S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE AND RESEARCH
CENTER,NAVSARI.

SUB - MEDICAL SURGICAL NURSING

TOPIC – Medical Case presentation on chronic obstructive
pulmonary disease

SUBMITTED TO, SUBMITTED BY,

MRS.NIKITA PATEL MS AVNI PATEL
ASSISTANT PROFESSOR 1st YEAR M.SC (N)
SSAGCON,NAVSARI SSAGCON,NAVSARI

DATE OF SUBMISSION

16-7-21
OUTLINE
 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Disease condition
 Anatomy and physiology
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography

INTRODUCTION
 Name-Patel Avni c.

Class- First year M.sc Nursing

Topic- Medical case presentation on Chronic obstructive Pulmonary disease

Date-

Introduction

As a part of our clinical experience in medical surgical nursing ,we posted in

Navsari hospital and we posted for training.I selected one patient for my case
presentation requirement.

HISTORY COLLECTION
INFORMATION DATA

Name – Mr AnilBhai ManguBhai Halpati

Age – 52 year
Sex - Male
Address –udhyog nagar,Navsari
Date of birth -04/09/1969
Education-10th pass
Religion- Hindu
Bed number- 03
Ward- Male medical ward
Medical diagnosis- chronic obstructive pulmonary disease
Surgery- not performed
Occupation- labour work
Date and time of admission-14-7-21

CHIEF COMPLAINT

Mr Anilbhai is complaining of breathing difficulty ,cough,

mucus production,
fever
fatigue
difficulty during exhaling air
prolonged expiration
HISTORY OF PRESENT MEDICAL ILLNESS

Mr.Anilbhai having present complaints are:

 Chronic coughing
 Dyspnea
 Tightness in the chest
 Respiratory insufficiency
 Increased work of breathing
 Production of purulent sputum

HISTORY OF PRESENT SURGICAL ILLNESS

No any significant data about present surgical illness.

HISTORY OF PAST MEDICAL ILLNESS

Patient having history of asthma since 2 years.& no any other history like,Anemia , seizures,
arthritis,heart disorders.
Trauma , injury- no any significant data about trauma or injury .
Hospitalization- 2 -3 times patient admitted in the hospital for the treatment of the asthma.
Childhood diseases and immunization- No any significant data about childhood
disease,patient taken all the vaccine like,tetanus,hepatitis,mumps,rubella,pertusis.

FAMILY HISTORY

KEY
 47 yr 52 year Male

Swati Anilbhai

Pal Female

24 year

Patient

FAMILY COMPOSITION

Name of the Ag Sex Education Occupation Income Marital Health

patient e status status
family
member
1Mr.anilbhai 52 male 10th pass Labour 12000 married ill
work
2.Mrs Swati 50 female illeterate House wife - married healthy
3Mr. Pal 24 male b.com - - unmarrie healthy
d

FAMILY HISTORY

Mr.Anilbhai living in a nuclear family.no any hereditary disorder is present in the family
member .All the members are well cooperate with each other.

PERSONAL HISTORY

 Mr Anilbhai is looking moderately nourished, skin colour is brown,he has a habit of

smoking.he is a vegetarian.in the routine food he takes dalroti,rice,sabji 2 times per
day.
Personal hygiene:
Oral hygiene-once a time
Bath-once in a day daily
Sleep and rest- 7 hours/day
Elimination:
 Bowel per day:regular per day
Urine frequency:1500ml/day
Mobility and exercise:
Moderate:moderate exercise he is doing.

ENVIRONMENTAL HISTORY:
Type of house: pacca
Ventilation:good
Water supply: municipality
Electricity: good
Drainage: closed drainage
Cooking:separate kitchen
Location of house: in village
Pet animals: No

PHYSICAL EXAMINATION

GENERAL HEALTH:
 Nourishment – Moderately nourished
 Body built- normally built
 Health - ill
 Activity – Dull
SKIN CONDITION:
  Colour- pale
 Texture-warm
 Temperature-100f
HEAD AND FACE :
 Scalp- No injury
 Hair condition- equally distribution of hair
EYES:
 Eye brow- Symmetrical
 Eyelashes-no any infection
 Eye lid- no swelling
 Eye ball-equally reaction to the light
 Conjunctivia- pinkish in colour
 Sclera-whitish
 Lens-opaque
 Vision-normal

EAR :

 External ear-no discharge

 Tympanic membrane-normal
 Hearing acuity-normal
NOSE:
 No bleeding and discharge
MOUTH:
 Pharynx- no redness/swelling/no gum bleeding
 Teeth-no dental carries
 Tounge-no ulcer/normal
NECK:
No lymphnode enlargement
Normal neck movement
CHEST :
 Shape- Barrelled chest
 Sound-wheezing sound present
 No hempoptysis
 Heart sound-s1 and s2 sound
 Breast/axilla- symmetry
ABDOMEN:
 Inspection-no lesion/no swelling
 Palpation-no tenderness
 Percussion-no mass/no distended bladder
 Auscultation-normal bowel sound
 Genitals-no ulcer/pain/itching/discharge
 Rectum-no hemorrhoids/no melina
EXTREMITIES
 Normal range of motion in both extremities

