Vet Case Presentation(COPD)

8/8/2019 Vet Case Presentation(COPD)

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INTRODUCTION

CASE STUDYCASE STUDY


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Chronic obstructive pulmonary disease (COPD) is a

chronic, progressive disease of the lungs that reducesairflow over time. It is characterized by symptomsthat include coughing, wheezing and shortness ofbreath. As the disease progresses, quality of life maybe severely compromised.

COPD is most commonly associated with smokingtobacco over a period of years. COPD involvesgradual, permanent damage caused to the lungs,which is why the condition is usually found in peopleover the age of 60. COPD often results from one oftwo conditions emphysema or chronic bronchitis though both conditions may coexist in an individualwith COPD.


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Emphysema is a condition in which the air sacs in the lungs(alveoli) are damaged, interfering with the normal

exchange of oxygen and carbon dioxide. Some of themeventually collapse. Thus, a single, large useless hole takesthe place of the many functional sacs (alveoli) that hadbeen supporting the airways (bronchioles). This makes itharder to exhale stale air from the lungs and inhale a fullbreath of clean air.

Emphysema is often the result of smoke that has triggeredthe immune system to produce more harmful enzymes.Although these harmful enzymes are normally preventedfrom causing any significant damage by a protective

protein, smoking reduces the proteins protective effect.Even if someone has plenty of the protein in their system,smoking generates certain substances that keep theprotective protein from doing its job.


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Many of the symptoms ofCOPD are similar to those ofasthma, although the two conditions are not related inany way. Asthma usually involves breathing difficultiesthat occur as a result of inflammation in the airpassageways, while COPD impedes breathing by

causing more permanent lung damage. COPD isgenerally considered more damaging to the lungs thanasthma.

The damage caused byCOPD cannot be reversed, butmany individuals can stop additional damage fromoccurring by quitting smoking, avoiding airborneirritants and using drug treatments such asbronchodilators


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COPD affects an estimated 17 million Americans and itsprevalence is rising. It affects more men than women

and more whites than blacks. It doesnt always producesymptoms and causes only minimal disability in manypatients. However, COPD tends to worsen with time.


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I. PERSONAL DATA



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Name:Mr. FS

Address:Taguig CityAge: 56

Sex:Male

Civil Status:Married

Religion:Roman CatholicBirth Date: 01/01/1953

Room and BedNo.:Room 151 W15-138-04

Attending Physician: M.U.M., MD

Medical Diagnosis: (COPD) ChronicObstructivePulmonaryDisease

Chief Complaint: Difficulty of Breathing


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II. MEDICAL

HISTORY



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A. History of Present Illness

3 days PTA, patient had shortness of breath

accompanied by productive cough withwhitish phlegm secretions, loss of appetite.Self- medicated with N-acetylcystane andsalbutamol nebulization, with unrecordeddose, Provided patient temporary relief.


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1 dayPTA, still with the persistence of above signs andsymptoms but associated with low grade fever,

undocumented no consultation was done self-medicated with biogesic with unrecorded dose.

Few hours PTA, patient still had the above signs and

symptoms, patient was brought to VMMC and patientwas diagnosed with HCAP. Hence, admitted.


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B. Past Medical History

Patient had asthma and developed COPD. He also had PTBand was diagnosed year 1959.

C. Family Medical History

Patients Mother was also diagnosed with PTB and she is alsosmoking.

(-)Cancer(-)Diabetes Mellitus(-) Asthma(-) Allergy


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D. Social History

The patient is smoking; he started at the age of 18 year 1971.He consumes 10-20 sticks per day. He smokes for 26 yearsand stop last 1997. He also drinks alcohol beverages but notto much as verbalized by the patient and wife.

E. Environmental History

The patient lives in Taguig City; their house is an apartmentstyle. There are two bedrooms for 8 of them which are thepatient itself, his wife, daughter and her family. Accordingto the wife they are to crowded in the house.


