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Group 7 Ablay-Andrade-Batario-BerbanoBibera-Borja-Borres-BurnsCabañero-Corsiga-CustodioCuyegkeng
BRONCHIAL ASTHMA IN ACUTE EXACERBATION CHRONIC OBSTRUCTIVE PULMONARY DISEASE
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 middleaged or older people. The disease isn't passed from person to person²you 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 ³blue 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 ³Blue 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 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.
Virginia Henderson Henderson defined nursing in functional terms. She stated, ³The 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 clothes²dress 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
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
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.
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. ³magana 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.
³hndi 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. ³ 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 NAME CLASSIFICATION & ACTION Miscellaneous respiratory tract drugs Mucolytic that reduces the viscosity of pulmonary secretions by splitting disulfide linkages between mucoprotein molecular complexes. INDICATION ADVERSE REACTION / SIDE EFFECTS CNS: fever, drowsiness, gait disturbances CV: tachycardia, hypotension, hypertension, flushing, chest tightness GI: stomatitis, nausea, vomiting RESPI: bronchospasm, dyspnea, cough SKIN: rash, diaphoresis OTHER: chills CONTRAINDICATI ON Contraindicated to patients with hypersensitive to drug. Use cautiously in elderly patients with severe respiratory insufficiency. Use I.V. formulation in patients with asthma or history of bronchospasm. NURSING CONSIDERATION - drug smells strongly of sulfur. Mixing oral form with juice or cola improves its taste - drug delivered to nasogastric tube maybe diluted with water. - monitor cough type and frequency - monitor patient for bronchospasm, specially if he has asthma - facial erythema may occur within 30-60 mins. Of start of IV infusion and usually resolves without stopping infusion.
ACETYLCYSTEIN E (fluimucil) Dosages: Inhalation solution: 10%, 20% I.V. injection: 20% solution (200mg/ml)
- for abnormal viscid thickened mucous secretions
CLASSIFICATION & ACTION Mucolytic It enhances pulmonary surfactant production and stimulates ciliary activity. These actions result in improved mucus flow and transport (mucociliary clearance). Enhancement of fluid secretion and mucociliary clearance facilitates expectoration and eases cough.
ADVERSE REACTION / SIDE EFFECTS Mild upper gastrointestinal side effects (primarily pyrosis, dyspepsia, and occasionally nausea, vomiting) have been reported, principally following parenteral administration. Allergic reactions have occurred rarely, primarily skin rashes. There have been extremely rare case reports of severe acute anaphylactictype reactions but their relationship to ambroxol is uncertain. Some of these patients have also shown allergic reactions to other substances.
CONTRAINDICATIO N should not be used in patients known to be hypersensitive to ambroxol or other components of the formulation.
NURSING CONSIDERATION -should be taken with food - monitor S/SX of aspiration of excess secretions and bronchospasms, if occurred notify physician - have suction apparatus immediately available. - tell the patient or family to report any difficulty clearing the airway or any other repi distress.
AMBROXOL (Mucosolvan) Dosage: Tablet: 75mg, 30 mg, 50mg Mucosolvan Liquid 30 mg, 60ml
acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport.
CLASSIFICATION & ACTION Antiasthmatic Bronchodilator its mechanism of action is related to the inhibition of phosphodiesterase activities, resulting in bronchodilating effects.
DOXOFYLLINE (ansimar) Dosage: Tab Adult 1 tab bid-tid. Syr Childn >12 yr 10 mL once-tid, <12 yr 69 mg/kg bid.
Bronchial asthma & pulmonary disease w/ spastic bronchial component
ADVERSE REACTION / SIDE EFFECTS After xanthine administration, nausea, vomiting, epigastric pain, cephalalgia, irritability, insomnia, tachycardia, extrasystole, tachypnea and occasionally, hyperglycemia and albuminuria, may occur. If a potential oral overdose is established, the patient may present with severe arrhythmias and seizure; these symptoms could be the 1st sign of an intoxication.
