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I.

Introduction
A. Background of the study

The case study that is to be presented features a patient who has emphysema.
Emphysema is a chronic obstructive pulmonary disease (COPD). It is often caused by
exposure to toxic chemicals, including long-term exposure to tobacco smoke or cigarette
smoking. The lungs become damaged because of reactions to irritants entering the airways
and alveoli.
Cigarette smoking is the major cause of emphysema, accounting for more than 80 percent of
all cases. Emphysema occurs most often in people older than age 40 who have smoked for
many years. Long-term exposure to secondhand smoke may also play a role. Smoking
stresses the natural antioxidant defense system of the lung, allowing free radicals to damage
tissue down to the cellular level. When cigarette smoke is inhaled, 80 to 90 per cent remains
in the lungs and causes irritation, increased mucus production and damage to the deep parts
of the lungs. Eventually mucus and tar clog up the air tubes, causing chronic bronchitis and
emphysema. Among other causes of emphysema are industrial pollutants, aerosol sprays,
non-tobacco smoke, internal-combustion engine exhaust, and physiological atrophy
associated with old age (senile emphysema).
It was verbalized by the wife of the patient that he used to work at the farm in Daliao. This
could be one factor that caused the patients disease.
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.
Emphysema is often the result of smoke that has triggered the immune system to produce
more harmful enzymes. Although these harmful enzymes are normally prevented from
causing any significant damage by a protective protein, smoking reduces the proteins
protective effect. Even if someone has plenty of the protein in their system, smoking
generates certain substances that keep the protective protein from doing its job.
We as nurses are involved in learning what type of nursing interventions we are to apply to
this type of patient. Beyond understanding the relevant health issue, this case study will also
explore other factors that can enhance our knowledge in the field of our nursing practice. This
is also the primary reason why we choose this case study because we know that it is highly
beneficial aside from it being considered distinctive or unique.
Included with the case study are the discussions of the anatomical parts, through physical
assessment of the patient, laboratory results and their corresponding findings, a reapplied
framework theory by Florence Nightingale. Added to this we also have a corresponding plan
for the patients discharge arrangement and finally a discussion of the patients daily activities
and nursing care plans.

B.

Objectives
General objectives

After exposure in the medical ward of Malta Medical Center Inc. the promotion of health and
the prevention of illness should have been applied through the use of effective nursing care.
Wellness should be met through the implementations that have been done with regards to the
application of the nursing process. That is after developing and implementing an intervention,
and monitoring the impact of that intervention to the patient. This is to know whether the
treatments given to him were effective or not.
Specific Objectives
Our objective is to develop our skills in identifying and assessing the health problems, how to
utilize and render quality health service in the care of an individual who has emphysema.
Other objectives would include the establishment of rapport for the patient to fully cooperate
with his treatment and so as to assess him with his health related problem.

II. Nursing Assessment


A. Personal Data
Name: Mr. C
Address: G. Robles Maybangkal Street, Daliao Toril, Davao City
Age: 65 years old
Birth date: March 30, 1948
Religion: Roman Catholic
Civil Status: Married
Nationality: Filipino
Occupation: Former Farmer
Admitted on: Feb. 10, 2014
Time: 9:10 p.m.
Admitting Diagnosis: COPD in exacerbation, Plural Effusion, Pneumonia, t/c
Electrolyte imbalance
o Chief Complaint: D.O.B. (Difficulty of Breathing)
o
o
o
o
o
o
o
o
o
o
o

B. History of Past illness


Patient has undergone, thoracentesis last June 15 at Southern Philippines Medical Center
prior to that admission he was diagnose with plural effusion, thoracentesis was perform and
after 5 days of admission he was discharge home.

C. History of Present Illness

After the patient was discharge home around 8:50pm (February 5, 2014) after 3 days at home
he experienced DOB and he was rush to the hospital accompanied by his wife and cousins.
-COPD
-Questionable Pneumonia
-Electrolyte Imbalance

D. Family History
According to patients wife they cannot recall any illness in the family of his husband except
from asthma.

A Patients Concept of Health Illness and Hospitalization


He didnt expect that this would happen to him, doctors doesnt have any idea of the source
of his illness but the patient says, that it might be from the work, he thought that it would just
be a simple cough due to tiring day but it lasted for about a month and he needs to be
admitted and undergone some procedures.

