COPD
COPD
COPD
This case study report has been prepared during my clinical practice in
college of medical science. It is the practical requirements of the post
basic bachelor-nursing curriculum.
I got myself completely involved in the care and management of the
patient during the period. However, the work would not be having
accomplished successfully with my efforts alone, without the guidance
and support of a number of people in the endeavor.
I have a great pleasure to express my gratitude to the SMTC for providing
this kind of course of study and present them in systematic way. I would
like to express my gratitude to campus chief Ms.Sovana Nepal for her
good management and for making this hospital practicum possible.
I sincerely like to thank co-ordinator ms anu vk (lecturer) ms jyoti dakhal
for their valuable guidance, supervision, direction, and co-operation
during hospital practicum.
Iam also thankful to all my teachers for their guidance and supervision
and library family for providing essential book for the case study.
I am equally thankful to my colleagues, seniors as well as juniors and also
thankful to my patient his family for providing the necessary information
so kindly and co-operatively.
Lastly, I am thankful to all helping hands that encouraged and supported
directly or indirectly to give case study report in final shape.
Thanks
Rashika chapagain
PBBN 3rd year
SMTC Background
CONTENT OF TABLE
1. background
2. Rational for the selection of case
3. Methodology for this case study
4. History taking and physical examination
5. Developmental tasks and crisis
6. Introduction about disease
7. Anatomy and physiology
8. Definition
9. Epidemiology
10. Pathophysiology
11. Causes
12. Signs and symptoms
13. Diagnostics
14. Management
15. Prognosis
16. Complications
17. Drugs profile
18. Nursing management
19. Application of nursing theory
20. Nursing care plan
21. Daily progress note Diversional therapy
22. Health education given during hospitalization
23. Discharge teaching
24. Learning from case study
25. Conclusion
26. References
BACKGROUND
A case presentation is the important method of specific educational activities. It
provides opportunity to read and discuss under specific problem.
For the fulfillment of bachelor degree in nursing, 3rd year curriculum , we have to
perform 1 case study in details. As suggested by curriculum, we have to take one
specific disease condition for case study and provide comprehensive and holistic
nursing care to the patient by applying knowledge of psychodynamic, basic science,
nursing theories and nursing process.
So, I have carried out this case study on case of “chronic obstructive pulmonary
disease” during the period of clinical assignment of cms Hopital. It is quite benefited
for my study. So, I have taken it as a golden opportunity. As a partial fulfillment of
post basic bachelor of nursing of Purvanchal University, where we student
individually have to complete 2case presentation individual. So I selected the case of
acute copds for study, which is most common disease in the world and during my
posting, there were many cases of acute copd.
•Copd is a more common disease in Nepal, especially to old aged . Its incidence is
increasing day by day. The predisposing factor of copd is preventable. Most of them
are due to smoking, poor environment and allergies. So we can minimize the
occurrences of copd by preventing the person from dust,irritants,smoking, allergies
etc. We can give health education about the preventive methods. The mortality rate is
increasing day by day so I choose this case study to go to depth and to know the
pathophysiology of copd and also to gain knowledge about how to manage the case at
hospital setting, how it effect on patient’s health, how to minimize morbidity and
mortality, to know about patient’s family environment, supporting system and
economic status and its effect in patient’s condition.
After gaining detail knowledge about copd, I can share my knowledge with my
patient’s family with confidently. This helps to prevent from complication and
provides supports to the patient and family
METHODOLOGY
The methodology adopted to produce this report was based on the observation,
examination and history taking of patient, discussion with teachers, senior’s staffs
and doctors and using various text books and reference of medicine.
• Specific objectives:
1. To gain detail information about the case copd by co-relating the book and
patient condition.
5. To give health teaching about the patient and visitors related to disease
condition and care.
• Education :- Illiterate
• Occupation :- farmer
• Religion :- Hindu
• Bed No. :- 09
• IP No. :- 1606150436
CHIEF COMPLAIN
According to patient he was feeling unwell for few days when he had developed
sob,coughing associated with the disease condition and then days he visited
chandreshwor primary health care (2016-06-17)and they administer tab
amoxicillin 500mg,tab azitro 500mg. Tab salbutamol 4mg,oxygen inhalation and
nebulization and
after that he was reffered to college of medical science for further treatment.He
arrived at emergency department on 016-06-19at 1pm.he was given inj hydrocort
100mg iv stat,inj pantium 40 mg iv stat,nebulization with asthalin and impravent
and oxygen inhalation. Investigation such as chest x-ray,laboratory (esr,cbc),
ECG,na,k+, urea,creatinine,ABG.then on 016-06-19 he was transferred to medical
intensive care unit.