SYSTEMIC ASSESSMENT
RESPIRATORY SYSTEM:
 chest movement –symmetrical
 shape- barrelled
INSPECTION
 chest wall configuration- normal
 presence of superficicial vein-absent
 angle of the ribs-45 degree
 intercostal space retraction- absent
 muscles of respiration-use of accessory muscles-yes
 Rate-tachypnea
 Rhythm-normal
 Depth-hyperphoea
 Audibility-audible
 Patient position-upright
 Mode of breathing-Normal
 Sputum colour-light yellow
PALPATIONS
General palpation
 Pulsation- present
 Masses-absemt
 Thoracic tenderness-absent
 Crepitus-absent
Thoracic excursion-bilateral increased
Tactile fremitus-absent
Tracheal position-midline
Percussion
Lung-resonant
Diaphragm- dull
Rib-flat
 Diaphargamatic excursion-3-5 cm
CARDIOVASCULAR SYSTEM

 Heart rate- 78 beats/min

 Murmur sound-absent
 Peripheral pulse- palpable
GASTROINTESTINAL SYSTEM
 Abdomen-no distension
 Liver-not palpable
 Spleen-not palpable
CENTRAL NERVOUS SYSTEM
 Response to stimuli-present
MUSCULOSKELETAL SYSTEM
 Movement-ROM normal
 Joints-no pain

INVESTIGATION

Laboratory data Normal value Patient value

Hematocrit 35-45% 35%
Hemoglobin 12-16gm/dl 10gm/dl
Cholesterol <200 mg/dl 180mg/dl
HDL <40 low/>60 high <50
LDL <100-optimal <80
triglyceride <150 normal <160
Total lymphocyte count 1500-1800cells/mm3 1600cells/mm3
Albumin 3.5-5.0gm/dl 4mg/dl
glucose 85-125mg/dl 80mg/dl
creatinine 0.6-1.2mg% 0.9mg%

CT SCAN
IMPRESSION
CT images can identify emphysema better and at an earlier stage than a chest x-ray. They can
also identify other changes of COPD such as enlarged arteries in the lungs. CT is sometimes
used to measure the extent of emphysema within the lungs.

PHARMACOLOGICAL MANAGEMENT
DRUG DOSE ROUTE FREQUENCY ACTION
Albuterol 2 mg By mouth TD Bronchodilator
Azithromycin 6oo mg oral OD Antibiotic
Theophyline 300mg Iv OD Bronchodilator
Predinisolne 50 mg oral TD Anti
inflammatory
DRUG NAME DOSE,ROUTE ACTION INDICATION CONTRAINDICATION SIDE EFFECT
Albuterol 2 mg Albuterol acts on beta-2  Breathing difficulty  overactive  nervousness
By oral adrenergic receptors to  Shortness of breath thyroid gland  headche
relax the bronchial  Chest tightness  diabetes  nasal irritation
smooth muscle.it  Copd  excess body  muscles ache
inhibits the release of acid  palpitations.
immediate  high blood
hypersensitivity presssure
 ketoacidosis
mediators from
cells,especially mast
cells.

 Community acquired  low amount of  Nausea

Azithromycin 6oomg It prevent bacteria from pneumonia magnesium in  Abdominal
oral growing by interefering  Pharyngitis the blood pain
with their protein  Acute bacterial sinusitis  myasthenia  Vomiting
synthesis.it binds to the  Genital ulcer disease gravis  Constipation
5os subunit of the  Pelvic inflammatory  hearing loss  Dizziness
bacterial ribosome,thus disease.  abnormal heart  tiredness
inhibitng translation of rhythm
mRNA,nucleic acid  slow heartbeat
synthesis is not
affected.
 ANATOMY AND PHYSIOLOGY
When the respiratory system is mentioned, people generally think of breathing, but breathing
is only one of the activities of the respiratory system. The body cells need a continuous
supply of oxygen for the metabolic processes that are necessary to maintain life. The
respiratory system works with the circulatory system to provide this oxygen and to remove
the waste products of metabolism. It also helps to regulate pH of the blood.

Organs involved in respiratory system

 Nose.
 Mouth.
 Throat (pharynx)
 Voice box (larynx)
 Windpipe (trachea)
 Large airways (bronchi)
 Small airways (bronchioles)
 Lungs.

ORGANS AFFECTED IN COPD

 LUNGS
 BRONCHI
 BRONCHILOES

LUNGS

The lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax).
The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches,
called bronchi.
Each lung is composed of smaller units called lobes. ... The right lung wt (600gm) consists
of three lobes: the superior, middle, and inferior lobes. The left lung wt (550) consists of
two lobes: the superior and inferior lobes.

• Each lobe of the lung has the same physiologic function, bringing oxygen into the
bloodstream and removing carbon dioxide.

The main function of the lungs is the process of gas

exchange called respiration (or breathing). In respiration, oxygen from incoming air enters
the blood, and carbon dioxide, a waste gas from the metabolism, leaves the blood. A reduced
lung function means that the ability of lungs to exchange gases is reduced.