F. Physical Examination/Assessment
Area
1. Hair

2. Scalp

3. Face

4. Eyes

5. Nose

Normal Finding

Actual Finding

I. Head
- Black slightly
grayish , thick.

- black, evenly
distributed and
covers the whole
scalp, thick, shiny,
free from split ends
- white, clean, free
from masses, lumps,
scars, dandruff and
lesions
- Oblong or oval.
Symmetrical. Facial
expression that is
dependent on the
mood or true
feelings, smooth and
free from wrinkles,
no involuntary
muscles involved
- parallel and evenly
placed, symmetrical,
non-protruding,
both eyes are black
and clear
- midline,

Analysis
-Aging

- without dandruff

- normal

- With wrinkles,
symmetrical. With
expression of pain
and anxiety

- patient is still
worried about his
condition and
appearance

- symmetrical, black
in color and can still
read with out
glasses

- normal

- symmetrical with

- patient has

symmetrical and
patent clear pinkish
with few cilia (-)
congestion
- pinkish,
symmetrical, tip
margin well define,
smooth and moist
- 32 permanent
teeth, well aligned,
free from carries or
filing.

NGT

undergone surgery

- crack and dry lips

- patient wasnt able


to eat and drink that
much due to his
tracheotomy
- patient was
instructed to gargle
bactidol

8. Speech

-No hoarseness and


well modulated.
Can able to say two
words with meaning

Can not speak,


makes some
moderate noise, can
communicate with
sign language or by
writing.

Tracheostomy can
block the vocal
cords thats why
patient wasnt able
to make any sounds

9. Ears

-Parallel,
symmetrical,
proportional to the
size of the head,
bean shaped, helix
is in line with the
outer canthus of the
eye, skin is the same
color as the
surrounding area,
clean, firm cartilage.
Ear canals are
pinkish with scant
amount of cerumen
and a few cilia. Able
to hear whisper
spoken 2 feet away.

-Normal Findings
except, Enable to
hear whisper spoken
2 feet away.

-Aging

10. Breath

-No halitosis, foul


odor, fruity and
sweet.

- With minimal
halitosis

- Halitosis may be
due to poor dental
hygiene

11. Throat

-No inflammation,
no difficulty in
swallowing and no
productive cough.

- No inflammation,
Presences of cough
with greenish
yellow phlegm and
experiencing
difficulty in
swallowing

-excessive mucus
production in his
lower lung due to
impaired defense
mechanisms caused
by prolonged years
of smoking.

6. Lips

7. Teeth and Gums

- with out dentures,


gums are normal in
color

12. Neck

1. Breathing

2. chest

- Proportional to the
size of body and
head, symmetrical
and straight. NO
palpable lumps,
masses, or areas of
tenderness

- Presences of
palpable lumps,
sensation of pain
when trying to
speak.

II. Thorax
- Normal breath
- Abnormal
sounds are
Respiration 40cpm,
bronchovesicular, a difficulty in
medium pitched
breathing.
sound or medium
Experiencing cough
intensity, heard
after nebulization.
posteriorly between
the scapulae. The
sound have blowing
quality with the
inspiratory phase
equal to the
expiratory phase
and Vesicular
sounds which heard
over the lung
periphery. It created
by air moving
through the small
airways. They are
soft, breezy and low
pitched and the
inspiratory phase is
about three times
longer than the
expiratory phase.
Respiration rate
ranges from 16 20
in normal adult.
- flat chest, tender:
brownish in color.

- a tube is inserted
in the fifth
intercostals space,
mid-axillary line.

- Lymph nodes are


present after
surgery, patients
feels pain in the
neck due to body
weakness in the area
of tracheostomy.

- Excessive phlegm
production blocks
his thorax and this
may cause difficulty
in breathing.

- to remove fluid
from the
intrathoracic space

3. Abdominal Exam

- Color is uniform,
symmetrical
movement caused
by respiration. Soft
abdomen, no
tenderness, no
lumps, or masses,
no organomegaly

- Unblemished skin,
uniform color,
symmetric
movement cause by
respiration , soft, no
tenderness, no
lumps or masses,

- normal

III. Limbs
1. Extremeties

- no areas of
tenderness, muscle
appear with good
muscle tone

- with IV catheter
on his right arm and
a red spots in the
site of the IV
catheter.

- red spots may


cause itchiness in
the site of IV and
also this may cause
infection or
phlebitis.

2. Nails

- transparent,
smooth and cover
with pink nail beds
and translucent

- pale nail beds and


peripheral last for
4seconds

- poor circulation

IV. Genitalia

-No discharges or
bleeding, no
difficulty in
urinating.

-There are no
discharges or any
bleeding.

-Patients urinate on
the bed pan

V. Mental State

- Can be able to
responds from any
questions and can
still be familiar to
his environment

- He can
answer/respond to
us a little bit slowly.

- Slightly anxious
about his condition,
and tries to think
about what when
wrong before he
experience his
illness.

VI. Hygiene and


comfort

- Full bath and able


to practice simple
hygiene and care for
himself.

- Patients depends
on significant others
in eating, taking a
bath (TSB) and
other chores that
involves wide
movement.

- Patient has a
drainage tube at his
chest and undergone
tracheostomy,
patients
experiencing body
weakness cannot
move properly