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GORDONSPATTERNOF

FUNCTIONING



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Before

Hospitalization

During

HospitalizationAnalysis

Health perception-HealthManagement pattern

Takes a bath twice a day.

Brushes teeth twice a day.

Sponge bath twice a day

done by wife.

Brushes teeth twice a day

Attributed to activity

intolerance related to

occurrence of

shortness of breathing.

Nutritional-Metabolic PatternConsumes 3 meals a day,

usually meat and rice; and 2

snacks; biscuit and juice.

Hypoallergenic Diet; 3

meals and 2 snacks a day.

To prevent episodes of

asthma attack.

Elimination Pattern

BM once a day

Urination- 7 to 10 times a

day.

BM every other day.

Urination 8 to times a day.

Decreased elimination

pattern related to

decreased peristaltic

movement due to

limited movement.

Activity-Exercise pattern Walking. Complete bed rest without

bathroom privileges.

Due to easy

fatigability.

Sleep-Rest Pattern

The patient is usually having

6 to 8 hours of sleep every

day.

Still 6 to 8 hours but

disturbed.

Disturbed sleeping

pattern is due to his

cough, uncomfortable

environment and

ortho nea.


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Before

Hospitalization

During

HospitalizationAnalysis

Sexuality Reproductive Pattern

Coping stress Tolerance Pattern

Values-Beliefs Pattern


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PHYSICALASSESSMENT



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Date: July 28, 2009

General Survey:Oxygen is administered regulated in 2-3 L per minute to

provide adequate blood oxygenation. An increase inthe anteroposterior diameter of the chest was also

noted, an indication of expiratory muscles utilizationduring exhalation process.

Vital Signs:

Temperature = 36.1 oC

Pulse Rate = 81 beats per minute

RespiratoryRate = 20 breaths per minute

Blood Pressure = 130/80 mmHg


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ASSESSMENT TECHNIQUESUSED

NORMALFINDINGS

FINDINGS ANALYSIS

Head

Hair andscalp

Inspection andpalpation

Smooth andshiny, thick; Noinfection andinfestations

- Thick strandsof hair, black incolor, smoothand shiny;Normo-cephalic

NormalFindings


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NORMALFINDINGS

FINDINGS ANALYSIS

Eyes andvision

Inspection Normal

vision, and

no disease

in the eyes;

no masses

and nodules,smooth and

round head

white sclera

Pupil black,

briskly and

reactive,

sclera white,

position of

the eyes aresymmetrically

close to each

other, doesnt

wear

eyeglassesbut able to

read print

materials

without

difficulty

Normal

Findings


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NORMALFINDINGS

FINDINGS ANALYSIS

Ears and

hearing

Inspection Color same

as facial,symmetricalauriclealigned withoutercanthus, nodischarges,normalhearing

Color same

as facial,Normal setof ears, nodischarge,able to hearwith normaltone ofvoice

Normal

Findings


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NORMALFINDINGS

FINDINGS ANALYSIS

Nose Inspection Symmetric; nodischarge

Nodischarge,symmetric, color

same asfacial,with 02cannula

Patient has02 cannula2-3L asordered

due todifficulty inbreathing,patient

gasp for airw/oO2


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ASSESSMENT TECHNIQUES USED

NORMALFINDINGS

FINDINGS ANALYSIS

MOUTH ANDLIPS

NECK ANDNAPE

Inspection

Inspectionand palpation

Smooth enamelpink gums, soft

lips, no lesions

No discomfort;no mass andnodules,uniform incolor, lesions, notenderness

Smooth yellowenamel, dark

pink gums,blackish pinklips, no lesions

Uniform incolor; no mass,nodules andlesions. Neckveins areengorged.

Smoking causesyellow teeth as

the yellow-tinted nicotinepasses throughthe mouth, itstains the teeth;dark gums and

lips are alsoeffect ofnicotine.

Enlargement ofneck veins is onesign of corpulmonale; signof jugular veindistention.


