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Institute of Nursing

NURSING CARE PROCESS

(Chronic Obstructive Pulmonary Disease)

Submitted by:

Cuaresma, Russiel Mae

BSN 138- Grp. 149

Submitted to:

Ms. Airene Gulapa

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jM chronic lung conditions that obstruct the airways in your lungs

jM refers to obstruction caused by CHRONIC BRONCHITIS and EMPHYSEMA
jM there is a blockage within the tubes and air sacs that make up the lungs which hinders
the ability to exhale and even breath

„
 
    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.

 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.

 

 

  
 

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-like͟ 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 body͛s
inability to produce sufficient amounts of alpha-1 antitypsin.

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This type of emphysema affects single alveoli entering directly into the walls of terminal
and respiratory bronchioles.

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M Smoking

M Exposure to occupational and environmental pollutants

M Genetic factors

M Allergies

M Nutrition

M Age, Gender

V  V

M Cough: productive or non-productive

M Dyspnea
 M Wheezing

M Chest pain

M Hemoptysis

M Cyanosis

M Swelling

M Respiratory failure

  

M Chest X-ray

M CT Scan (computerized Tomography)

M Arterial Blood Gas

V



M Bullectomy

M ðung volume Reduction Surgery (ð RS)

M ðung Transplant


   

Name: TSG Jean Dela Cruz

Address: #30 Bacarra, Ilocos Norte
Age: 56 years old.
Gender: Male
Religious Affiliation: Adventist
Marital Status: Married
Chief Complaint: fever and cough associated with DOB and light headedness
Provisional Diagnosis: COPD; CAP MR
Attending Physician: Major Gaurano/ Dr. Cunanan/ Palma/ ðulu

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A.M Past Health History

Patient JDC stated that he had chicken pox when he was 6 y/o and measles as
well in the same year. He also had mumps when she was on high school. He has
complete immunization. The patient had a motor vehicle accident because the
jeepney bumped him and his right finger was fractured as he stated. He
experienced to be hospitalized in 2001 because of difficulty of breathing and
diagnosed of COPD. The only medication she took previously was vitamins. On
1998, He travelled abroad, the government sent him in the US for military
schooling, and he stayed there for 10 months.

B.M History of present Illness

Patient is a diagnosed case of COPD since 2000 and was apparently able to
perform his tasks/ duties without significant symptoms.

2 days PTA, Patient had undocumented fever associated with productive cough
with mucopurulent sputum and slight difficulty of breathing. He sought consult
at CGEASH and was diagnosed to have UTI and given ofloxacin and was discharge
stable. At home, symptoms persisted now accompanied by dizziness. He went
back to CGEASH and was noted to be hypotensive. He was then referred to
AFPMC hence admission.
 C.M Family History

His father has asthma and history of hypertension and was died because of
cardiac arrest at the age of 84. On his mother side, there was no hereditary
disease stated. His eldest brother has asthma and his brother Efren was just
recovered from TB.

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A.M Psychological Health

1.M Coping Pattern

The client narrated that whenever he had problems, he will not tell it to anyone
until he can bear it. And if there͛s a problem within the family they talk about it
sincerely. He had a good atmosphere with his colleagues in the military.

2.M Interaction Pattern

HE currently lives at the barracks with his colleagues. Since the client is a military he
is assigned in different places, that͛s why he has a lot of friends in different places,
he just often sees his family.

3.M Cognitive pattern

The patient can read and write. He finished college in the course of Automotive
mechanic and joined the military on 1978.

4.M Self Concept

The patient͛s wife said that his husband is a jolly person. They never see him sad.
Since he is a military, he always assigned in different places and far from his family
that͛s why he finds his happiness when he is with his family. He does not think of
his problems much and just laugh at it. His wife said that her husband never
complain even if he is not feeling well. He does not want to be a burden to his
family.

Interpretation: the client has a productive life. He doesn͛t waste his time on nonsense
things, the most important moment in his life was when he was with his family even
there is sometimes misunderstanding among the family members.

Analysis:
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B.M Social Cultural Pattern

1.M Cultural Patterns

The client is an Ilocano, he said that he don͛t believe that ilocanos are ͞kuripot͟ but
rather thrifty. They also practiced Ilocano culture like ͞padasal͟ every year for their
loved ones who passed a away. They offer prayers together with a dead cow. He
smokes 3 packs of cigarette per day since he was 17 years old but stopped it 5 years
ago(2005). He also drinks alcoholic beverages occasionally.

2.M Significant Relationship

The client is married for 36 years to Ms. Susana Salvador. They have 5 children and 3
of them had already their own family. He also has his ͞barkadas͟ inside the military.

