Conceptualize the pathophysiological alterations related to the case.

Trace the pathophysiological changes and highlight problems that are experienced by the client.

INTRINSIC EXTRINSIC
Male PATIENT
74y/o (+) hypertension -30pack/year smoker history (quit
(+) MI smoking after MI
(+) Hypertension -diagnosed w/ COPD
-denied drinking alcohol
(+) Diabetes Mellitus -no allergy to medication
(+) Heart failure and food
1. Father died of -had Appendectomy 20 yrs ago
myocardial infarction at
age of 59 years (diabetes,
hypertension, smoker)
2. Mother alive (atrial
fibrillation, heart failure)
3. Healthy siblings

Inflammation
 Neutrophil elastase and Oxidative stress, inflammatory
matrix metalloproteianases mediators, cytokines

Destruction
of alveolar Fibrosis and thickening Edema and smooth muscle
walls and of the bronchiolar walls contraction
capillaries

Impaired Air
Enlarged gas trapping
Narrowing of small airways
air spaces diffusion on
expiration

Chronic bronchitis

Laboratory procedures: CBC, Serum Na, K, Creatinine , ABG COPD

Make a care plan for 2 priority nursing problems identified.

ASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Ineffective Bronchospasm Short Term: Place patient with A sitting position After 48hrs of
the patient was breathing pattern During the first proper body permits maximum nursing
unable to speak in related to Increased 15minutes of duty alignment for lung excursion interventions
full sentences as pneumonia as production of the patient will maximum and chest
verbalized by the evidenced by secretions; verbalize comfort breathing pattern. expansion. Patient maintains
wife. shortness of retained and demonstrate an effective
breath. secretions; thick, effective Encourage These techniques breathing pattern,
viscous secretions breathing sustained deep promotes deep as evidenced by
Objective: techniques. breaths by: inspiration, which relaxed breathing
-productive cough Allergic airways Using increases at normal rate and
(but unknown demonstration: oxygenation and depth and
color of the Hyperplasia of Long Term: highlighting slow prevents absence of
sputum) bronchial walls During the 8 inhalation, atelectasis. dyspnea.
- (+) audible hours of nursing holding end Controlled Patient’s
wheezing Decreased intervention, the inspiration for a breathing respiratory rate
-mild chest energy/fatigue client will: few seconds, and methods may also remains within
tightness, Maintain patent passive exhalation aid slow established limits.
-shortness of Possibly airway with Utilizing incentive respirations in Patient’s ABG
breath evidenced by: breath sounds spirometer patients who are levels return to
clear. Requiring the tachypneic. and remain within
Statement of Demonstrate patient to yawn Prolonged established limits.
difficulty behaviors to expiration Patient indicates,
breathing improve airway prevents air either verbally or
clearance by trapping. through behavior,
Changes in effective feeling
depth/rate of coughing. Encourage This method comfortable when
respirations, use Respiratory rate is diaphragmatic relaxes muscles breathing.
of accessory within normal breathing for and increases the Patient reports
muscles range. patients with patient’s oxygen feeling rested
Fever is not chronic disease. level. each day.
Abnormal breath present. Patient performs
sounds, e.g., Take all his Evaluate the This training diaphragmatic
wheezes, rhonchi, medication. appropriateness improves pursed-lip
crackles Maintained in a of inspiratory conscious control breathing.
minimal oxygen muscle training. of respiratory Patient
Cough support. muscles and demonstrates
(persistent), inspiratory muscle maximum lung
with/without strength. expansion with
sputum adequate
production Provide Beta-adrenergic ventilation.
respiratory agonist When patient
medications and medications relax carries out ADLs,
oxygen, per airway smooth breathing pattern
doctor’s orders. muscles and cause remains normal.
bronchodilation to
open air passages. Goal is met.

Avoid high Hypoxia triggers

concentration of the drive to
oxygen in patients breathe in the
with COPD. chronic CO2
retainer patient.
When
administering
oxygen, close
monitoring is very
important to
avoid uncertain
risings in the
patient’s PaO2,
which could lead
to apnea.

Maintain a clear This facilitates

airway by adequate
encouraging clearance of
patient to secretions.
mobilize own
secretions with
successful
coughing.

Suction This is to clear

secretions, as blockage in
necessary. airway.