BRONCHI
The bronchi are the airways that lead from the trachea into the lungs and then branch off into
progressively smaller structures until they reach the alveoli, the tiny sacs that allow for the
exchange of oxygen and carbon dioxide in the lungs.
While the bronchi function primarily as passageways for air, they also play a role in immune
function. A number of different medical conditions can affect the bronchi,
including bronchitis, asthma, chronic obstructive pulmonary disease (COPD), and lung
cancer.

BRONCHIOLES

Bronchioles are air passages inside the lungs that branch off like tree limbs from the bronchi
—the two main air passages into which air flows from the trachea (windpipe) after being
inhaled through the nose or mouth.
FUNCTION
The function of the bronchioles is to deliver air to a diffuse network of around 300 million
alveoli in the lungs.5 As you inhale, oxygenated air is pulled into the bronchioles. Carbon
dioxide collected by the alveoli is then expelled from the lungs as you exhale.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

INTRODUCTION
COPD, or chronic obstructive pulmonary disease, is a long-term lung disease that refers to both
chronic bronchitis and emphysema. COPD symptoms include persistent cough with mucus and
shortness of breath. There are four stages of COPD. Treatment includes medications and lifestyle
changes.
DEFINITION
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that
causes obstructed airflow from the lungs.

Emphysema and chronic bronchitis are the two most common conditions that contribute
to COPD. These two conditions usually occur together and can vary in severity among
individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to
and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus
(sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages
(bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke
and other irritating gases and particulate matter.
How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes
(bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree —
into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).

The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air
you inhale passes into these blood vessels and enters your bloodstream. At the same time,
carbon dioxide — a gas that is a waste product of metabolism — is exhaled.

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of
your body. COPD causes them to lose their elasticity and over-expand, which leaves some air
trapped in your lungs when you exhale.

CAUSES

Causes of airway obstruction include:

 Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers
of the alveoli. Small airways collapse when you exhale, impairing airflow out of your
lungs.
  Chronic bronchitis. In this condition, your bronchial tubes become inflamed and
narrowed and your lungs produce more mucus, which can further block the narrowed
tubes. You develop a chronic cough trying to clear your airways.
Cigarette smoke and other irritants

In the vast majority of people with COPD, the lung damage that leads to COPD is caused by
long-term cigarette smoking. But there are likely other factors at play in the development
of COPD, such as a genetic susceptibility to the disease, because not all smokers
develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air
pollution, and workplace exposure to dust, smoke or fumes.

Alpha-1-antitrypsin deficiency

In about 1% of people with COPD, the disease results from a genetic disorder that causes low
levels of a protein called alpha-1-antitrypsin (AAt). AAt is made in the liver and secreted into
the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can cause liver
disease, lung disease or both.

For adults with COPD related to AAt deficiency, treatment options include those used for
people with more-common types of COPD. In addition, some people can be treated by
replacing the missing AAt protein, which may prevent further damage to the lungs.

Risk factors

Risk factors for COPD include:

 Exposure to tobacco smoke. The most significant risk factor for COPD is long-term
cigarette smoking. The more years you smoke and the more packs you smoke, the
greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at
risk, as well as people exposed to large amounts of secondhand smoke.

 People with asthma. Asthma, a chronic inflammatory airway disease, may be a risk
factor for developing COPD. The combination of asthma and smoking increases the risk
of COPD even more.

 Occupational exposure to dusts and chemicals. Long-term exposure to chemical

fumes, vapors and dusts in the workplace can irritate and inflame your lungs.
  Exposure to fumes from burning fuel. In the developing world, people exposed to
fumes from burning fuel for cooking and heating in poorly ventilated homes are at
higher risk of developing COPD.

 Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of

some cases of COPD. Other genetic factors likely make certain smokers more
susceptible to the disease

CAUSES AND RISK FACTOR

BOOK PICTURE CLIENT PICTURE
Emphysema -
Chronic bronchitis present
Alpha 1 antitrypsin deficiency -
smoking present
Ashthma present
Genetics

TYPES

Types of COPD
COPD is an umbrella term used when you have one or more of these conditions:
Emphysema. This results from damage to your lungs’ air sacs (alveoli) that destroys the walls
inside them and causes them to merge into one giant air sac. It can’t absorb oxygen as well, so
you get less oxygen in your blood. Damaged alveoli can make your lungs stretch out and lose
their springiness. Air gets trapped in your lungs and you can’t breathe it out, so you feel short of
breath.
Chronic bronchitis. If you have coughing, shortness of breath, and mucus that lingers at least 3
months for 2 years in a row, you have chronic bronchitis. Hair-like fibers called cilia line your
bronchial tubes and help move mucus out. When you have chronic bronchitis, you lose your cilia.
This makes it harder to get rid of mucus, which makes you cough more, which creates more
mucus.
PATHOPHYSIOLOGY
Chronic obstructive pulmonary disease is a mixture of 3 separate progress.These process are
chronic bronchitis,emphysema,and to a lesser extent ,asthma,progression of copd is
characterized by the accumulation of inflammatory mucous exudates in the lumens of small
airways and thickening of their walls.
Due to causes and risk factors of the COPD