Patient history of copd since 10 years, patient taken salbutamol 4mg bd and
salbutamol inhalation.
Patient biodata
General examination:-
Vital sign-
Height :- 160cm
Weight :- 48kg
BP :- 130/80 mm of Hg
Pulse :- 120/min
Respiration :- 26/min
Temperature :- 98.6f
Birth History:
Place of delivery: Home delivery.
Mode of delivery: Normal delivery.
Birth weight: Could not be verified.
Any birth complication: No
Lunch (9 to 10 am)
Snacks(2-3pm)
Dinner (7 to 8 pm)
INDEX
Male
Female
Death Male
Death Female
Client
ENVIRONMENTAL HISTORY
Type of drainage system - open
Type of toilet used - water seal latrine
Source of drinking water – government tap
Kitchen style – separate
Type of fuel used in cooking - wood
PHYSICAL EXAMINATION
While doing head to toe examination, I followed systematic approach of head to toe
examination and use following method for physical examination
Inspection
Palpation
Percussion
Auscultation
Measurement
VITAL SIGNS:
Temp: 98.6ºF
Pulse: 120/min
Resp.:26 /min
B.P:130/80mm of hg.
Height: 160cm
Weight: 48 kg
GENERAL APPEARANCE:
State of consciousness: oriented to time, place, and person.
Responses to the verbal commands, touch: normal
Gait: straight
Physical build: undernourished
Facial expression : lethargic.
Hygienic status: poorly groomed
Speech: spontaneous and audible but low in pitch.
Skin:
Examination Findings
Inspection
All over the body for color color uniform all over the body
Any patches or lesions or any Skin free of lesion and abrasions
evidence of itching. wrinkles present on face.
Wrinkles Edema absent
Edema Cyanosis absent
cyanosis Dry white in color uniform distribution
Hair distribution
Cleanliness Dandruff hair
Evidence of injury No any evidence of injury
Palpation Temperature
Edema Warm skin, even temperature
Dehydration Edema absent
Texture Elastic skin: skin comes back to previous
state quickly
Smooth skin
Lymph Nodes:
Examination Findings
Inspection
Redness or enlargement of lymph Lymph nodes not visible, no
nodes redness
Inspection
Redness or enlargement of lymph Lymph nodes not visible, no redness
nodes
Palpation
Enlargement Lymph nodes not palpable
Tenderness No tenderness
Examination Findings
Inspection
Shape and size Uniform size and shape
Swelling, injury or infection on head Swelling of face not present
Face for movement of two sides Easily movable
Palpation
Swelling, tenderness and depression Swelling not present on face
Percussion
To sinuses for tenderness No tenderness over maxillary and
frontal sinuses
Eye :
Examination Findings
Inspection
Eye for bulges No bulges
Eyelids No swelling, redness, drooping
Palpebral Pink in color, no discharge, foreign body, dryness
conjunctiva. or tear flowing.
Bulbar conjunctiva Transparent white in color
Cornea Transparent, no abrasions, or white spots
Sclera White in color with few small blood vessels
Pupils Round and uniform in size and shape , when light
approaches pupils constrict but
poor response as patient dosent open eye himself.
Eye movement Equal eye movements
Well movement
Ear:
Examination Findings
Inspection
External ear for location Top of pinna meets the
eye- occupit line.
Pinna for any lump or lesion No lump, lesion, smooth
rounded
External auditory canal for any No redness,but wax present
redness discharge, mass, foreign in both ear.
body, or cerumen. No redness or swelling.
Mastoid area for redness or
Swelling
Palpation
Pinna No tenderness
Skin flap No tenderness
Mastoid area No tenderness
Nose:
Examination Findings
Inspection
Nose for location Centrally located
Nostrils Nostrils are uniform in size and do
not flare.