Encourage Extra activity can

frequent rest worsen shortness
periods and teach of breath. Ensure
patient to pace the patient rests
activity. between
strenuous
activities.

Teach patient These measures

about: allow patient to
pursed-lip participate in
breathing maintaining
abdominal health status and
breathing improve
performing ventilation.
relaxation
techniques
performing
relaxation
techniques
taking prescribed
medications
(ensuring
 accuracy of dose
and frequency
and monitoring
adverse effects)
scheduling
activities to avoid
fatigue and
provide for rest
periods

ASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Activity Dec. oxygen Assess the Patients with After 48 hrs of nursing
no change in his Intolerance carrying capacity To restore the patient’s COPD can interventions,
alertness, as related to of Hgb patients ability respiratory experience
stated by his Imbalanced to perform response to hypoxia during Patient is able to provide
wife between regular activities activity which an increased positive verbal feedback in
oxygen supply Decreased in a healthy includes activity and may response to activity level
and demand nutrition in cells manner without monitoring of need
Objective: due to experiencing respiratory rate oxygenation to Patient is able to display
-mild chest inefficient work any signs or and depth, avoid hypoxemia and use effective energy
tightness of breathing as symptoms of oxygen which put them management/conservation
-shortness of evidenced by Decreased ATP activity saturation, and at risk for techniques
breath, shortness of production since intolerance. use of accessory exacerbations of
-productive breath oxygen is needed muscles for the condition. Patient is able to perform
cough for oxidation of respiration. basic activities without
CHO/glucose excessive exhaustion or
 Assess the Adequate energy loss of energy
patient’s reserves are
nutritional status. needed during Patient is able to display
Decreased activity. physiological
energy or muscle improvements over time
weaknes Maintain Helps in building
prescribed tolerance and Patient is able to maintain
activity levels. minimizing regular cardiovascular and
episodes of respiratory functions
Activity dyspnea. during activities
intolerance
Provide at least Allotment of Goal is met.
90 minutes of undisturbed rest
undisturbed rest reduces demand
in between for oxygen and
activities. allows adequate
physiologic
recovery.

Instruct patient These

with energy techniques
conservation reduce oxygen
techniques, such consumption,
as: allowing a more
Placing prolonged
frequently used activity.
items within easy
reach
Sitting to do tasks
Frequent position
changes
Working at an
even pace
Teach the patient These
on excercises techniques
that enhances prolong
breathing exhalation
capacity such as period which can
diaphragmatic decrease
and purse-lip retention of
breathing. carbon dioxide.

If needed, assist
the patient for a This program
referral to a allows the
pulmonary patient to learn
rehabilitation about nutrition,
program. breathing and
relaxation
techniques,
medication
education,
avoiding
exacerbations,
and ways on how
to live better
while having
COPD.
DRUG STUDY:

