BIOGRAPHICAL INFORMATION

Name :- Wamanrao Bhagat

Age : 68year
Sex : -male
Date of admission : 11 /5/2022
Address : -Sant Kabir Ward Near Shivaji Market Hinganghat Wardha
Religion : hindu
Marital status: marrid
Education: -10th class
Occupation: - farmer
Provisional diagnosis: - COPD
Date of surgery: not done
Bed no : 7
Diagnosis:- COPD
Chief Complaint: Difficulty in breathing and Cough, fever

 Present medical status: Patient is now(13-6-2022) connected to a ‘T’ piece towards a O2 with 3 liters
of O2 on flow along with atmospheric air. On and off nebulization is given in addition to the chest
percussion.
Associated medical problems: No associated medical problems. Family history No relevant family history

Personnel history: Chronic smoker since his age 12 year , No habit of drinking
HISTORY OF PRESENTILLNESS: Patient come with chief complaints of generalized edema since 3
day, weakness since 3-4 days, loss of appetite since 3-5 days, cough with sputum since 3-4 days . after
certain investigation patient was diagnosed with COPD .where patient was admitted MICU

HISTORY OF PAST ILLNESS: Difficulty in breathing is present since 4 years and he was using inhaler
since the same, initially the difficulty was on severe exertion only. It became worsen on 11-5-2022,
immediately he got admitted in Kasturba hospital During the time of admission patient was having difficulty
in breathing, patient is conscious ,oriented and obeying commands on that day he was ventilated in SIMV
mode with the help of ET tube.  13-6-2022 he was done tracheostomy and connected to a ‘T’ piece
connector to the ventilator
 Immunization History: patient is immunized only with BCG.
 Surgeries :no significant history of any surgery
 Allergies: no history of any allergy from food, medications, etc
FAMILY COMPOSITION :-

Sr . Name of the family Age /sex Relationship Education Occupation Health status
no member With client

1 Wamanrao Bhagat 68 year /M Patient B.A Work in Unhealthy

company

2 Sunita Anup Moon 37 year /F Patient B.A Work in Healthy

Daughter company
 4 Samiksha Anup moon 17year/F Granddaughter 12 th Student Healthy

3 Sumit Anup moon 15 year/F Grandson 9 th Student Healthy

Socio economic history:- Type of house: Pakka type, No. of rooms: 4 rooms, Kitchen : separate Type
of drainage: open drainage,Type of toilet used: water seal,Sources of water: Hand pump and tap ,Type of
fuel: wood and gas, Adequate lighting: present ,Facilities available in surrounding: medical shops, schools
available, Monthly income: Rs 37000  Bread winner : Self, daughter
Personal History: Smoking : Smoker, smoke 12 sticks per day from 20 years,Food habbit: Mixed diet ,
2-3 times a day ,Food allergy : not known ,rug allergy: Not Known, Bowel and Bladder: Regular  Sleeping
pattern: Disturbed due to hospitalization, Hobbies: He likes to watch TV, listen radio
1. . PHYSICAL EXAMINATION
General Appearance:
Level of consciousness: conscious
Orientation: oriented to time , place and person
Pallor/cyanosis/edema/jaundice /clubbing: absent
Mood: good
Body built: moderate
Anthropometric measurement
Weight –60kg
 Height -163cm
BMI(weight in kg/height in meter)-27 (BMI) normal