Affects ciliary cleaning mechanism of respiratory tract

Airflow is obstructed & air becomes trapped behind the obstruction

Alveoli greatly distend & lung capacity decreased

Increased accumulation of the mucus from mucus glands

Produce more irritation , infection

Damage to lungs

The pathophysiology of copd thus include the narrowing of the airway ,damage to the lungs
and other supportive tissue,hyperactivity of the lungs, dysfunction of the cilia in the airways
and constant damage of the alveolar walls.as the copd condition progresses patient of copd
manifest wheezing,productive cough, difficulty in clearing alveoli and shortness of breath.as
the pressure in the chest increases the patient faces more difficulty during exhaling air , rather
than inhalation.
CLINICAL MANIFESTATIONS

BOOK PICTURE CLIENT PICTURE

1)chronic coughing present
2) Shortness of breath present
3) frequent respiratory infections
4) production of purulent
5) chronic coughing
6) production of purulent sputum
7) acute & chronic respiratory failure
8) wheezing present
9) Increased work of breathing present
10) Weight loss
11) Respiratory insufficiency present
12) Tachypnea present
13) prolonged expiration
14) Pitting peripheral edema
15) blue fingernails
16) swollen ankles,feet,or legs
17)Barrel chest present
18) pursued lip breathing present
19) Reduction in renal flow
20) Right heart failure
DIAGNOSTIC EVALUATION

 Lung (pulmonary) function tests. These tests measure the amount of air you can
inhale and exhale, and whether your lungs deliver enough oxygen to your blood. During
the most common test, called spirometry, you blow into a large tube connected to a
small machine to measure how much air your lungs can hold and how fast you can blow
the air out of your lungs. Other tests include measurement of lung volumes and
diffusing capacity, six-minute walk test, and pulse oximetry.

 Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD.
An X-ray can also rule out other lung problems or heart failure.

 CT scan. A CT scan of your lungs can help detect emphysema and help determine if
you might benefit from surgery for COPD. CT scans can also be used to screen for lung
cancer.

 Arterial blood gas analysis. This blood test measures how well your lungs are bringing
oxygen into your blood and removing carbon dioxide.

 Laboratory tests. Lab tests aren't used to diagnose COPD, but they may be used to
determine the cause of your symptoms or rule out other conditions. For example, lab
tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin
deficiency, which may be the cause of COPD in some people. This test may be done if
you have a family history of COPD and develop COPD at a young age.
BOOK PICTURE CLIENT PICTURE
Lung ct scan present
Lung function test
Arterial blood gas test
AAT deficiency test
Laboratory test present
x-ray present
MEDICAL MANAGEMENT

The goals of COPD treatment are:

 To prevent further deterioration in lung function.
 To alleviate symptoms
 To improve performance of daily activities and quality of life.

MEDICAL MANAGEMENT

Medications

Several kinds of medications are used to treat the symptoms and complications of COPD.
You may take some medications on a regular basis and others as needed.
Bronchodilators

Bronchodilators are medications that usually come in inhalers — they relax the muscles
around your airways. This can help relieve coughing and shortness of breath and make
breathing easier. Depending on the severity of your disease, you may need a short-acting
bronchodilator before activities, a long-acting bronchodilator that you use every day or both.

Examples of short-acting bronchodilators include:

 Albuterol (ProAir HFA, Ventolin HFA, others)

 Ipratropium (Atrovent HFA)

 Levalbuterol (Xopenex)

Examples of long-acting bronchodilators include:

 Aclidinium (Tudorza Pressair)

 Arformoterol (Brovana)

 Formoterol (Perforomist)

 Indacaterol (Arcapta Neoinhaler)

 Tiotropium (Spiriva)

 Salmeterol (Serevent)

 Umeclidinium (Incruse Ellipta)

Inhaled steroids

Inhaled corticosteroid medications can reduce airway inflammation and help prevent
exacerbations. Side effects may include bruising, oral infections and hoarseness. These
medications are useful for people with frequent exacerbations of COPD. Examples of inhaled
steroids include:

 Fluticasone (Flovent HFA)

 Budesonide (Pulmicort Flexhaler)

Combination inhalers

Some medications combine bronchodilators and inhaled steroids. Examples of these

combination inhalers include:
  Fluticasone and vilanterol (Breo Ellipta)

 Fluticasone, umeclidinium and vilanterol (Trelegy Ellipta)

 Formoterol and budesonide (Symbicort)

 Salmeterol and fluticasone (Advair HFA, AirDuo Digihaler, others)

Combination inhalers that include more than one type of bronchodilator also are available.
Examples of these include:

 Aclidinium and formoterol (Duaklir Pressair)

 Albuterol and ipratropium (Combivent Respimat)

 Formoterol and glycopyrrolate (Bevespi Aerosphere)

 Glycopyrrolate and indacaterol (Utibron)

 Olodaterol and tiotropium (Stiolto Respimat)

 Umeclidinium and vilanterol (Anoro Ellipta)

Oral steroids

For people who experience periods when their COPD becomes more severe, called moderate
or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids
may prevent further worsening of COPD. However, long-term use of these medications can
have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an
increased risk of infection.