Nasal septum No polyp or deviation
Nasal canals Dark pink in color, no discharge or
foreign body.
Smelling Good smelling capacity present.
Palpation
Gums No swelling, tenderness
Teeth No loose tooth
Smell Foul odour, or smell of alcohol
Slightly present
Neck :
Examination Findings
Inspection
The neck position Centrally located
For enlargement of thyroid gland No enlargement
Ability to move neck able to move by self
Back of neck for lump or
Tenderness No swelling or lump
Palpation
Back of neck for tenderness No tenderness
Thyroid gland for tenderness Thyroid not palpable and non
tender
Percussion
The front and back of of the chest. Hyperesonant sounds over the lungs.
Auscultation Breath sounds with wheezing
The front and back of chest. present
Heart :
Examination Findings
Palpation
Heart to determine the size Heart normal in size apex beat
palpable at 5th intercostals.
Percussion
Heart Dull sound over heart from 2nd
to 5th intercostals.
Auscultation
Heart sound in aortic ,pulmonary, Lub dub sound present in all
tricuspid and bicuspid area areas.
Breast :
Examination Findings
Inspection
Both breast for size, uniformity, Breast and nipple are uniform in
color. size and shape, nipple point to same
Any swelling, dimpling or direction.
retraction No swelling , dimpling or
Nipples retraction.
No cracks or secretion present.
Palpation
Breast to check for mass , No mass, swelling or tenderness
swelling or tenderness present.
Abdomen:
Examination Findings
Inspection
Shape, size, scars, swelling, Not distended , no scar,
and distended blood vessels Swelling absent.
Auscultation
Bowel sounds Bowel sounds are present in all
quadrants every 5-10 secs, gurgling
sounds.
Percussion
In all areas Tympany over stomach and intestines
whereas dull over liver, spleen and
Kidneys for tenderness kidneys
Non tender kidneys.
Palpation
All areas of abdomen Soft, non tender
Liver Non palpable
Spleen not palpable
Kidneys not palpable
Anus :
No any irritation , crack, fissure or enlarged vessels reported.
Genitalia:
No redness, swelling discharge.
Arms and legs:
Examination Findings
Inspection
arms and legs for symmetry, Symmetrical in size and shape,
edema or lesions. edema absent.
Palpation
Arms and legs for edema Edema absent.
Musculo skeletal system:
Examination Findings
Inspection
Muscles and joints No bone or joint deformity
Nervous system:
Examination Findings
Muscle strength equal strength in both hands and feet
Sensation Good sensory intact
Reflexes Present
FINDINGS:
Dyspnoea & use of accessory muscle for respiration
NO Cynosis
Cough : Productive moderate .
B/L Wheeze sound on auscultation,hyperresonant sound on percussion and
barrel shaped chest on inspection.
Wax (moderate amount ) present at B/L ear.
Dental carreies present at 2nd molar teeth.
DEVELOPMENTAL TASK:
Likewise the developmental tasks and crisis of the elderly according to Erickson is
“Ego integrity versus despair” this means that the older adults must be convinced that
his\her life has had some purpose, meaning and self fulfillment; failure to esolve this
stage can lead to poor adaptation to advanced age fear of death.
Also known as chronic obstructive lung diseases. It refers to several disorders that
affect the movement of air in and out of the lungs. It occurs as a result of an increased
airway resistance secondary to bronchial mucosal edema or smooth muscle
contraction. COPD is the combination of chronic bronchitis and pulmonary
emphysema.
Chronic bronchitis : the lining of the airway is constantly irritated and inflamed,this
causes the linig to thicken lot of thick mucous forming in airway making it hard to
breath.
Emphysema:the walls between many of the air sac are damaged due to excess mucus.
As the result ,the air saces lose their shape and the amount of gas exchange in the
lungs is reduced.
Incidence
Globally, 10%–20% of the population older than 40 years (an estimated 80 million)
are COPD sufferers, resulting in more than 3 million deaths each year(2012). COPD
is projected to be the third leading cause of death by the year 2020. According to
surveys by the Asian Pacific Society of Respiratory Diseases, 6.2% of the global
COPD burden is born by 11 Asian countries. In Nepal, COPD accounts for 43% and
2.56% of hospitalizations.