HEAD TO TOE EXAMINATION

 Head
● Scalp- scalp are clear, no dandruff seen
● Hair distribution- equally distributed and black in colour
● Any Abnormality- No Eyes:
● Eyebrows -equally distributed in both eyes
● Eye lashes: normal: absence of infection , sty
● Eyelids:- symmetrical ;absence of edema, lesions,ectr-pion,entr-pion
● Eyeballs: normal: absence of sunken and protruded
● Conjunctiva: pink in colour
● Sclera:-white in colour
● Cornea and iris: normal; absence of irregularities and abrasions
● Pupil:- 3mm reacted toward light
● Lens: opaque
● Visual acuity:- normal Ears:
● Auricles:- normal
● Ear Drum:- normal
● Hearing aid :- hearing of both ear is appropriate towards sound Nose:
● Discharge:- No discharge present
● Nasal septum:- Not deviated nasal septum
● Nasal polyps- absent
● Any Abnormality- No
Mouth and pharynx:
● Lips:-brown in color,
● Gums:- healthy
● Teeth:- white in color
● Tongue:- coated, no sign of dehydration, moisturize tongue
 ● Any Abnormality- no
 Neck:
● Inspection- presence of jugular vein pulse
● Palpation- presence of elasticity of carotid artery pulse
Chest
● Inspection:-Symmetrical in both side
● Nipple:- Both nipple is symmetrical
● Palpation:- No abnormal mass palpate in chest
● Auscultation- wheezing sound is present
● Any Abnormality- No
 Abdomen:-
● Inspection:- Symmetrical
● Palpation:- No any splenomegaly and hepatomegaly
● Percussion: no any fluid present
● Auscultation:- hypoactive bowel sound present
● Colour- Brown in colour
● Shape- normal curvature ,no kyphosis present
● Lesion- on any lesion seen
Extremtities Range of motion- normal
Symmtery- symmetrical
Any abnormality- no other sign of abnormality seen
SYSTEMIC EXAMINATION
Respiratory System:-
● Inspection- symmetrical in shape and size
● Respiratory rate- 41 breath/min.
● Auscultation- wheezing sound present
● Percussion- improper chest expansion
 Cardiovascular System

● Inspection:-normal
● Blood pressure- 128/90 mmhg
● Auscultation:S1 and S2 sound present
● Heart rate:- 24 b/m Musculoskeletal System
● Inspection: symmetrical
● Palpation:- no swelling
● Range of motion: good range of motion
● Muscle tone and strength:- normal not good slightly weak Neurological System

BLOOD INVESTIGATIONS
Name of Patient's Value Normal Value Remarks
Creatinine 1.46 0.67- 1.17 mg/dL Increased

BUN: 14 14 (8 to 24 mg/dl in males)

(6 to 21 mg/dl in
females
Sodium: (135-145 mEq/L)
130
Potassium: 3.3 (3.5-5.0 mEq/L)

Chloride: (98-108 mmol/L)

84

HAEMATOLOGICAL
INVESTIGATIONS (4.5-5.5million/cubic
RBC: 3.6 mm)
 WBC: 12,500 (4,00,000-
10,00,000per cubic
mm)

NEUTROPHILS: 90 (40-80%)

LYMPHOCYTES: 6 (20-40%)