Phosphodiesterase-4 inhibitors

A medication approved for people with severe COPD and symptoms of chronic bronchitis is
roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway
inflammation and relaxes the airways. Common side effects include diarrhea and weight loss.

Theophylline

When other treatment has been ineffective or if cost is a factor, theophylline (Elixophyllin,
Theo-24, Theochron), a less expensive medication, may help improve breathing and prevent
episodes of worsening COPD. Side effects are dose related and may include nausea,
headache, fast heartbeat and tremor, so tests are used to monitor blood levels of the
medication.
Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can

aggravate COPD symptoms. Antibiotics help treat episodes of worsening COPD, but they
aren't generally recommended for prevention. Some studies show that certain antibiotics,
such as azithromycin (Zithromax), prevent episodes of worsening COPD, but side effects and
antibiotic resistance may limit their use

BOOK PICTURE CLIENT PICTURE

Bronchodilator ( albuterol) 
Systemic corticosteroids( prednisone)
Antibiotic ( amoxicillin)
Azithromycin 
Phosphodiesterase -4 inhibitors
Theophyline 
Anxiolytics
opiods 

SURGICAL MANAGEMENT

BULLECTOMY

A bullectomy is a surgical procedure that involves removing bullae, which are enlarged,
damaged air sacs in the lungs. A surgeon will remove one or more bullae through small
incisions in the chest.

Bullae can grow up to 20 centimeters across. Those that take up more than one-third of the
space in and around the lung are called giant bullae.

Doctors may recommend a bullectomy if the bullae significantly interfere with a person’s
breathing or cause health complications.

Bullae can cause symptoms of underlying conditions to become more noticeable. For
example, a person with chronic obstructive pulmonary disease (COPD) may have
exacerbated symptoms, such as:
  wheezing

 coughing up mucus

 tightness or pressure in the chest

 difficulty breathing in

 general fatigue from low oxygen levels

If they burst, bullae can cause a collapsed lung. If the lung collapses two or more times, a
person may need a bullectomy.

LUNG VOLUME REDUCTION SURGERY

Lung volume reduction surgery is used to improve breathing in some people with severe
emphysema, a type of chronic obstructive pulmonary disease (COPD).

During surgery, small wedges of damaged lung tissue are removed to allow the remaining
tissue to function better. After surgery, people often have less shortness of breath, have better
quality of life and are better able to exercise.

During lung volume reduction surgery, a chest (thoracic) surgeon removes small wedges of
damaged lung tissue, usually about 20 to 30 percent of each lung, to allow the remaining
tissue to function better. As a result, the diaphragm contracts and relaxes more effectively and
efficiently, so you can breathe more easily.

To determine whether you might benefit from lung volume reduction surgery, your doctor
may recommend the following:

 Imaging and physiological evaluation, including tests of your heart and lung function,
exercise tests, and a computerized tomography (CT) scan of your lungs to assess the
severity and location of the emphysema

 Initiation of pulmonary rehabilitation, a program that empowers people to take care of

themselves by increasing awareness of their physical function and emotions.

LUNG TRANSPLANT

A lung transplant is a surgical procedure to replace a diseased or failing lung with a healthy
lung, usually from a deceased donor. A lung transplant is reserved for people who have tried
other medications or treatments, but their conditions haven't sufficiently improved.

Depending on your medical condition, a lung transplant may involve replacing one of your
lungs or both of them. In some situations, the lungs may be transplanted along with a donor
heart.
 While a lung transplant is a major operation that can involve many complications, it can
greatly improve your health and quality of life.

When faced with a decision about having a lung transplant, know what to expect of the lung
transplant process, the surgery itself, potential risks and follow-up care.

NURSING MANAGEMENT

Assess the client status ask detail about the ,occupational exposure history ,positive family
history of respiratory disease.

Note the amount ,colour,and consistency of sputum.

The nurse should be inspect for use of accessory muscles during respiration and use of
abdominal muscles during expirations.

The nurse plays a key role in identifying potential candiadtes for pulmonary rehabilitation
and in facililtating and reinforcing the material learned in the rehabilitation program.

 Inspiratory muscle training. This may help improve the breathing pattern.

 Diaphragmatic breathing. Diaphragmatic breathing reduces respiratory rate, increases

alveolar ventilation, and sometimes helps expel as much air as possible during expiration.

 Pursed lip breathing

 Maintain the patients diet

 Encourage fluids

 Allow activity as tolerated

 Provide emotional support to allay the patients anxiety

 Weight thw patient daily

 Keep the patient in high fowlers position.

 Avoid exposure to chemical irritants and pollutants.