CONTRAINDICATI ON Individuals who have shown hypersensitivity to Ansimar and its components. Patients with acute myocardial infarction and hypotension. Use in lactation: Doxofylline is contraindicated in nursing mothers.
-maybe taken with or without food - assess lung sounds, BP before administration and during peak of medication. Note amount, character, and color sputum produced. - monitor pulmonary function test before initiating therapy and during therapy to determine effectiveness of medication. - observe for paradoxial bronchospasm ( wheezing ). If occurred, withhold medication and notify physician.
DRUG NAME COMBIVENT (albuterol) Dosage: Each Combivent inhaler is good for 200 "sprays" (pumps).
CLASSIFICATION & ACTION Antiasthmatic Bronchodilator expected to maximize the response to treatment in patients with chronic obstructive pulmonary disease (COPD) by reducing bronchospasm through two distinctly different mechanisms, anticholinergic (parasympatholytic) and sympathomimetic.
INDICATION chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator.
ADVERSE REACTION / SIDE EFFECTS edema, fatigue, hypertension, dizziness, nervousness, paresthesia, tremor, dysphonia, insomnia, diarrhea, dry mouth, dyspepsia, vomiting, arrhythmia, palpitation, tachycardia, arthralgia, angina, increased sputum, taste perversion, and urinary tract infection/dysuria.
CONTRAINDICATION COMBIVENT Inhalation Aerosol is also contraindicated in patients hypersensitive to any other components of the drug product or to atropine or its derivatives.
NURSING CONSIDERATION -do not use more than 12 inhalations in a 24hour period. Doing so may increase the risk of serious side effects. - Extreme heat can cause the medicine canister to burst. Do not store your inhaler in your car on hot days. Do not throw an empty canister into open flame. - 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.
CLASSIFICATION & ACTION Corticosteroids Not clearly defined. Suppresses immune response, stimulates bone marrow and influences protein, fat and carbohydrate metabolism
HYDROCORTISO NE SODIUM SUCCINATE (solu-cortef) Dosage: Injection: 100mg vial, 250mg vial, 500mg vial, 1,000mg vial
- severe inflammation - shock - treatment for ulcerative colitis
ADVERSE REACTION / SIDE EFFECTS CNS: insomnia, psychotic behavior, vertigo, headache, seizures CV: heart failure, hypertension, arrythmias, thrombophlebitis, thromboembolism GI: peptic ulceration, GI irritation, increased appetite, nausea, vomiting HEMATOLOGIC: easy bruising SKIN: delayed wound healing MUCOSKELETAL: muscle weakness, osteoporosis METABOLIC: hypokalemia, hyperglycemia, carbo intolerance, hypocalcemia
CONTRAINDICATI ON Contraindicated to patients hypersensitive to drugs and in those with systematic fungal infections.
NURSING CONSIDERATION -give oral dose with food when possible. Patient may need another drug for GI irritation - monitor patient¶s weight, BP and electrolyte level - watch for depression or psychotic episodes especially during high dose therapy - warn patient about easy bruising - unless contraindicated, give a low sodium diet that is high in potassium and protein. Give potassium suplements
CLASSIFICATIO N & ACTION
ADVERSE REACTION / SIDE EFFECTS
NURSING CONSIDERATIO N
RANITIDINE HCL (zantac) Dosage: Injection: 25mg/ml Syrup: 15mg/ml Tablets: 75mg, 150mg, 300mg
Antiulcer drugs Competitively inhibits action of histamine on the H2 receptor sites of parietal cells decreasing gastric acid secretion.
- active duodenal and gastric ulcer - GERD - heartburn
CNS: headache, vertigo, malaise HEPATIC: jaundice OTHER: burning and itching at the injection site
Contraindicated to patients hypersensitive to drugs.
- assess patient for abdominal pain. Note presence of blood in emesis, stool or gastric aspirate. - drug maybe 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.