EOSINOPHILS: 2 (1-6%) 2
(1-6%)
MONOCYTES: 2 (2-10%)
BASOPHILS: 0 (0-2%) 0
(0-2%)
PLT: 1.0
(150,000-400,000
lakhs/cumm)
PCV: MCV:91.1 (81-101) 33
(40-50%)
MCH: 30.4
(27-32)
  ANATOMY AND PHYSIOLOGY OF LUNGS
The lungs consist of right and left sides. The right lung has three lobes: Upper lobe, Middle lobe, Lower
lobe The left lung has two lobes: Upper lobe, Lower lobe. The heart sits in the mid chest extending into the
left side The lungs, which is the organ for respiration is a paired cone shaped organs lying in the thoracic
cavity separated from each other by the heart and other structures in the media stinum. Each lung has a
base resting on the diaphragm and an apex extending superiorly to a point approximately 2.5 cm superior
to the clavicle. It also has a medial surface and with three borders- anterior, posterior and inferior. The
broad coastal surface of the lungs is pressed against the rib cage, while the smaller mediastinal surface
faces medially. The lungs receives the bronchus, blood vessels, lymphatic vessels and nerves through a slit
in the mediastinal surface called the helium, and the structures entering the helium constitutes the lungs
root
 The right lung is larger and weighs more than the left lung. Since the heart tilts to the left, the left lung is
smaller than the right and has an indentation called the cardiac impression to accommodate the heart. This
indentation shapes the inferior and anterior parts of the superior lobe into a thin tongue- like process called
the lingual. Starting from the trachea (windpipe), two large tubes known as bronchi (airways) separate and
distribute air to the left and right sides of the lungs. Pleura Each lung is invested by and enclosed in a
serous pleural sac that consists of two continuous membranes.
The visceral or pulmonary pleura invest the lungs,The parietal pleura line the pulmonary cavities and
adhere to the thoracic wall, mediastinum and diaphragm.The parietal pleura consist of four parts: coastal
pleura which lines the internal surface of the thoracic wall, mediastinal pleura which lines the lateral aspect
of the mediastinum, diaphragmatic .pleura which lines the superior surface of the diaphragm on each side
of the mediastinum, cervical pleura extends through the superior thoracic aperture into the root of the neck,
forming a cup-shaped dome over the apex of the lung.
Pleural Cavity The pleural cavity is the potential space between the visceral and parietal layers of the
pleural and it contains a capillary layer of serous pleural fluid which lubricates the pleural surfaces and
allows the layers to slide smoothly over each other during respiration. Surface tension created by the
pleural cavity provides the cohesion that keeps the lung surface in contact with the thoracic wall. Lobes
and Fissures of the Lungs Each lung is divided into lobes by fissures. Both lungs have oblique fissure and
the right is further divided by a transverse fissure. The oblique fissure in the left lung separates the superior
and the inferior lobe. The oblique and horizontal fissure divides the lungs into superior, middle and inferior
lobes.
Thus the right lung has three lobes while the left has two. Each lobe is supplied by a lobar bronchus. The
lobes are subdivided by bronchopulmonary segments which are supplied by the segmental bronchi.
Tracheobronchial Tree All the respiratory passages from the trachea to the respiratory bronchioles are
called the tracheobronchial tree. The trachea divides at the sternal angle into right and left primary
bronchus which goes into the right and left lungs. Each bronchus enters the lung at a notch called the
hilum. Blood vessels and nerves also connect with the lungs here and together with the bronchus forms a
region called the root of the lungs. The right main bronchus is larger in diameter and more vertical making
it directly in line with the trachea than the left main bronchus. Thus swallowed objects that accidentally
enter the lower respiratory tract are most likely to become lodged in the right main bronchus. The main
bronchi divide into lobar or secondary bronchi within each lung. Two lobar bronchi exist in the . left lung,
and three exist in the right lung. The lobar bronchi, in turn give rise to segmental or tertiary bronchi. The
tertiary bronchi supply the bronchopulmonary segments. Bronchopulomonary Segment Functionally, the
lung is divided into a series of bronchopulmonary segments. The bronchopulmonary segments are the
largest subdivision of a lobe. They are separated from adjacent segments by connective tissue septa and are
also surgically resectable. They are 10 bronchopulmonary segments in the left lung and 8-10 in the left
lung. The bronchi further divides, finally giving rise to the bronchioles which are less than 1mm in
diameter. Each bronchioles divides into 50 to 80 terminal bronchioles, the final branches of respiratory
bronchioles. The functional unit of the lungs which is the acinus includes the respiratory bronchioles,
alveolar ducts, and sacs and the alveolar. Approximately 16 generations of branching occur from the
trachea to the terminal bronchioles. As the air passageways of the lungs become smaller, the structure of
their walls changes. Blood supply The bronchial arteries arising from the aorta provide blood supply to the
non-respiratory airways, pleura, and connective tissue while the pulmonary arteries supply the respiratory
units (acini) and participate in gas exchange. Venous drainage is mainly by the pulmonary veins (right and
left superior and inferior pulmonary veins), though the venous of drainage from the walls of the larger
bronchi is carried out by the bronchial veins. All four veins (pulmonary veins) drain into the left atrium.
Nerves supply The lungs and airways are innervated by the branches of sympathetic trunk and vagus nerve.
Sympathetic nervous stimulation results in bronchodilation and slight vasoconstriction, while
parasympathetic nervous system stimulation results in bronchoconstriction and indirect vasodilation. The
function of the lungs is controlled through the respiratory centre with groups of neurons located at the pons
and the medulla oblongata, and complex interactions of specialized peripheral central chemoreceptors.