THEORY APPLICATION
Abdellab’s typology of 21 problem

NAME- Mr AnilBhai ManguBhai Halpati

AGE-52 year

SEX-Male

EDUCATION- 10th pass

OCCUPATION- Labour work

MARITAL STATUS- married

RELIGION- Hindu

DIAGNOSIS- chronic obstructive pulmonary disease

THEORY APPLIED- ABDELLAH’S TYPOLOGY OF 21 PROBLEM

COMPREHENSIVE NURSING CARE

 Recognizing the nursing problem of patient

 Deciding the appropriate courses of action to talk in terms of relevant nursing
principles.
 Providing continuous care to relive pain.
 Adjusting total nursing care plan meet the patient individual needs.
  Helping the indivodual to become more self directing in attaining.
 Carrying out continous evaluation and research to improve nursing techniques.

These original premises have undergone evolutionary process .

PARADIGM

Human being

Health

Environment

Nursing

AREAS

1. The physical,sociological,and emotional needs of the patients.

2.The types of interpersonal relationship between of the nurse and the patient.

3.The common elements of patient.

NURSING PROCESS

1. Ineffective airway clearance related to bronchospasm/ hyperplasia of bronchial walls as

evidenced by abnormal breath sounds.eg.( wheezes,crackles).

2.Impaired gas exchange related to alveolar capillary membrane changes as evidenced by

inability to move secretions.

3.Ineffective breathing pattern related to retained secretions as evidenced by increase

respiratory rate above the normal range.

4.Imbalanced nutrition less than body requirement related to dyspnea as evidenced by altered
taste sensation.
5.Activity intolerance related to imbalanced between oxygen supply and demand due to
inefficient work of breathing as evidenced by shortness of breath.

6.Risk for infection related to inadequate acquired immunity destruction.

Other possible Nursing diagnosis

 self care deficit may be related to intolerance to activity ,decreased

strength/endurance as evidenced by observation.
 Ineffective coping may be related to decreased
socialization,depression,anxiety and inability to work.
ASSESSMENT NURSING GOAL INTERVENTION IMPLIMENTATION RATIONALE EVALUATION
DIAGNOSIS

Subjective data: Ineffective airway Maintain Assess and monitor Assessed and To obtain After providing
clearance related airway respiration and monitored respiration baseline data all the nursing
Clients said that:I to bronchospasm/ patency with breath sound. and breath sound. care clients
am having hyperplasia of breath sounds breathing pattern
breathing bronchial walls as clear. Monitor and graph Monitored and graph is normal
difficulty evidenced by serial ABGs,pulse serial ABGs,pulse To know the somewhat.
abnormal breath oximetry and chest oximetry and chest x regression of
Objective data: sounds.eg. x ray. ray. disease.
( wheezes,crackle
By auscultate s). Encourage Encourage d To cop up with
breath sound. abdominal or abdominal or pursed or control
pursed lip breathig lip breathig exercises. dyspnea.
exercises.
Increased fluid intake.
Increased fluid
intake. Demonstrated chest Hydration helps
physiotherapy decrease the
Demonstrate chest viscosity.
physiotherapy
 Administer
bronchodilator
according to doctor Administer
order. dedbronchodilator
according to doctor To maintain
order. airway patency.

ASSESSMENT NURSING GOAL INTERVENTION IMPLIMENTATION RATIONALE EVALUATION

DIAGNOSIS

Subjective data: Impaired gas Improve ventilation Assess and record Assessed and record To obtain After providing
exchange and respiratory respiratory rate,depth. baseline data. all the nursing
Client said that: related to adequateoxygenation rate,depth. care patients gas
I am having alveolar of tissue. exchange is
constant cough capillary Palpate for improve
membrane fremitus. Palapted for fremitus. A decrease of somewhat.
Objective data: changes as vibratory tremors
evidenced by suggest fluid
Inability to inability to collection of air
move secretions move
secretions. trapping.

Encourage the Encouraged the Thick ,tenaciousc

expectoration of expectoration of opious secretions
sputum. sputum. are major source
of gas exchange.

To minimize the
Provide humidified Provided humidified symptoms of
oxygen as ordered. oxygen as ordered. severe dyspnea.

To decrease the
paco2.
Administer Administered
noninvasive noninvasive positive
positive pressure pressure ventilation
ventilation.
ASSESSMENT NURSING GOAL INTERVENTION IMPLIMENTATION RATIONALE EVALUATION
DIAGNOSIS

Objective data: Ineffective Improvement of Auscultate breath Auscultated breath To provide After providing
by checking breathing breathing sounds every 2 to 4 sounds every 2 to 4 immediatement all the nursing
respiratory rate pattern related pattern. hours as indicated. hours as indicated. treatment. care clients
to retained breathing pattern
secretions as Place a pillow Placed a pillow when To provide is normal
evidenced by when the client is the client is sleeping. adequate lung somewhat.
increase sleeping. expansion while
respiratory rate sleeping.
above the Maintain a patent
normal range airway ,suctioning Maintained a patent To remove
of secretions may airway ,suctioning of secretions that
be done as ordered. secretions may be obstructs the
done as ordered. airway.
Provide respiratory
support. Provided respiratory Aid in relieving
support the patient from
dyspnea.

Administer long
acting
bronchodilators
 Administered long To decrease
acting bronchodilators hyperinflation.