PATHOPYSIOLOGY
Causative factor
Broncho constriction
CAUSES OF COPD
Allergic factors
Alpha-1 antityrpsin (ATT)
deficiency
CLINICAL FEATURES
According to book According to client
Shortness of breath Shortness of breath
Wheezing (adventitious sound) Expiratory wheezing
Cough Cough
Purulent sputum Purulent sputum
Crackles, ronchi
Weight loss and anorexia Thin body built (48 kg)
Increased anterior-posterior diameter Barrel shaped chest
of chest
Fatigue fatigue
Cyanosis Cyanosis
Pursed lip breathing Pursed lip breathing
Dyspnea Dyspnea
Extertional dyspnea Extertional dyspnea
Diagnostic procedure
History taking
Physical examination History taking
Arterial blood gases. Physical examination
Sputum culture: to identify ABG: PH7.36,
organisms if sputum is persistently Paco2:42.7, Pao2:103,
present and purulent. SCO3:23.6
Sputum AFB =negative
Routine blood test- TC, DC, ESR, Spirometry
HB, Urea. Complete blood count :
Chest X-Ray Chest x-ray:B/L decreased
ECG: to assess cardiac status if there entry
are features of cor pulmonale. ECG
Echocardiogram: to assess cardiac ECHO
status if there are features of cor Bio-chemistry
pulmonale. RBS monitoring.
FINDINGS
Parameters Findings Unit Referred range
Biochemistry
Blood urea 59.3 Mg/dl 15-40
Hematological
WBC count 3510 Mm3 4,000-11,000
Differential count
Neutrophil 88 % 40-70
Lymphocyte 09 % 20-45
Monocyte 02 % 2-10
Eosinophil 01 % 1-6
Basophil 00 % 0-1
Platelets 155000 Cells/cumm 1,50,000-4,00,000
Hemoglobin 13.8 Gm/dl 13.5-16.0
RBC 4.74 Million/cumm 3.5-5.5
MCH 30.8 Pg 27-32
MCV 90 Fl 76-96
TREATMENT
-Otitis media- H. influenza, M.catarrhalis: Adult: One tablet every 8 hrs. In severe
infections 2 tablets every 8 hrs.
Intravenous
-Infections caused by Beta-lactamase producing strains of organisms indicated: Adult:
Amoxycillin sodium1.0g + Calvulanate potassium200mg injections given every 6 or 8
hrs.
Contraindication:
Penicillin allergy
Special precaution:
History of allergy especially to cephalosporins, infectious mononucleosis, severe
renal impairment
Adverse reactions:
Nausea, vomiting, diarrhea, indigestion, rash and urticaria, candida superinfection.
Nursing consideration:
Teach patient and family to report sore throat, fever, fatigue ( may indicate
super infection or aggranulocytosis).
Adequate intake of fluids (2 liters) during diarrhea episodes.
To use alternative contraceptive measures if using oral contraceptives.
Perform scratch test to assess allergy after securing order from prescriber
usually done when penicillin is only product of choice.
Shake suspension before each dose may be used alone or mixed in drinks, use
immediately.
Discard unused portion of suspension after 14 days.
Perform or provide adrenaline, suction, tracheostomy set, ET intubation
equipment on unit so that it can be used in case of emergency.
2. Injection Hydrocortisone
Category: Glucocorticoid
Mechanism of action
6 -8 hourly.
Anti-inflammation, immunosupression.
Adults: 150-240mg 12hourly.
Shock
Adults: Elderly, children 12yrs and older 100mg 6hourly.
Contraindication
-Abruptly withdrawing the drug after long term therapy may cause anorexia,
nausea, fever, headache, sudden severe joint pain, rebound inflammation, fatigue,
weakness, lethargy, dizziness
Nursing consideration
Examine the patient for edema, weight gain and advise patient to report fever,
muscle aches, sore throat.
Monitor the patients for signs and symptoms of hypocalcaemia, hypokalemia.
Determine if the patient has diabetes mellitus and anticipate and increase in
his/her antidiabetic drug because of raise blood glucose level.
Hydrocortisone crosses the placenta and is distributed in breast milk. Patients
taking hydrocortisone should not breast feed.
Prolonged hydrocortisone use during first trimester of pregnancy may produce
cleft palate in the neonate.