DISEASE CONDITION CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

COPD is a disease of the lung. The lungs are the organs found in the chest which are invloved in breathing.
Air enters the nose and mouth, then travels to the lungs via the trachea, which divides into smaller airways
called bronchi and, subsequently, bronchioles. (See diagram below). The lung tissue itself is a spongy
material, consisting of a series of folded membranes (the alveoli) which are located at the ends of very fine
branching air passages (bronchioles). COPD is a disease of the smaller airways in the lungs.s

TYPES OF COPD
1. Chronic bronchitis: Defined as chronic cough with mucous production on most days for greater than
three months, for at least two consecutive years.
2. Emphysema: Defined as an enlargement of the alveoli and bronchioles, and destruction of the alveolar
walls. These disease processes affect the bronchi and alveolar walls, respectively. The end result of both is
the destruction of lung tissue and obstruction of the airways of the lung, leading to impaired gas exchange.
The two conditions usually occur together, causing chronic airflow limitation.

ETIOLOGY RISK FACTORS

Long term exposure to things that irritate your lungs. Cigarette pipe, bidi ,tobacco Passive smoking Dust,
air pollution Chemical pollution Age >40 yrs Genetics Tobacco Gender/age Respiratory infection Chronic
bronchitic Lung growth and development

 PATHOPHYSIOLOGY

Noxious particles and genes (tobacco,smoke,air pollution) Continual bronchial irritation&inflammation

Breakdown of elastin in connective tissue of lung Chronic bronchitis
 Bronchial edema
 Hypersecretion of mucous
 Chronic cough
 Bronchospasm Emphysema
 Destruction of alveolar septa
 Airway instability Airway obstruction Air trapping Dyspnea Frequent infection Abnormal ventilation-
perfusion ratio Hypoxemia Hypoventilation Cor-pulmonale
SIGN AND SYMPTOMS
Book picture Patient picture
occasional shortness of breath,

mild but recurrent cough

 needing to clear your throat often, especially first
thing in the morning late symptoms
 wheezing, which is a type of higher-pitched noisy
breathing, especially during exhalations
 chest tightness
 chronic cough, with or without mucus
 need to clear mucus from your lungs every day
 frequent colds, flu, or other respiratory infections
 lack of energy
 fatigue
 swelling of the feet, ankles, or legs
 weight loss
● Shortness of breath
● Wheezing sound present
● Cough with mucous
DIAGNOSTIC EVALUATION
Book picture Patient picture
History collection
Physical examination
Lung function test
Chest X-ray CT scan ABG
Laboratory test History
collection Complete
hemogram KFT,LFT,PT,INR
Chest X-ray ABG

Medical Management
Book picture Patient received
Oxygen therapy If your blood oxygen level is too
low, you can receive supplemental oxygen through a
mask or nasal cannula to help you breathe better. A
portable unit can make it easier to get around.
Medicationz
1.Bronchodilators Short acting bronchodilators
Albuterol Ipratropium levalbuterol long-acting
bronchodilators salmeterol
2.Inhaled steroids Fluticasone Budesonide
3. Phosphodiesterase-4-inhibitors Roflumilast
4. Antibiotics azithromycin Oxygen therapy
Bronchodilators Antibiotics

SURGICAL MANAGEMENT
Book picture Patient received
1.bullectomy. During this procedure, surgeons
remove large, abnormal air spaces (bullae) from the Not plan for any surgical treatment
lungs. Another is lung volume reduction surgery,
which removes damaged upper lung tissue. Lung
volume reduction surgery can be effective at
improving breathing, but few patients undergo this
major, somewhat risky procedure.
2.Lung transplantation it is an option in some cases.
Lung transplantation can effectively cure COPD, but
has its many risks. There is a less invasive method of
improving the efficiency of airflow in people with
severe emphysema called endobronchial valves
(EBV), which are one-way valves that divert
inspired air to healthy lungs and away from non-
functioning, damaged lungs.