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NORMALFINDINGS

FINDINGS ANALYSIS

UPPER

EXTREMETIES

Inspection Uniform skin

color,NormalROM, Left andRight upperextremities aresymmetric,complete

fingers, nailbeds pink,capillary refillof


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NORMALFINDINGS

FINDINGS ANALYSIS

CHEST ANDAC

Ins ecti n,sc ltati n,

al ati n

oiscolorationof

s in, no lesion,nor al

ia eter ofc est- reastandni le aresy etric; no

ass or nodule,nor alres irationrate; Nor al

reat sounds;nor al eart

eat; nodefor ities ofs ine

Increasedantero-

osteriordia eter ofc est ( arrelc est);

resenceofeezes;

Pulse rate 2

arrel c estdevelopeddue

to t eutilizationoft e accessoryusclesof

reat ing fort e purpose of

expiration.


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NORMALFINDINGS

FINDINGS ANALYSIS

ABDOMEN Inspectionand

Ausculta-tion

Uniform color,no lesions, notenderness;Bowelmovement

(Normo-active)

Active BowelMovement

- NormalFindings.


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NORMALFINDINGS

FINDINGS ANALYSIS

GEN

ITALS /RECTUM

LOWEREXTREMITIES

Inspection

Inspection

No foul Smelldischarges, nolesions in theskin, Nohemorrhoids

Uniform skincolor, normalROM,complete toes,

nail bedspink, canmaintainbalance andnormal gait

N/A

Normal

Patientrefuses to beassessed

- NormalFindings.


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LABORATORYRESULTS



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RESULT NORAMAL

RANGE

ANALYSIS INTERPRETATI

ON

WBC COUNT 11.2 5-10 x 10 / L ABNORMAL INCREASEDWBC ISAN INDICATION OFPRESENCE OFINFECTION.

SEGMENTER 0.79 0.60 0.70 ABNORMALINCREASED

SEGMENTERIS AN

INDICATIONOF

INFECTION.

LYMPHOCYTE 0.20 0.20 0.40 NORMAL

MO LO N

4 M-

40

80 g/ NORMAL

MATOCR T 0.50 M- 0.40 0.54 NORMAL

MATOLO Y S CT ON


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RESULT NORMAL

RANGE

ANALYSIS INTERPRET

ATION

CREATININE 160 53 -133 ABNORMAL INCREASEDCREATININE IS

ANINDICATION

OF INFECTION

POTASSIUM 4.9 3.9 ABNORMAL BRONCHODILATORS ONE SIDEEFFECTIS

INCREASEDIN

POTASSIUM

CHEMISTRY SECTION


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PATHOPHYSIOLOGY



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DRUG STUDY



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Generic

name

Brandname

Dosage Mechanismof Action

Indication Contraindi-cation

Adversereaction

NursingResponsi-bilities

Levo-flixaci

n

Floxel AdultTab250-500 m once daily. IV

500 m administeredby slowinfusion over60 min every24 hr or 750m administeredby slow

infusion over90 min every24 hr. 750-mg tabAcutebacterialsinusitis,community-aquired

pneumonia750 m for 5days.Nosocomialpneumonia,complicatedskin & skinstructureinfection

750 m

for7-14 days.

Antacids,sucralfate, metalcations &

multivit prepcontainin Znmay interfere w/absorption.Concomitantadministration oftheophylline,fenbufen orsimilar NSAID

may increasethe risk ofCNSstimulation &convulsiveseizures.Disturbances ofblood lucosereported inpatients treated

concomitantlyw/ quinolones &an antidiabetica ent. IVDo notco-administer w/soln containin

multivalentcations e

throu

h the

same IV line.Warfarin.