3. Asthaline
Mechanism of action
Oral
Bronchospasm in patients with reversible obstructive airway disease:
Inhalation
Bronchospasm in patients with reversible obstructive airway disease:
200-400 mcg Rota caps dry power three or four times a day or 2.5mg nebulizer
solution three or four times a day.
Children [6-12yrs] : 100mcg Aerosol or 200mcg Rota caps dry powder three or four
times a day.
Contraindication
Side effects
Nursing Considerations
Monitor the patient’s 12 lead ECG, pulse rate, respiratory rate, depth, rhythm and
type and ABG and serum potassium levels.
Auscultate the patient’s breathe sounds for wheezing and for crackles.
Encourage patient to take plenty of fluids.
Urge patient to avoid excessive use of caffeinated products, such as chocolate,
cococola, and tea.
4 Ipravent
Contraindications:
History of hypersensitivity to atropine
Drug interaction; Cromolin inhalation solution
Adverse effects:
Frequent : Cough, dry mouth, headache, nausea., nasal irritation
Occasional: Dizziness, transient increased bronchospasm
Rare: Hypotension, insomnia, metallic taste, palpitation, urine retention etc.
Nursing consideration
Monitor vitals and breathe sounds.
Monitor the patient’s ABG levels.
Instruct patients not to take more than 2 inhalations at a time because excessive
use decreases the drugs effectiveness and may cause paradoxical
bronchoconstriction.
Advise the patient to rinse his\her mouth with water immediately after inhalation
to prevent mouth and throat dryness.
Encourage the patient to drinks plenty of fluids.
Urge the patient to avoid excessive use of caffeinated products like chocolate,
coca cola, coffee and tea.
6. Tablet pantop
Generic Name: Pantoprazole
Brand Name: Pantop
Drug class and Mechanism
Pantoprazole is in a class of drugs called proton pump inhibitors (PPI) that block
the production of acid by the stomach.. Proton pump inhibitors are used for the
treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD)
which are caused by stomach acid. Pantoprazole, like other proton-pump
inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By
blocking the enzyme, the production of acid is decreased, and this allows the
stomach and esophagus to heal.
Availability
Tablets : 20-40mg
Powder for injection : 40 mg
Storage
Dosages
Contraindication
Not known
Side effects
The most common side effects are diarrhea, nausea, vomiting, headaches, rash and
dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps,
and water retention occur infrequently.
Nursing Consideration
This medication will not work for viral infections (such as common cold, flu).
Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.
Azithromycin is also used to treat lung and other respiratory infections, such
as bronchitis, sinusitis, community acquiredpneumonia, some cases of chronic
obstructive pulmonary disease (COPD), andwhooping cough (pertussis).
CONTRAINDICATION
Nausea
Vomiting
Diarrhea
Gas
Loose stools
Stomach discomfort
Some people may also experience cramps and yeast or vaginal infection.
Get emergency medical help right away if you experience any of the following:
Chest pain
Seizures
Fluid build-up between the lungs and the chest wall (symptoms may include
chest pain or heaviness, or difficulty breathing difficulties)
NURSING IMPLICATIONS
Assessment & Drug Effects
Monitor for and report loose stools or diarrhea, since pseudomembranous colitis
(see Appendix F) must be ruled out.
Monitor PT and INR closely with concurrent warfarin use.
Patient & Family Education
Direct sunlight (UV) exposure should be minimized during therapy with drug.
Take aluminum or magnesium antacids 2 h before or after drug.
Report onset of loose stools or diarrhea.
Do not breast feed while taking this drug without consulting physician.
7 tab doxobid 400mg po hs
Generic name: Doxofylline
Trade name: doxobid
Side effects
Treatment with the bronchodilator Doxobid (Doxofylline) could trigger side effects in
some patients. You must inform your physician if this occurs. Possible examples
include:
Sickness
Headaches
Stomach discomfort
Problems sleeping properly
Changes in behavior or mood
Other reactions may also occur. If you experience any side effects which are serious
in nature, it will be necessary for you to attend the hospital immediately or to see your
physician.
Precautions
Doxobid (Doxofylline) is not a cure for asthma or any other breathing condition. It is
only used to treat the symptoms.