COMPLICATIONS
Book picture Patient picture
 Secondary polycythaemia: This is an increase in
the number of red blood cells in the blood to try to
compensate for reduced oxygen levels. The blood
subsequently becomes ‘thicker’ with sluggish flow
which can lead to clotting
 Right heart failure;
 Pneumothorax: This is leakage of air from the
lung into the surrounding pleural space due to
rupture of
a bulla (dilated air space). This can lead to collapse
of the lung and may require insertion of a chest
drain;
 Respiratory failure: This is often caused by acute
infective exacerbations. Death can sometimes occur
from a severe decline in respiratory function
1. DESCRIPTION OF NURSING THEORY IN BRIEF: VIRGINIA HENDERSON’S THEORY OF
NURSING This theory was given by Virginia Henderson born in 30 november1897, in Kansas city,
Missouri and died on 17 march 1996. Henderson’s interest in nursing involved during world war 1 from her
desire to care for sick and wounded military personnel.
2. NURSING DEFINITION “The 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 (or to peaceful death) that he would
perform unaided if he had the necessary strength, will or knowledge.”
3. HENDERSON’S THEORY AND NURSING PROCESS
Nursing Process Henderson’s fourteen components and definition of Nursing Nursing Assessment Assess
needs of human being based on the 14 components of basic nursing care:
Breathe normally
Eat and drink adequately
Eliminate body wastes
Move and maintain desirable postures
Sleep &rest
Select suitable clothes: dress and undress Maintaining body temperature within normal range by adjusting
clothing and modifying environment.
Keep the body clean and well groomed and protect the integument
 Avoid the dangers in environment and avoid injuring others.
 Communicate with others in expressing emotions, needs, fears or opinions.
 Workship according to one’s faith.
 Play or participate in various forms of recreation.
Learn, discover or satisfy the curiosity that leads to normal development and health and use the available
facilties.
Nursing Diagnosis Analysis: compare data to knowledge base of health and disease indentify individual’s
ability to meet own needs with or without assistance, taking into consideration strength , will , or
knowledge.
Nursing Plan Document how the nurse can assist the individual ,sick or well
Nursing implementation Assist the sick or well individual in the performance of activities in meeting human
needs to maintain health,recover from illness, or to aid in peaceful death. Implementation based on
physiological principles, age ,cultural background , emotional balance, and physical and intellectual
capacities. Carry out the treatment prescribed by the physician.
Nursing evaluation Use the acceptable definition of nursing and appropriate laws related to the practice of
nursing. The quality of care is drastically affected by the preparation and native ability of the nursing
personnel rather than the amount of hours of care. Successful outcomes of nursing care are based on the
speed with which or degree to which the patient performs independently the activites of daily living.
ASSESSMENT ACCORDING TO NURSING THEORY CONCEPT
14 human needs Patient needs Breathe normally Patient is unable to breathe normally where SPO2 is 90%;
heart rate 124b /min ;pulse rate 41b/min. blood pressure is 148/110 last recorded.
Patient is having difficulty in breathing.
Eat and drink adequately Patient doesn’t feel urge to eat food , eats half chappati 3 times in a meal /day
Eliminate body wastes Patient bowel pattern is normal,able to excrete nitrogenous waste product out of the
body ,there is proper urine output Move and maintain desirable postures
Patient is feeling restless due difficulty in breathing Sleep &rest Patient sleeping pattern is normal
Select suitable clothes: dress and undress Maintaining body temperature within normal range by adjusting
Wearing Hospital clothes, and body temperature is normal clothing and modifying environment.
Patient is provided with hospital clothes , and environment is under comfortable zone – absence of loud
noises, warm environment due to presence of central heating lines Keep the body clean and well groomed
and protect the integument Patient used to bath daily at home but havnt taken bath since admitted in the
hospital apart from that patient has maintained himself properly and well groomed.
Avoid the dangers in environment and avoid injuring others Physically restraint due to restlessness and
abnormal breadth.
Communicate with others in expressing emotions, needs, fears or opinions. Patient is unable to communicate
as patient is feeling difficulty in breathing.
Workship according to one’s faith According to patient’s attendant patient worship everyday . Play or
participate in various forms of recreation. Participates in different home- activites and spends time with
relatives and friends as stated by his son Learn, discover or satisfy the curiosity that leads to normal
development and health and use the available facilties. Patient is not fully aware of the available health
facilities.
NURSING DIAGNOSIS
1 Ineffective airway clearance related to increased production of secretion as evidence by SPO2 -89%,
increased respiration rate 41br./min, abnormal breath sound e.g- wheezes sound
2.Impaired breathing pattern related to retained secretion as evidence by presence of non- productive cough,
wheezing sound on auscultation, increase respiration rate 41 br./min.
3. imbalance nutrition less than body requirement related to decrease food intake due to fatigue evidence by
reported as lack of interest in food, poor muscle tone.
4.Activity intolerance related to imbalanced between oxygen supply and demand due to efficient work of
breathing as evidenced by shortness of breath, tachypnea.
5. risk for infection realted to inadequate primary defenses (decreased ciliary action, stasis of secretions)
Nursing Nursing diagnosis Expected outcome Planning Rationale Implementation Evaluation