Treatment ofadults 1 yr w/mild, moderate &

severe infectionscaused bysusceptiblestrains ofmicroor

anismsin the followin

conditions:Community-acquired

pneumonia,acute bacterialexacerbation ofchronicbronchitis, acutemaxillarysinusitis,complicated &uncomplicated

skin & skinstructureinfections, acutepyelonephritis,complicated &uncomplicatedUTI, nosocomialpneumonia,chronic bacterial

prostatitis.

Hypersensitivity toquinolones. IV

Epilepsy,history oftendondisordersrelated tofluoroquinolonetherapy.Childn,pre

nancy &

lactation.

Diarrhea,abdominaldiscomfort,

nausea,anorexia,abdominalpain,vomitin

,stomatitis &heartburn;insomnia,headache &

dizziness;rash, pruritus& eczema;muscle &

joint pain;bone marrowdepression.Increasedliver

enzymes.Pain,reddenin

atthe inj site,phlebitis.


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Genericname

Brandname

dosage Mechanismof Action

Indication Contraindication

Adversereaction

Nursingresponsibilities

Isosorbide-5-mononitrate

Angistad

Tab 40 m

once daily,

may beincreasedto 40 m

bid. SR cap1 cap daily.

Antihypertensive a

ents, e

-

blockers, Caanta

onists &vasodilators;neuroleptics ortricyclicantidepressants, alcohol,dihydroer

otamine; NSAIDs;

sildenafil,tadalafil &vardenafil.Isosorbidemononitrate ;Belon

s to theclass of or

anicnitratevasodilators.Used in thetreatment ofcardiac disease.

Lon

-termtreatment of

ischaemic heartdisease. Preventionof an

ina attacks.Follow-uptreatment of heartattacks whensymptoms ofan

ina persist.Pulmonary

hypertension.Treatment ofchronic cardiacfailure, incombination w/cardiac

lycosides&/or diuretics.

Acute I w/ low-fillin

pressures,

left heart failurew/ low-fillin

pressures,shock, very lowBP, hypertrophicobstructivecardiomyopathy,constrictivepericarditis,

pericardialtamponade,aortic stenosis,mitral stenosis,markedanemias, headtrauma, cerebralhemorrha

e,closed-an

le

laucoma,hyperthyroidism,concomitanttherapy w/sildenafil,tadalafil &vardenafil.

Headachesat the

be

innin

oftreatment,fall in BP,nausea,vomitin

,transientskindisorders

(flushin

)& aller

icskinreactions.Rarely,paradoxicalnitrateeffects&/ormarkedparadoxicalbradycardia.


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Generic

name

Brandname

dosage Mechanismof Action


Adversereaction


losar

tan

Acet Acet/Acet-MS/Acet-ES

tabAdult &childn >12yr325-1000m 4-6 hrly.Childn 10-20 m /k 4-6 hrly. ax:4 /day.Acet syr

Adult &childn >12yr2-4 tsp,childn 6-12yr1-2 tsp,1-5 yr-1tsp.Infant3 mth-


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Genericname

Brandname

dosage Mechanism ofAction


Adversereaction


Bude-sonide

Symbicort

SYMBICORT should beadministered by the

orallyinhaledroute inpatientswithasthma 12years ofa e andolder.

SYMBICORT shouldnot be usedfortransferrin patientsfromsystemiccorticostero

id therapy.

Budesonide is ananti-inflammatorycorticosteroid thatexhibits potent lucocorticoidactivity and weakmineralocorticoidactivity. In standardin vitro and animalmodels, budesonidehas approximatelya 200-fold hi heraffinity for the

lucocorticoidreceptor and a1000-fold hi hertopical anti-inflammatorypotency thancortisol (rat crotonoil ear edemaassay). As a

measure ofsystemic activity,budesonide is 40times more potentthan cortisol whenadministeredsubcutaneously and25 times morepotent whenadministered orallyin the rat thymusinvolution assa .