3.M Recreation Patterns

The client͛s past time is cleaning and assembling his guns ͞yan ang paborito kong
gawin ang mangalikot͟ as he stated. He also jogs inside the barracks thrice a week.
And in terms of family they fond of going to beaches. And with barkadas he drink.

4.M Environment

He currently lives at barracks in ðibis Quezon city. He described that their barracks is
located along the highway, at the back of target rails, beside of Marikina River and
near eastwood.

5.M Economic

The client stated that his salary (Php30,000 with deduction) is enough for him and
for her family since all her children was already graduated. He also has Philhealth
that͛s why he has no problem in financing his medications.

Interpretation: The client attains integrity at this point of his life. It is evidenced
by how he views his life. The client shows optimism and has a feeling of happiness
in every way in his daily living.

Analysis: According to Erikson, the developmental task at this time is ego integrity
versus despair. People who attain ego integrity view life with a sense of wholeness
and derive satisfaction from past accomplishments.(Kozier and Erb͛s Fundamental
of Nursing 8th edition p.422
C.M Spiritual Pattern

The client values his family so much. Their family was belonging to a religion of Seventh
day Adventist. They go to church every Saturday. Their religion believe that pigs are
dirty that͛s why they don͛t eat pork.

Analysis: Elders take their faith and religious practice very seriously, and display a high
level of spirituality. It would be a mistake, however, to assume that religiousity increase
with age.(Kozier and Erb͛s Fundamental of Nursing 8th edition p.419)
  
 
1.M m

    V 
Conscious, Coherent, weak looking, not in cardiopulmonary distress.
2.M    
Supple neck, (-) cervical lymphadenopathies
3.M 
Pink palpebral conjunctiva, anicteric sclera
4.M 

No tragal tenderness, no discharge
5.M Y
Nasal septum midline, no nasal discharge
6.M 
Moist buccal mucosa
7.M 
No denture, with dental caries
8.M 
 
No tonsillopharyngeal congestion
9.M „
Adynamic precordium, tachycardic, regular rhythm, no murmur
10.M ð
Symmetrical chest expansion, no retractions, decreased breath sounds at Right
lower lung field, (+) occasional crackles.
11.M 
Flat, NABS, soft, non tender
12.M !
  
Pulse fulland equal, (-) edema
13.M Y
 
Oriented to 3 spheres,(-) sensory deficit
14.M V 
Warm and moist
15.M ð  
(- ) lymphadenopathies



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Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To prevent Albuterol hypersensitivity Drowsiness, Angina, Teach the patient
exercise- attaches to Arrythmias, dry mouth, how to use inhaler
induced beta2 heartburn, nausea and properly, tell him to
pneumonia receptors on vomiting, diaphoresis shake canister well
bronchial cell before using it.
To treat membranes,
bronchospasm which Advise patient to
in patients with stimulates the wait at least 1 min
reversible intracellular between inhalations
obstructive enzyme
airway disease adenylate Instruct patient to
or cyclase to wash mouthpiece
bronchospastic convert ATP to with water once a
attack cAMP. This week and allow it to
reaction air-dry .
decreases
intracellular
calcium levels.
It also
increases
intracellular
levels of cAMP.
Together,
these effects
relax bronchial
smooth-muscle
cells and inhibit
histamine
release.

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Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To treat acute Inhibits RNA- Concurrent therapy Dizziness, headache, Use cautiously in
exacerbations of dependent with astemizole, altered smell and taste, patients with renal
chronic protein cisapride, pimozide, stomatitis, tooth impairment
bronchitis synthesis in or terfenadine, discoloration,
caused by H. many types of hypersensitivity to hypoglycemia, Instruct patient not
influenza, M. aerobic, gram clarithromycin, abdominal pain, to crush or chew ER
catarrhalis or S. positive and erythromycin or any anaphylaxis tablets
Pneumoniae gram-negative macrolide antibiotic
bacteria. Advise patient to
take it with full
stomach

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Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To treat Interferes with Hypersensitivity to Chills, fever, headache, Protect powder
infections of the bacterial cell cephalosporins or abdominal cramps, from light
lower wall synthesis their components diarrhea, dyspnea
respiratory by inhibiting Monitor patient for
tract, skin, soft the final step in allergic reactions
tissue, urinary the cross-
tract, bones and linking of Obtain further
joints; sinusitis, peptidoglycan assessment
intra-abdominal strands.
infections and Peptidoglycan
septicemia makes the cell
caused by membrane
anaerobes rigid and
protective.
Without it,
bacterial cells
rupture and
die.