assessment
Subjective data Ineffective airway To maintain Assess the airway of To get the baseline Assessment of airway To check the
Patients states clearance related to patency with breath the patient. data of the patient done. effectiveness of
that I am not able increased production sounds nursing intervention
to breathe of secretion clear/clearing Provide chest Reassess the Chest physiotherapy provided to the
properly physiotherapy airway. Will help was provided patient Airway clear
to remove out the to some extent. spo2-
secretion which is c 96%. Respiratory rate
accumulated inside is 28breath /mint
Provide prescribed
bronchodilat or Reassess the airway of
Objective Data through nebulizer patient to the patient
observed through
Increase
respiratory efforts
,Spo2 -
90%,tachypn ea - Oxygen therapy give Helps in
to the patent 2 lit/min. maintaining Oxygen therapy given
41 breath/min.
oxygen content in to the patent 2 lit/min
ABG shows
Respiratory the body

acidosis
Nursing Nursing diagnosis Expected outcome Planning Rationale Implementation Evaluation

assessment
Subjective Data Impaired breathing To improve Assess patient’s  To know for any Assessed patient’s After providing
Patient states that pattern related to breathing pattern respiratory status every shortness of breath, respiratory status every nursing interventio n
I am having retained secretion To maintain 2-4 hours and notify tachypnea 2-4 hours and notify patient reported with
difficulty in as evidence by respiratory rate any abnormal findings.  To know decreased any abnormal findings no sign difficulty in
breathing. presence of non- within normal Auscultate breath breath sound like Auscultated breath breathing and
productive cough, limits. sounds every 2to 4 crackles, wheezes, sounds every 2to 4 respiratory rate is
Objective Data wheezing sound on hours. As indicated and rhonchi  hours. As indicated normal 28br./min
Observed by auscultation, Place a pillow when Provides adequate Placed a pillow when patient condition is
auscultation – increase respiration patient is lying lung expansion while patient is lying better than before
wheezing sound , rate 41 br./min patient is lying Provided respiratory
Provide respiratory
Increased  Aid in relieving the support.
support.
respiration rate - patient from dyspnea
41 br./min Provide medication to Provided medication
 Act as a
the patient as prescribed bronchodilator to the patient as
by the doctor  To check the prescribed by the
Reassess the patient effectiveness of doctor
condition nursing intervention Reassessed the patient