ASSESSMENT NURSING GOAL INTERVENTION IMPLIMENTATION RATIONALE EVALUATION

DIAGNOSIS

Subjective data: Imbalanced Display Ascertain Ascertained To obtain After providing

nutrition less progressive understanding of understanding of baseline data. all the nursing
Client said that I than body weight gain individual individual nutritional care clients
am feeling requirement toward the goal nutritional needs. needs. nutritinal level is
weakness. related to as appropriate. improve
dyspnea as Auscultate bowel Auscultated bowel Diminished or somewhat.
Objective data: evidenced by sounds. sounds. hypoactive
altered taste bowel
By altered taste sensation. Instruct the patient Instructed the patient
sensation. to frequently eat to frequently eat high To maintain
high caloric foods caloric foods in body weight.
in smaller portions. smaller portions.

Can produce
Avoid gas Avoid gas producing abdominal
 producing foods foods and carbonated distension which
and carbonated beverages. hampers
beverages. abdominal
breathing

Avoid very hot or

very cold foods. Avoided very hot or To aggravate
very cold foods. coughing
spasms.

ASSESSMENT NURSING GOAL INTERVENTION IMPLIMENTATION RATIONALE EVALUATION

 DIAGNOSIS

Subjective Activity Reports Assess the patients Assessed the patients To obtain After providing
data:client said intolerance reduced nutritional status. nutritional status baseline data. all the nursing
that I am feeling related to episodes of care clients
weakness. imbalanced dyspnea during Maintain Maintained prescribed Helps in building tolerance level is
between oxygen an activity. prescribed activity activity levels. tolerance . comfort
Objective data: supply and levels. somewhat.
demand due to
Patients is not inefficient work Teach and assist
able to do their of breathing as the patient with Taught and assisted Aids in building
work without evidenced by active ROM the patient with active stamina and
assistance. shortness of exercise. ROM exercise. avoid
breath. complications of
limited mobility

Provide at least 90 Provided at least 90 Undistrubed rest

minutes of minutes of undistrubed reduces demand
undistrubed rest in rest in between for oxygen
between activities. activities. allows..
HEALTH EDUCATION

1. Give up smoking
Giving up nicotine is one of the most important things you can do for your health. More than
3 million Americans quit every year. There are several helpful techniques to help you to quit.
Talk with your provider to determine which one may be most helpful to you:

 Medications
 Nicotine replacement therapy
 Self-help materials
 Counseling
 Group programs

Learn more about quitting smoking.

2. Eat right and exercise

Shortness of breath that comes with COPD can make it hard to heat a balanced diet. Eating a
healthy diet and exercising are important to keeping and improving your fitness level. Always
talk with your provider before starting a diet or exercise plan and start slowly.

 Eat small, more frequent well-balanced meals.

 Use a smaller plate and portions.
 Keep a bottle of water with you and drink before you eat.
 Eat one fresh vegetable or fruit with every meal.
 Keep moving to keep your muscle strength.
 Use a step counter to track how much you walk every day, then try to "beat" your
number by one step the next day.
 Build muscle by lifting a can of vegetables or using a exercise band.
 If physical therapy is prescribed, do your exercises and go to your appointments.

Learn more about nutrition and exercise with COPD.

3. Get rest
Rest is important to over all health, but there are several things that can make sleep difficult if
you have COPD. Most of the sleep problems related to COPD can be helped-talk with your
provider.

 Try to avoid napping so you are tired at bedtime.

 Try to get 30 minutes of exercise three times a week.
 Don't do anything stimulating (exercising, working, arguing) 2 hours before bedtime.
 Have a small high-protein snack such as cheese and crackers, a glass of milk or
handful of nuts before bed. Avoid large meals and a lot of carbohydrates.
 Keep your bedroom cool, dark, and quiet.
  Wear socks to keep your feet warm.
 No caffeine after 5 p.m.
 Keep regular bedtime and wake-up times.

4. Take your medications correctly

Most people with COPD take medicine to help with regular and occasional breathing
problems. Your drug treatment plan is tailored to your needs you need to monitor how it is
working and talk with your provider when you have questions or concerns.

 Use a daily routine for taking your medicine. Combine taking your drugs with another
daily routine such as brushing your teeth. Keep your medicines with your toothbrush.
 If you take pills a different times during the day, use a medicine checklist to help you
keep track of when you need to take which pill.
 Get a pillbox with sections for different days of the week and even times during the
day to help you not miss a dose.
 Tell your doctor about unpleasant side effects they may be relieved by changing the
dose or medication.
 Keep all your medicines with you while traveling, never check them in your luggage.

Download the COPD Medication Checklist.

5. Use oxygen appropriately

Some people with COPD need oxygen therapy to help their body work properly. Oxygen
therapy allows you to be more active and does not cause any harm to your lungs or body if it
is used correctly. You may need it for sleep, rest and activity.

6. Retrain your breathing

Learning new breathing techniques will help you move more air in and out of your lungs.
This helps decrease shortness of breath.

 Diaphragmatic breathing: Breathe in slowly and deeply through your nose. While
breathing in, push your stomach out. This uses the diaphragm and the lower
respiratory muscles.
 Pursed lip breathing: use the same diaphragmatic breathing technique, but when you
breathe out, purse your lips slightly like you are going to whistle. Breathe out slowly
through pursed lips. Do not force the air out.