NAME OF MECHANISM CLASSIFICAT INDICATIONS CONTRAINDICATI COMMON SIDE NURSING CONSIDERATIONS

DRUG OF ACTION ION ON EFFECTS

Generic inhibits ACE Indicated for contraindicated in headache. Monitor patients closely in any
name: angiotensin- inhibitor the treatment patients with a dizziness. situation that may lead to a
Lisinopril converting of history of ACE- persistent cough. decrease in BP secondary to
enzyme (ACE) hypertension inhibitor induced low blood pressure. reduction in fluid volume (excessive
in human in adult angioedema, chest pain. perspiration and dehydration,
Brand Name: subjects and patients and hereditary vomiting, diarrhea) because
Zestril, animals. ACE pediatric angioedema, or excessive hypotension may occur.
Prinivil is a peptidyl patients 6 idiopathic Arrange for reduced dosage in
dipeptidase years of age angioedema. Risk patients with impaired renal
that catalyzes and older to of angioedema function.
the lower blood may also be
Dosage/Rout conversion of pressure. higher in patients
e/Frequency: angiotensin I Lowering with a history of
20 mg BID PO to the blood angioedema
vasoconstricto pressure unrelated to ACE
r substance, lowers the risk inhibitors.
angiotensin II. of fatal and
Angiotensin II non-fatal
also cardiovascular
stimulates events,
aldosterone primarily
secretion by strokes and
the adrenal myocardial
cortex. infarctions.
Generic relaxing the beta- used for the thyrotoxicosis. Hoarseness, throat -Notify physician immediately of
name: muscles agonists prophylaxis of diabetes. irritation, headache, worsening asthma or failure to
Salmeterol around the (LABAs) mild to low amount of rapid heartbeat, respond to the usual dose of
airways so moderate potassium in the nervousness, cough, salmeterol.
that they asthma and blood. dry mouth/throat, -Do not use an additional dose prior
Brand Name: open up and COPD and high blood or upset stomach to exercise if taking twice-daily
Advair you can should never pressure. may occur. doses of salmeterol.
Diskus breathe more be used to -Diminished -Take the pre-exercise dose 30–60
easily. treat acute blood flow min before exercise and wait 12 h
bronchospas through arteries before an additional dose.
- induces m. of the heart.
Dosage/Rout prolonged -prolonged QT
e/Frequency: bronchodilata interval on EKG.
50/500 dry tion, reduced -abnormal EKG
powdered vascular with QT changes
inhaler (PDI) permeability, from birth.
one puff inhibition of -seizures.
inhaled twice inflammatory
daily mediators,
stimulation of
ciliary
function and
modulation of
ion ...
Generic acts on beta-2 Sympathomi Relief and -overactive CNS: Restlessness, Nursing assessment should include
name: adrenergic metic, prevention of thyroid gland. apprehension, listening to lung sounds, obtaining
Albuterol receptors to Beta2- bronchospas -diabetes. anxiety, fear, CNS blood pressure, and heart rate prior
relax the selective m in patients -a metabolic stimulation, to use and during use of albuterol. If
bronchial adrenergic with condition where hyperkinesia, a patient has a productive cough, it's
Brand Name: smooth agonist, reversible the body cannot insomnia, tremor, important to assess amount, color,
AccuNeb, muscle. It also Bronchodila obstructive adequately use drowsiness, and consistency of sputum.
Novo-Salmol inhibits the tor, Anti airway disease sugars called irritability,
(CAN), release of asthmatic Inhalation: ketoacidosis. weakness, vertigo,
Proventil, immediate Treatment of -excess body acid. headache
Proventil hypersensitivit acute attacks -low amount of CV: Cardiac
HFA, y mediators of potassium in the arrhythmias,
Salbutamol from cells, bronchospas blood. tachycardia,
(CAN), especially m -high blood palpitations, PVCs
Ventodisk mast cells. Prevention of pressure. (rare), anginal pain
(CAN), exercise- -diminished blood Dermatologic:
Ventolin HFA induced flow through Sweating, pallor,
bronchospas arteries of the flushing
m heart. GI: Nausea,
Unlabeled vomiting, heartburn,
Dosage/Rout use: Adjunct unusual or bad taste
e/Frequency: in treating in mouth
metered- serious GU: Increased
dose inhaler hyperkalemia incidence of
(MDI) or in dialysis leiomyomas of
solution for patients; uterus when given
nebulization seems to in higher than
every 6 hours lower human doses in
as needed potassium preclinical studies
concentration Respiratory:
s when Respiratory
inhaled by difficulties,
patients on pulmonary edema,
hemodialysis coughing,
bronchospasm,
paradoxical airway
resistance with
repeated, excessive
use of inhalation
preparations
Generic -inhibits tetracycline indicated for Liver disease due weight loss -Take capsule or tablet forms with a
name: bacterial antibiotics the treatment to rare fatal nausea full glass (240 mL) of water to
Doxycycline protein of the hepatotoxicity. vomiting ensure passage into stomach and
synthesis by following History of yeast diarrhea prevent esophageal ulceration.
Brand Name: binding to the infections and infections. rash -Avoid exposure to direct sunlight
Vibramycin, 30S ribosomal diseases: Recent colitis skin sensitivity to and ultraviolet light during and for 4
Oracea, subunit. Rocky caused by sunlight or 5 d after therapy is terminated to
Adoxa, - has Mountain antibiotic use. hives reduce risk of phototoxic reaction.
Atridox bacteriostatic spotted fever, Kidney disease anemia, and
activity typhus fever diarrhea from C. vaginal yeast
against a and the Dificile. infection
broad range typhus group, History of lupus
Dosage/Rout of Gram- Q fever, (autoimmune)
e/Frequency: positive and rickettsialpox, Porphyria (a blood
100mg OD Gram negative and tick disease)
for one week bacteria. fevers, Myasthenia
respiratory gravis.
tract
infections,
urinary tract
infections.