provided to the condition

patient
Nursing Nursing Expected Planning Rationale Implementation Evaluation
assessment diagnosis outcome
Subjective Data Imbalance Maintain Assess the patient dietary To get the baseline data Reassess the dietary Patient dietary
Patient says that I nutrition less their pattern. of the patient pattern Patient eats small pattern was
am not feeling than body lifestyle meals like half chapatti 3 improved to some
urge to eat requirement changes to times a day. Bowel sounds extent as started
anything related to balance Assess for the bowel Hypoactive bowel were 8 Patient was guided taking 1 chappati at
decrease food their sounds Give frequent oral sounds reflects limited to do proper oral care, and a time.
intake due to healthy diet care, remove expectorated fluid intake and poor expectorate their
fatigue evidence secretions promptly food choices Noxious secretions.
Objective Data by reported as taste,smell, Patient was told to take
Observed by lack of interest Encourage a rest period of Helps reducing faigue rest before and after
reported as lack in food, poor 1 hr. before and after during mealtime and meal .
of interest in muscle tone meals provides an opportunity
food, poor Instruct patient to increase to increase total caloric
muscle tone fluid intake 2.5 litres per intake Fluids aids in
day or more Instruct the decreasing the viscosity
patient to frequently eat of secretions for
high caloric foods in paitents with chronic
smaller portions started increased of production
taking fluid content. of sputum.
Patient started taking high
Patient started taking high
calorie food in smaller
calorie food in smaller
portions.
portions.
Nursing Nursing diagnosis Expected Planning Rationale Implementation Evaluation
assessment outcome
Subjective data Activity Patient will Assess activities the Reassess activities of Patient able to do
Patient says that I Intolerance participate in
patient currently partakes the patient   same daily activity
am not able to related to exercise while
daily activity Imbalance maintaining in Depression due to a loss
between oxygen respiratory of independence or
 
supply and pattern and
demand  and vital signs anxiety from a fear of
Deconditioning  within normal dyspnea can prevent the
limits 
patient from attempting Assessed emotional
physical activity.  factors affecting
Assess emotional factors To ensure the patient is activity.
affecting activity. safe to partake in
exercise, monitor vital
Objective data signs and changes in the Monitor
Dyspnea 
Fatigue  Monitor respiratory pattern as cardiopulmonary
Weakness  well as fatigue and an
Shortness of cardiopulmonary response.
breath with response. increased need for
minimal exertion  supplemental oxygen.
Abnormal rise in
BP or HR in Increase activity Teaching conservation
response to gradually. Perform
activity  Teach conservation techniques.
techniques. tasks that require the
most effort when
feeling the most
energized. 
Nursing Nursing diagnosis Expected Planning Rationale Implementation Evaluation
assessment outcome
Request for  Deficient Patient will Assess how the patient Medical information can Assess how the Patient same
additional Knowledge related verbalize learns best. be complicated. Use patient learned
knowledge improve
information or to Lack of factors that repetition. Provide verbal best.
clarification  information contribute to and written education as but daily health
Verbalizes provided ,Lack of worsening well as pictures or videos
education are give
inaccurate understanding and COPD  that reinforce breathing
information  Misinterpretation of Patient will techniques or how to
Demonstrates education  demonstrate properly use inhalers or
incorrect appropriate use oxygen.
techniques  of inhaler and Assess readiness and Assess the patient’s
Poor follow- oxygen  motivation. interest in learning about Assess readiness
through with tests Patient will their disease. If the patient and motivation.
or treatment  verbalize is not mentally or
Development of symptoms that emotionally ready to
worsening warrant accept teaching it will be
conditions  assessment and futile
intervention  Assess for a support Chronic conditions can be
system. difficult to manage alone. Assess for a support
Assess for family system.
members or friends that
can support the patient in
reinforcing teaching
instructions.