If this medicine does not work for your symptoms, your physician may advise
alternative treatments.
SURGICAL MANAGEMENT :
1. Bullectomy
A bullectomy is the surgical removal of a bulla, a large air-filled space that can squash
the surrounding, more normal lung.
2. Lung Transplantations.:
COPD is the most frequent indication for lung transplantation. The survival rate
following transplantation for emphysema is the highest of any patient population with
lung disease. There is still debate as to when a transplant should be offered.
It is a surgical procedure for patients with severe emphysema. The hyper inflated
portion of the lungs is removed so that the patient’s chest wall and diaphragm can
return to normal positions, there by easing breathing, most often it is used as a bridge
to transplantation that improves respiratory function for patients during the prolonged
waiting time for donor organs
COPD is a long-term (chronic) illness. The disease will get worse more quickly if you
do not stop smoking.Patients with severe COPD will be short of breath with most
activities and will be admitted to the hospital more often. These patients should talk
with their doctor about breathing machines and end-of-life care.
COMPLICATION:
1. Respiratory infection
2. Acute respiratory failure
3. Spontaneous Pneumothorax
4. Lung cancer
5. Hypoxemia
6. Corpulmonale
7. Depression
NURSING MANAGEMENT:
Assessment:
- Increased shortness of breath
- Productive cough
- Wheezing respiration
- Activity intolerance
- reduced socialization
- Loss of appetite
Nursing diagnosis:
1. Activity intolerence related to imbalance between oxygen supply & demand
evidenced by fatigue and weakness.
2. Ineffective coping related to long-term illness, separation from accustomed
routine and support system, unfamiliar surroundings as evidenced by anxious
mood and reduced socialization.
3. Deficient knowledge regarding disease condition, treatment self-care and
discharge needs related to lack of information.
4. Risk for infection related to ineffective pulmonary function.
5. Risk for Imbalance nutrition: less than body requirement related to reduced
appetite decreased energy level and dyspnea.
NURSING CARE PLAN
1. Imbalanced nutrition; less than body Patient’s nutritional Nutritional intake is assessed Identifies deficits in nutritional Patient was able to
requirement related to anorexia. intake will be through taking history a. intake eat and drink
increased within 2 adequately.
(Related to nursing problem no.6:- days Oral hygiene maintained. Reduces unpleasant taste and
To facilitate the maintenance of increases appetite
nutrition of all body cells.) Advised to offer small Promotes appetite positive
frequent meal in pleasant environment for intake.
environment.
Advised for nutritious diet Provides Encouragement for
and its importance. eating
2. Ineffective breathing pattern To maintain Assessed the It helps for further Patient felt
related to hypoxia as evidence by effective way of general condition of intervention. easy
shortness of breath. breathing. patient breathing
It helps for further
(Related to nursing problem no. 5:- Assessed the after nursing
intervention.
To facilitate the maintenance of a respiratory intervention.
supply of oxygen to all body cells.) status.(rate and
depth)
Helps for easy
Kept the patient in
breathing.
prop –up position.
Open window & It helps cross
Day-2 016-06-20
Day-3
Client stable
Oxygen therapy
Vitals stable
Intravenous and oral medicine continue
Sputum for AFB II send
Shift to medicine ward
Tab doxobid 40mg po hs.
Day-4
Client stable
Sputum for AFB III send
Reports collected; AFB negative
Oxygen inhalation intermitted
Spo290% without 02.
Day 5th
Patient’s stable
Vital sign stable
Spo2 90% without oxygen
Pt is ni noramal diet
Plan for discharge.
Discharge Medication
1
Tab- Frusal OD×Coninue….
2
Health teaching is very important to promote health, prevent and to cure disease more
quickly without complications. As a good nurse we should deliver patient health
education. Health education can be given in the following topics:-
Nutrition: - Good nutritious food is very essential for all type of sick persons. I
advised her to take nutritious food with high protein and more vegetables and
fruits to increase the immune system to protect the patient from several diseases
and tissue repair. Education was also given about low sodium, low fat &
cholesterol diet) with high calcium and magnesium containing diet to prevent the
increase of blood pressure. Importance of frequent urination and regular emptying
of bowel and bladder. I advised to take her adequate fluids and roughage diet to
prevent constipation.