   

Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To liquefy Decreases Hypersensitivity Dizziness, Use cautiously in
abnormal, viscosity of hypertension, patients with
viscid, or pulmonary constipation, asthma or history of
thickened secretions by bronchospasm, clammy bronchospasm
mucus breaking skin, pruritus because drug may
secretions in disulfide links adversely affect
chronic that bind respiratory function
pulmonary glycoproteins
disorders in mucus. Encourage patient
(including to consume 2-3 ð of
emphysema, fluid daily
bronchitis,
tuberculosis and Obtain further
cystic fibrosis) assessment and
and in notify it to the
pneumonmia, physician
pulmonary
complications of
thoracic or
cardiovascular
surgery and
tracheostomy
care

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Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To treat acute Interferes with hypersensitivity Headache, increased Use cautiously in
exacerbations of bacterial cell ICP, light-headedness, patients with renal
chronic replication by sleep disturbance, impairment
bronchitis inhibiting the taste perversion,
caused by H. bacterial diarrhea, back pain, Take it 1-2 hrs
influenza, M. enzyme DNA photosensitivity before meal
catarrhalis or S. gyrase, which is
Pneumoniae essential for Advice the patient
replication and to complete the
repair of regimen as
bacterial DNA prescribed even if
symptoms subsided.

Avoid excessive
exposure to sunlight

Increase fluid intake


„ ! 

Indication Action Contraindication Adverse Reaction Nursing

Responsibility
To treat Interferes with Hypersensitivity to Chills, fever, headache, Complete the
uncomplicated bacterial cell cephalosporins or abdominal cramps, prescribed course of
UTIs caused by wall synthesis their components diarrhea, dyspnea, therapy
E. coli by inhibiting hearing loss, athralgia,
the final step in facial edema Immediately report
the cross- severe diarrhea to
linking of prescriber
peptidoglycan
strands. Be aware of allergic
Peptidoglycan reactions
makes the cell
membrane
rigid and
protective.
Without it,
bacterial cells
rupture and
die.


 
 



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In the case of our patient, he had COPD due to his lifestyle specifically heavy smoking
and drinking for years.




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ͻHost
-male
- 56 years old
- ðifestlye (smoking and alcoholic drinker)

ͻAgent
-M Smoking

ͻEnvironment
-living conditions

   

AE T
mokin and
drinkin
male

ears old
Lifestl
e smokin 
and al oholi drinker

HT

Environment

Livin ondition


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The agent-host-environment model is primarily use in predicting illness rather than

promoting wellness, although identification of risk factors that result from the interactions of
agent, host, and environment are helpful in promoting and maintaining health. Because each of
the agent-host-environment factors constantly interacts with others, health is an ever changing
state. Health is seen when all three elements are in balance while illness is seen when one, two,
or all three elements are not in balance
(Fundamentals of Nursing by Kozier 2004)
COPD or Chronic Obstructive Pulmonary disease is a chronic lung conditions that
obstruct the airways in your lungs. It refers to obstruction caused by CHRONIC BRONCHITIS and
EMPHYSEMA and there is a blockage within the tubes and air sacs that make up the lungs which
hinders the ability to exhale and even breath.

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I therefore conclude that my client is suffering from COPD or chronic pulmonary
disease due to her lifestyle specifically heavy smoking and drinking.M


  
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 Discharge Plan
    
'M Advised patient to adhere and complete the medication regimen to ensure complete healing.
'M Stress to the patient the importance of following the prescribed regimen so that the healing
process can continue uninterrupted.
'M Advised patient to adhere medication regimen even if he/she is feeling better.

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'M Encouraged patient to do relaxation technique such as deep breathing exercise.
'M Encouraged patient to do physical activities within his tolerance.
'M Instruct significant others to assist the patient if needed.


 
'M Encouraged patient to follow treatment as prescribed and to continue medication as prescribed.
'M Encouraged patient to follow physician͛s prescription for her own fast recovery.

   
'M Advised patient to stop smoking/alcohol intake.
'M Advised patient to eat nutritious foods like fruits and vegetables.
'M Encouraged patient to have proper hygiene every now and then.

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'M Encouraged patient to follow scheduled check-ups prescribed by the physician.
'M Advised patient to reduced stressful activities and to have proper good rest.
'M Encouraged patient to take good care of her health.


 
'M Advised patient to reduced environmental stress and to have a good rest.
'M Encouraged patient to eat foods rich in vitamins and minerals like fruits and vegetable.
'M Informed patient to refrain from drinking alcoholic beverages.

V
  
'M Encourage patient to strengthen his belief to our God Almighty.
'M Encourage patient and family members to have faith in God and asked for guidance.