CLASSIFICATION & ACTION
ADVERSE REACTION / SIDE EFFECTS
CEFUROXIME for injection USP Dosage: I.V. administration: 250mg,500mg,75 0mg,1 gm
Antibacterial inhibits synthesis of bacterial cell wall, causing cell death.
Lower Respiratory Tract Infections Urinary Tract Infections Skin and SkinStructure Infections Bone and Joint Infections Meningitis
Diarrhea; headache; loose stools; nausea; vomiting. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody stools; change in the amount of urine; dark urine; easy bruising or bleeding; fatigue; fever; seizures; severe diarrhea; stomach cramps/pain; vaginal irritation or discharge
Cefuroxime for Injection USP and Dextrose Injection USP is contraindicated in patients with known allergy to the cephalosporin group of antibiotics.
- Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated - Inspect IM and IV injection sites frequently for signs of phlebitis. - Monitor for manifestations of hypersensitivity Discontinue drug and report their appearance promptly. -Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. - Report onset of loose stools or diarrhea.
CLASSIFICATIO N & ACTION Antibiotic, Cephalosphorin (3rd Generation) inhibits mucopeptide synthesis in the bacterial cell wall, making it defective and osmotically unstable. The drug is usually bactericidal. It is more effective against rapidly growing organisms forming cell walls.
CEFTAZIDIME (Zeptrigen) Dosage: Powder for injection: 500 mg 1 gram 2 grams 6 grams
ADVERSE REACTION / SIDE EFFECTS Lower CNS: Headache, Respiratory dizziness, Tract Infections, lethargies, Skin and Skinparesthesias, Structure malaise, fatigue, Infections , vertigo, Urinary Tract confusion, Infections , Intra- precipitation of abdominal seizures, Infections, (especially Central Nervous inclients with System impaired renal Infections function) GI: nausea, vomiting, diarrhea, glossitis, abdominal cramps or pain, dyspepsia, anorexia, flatulence, cholestasis, pseudomembrano us colitis Local: Pain, abscess at injection site, phlebitis, inflammation at IV site
CONTRAINDICA TION Patients with allergies to penicillins, cepahlosporins.
NURSING CONSIDERATIO N -Monitor prothrombin time in patients w/ renal or hepatic impairment, in a poor nutritional state or are on prolonged therapy. - Have Vit. K available in case hypoprothrombine mia occurs. - Do not mix with aminoglycoside solutions, administer these drugs separately.
CLASSIFICATION & ACTION
ADVERSE REACTION / SIDE EFFECTS
DILTIAZEM HCL (dilzem) Dosage: Tablet: 30mg, 60mg, 90mg, 120mg Injections: 5mg/ml (25mg & 50mg)
Antianginals - angina pectoris A calcium - HPN channel blocker that inhibits calcium ion across cardiac and smooth muscle cells, decreasing myocardial contractility and oxygen demand. Also dilates coronary arteries and arterioles.
CNS: headache, dizziness, somnolence CV: edema, arrythmias, flushing, bradycardia, hypotension, heart failure, AV block GI: nausea, constipation, abnormal discomfort SKIN: rash
Contraindicated to patients with hypersensitive to drug and in those with systolic blood pressure below 90mm Hg. Use cautiously in elderly patients and in those with heart failure or impaired hepatic or renal function.
- monitor blood pressure and heart rate before, when starting therapy and during dosage adjustments. - if systolic blood pressure is below 90 or heart rate is below 60 bpm, withhold dose and notify physician. - tell patient to swallow extended release capsules whole, and not to open, crush or shew them.
ADVERSE REACTION / SIDE EFFECTS NITROGLYCE Antianginals - to prevent CNS: RIN PATCH Reduces chronic headache, (deponit) cardiac anginal attack dizziness, oxygen Dosage: - acute angina weakness Transdermal: demand by pectoris CV: orthostatic decreasing left - HPN 0.1mg/ hour, hypotension, ventricular 0.2mg/hour, tachycardia, end- diastolic 0.3mg/hour, flushing, pressure 0.4mg/hour, palpitation, (preload) and 0.6mg/hour, fainting to a lesser GI: nausea, 0.8mg/hour extent, vomiting systemic SKIN: rash vascular resistance (afterload). Also increases blood flow through coronary vessels.