Rest and sleep: - Without proper sleep and rest it is difficult to recover from the
diseases. I strongly told her to take complete rest and sleep which will help
patient’s body to recover from the diseases. It helps to decrease oxygen demand
also. Follow your provider's recommendations for physical activity. Exercise
helps strengthen your heart and body and improves your blood flow and energy
level. Avoid outdoor exercise if it is very hot, cold or humid; consider indoor
activities on these days. Balance exercise with rest.so encourage to do gradual and
light exercises that demand less oxygen.
Prevention from infection:- I aware her about the disease to prevent from further
spread of infection. Patient should also focus on the proper disposal of used
objects, urine, stools and proper hand washing before and after use. I gave health
education regarding the proper cleanliness of the utensils used by the client eg
sputum mug and proper disposal of the sputum to prevent the risk of infection.
Medication :Instruction about medication (its continuation & side effects).
Personal hygiene and safe environment:I encouraged patient to maintance of
hand hygine & importance of wearing clean clothes,keeping short nails.I also
encouraged patient to stay away from pollution,smoke,wood fires etc.
Activity & exercise, maintenance of weight: Weigh yourself and write down
your weight every day. Weigh yourself in the morning after you use the bathroom
but before eating breakfast. Tell your healthcare provider as soon as possible if
you gain weight, or if you keep gaining weight over weeks to months. Weight
gain may mean your body is having trouble getting rid of extra fluid.
Breathing exercise:I taught & encouraged patient to imporatance of deep
brathing & coughing exercise & purse lip breathing.
Avoid mental tension: Get enough rest, shorten your working hours if possible,
and try to reduce the stress in your life. Anxiety and anger can increase your heart
rate and blood pressure. If you need help with this, ask your healthcare provide
mental tension & any kinds of the stress can agreevate disease process.
Never start smoking again:Avoiding noxious agents such as alcohol,smoking &
participating in activites/exercise all aid in preventing extacerbation of cardaic
failure.
when to seek medical help imediately:
You have chest pain or pressure.
You feel dizzy or faint or pass out.
You are having trouble breathing.
Your pulse is racing (very fast heart rate).
Follw up visit:Importance of regular follow up.
Diversional Therapy
According to book According to my Clients
Games, outings, computers, gentle • Individual emotional and
exercise, music, arts and crafts. Individual social support
emotional and social support • Gentle exercise.
Sensory enrichment, activities like • Relaxation technique
massage and aromatherapy, pet therapy • Talking with other Client
Discussion groups, education sessions like • Listening folk music by mobile
grooming, beauty care, cooking phone.
WHAT I LEARNED FROM MY CASE STUDY
Case study is the effective method of learning about the related disease in depth and
practice. case study gives the comprehension with book and real situation.
I learned and experience many things from my case study of COPD and which are
listed below.
1) About patient:
During case study I was completely involved and attached with my
patient. I know the emotional status and medical reaction of the patient
about the treatment and disease.
2) About family and Environment:
I also get opportunity to learn general attitude of family and their
environment, socio-cultural educational, religious and economical
status.
3) About nursing care:
I applied nursing theory while giving care to patient. It is the scientific
method of caring the patient
4) About diversional therapy and management
I got chance to detect the stressful factor and different therapy to
overcome from stress
5) About Documentation:
During the case study I develop further skills in documentation in a
more revised manner.
CONCLUSION
In 4 weeks posting in CMS, I selected a case COPD with Corpulmonale. I tried my
best to provide good nursing care to my patient during hospitalization. I maintained
good relationship with the patient and her family and they also co-operate me as well.
I got an opportunity for comprehensive study and provide holistically quality care.
I am fully satisfied with my case study because I got an opportunity to learn about the
patient’s disease condition, its causes, signs and symptoms, management also
prevention of disease.
And lastly, I am satisfied with my case study because I got an opportunity to learn
about application of nursing theory, nursing process and Therapeutic Relationship,
rehabilitation process,counseling technique in detail. I also counseled the patient
about diet, rest and personal hygiene.
Research on copd:
5. Phipps WJ, Monahan FD & et al (2003). Medical Surgical Nursing, 7th edition,
Mosby, Missouri, PP. 574-580.