Instruct on how to COPD exacerbations refer

prevent and recognize to a worsening in Instruct on how to
exacerbations. symptoms for days or
prevent and
weeks and often require
hospitalization recognize
exacerbations.
Date Diet Medication Nurse assessment/intervention/planning/evaluation
Assessed in all morning care Patient’s general condition was restless Increase
respiratory efforts ,Spo2 - 90%,tachypnea - 41 breath/min. ABG shows
Respiratory acidosis
Monitored of vital sign regularly, Attended doctor’s round, nebularization give to
patient , I/V site changed.
B.P=120/80 mm of hg,
R.R=41/min,
Pulse=99 b/min,
Temp.=98ºf
Weight:70kg

Date Diet Medication Nurse assessment/intervention/planning/evaluation

Assessed in all morning care Patient’s general condition was good but have same
breathing difficultly
Monitored of vital sign regularly, Observed by auscultation – wheezing sound ,
Increased respiration rate -41 br./min Attended doctor’s round , Nail care given, I/V
Date Diet Medication site Nurse
changed, Detail history was done.
assessment/intervention/planning/evaluation
B.P=130/80 mm of hg,
Assessed in all morning care Patient’s general condition was good well oriented
R.R=41/min,
patient says I was not able to take food it test are not good lack of interest in food,
Pulse=100 b/min,tachycardia
poor muscle tone
Temp.=96 ºf
Monitored of vital sign regularly, Attended doctor’s round, nebularization give to
Weight:70kg
patient , I/V site changed.
B.P=120/80 mm of hg,
R.R=41/min,
Pulse=99 b/min,
Temp.=98ºf
Weight:70kg
Date Diet Medication Nurse assessment/intervention/planning/evaluation
Assessed in all morning care Patient’s general condition was restless Increase
respiratory efforts ,Spo2 - 90%,tachypnea - 41 breath/min. ABG shows
Respiratory acidosis
Monitored of vital sign regularly, Attended doctor’s round, nebularization give to
patient , I/V site changed.
B.P=120/80 mm of hg,
R.R=41/min,
Pulse=99 b/min,
Temp.=98ºf
Weight:70kg
HEALTH EDUCATION
1.Diet recommendations  vegetables  fruits  grains  protein  dairy  Liquids =Drink plenty of
fluids. Drinking at least six to eight 8-ounce glasses of non-caffeinated liquids a day can help keep
mucus thinner.
This may make the mucus easier to cough out. Limit caffeinated beverages because they can
interfere with medications. If you have heart problems, you may need to drink less, so talk to your
doctor. Eating habits A full stomach makes it harder for your lungs to expand, leaving you short of
breath. If you find that this happens to you, try these remedies:  Clear your airways about an hour
before a meal.  Take smaller bites of food that you chew slowly before swallowing.  Swap three
meals a day for five or six smaller meals.  Save fluids until the end so you feel less full during the
meal. Breathing Exercises with COPD
1.Pursed lip breathing  While keeping your mouth closed, take a deep breath in through your nose,
counting to 2. Follow this pattern by repeating in your head “inhale, 1, 2.” The breath doesn’t have to
be deep. A typical inhale will do.  Put your lips together as if you’re starting to whistle or blow out
candles on a birthday cake. This is known as “pursing” your lips.  While continuing to keep your
lips pursed, slowly breathe out by counting to 4. Don’t try to force the air out, but instead breathe out
slowly through your mouth.
2.Coordinated breathing of the patient patient To check the effectiveness of the nursing intervention
provided to the patient
Summary
We discus the case of COPD. My patient name Wamanrao Bhagat she is 68year old male Date of admission
: 11 /5/2022. He live at Sant Kabir Ward Near Shivaji Market Hinganghat Wardha. He diagnos as since 4
yaer COPD. He admitted in ICU with chife complaint difficulty in breathing and Cough, fever now he
Patient is now(11-5-2022) connected to a ‘T’ piece towards a O2 with 3 liters of O2 on flow along with
atmospheric air. On and off nebulization is given in addition to the chest percussion. Associated medical
problems: No associated medical problems. Family history No relevant family history precipitating factor
Chronic smoker since his age 12 yera , No habit of drinking