CLASSIFICAT ION & ACTION
CONTRAINDI NURSING CATION CONSIDERAT ION Contraindicate d to patients with early MI orthostatic hypotension, allergy to adhesives. Use cautiously to patients with hypotension. - closely monitor VS particulary the BP - apply to a non hairy part of the skin except distal part of the arms and legs. - remove patch before defibrillation.
CLASSIFICATI ON & ACTION
AZITHROMYCI N (zithromax) Dosages Powder for oral suspension: 100mg/5ml, 200mg/5ml Tablets: 250mg, 500mg, 600 mg
Anti ± infectives Binds to the 50S subunit of bacterial ribosomes, blocking protein synthesis; bacteriostatic or bactericidal, depending on concentration.
- acute bacterial worsening of COPD - community acquired pneumonia - patients with advanced HIV infections
ADVERSE REACTION / SIDE EFFECTS CNS: dizziness, vertigo, headache, fatigue, somnolence CV: chest pain, palpitation GI: nausea, vomiting, diarrhea, abdominal pain,, flatulence SKIN: photosensitivity , rash
NURSING CONSIDERATI ON - give meds 1 hour before or 2 hours after meals - do not give with antacids - monitor patients with super infections. Drug may cause overgrowth of no susceptible bacteria or fungi. - advise patient to avoid excessive sunlight and to wear protective clothing and use sunscreen when outside.
Contraindicate d to patients with hypersensitivity to erythromycin. Use cautiously in patients with impaired hepatic function.
CLASSIFICATION & ACTION Anxiolytics A benzodiazepine that depresses the CNS, and suppresses the spread of seizure activity.
DIAZEPAM (valium) Dosage: Capsules: 15mg Injection: 5mg/ml Tablets: 2mg, 5mg, 10mg Oral solution: 5mg/5ml, 5mg/ml
- anxiety - acute alcohol withdrawal - muscle spasm - preop sedation - severe recurrent seizure
ADVERSE REACTION / SIDE EFFECTS CNS: drowsiness, slurred speech, fatigue, headache, insomnia, hallucinations CV: hypotension, bradycardia GI: nausea, constipation, diarrhea URINARY: retention and incontinence HEPATIC: jaundice RESPIRATORY: respi depression, apnea SKIN: rash OTHERS: altered libido, physical or psychological dependence
CONTRAINDICATI ON Contraindicated to patients hypersensitive to drugs and patients experiencing shock, coma or acute alcohol intoxication .
NURSING CONSIDERATION - inject deeply into a large muscle. - if patient takes other CNS drugs observed for over sedation - warn patient to avoid hazardous activities that require alertness and good coordination until effects of drug are known. - advise patient to use sugarless hard candy or gum to relieve dry mouth.
NURSING CARE PLAN
NURSING CARE PLAN
Assessment Objectives: Positive wheezes sound in both lungs Positive productive cough Positive sputum, greenish in color RR 39 With et tube connected to ventilator Diagnosis Planning After a week, the client will maintain airway patency Intervention Give expectorant or bronchodilators as ordered. Rationale For immediate recovery, broncho airway resistance secondary to bronchoconstricti on Oxygen has been shown to correct hypoxemia, which can be caused by retained respiratory secretions To clear airway when secretions are blocking airway Upright position allows for maximal air exchange and lung expansion. And also will be easy to expectorate the sputum Evaluation Client still have productive cough but he can already expectorate it
Ineffective airway clearance related to secretions in the bronchi
Administer oxygen as ordered
Position client to optimize respiration (head of bed elevated 45 degree)
Intervention Performed back tapping
Rationale Chest Physical Therapy help mobilizes bronchial secretions
Assessment Objective: Loss of weight From 70 kgs ± 55 kgs) Less of muscle mass Poor muscle tone Altered taste sensation Aversion to eating
Diagnosis Nutritional imbalanced less than body requirements
Planning The patient will display progressive weight gain toward goal as appropriate at least half kilo per week.
