSE REACTION -headache -edema -dizziness -flushing -palpitation -fatigue -nausea -abdominal pain NURSING CONSIDERATIONS -monitor v/s especially the BP -should be administered with food or after eating .Brand name: -lipitor Doctor’s order: -80mg 1tab HS ACTION -lactation -selectively HMGCoA reductase which converts HMG-CoA to mevalonate.

Drug name: -digoxin Brand name: -lanoxin Doctor’s order: -0.25mg 1tab OD -atrial fibrillation ACTION -(+) inotrophic effect more available calcium promotes increase forces to increase cardiac output -hypersensitivity -intermittent complete heart block -2nd heart block -anorexia -GI disturbance -atrial tachycardia -gynecomastia -CNS effect -monitor v/s especially the PR -should be administered with food or after eating -watch out for the adverse reaction of drug DRUG Drug name: -pantoprazole Na Brand name: -pantoloc Doctor’s order: -40mg OD INDICATION -relieve acid indigestion ACTION -inhibits both basal & stimulated gastric acid secretion CONTRAINDICATI ON -hypersensitivity to pantoprazole Na and its components ADVERSE REACTION -abdominal pain -diarrhea -constipation -flatulence -nausea -headache -dizziness NURSING CONSIDERATIONS -should be taken on an empty stomach (take 1 hour before meal) Drug name: -montelukast -prophylaxis & treatment of asthma. including prevention of day & -hypersensitivity to montelukast and its component -abdominal pain -thirst -watch out for the adverse reaction of the drug .

Brand name: -singulair Doctor’s order: -10mg 1tab OD night time symptoms ACTIONMontelukast is a selective leukotriene receptorantagonist that blocks the effects of cysteinyl leukotrienes in the airways. -headache -vomiting DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS .

tiotropium bromide inhibits the cholinergic (bronchoconstrictive ) effects of acetylcholine. released from parasympathetic nerve endings. It has a similar affinity to the subtypes of muscarinic receptors M1-M5. tiotropium bromide competitively and reversibly antagonises the M3- -hypersensitivity to tiotropium Br and its component -dry mouth -constipation -cough & local irritation -tachycardia -urinary retention -do not take more than there recommended dose . In the airways.Drug name: -tiotropium Br Brand name: -spiriva Doctor’s order: -OD at HS -maintenance treatment for patients with COPD ACTION -By binding to the muscarinic receptors in the bronchial smooth musculature.

resulting in relaxation .receptors.

5. NCP ASSESSMEN T Subjective “Makakaalis na daw ako dito sa hospital sabi ng doctor” as verbalized by the client. 3. 5. Promote . 2. Discuss present resources used by client. EVALUATI ON After 30-60 mins of nursing interventio n. Objective: -no unexpected acceleration of illness symptoms -no difficulty of breathing noted -no pain noted DIAGNOSIS Readiness for enhanced therapeutic regimen management -A pattern of regulating & integrating into daily living a program for treatment of illness & its sequelae that is sufficient for meeting healthrelated goals & can be strengthened . Assess client’s level of understanding of therapeutic regimen.V. To promote wellness. INFERENCE Difficulty of breathing ↓ Hospitalizatio n ↓ Medical Mngt ↓ Nursing Mngt ↓ Good Prognosis ↓ Restoration of Health ↓ MGH ↓ Readiness for enhanced therapeutic regimen management PLANNIN G Short-term goal: After 3060 mins of nursing interventio n. Identify steps necessary to reach desired health goals. the client assumes responsibili ty for managing treatment regimen. 3. Accept client’s evaluation of own strength/ limitation while working together to improve abilities. To note whether changes can be arranged. 4. the client will assume responsibil ity for managing treatment regimen. Understanding the process enhances commitment & achievement of goals. 4. RATIONALE 1. Provides opportunity to assure accuracy & completeness of knowledge base for future learning. INTERVENTIO NS 1. Promote sense of selfesteem & confidence to continue effort. 2.

.client/SO choices & involvement in planning.

1cap spray at HS Health Teachings  Provide patient and relative written and verbal information regarding the following: . building up strength is essential as one goes on until hard exercises are tolerated.VI.  Adequate rest periods must be given in between exercises to prevent straining.  Moderate exercise such as walking should be encouraged.25mg 1tab OD pantoprazole (Pantoloc) 40mg OD montelukast (Singulair) 10mg 1tab OD Inform patient regarding side effects of medication to alleviate patient anxiety if said side affects manifest.  Always bear in mind that one has to start on easy-to-do exercises first and must rest frequently. Treatment  tiotropium bromide (Spiriva). Discharge Planning Medication  Encourage strict medication compliance and to take medications Instruct patient and significant others to keep a list of as directed to attain therapeutic effects.  medications with their respective dosage and frequency of intake to prevent medication errors and their purpose. o o o o o o o o  Exercise telmisartan + hydrochlorothiazide (Micardis Plus) 40mg 1tab OD diltiazem (Cordazem) 90mg 1tab BID nicorandil (Aprior) 10mg 1tab BID atorvastatin (Lipitor) 80mg 1tab HS amlodipine (Vasalat) 5mg 1tab OD digoxin (Lanoxin) 0.

about 2 grams per day is recommended. o Indicate enough bed rest to reduce exertion and to avoid all strenuous activities that has not been approved by the physician. Fish.o Contacting the healthcare provider when signs of recurrence or complications of the disease appear.  Protein intake is recommended but must not be from fatty sources. and any development of complication.  Intake of vitamin supplements and other sources of minerals are recommended. Out-Patient Follow-up  Assert importance of follow up visits to physician. o Providing support. The patient and family need assistance. and oral cavity infections.  Excessive fluid intake should be discouraged. and support every time patient requires treatment to prevent serious complications and improve condition.  Advise patient and family to report to the physician if any recurrence or severity of symptoms.  It is advisable that cholesterol intake be limited  Sources of fiber are to be added to the diet to aid in digestion. Diet  Alcohol use should be discouraged. but fluid restriction is rarely indicated. explanation. any adverse effects of the medication. o Seek medical advice from healthcare provider for immediate treatment of upper respiratory system. chicken and beans are good sources of protein so long as it is not contraindicated by the patient’s physician.  Depending on the health care provider a diet that is low in sodium content. . especially shortness of breath and chest tightness.

.Spiritual  Encouraged the client to always pray to God and also provide spiritual tools for the client if necessary.

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