7. Avoid infections
If you have COPD, you have an increased risk of lung infections.
  Vaccines are often recommended. The influenza vaccine is recommended yearly. The
pneumonia vaccine is recommended every 5 to 7 years.
 Wash your hands frequently to prevent the spread of germs and infections.

Learn more about avoiding infections.

8. Learn techniques to bring up mucus

When mucus collects in the airways, it can make breathing difficult and can lead to infection.
Your doctor can demonstrate these techniques for you. Use the techniques after using your
bronchodilator medicine.

 Deep coughing: take a deep breath and hold it for 3 seconds. Use your stomach
muscles to expel the air. Avoid a hacking cough or just clearing your throat.
 Huff coughing: take a breath that is slightly deeper than normal. Use your stomach
muscles to make a "ha, ha, ha" sound while you exhale. Follow this by diaphragmatic
breathing and a deep cough if you feel mucus moving.

Learn more about techniques for bringing up mucus.

9. Make and use an action plan

Your doctor or healthcare provider will help you understand when your symptoms are getting
worse and what you can do about it. Do not ignore your symptoms they will not go away.
Know when to call your provider and when to go to the Emergency Department.

10. Learn more about COPD

You can live a healthy and happy life with COPD. Learn about the disease. Write down your
concerns or areas where you want to see change and talk with your provider. Understanding
how the disease can impact your life and what you can do to prevent or fix problems can help
you take charge of your life and live the way you want to live

Complication

COPD can cause many complications, including:

 Respiratory infections. People with COPD are more likely to catch colds, the flu and
pneumonia. ...
 Heart problems. ...
 Lung cancer. ...
 High blood pressure in lung arteries. ...
 Depression.

DIET

Protein-rich foods

Eat high-protein, high quality foods, such as grass-fed meat, pastured poultry and eggs,
and fish — particularly oily fish such as salmon, mackerel, and sardines.

Complex carbohydrates

If you include carbohydrates in your diet, opt for complex carbohydrates. These foods are
high in fiber, which helps improve the function of the digestive system and blood sugar
management.

Foods to incorporate into your diet include:

 peas

 bran

 potatoes with skin

 lentils

 quinoa

 beans

 oats

 barley

Potassium-rich foods

Potassium is vital to lung function, so a potassium deficiency can cause breathing issues. Try
to eat foods containing high levels of potassium, such as:
  avocados

 dark leafy greens

 tomatoes

 asparagus

 beets

 potatoes

 bananas

 oranges

Potassium-rich foods can be especially useful if your dietitian or doctor has prescribed you
a diuretic medication.
SUMMARY

In this assignment I had include the following topic:

 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Disease condition
 Anatomy and physiology
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography
Conclusion

A group of lung diseases that block airflow and make it difficult to breathe.
Emphysema and chronic bronchitis are the most common conditions that make up COPD.
Damage to the lungs from COPD can't be reversed.
Symptoms include shortness of breath, wheezing or a chronic cough.
Rescue inhalers and inhaled or oral steroids can help control symptoms and minimise further
damage.
BIBLIOGRAPHY

1. lewis’s medical surgical nursing,second south asia edition ,new delhi,reed

elsevier india pvt,ltd ,page num 587-628.

2.Brunner and suddharths textbook of medical surgical nursing,twelth

edition,new delhi,page num,602-619.

3. Black J.M & Matassarin E(1997),MEDICAL SURGICAL NURSING:Clinical

Management for continuity of care.J.B.Lippincott.co

4. Smeltzer S.C.&Bare,B(2003) BRUNNER & SUDDARTHS TEXTBOOK OF

MEDICAL SURGICAL NURSING (10th edition).

5. Brunner & siddharts, ‘’ TEXTBOOK OF MEDICAL SURGICAL NURSING’’

Jaypee Brothers medical publishers(p) LTD,13th edition

6 F.A.Davis,”DRUG GUIDE FOR NURSES,” 9th edition, Nursing Robert Martone

Publication.

7.Javed Ansari and Davinder Kaur, ‘’TEXTBOOK OF MEDICAL SURGICAL

NURSING- 1’’, first edition, pee vee publication, 2015

8.Ksum Samant,"MEDICAL SURGICAL NURSING," 3rd edition, Vora medicak

Publication.

9.Kochuthresiamma Thomas," MEDICAL SURGICAL NURSING -I," 1st edition,

Jaypee publication.
10.Ross and Wilson’’ANATOMY AND PHYSIOLOGY,” 12TH edition, jaypee
Publication.

NET REFRENCES

 https://www.mayoclinic.org/diseases-conditions/copd/symptoms-
causes/syc-20353679#:~:text=Chronic%20obstructive%20pulmonary
%20disease%20(COPD,(sputum)%20production%20and
%20wheezing.
 https://www.webmd.com/lung/copd/10-faqs-about-living-with-copd
 https://www.nursingcenter.com/journalarticle?
Article_ID=1208806&Journal_ID=54016&Issue_ID=1208667