Rationale To have primary basis, because copd patient habitually eat poorly
Evaluation Client has increased appetite
Evaluated weight and body size
Provide good oral hygiene
Auscultated bowel sounds
Hypo active sounds may reflect decrease gastric motility and constipation Helps reduce fatigue during mealtime and provide opportunity to increase total caloric intake or decrease desire to vomit
Provide frequent small feeding
Intervention Encourage patient to avoid drinking carbonated beverage Encourage patient to avoid very hot and very cold foods Encourage to eat nutritious foods
Rationale Can produce abdominal distention or increase dyspnea Extreme in temperature can precipitate or aggravate cough system To meet the total weight gain needs
Assessment Objective: (+) DOB RR= 36 (+) productive cough with green in color sputum secretion Contraction of abdominal muscles during inspiration Restlessness With pulse oximeter With mechanical ventilator ABG¶s result Ph= 7.285 decreased (+)
Diagnosis Impaired gas exchange related to alveolar capillary membrane changes (COPD)
Client will be able to demonstrate improved ventilation and adequate oxygenation of tissues by ABG¶s within client¶s normal limits and absence of symptom of respiratory distress after
Intervention Elevate head of bed or position the client approximately (Moderate High back Rest) provide airway adjuncys and suction as indicated Auscultate chest and check for breath sounds Performed back tapping after the nebulization Assesslevel of consciousness and mentation changes
Rationale Correct positioning will maintain airway patency and promote drainage secretions
To identify the presence of secretions To easily remove the secretion
Pco2= 93.4 (+) increased Pco2= 63 (+) decreased Hco3= 43.9 (+) increased
Evaluate pulse oximetry to determine oxygenation Suction PRN as ordered
To know if the patient can response to the motor, eye opening and verbal To assess respiratory insufficiency To clear airway when secretions are blocking airway
Assessment Objective: dyspneic Restlessness Increased use of accessory muscle uncooperative with ET tube connected to ventilator machine unstable cardiac rate pursed lip breathing wheezes lethargic increased RR(39 bpms)
Diagnosis Impaired Spontaneous Ventilation related to problem with secretion management
Planning After the nursing intervention, the client will: maintain effective pattern via ventilator with absence of retractions or use of accessory muscles within acceptable range.
Intervention Assessed spontaneous respiratory pattern, noting rate, depth, rhythm, symmetry of chest movement and use of accessory muscles Administered sedative drugs as required
Rationale to measure the work of breathing
the client maintain effectivenes s respiratory pattern via ventilator
Verified clients respirations are in phase with the ventilator
to synchronize respirations and reduce work of breathing(to relax the patient prior to intubation as order) to decrease work of breathing maximizes Oxygen delivery
Intervention Checked cuff inflation at time whenever cuff is deflated or reinflated.
Rationale to prevent risk associated with under or over inflation
Checked tubing for obstruction
to prevent risk associated with under or over inflation
to clear the secretion
Noted inspired humidity and temperature, maintain hydration
to liquefy secretions facilitating removal
Intervention Noted changes in chest symmetry
Rationale may indicate improper placement of ET tube
Elevated the head part of the bed in 45 degree
to facilitate oxygen
Assessment Subjective data: ³Natatakot ako sa kung anu man ang pwedeng mangyari sa akin´ as stated. Objective data: Poor eye contact Tearfulness Elevated Blood pressure 150/100 Restlessness With body weakness Slightly irritable Pale
Rationale To ease anxiety
Anxiety R/T changes in health status
Will appear relaxed and report anxiety is reduced to a manageabl e level
Encourage client to acknowledge and to express feelings of sadness, fear or anger.