SYMBICORTshould only beused forpatients not

adequatelycontrolled onother asthma-controllermedications(e. ., low- tomedium-doseinhaledcorticosteroids)

or whosedisease severityclearly warrantsinitiation oftreatment withtwomaintenancetherapies.SYMBICORT is

not indicated inpatients whoseasthma can besuccessfullymana ed byinhaledcorticosteroidsalon withoccasional useof inhaled,short-actin beta2-a onists.

SYMBICORT iscontraindicatedin the primarytreatment of

statusasthmaticus orother acuteepisodes ofasthma whereintensivemeasures arerequired.Hypersensitivit

y to any of thein redients inSYMBICORTcontraindicatesits use.

Lon -actin beta2-adrener ica onists may

increase therisk ofasthma-related death


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MEDICAL-SURGICALINTERVENTION



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y The main goal of treatment is to relieve symptoms and

prevent complications. Bronchodilators can helpalleviate bronchospasm and and enhance mucociliaryclearance of secretions. Effective coughing, posturaldrainage, and chest physiotherapy can help mobilize

secretions

yAdministration of low concentrations of oxygen helpsrelieve symptoms; arterial blood gas analysis

determines oxygen need and helps to avoid carbondioxide narcosis.


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Antibiotics help treat respiratory tract infections.Pneumococcal vaccination and annual influenza

vaccinations are important preventive measures.

Some patients benefit from inhaled corticosteroids asmaintenance therapy. Oral corticosteroids are

occasionally needed for acute exacerbations


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NURSINGCAREPLAN


Cues Nursing Analysis Objectives Interventions Rationale Evaluation


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Cues NursingDiagnosis

Analysis Objectives Interventions Rationale Evaluation

Snahihirapanako

humin a asverbalizedby thepatient.Odyspneaproductivecou hV/S taken as

follows:BP: 130/ 0PR: 1RR: 26TEMP: 36.1

Ineffectiveairway

clearance

related toincrease

productionof

secretions.

ChronicObstructionPulmonary

Disease(COPD) is a

diseasecharacterized

by airflowlimitationsthat is not

fullyreversible. Air

flowlimitations are

usuallypro ressive

andassociated

with aninflammatoryresponse in

the lun

sstimulated byirritants.Commoncause ofCOPD is

ci arette, airpollution,

aller ens andinfection thatmay also actas irritants.

After 4 hoursof nursin

interventions,

the client willdemonstratebehaviors to

improveairway

clearance.Example:

cou heffective and

expectoratesecretions

Monitor vital si

ns

Assist patient toassume positionof comfort.Example elevateshead of bed,encoura

e patientto lean on overbed table or sit on

the ed

e of thebed.

Keepenvironmentalpollution to aminimum.Example dust,smoke and

feather pillows,accordin

toindividualsituation

To have abaseline data.

Elevate of thehead of the bedfacilitatesrespiratoryfunction by useof

ravity.

Precipitator ofaller

ic type orrespiratoryreactions thatcan tri

er or

exacerbateonset of acuteonset.

After four hoursof nursin

interventions, the

patient was ableto demonstrate

behaviors toimprove airway

clearance.Example cou

heffective andexpectoratesecretions

Cues Nursing Analysis Objectives Interventions Rationale Evaluation


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Cues NursingDiagnosis

Analysis Objectives Interventions Rationale Evaluation

Encoura

e deepbreathin

exercise.

Observecharacteristic ofcou

h. Assist withmeasures toimproveeffectiveness orcou

h effort.

Administermedications asprescribed by thephysician.

Providesupplementalhumidification likenebulizer.

Provides patientwith somemeans to copeor control

dyspnea.

Cou

hin

is themost effectivein an upri

htposition or headdown position.

A variety ofmedicationsmay be used todecrease mucusand to improverepiration.

Humidity helpsreduce viscosityof secretions,facilitatin

expectorationand may reduceor preventformation ofthick mucusplu

s in

After four hoursof nursin

interventions, thepatient was able

to demonstratebehaviors to

improve airwayclearance.

Example cou

heffective andexpectoratesecretions

Vet Case Presentation(COPD)

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