Be available to client for listening and talking.
To establish therapeutic relationship/ communication
Provide accurate information about the situation.
Helps client to identify what is reality based
Intervention Provide quiet and calm environment.
To be able the pt. to relax and relieve anxiety.
Encourage SO not to leave the patient alone.
In order for pt. to have someone if he needs a should to lean on
Use comfort measures. ( Clean linen,siderails)
In order for patient to relax and be comfortable.
Encourage to use diversional activities.
To divert anxiety.
Objective: Weak in appearance. Inability to ingest food safely. Inability to chew or swallow food. Inability to used bathroom. With foley catheter. With diaper (+) pain Uncooperative
Self Care Deficit related to weakness
After nursing intervention, the client will be able to: Perform selfcare activities within level of own ability
Plan time for listening to the client feelings and concern
To discover barriers to participation in regimen and to work on problem solution
Client now perform easy activity of daily living but still with supervision
Identify energy saving behavior Implement bowel or bladder training as indicated
To avoid fatigue
adaptive devices promote independence and safety
Assist with necessary adaptations to accomplish ADL¶s, begin with familiar Help client into sitting position
To encouraged client and build on
Gravity assist with swallowing and spiration with decreased when sitting upright
Intervention Advise S.O. to prepare small portion of favorite foods that acoording to clients diet
rationale Functional feeding can be improved by altering physical context of the meal to appeal to the client finger foods can be nutritious as well as allowing independenc e and the choice of what and when to eat
advise S.O. to provide finger foods
COMPLETE BLOOD COUNT and PLATELET COUNT
JUNE 29, 2010
PARAMETER Hemoglobin Hematocrit Red Cell Count White Cell Count Neuthophils Lymphocytes Eosinophils Basophils Platelet MCV MCH MCHC
RESULTS 16.30 0.50 5.47 8.40 0.920 0.80 0 0 266.00 90.90 29.80 32.80
10^9/L fL Pg g/dL
NORMAL VALUES (13-17) (0.4-0.5) (4.5-5.5) (5-10) (0.55-0.65) (0.25-0.35) (0.02-0.04) (0-0.05) (140-340) (86-100) (26-31) (31-37)
JUNE 28, 2010
TEST NAME Blood Urea Nitrogen Creatinine Sodium Potassium
RESULT 12 0.8 133 4.7
UNITS mg/dL mg/dL mmol/L mmol/L
REFERENCE VALUES. 9-20 0.66-1.25 137-145 3.5-5.1
JUNE 29, 2010 MACROSCOPIC Color Transparency Reaction Specific Gravity Albumin Sugar MICROSCOPIC WBC RBC Bacteria E.cells Amorphous Urates Mucuos Treads Cast Crystals Yellow Clear 5.5 1.020 Negative Negative 2.5 None seen Moderate Rare Few
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)
Ph PC02 P02 HC03 BE 02 sat Temp. FI02 RR site
RESULT 7.285 93.4 63 43.9 17 85 37.8 32% 28bpm RBA
NORMAL VALUES 7.35-7.45 35-45 mmHg 80-100 mmHg 22-28 meq/l (+-)2 80-100%
ARTERIAL BLOOD GASES (JULY 1, 2010)
Ph PC02 P02 HC03 BE 02 sat Temp. FI02 RR site
RESULT 7.328 96.7 54 51.3 25 83 36.2 44% RBA
NORMAL VALUES 7.35-7.45 35-45 mmHg 80-100 mmHg 22-28 meq/l (+-)2 80-100%
ARTERIAL BLOOD GASES (JULY 2, 2010)
Ph PC02 P02 HC03 BE 02 sat Temp. FI02 RR site
RESULT 7.31 79.7 57 40.4 -14 85% 36.8 70% MV 22 LBA
NORMAL VALUES 7.35-7.45 35-45 mmHg 80-100 mmHg 22-28 meq/l (+-)2 80-100%
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.
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
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