anp-case-presentation-on-COPD-final-Copy.pdf

payalba jadeja

1. Case Study
Identification data
Introduction
Name : Mrs. Ramashri
Age &sex : 62 yrs. / female
Ward : Chest female ward
Bed no. : 03
Address : Malihabaad, lucknow.
Education : Illitrate.
Occupation : House wife.
Religion : Hindu
Date of admission: 17/06/18
Diagnosis : Chronic Obstructive Pulmonary Disease.
Ward : Female medicine ward.
Chief complaints:-
Mrs.nirmalawas admitted in the hospital with complaints of :-
Shortness of breath x 1 week
Chest pain x 1 week
Cough since x 1 week.
History of present illness:-
Patient is having chest pain cough since 1 week.
History of past illness:-
Patient told about 6 month back she has same problem .
Surgical history of the client
Past surgical history -
There is no any past surgical history.
Present surgical history
Not undergone through any surgery.

2. Family history –
My patient belongs to nuclear family.total 4 members are there in her family her husband 1sonand one daughter
. Her husband is a driver his monthly income is sufficient for his family.
Family tree –
Raghuraj 70 yrsRamashri 62 yrs.
Raghvendra 40yrs.Sheela 35yrs
Male Female death Male death
Male patient Female patient
Family composition:-
S.no Member Age/sex Relationship Education Health
1. Raghuraj 70/f Self Illiterate Sick
2. Ramashri 62/m Husband secondary Good
3. Raghvendra 40/f Son Graduate Good
4. Sheela 35/m daughter Graduate Good
Socio economic history
Family income : 6000/-
No. Of earning member: 1
Per capita income : Rs 1500/-

3. Education : Nil.
Social support : Good.
Relationship with neighbours: Good.
Toilet facility : Available
Environmental history
Type of house : Kaccha
Ventilation : Adequate
Electricity : Available
Tape water : Not present
Well : Present
Hand pump : Present
Tube well : Present
Open drainage system : Present
Personal history
Health facility near by home: Present
Sleep pattern : Irregular
Allergy : Not present
Health habbits : Good
Religion history : Superstitious
Exercise : No.
Dietary pattern : Vegeterian.
Physical examination:
General appearance : Conscious.
Height : 5’2”
Weight : 54kg
Temperature : Afebrile
 Pulse : 78 beats/min.
Respiration : 20 breaths/min.
Blood pressure : 130/70 mm of hg.
General appearance
Behavior : Good
Head : Normal in shape

4. Hair : Normal white in color
Face : Cleft lip & congenital abnormality is not observed
Ear : Shape , hearing activity is normal. Discharge , wax foreign body & pain
not observed.
Eyes : Pupil black in color , equal in size and reactive to light, corneal reflex observed .
Nose : Running nose , polyp & bleeding not observed.
Mouth/lips: Breath odors not present, cleft lip is not observed.
Teeth : No discoloration observed.
Gums : Texture is moist & bleeding not observed.
Tongue : Normal ,moist& pink in color.
Tonsil : Normal in size .
Neck : Symmetrical ,veins and movement are normal carotid pulse present & palpable.
Lymph nodes: Not observed
Skin : Brown in color , wrinkles & dryness observed. Surgical wound observed.
Nails : Normal in shape.
Odema : No peripheral edema observed.
Vital signs –
Temparature: Febrile
Pulse : 78 beats /min
Respiration: 20 breath /min.
Ribs : Normal
Abdomen : Abdominal reflexes are present. Distention &ascities is not observed.
Bones : Deformity not observed.
Back : Normal, spinabifea , kyphosis & scoliosis nit observed
Extremities: Range of motion is normal
Bowel activity: Regular once in a day/
Bladder activity : Regular
Rectum : Anatomical structure and opening is normal
Sleep pattern: Regular
Systemic examination:
Central nervous system
Consciousness: Lethargy
Speech : Clear
Coordination: Present
Papillary reaction to light:Equal size reactive to light
Reflexes
Biceps : Normal flexion is found
Triceps : Normal

5. Plantar reflex: Normal flexion is see
Respiratory system
Respiratory rate: 20 breaths/min
Pattern: : Normal abdomino thoracic
Cyanosis : not observed
Cough : present
Flaring of nostrils: present
Presence of wheezing / stridor : not present
Cardio vascular system
Heart rare : 80 beats /min.
Pulse : Rhythm normal.
Radial : right present , pedal right present.
Blood pressure : 130/70 mm of hg.
Murmur : Not heard.
Gastro intestinal system
Distended : Not observed.
Ascities : Not observed.
Visible peristalsis: Not observed.
Palpable mass : Not palpable.
Abdominal reflex: Present.
Bowel sound : Audible.
Liver : Palpable.
Spleen : Not palpable.
Musculoskeletal system:
Range of motion: Normal.
Joint pain : Not observed.
Genitor urinary system:
Urine : Normal.
History of constipation :Not present
Reproductive system:
Genitalia : Normal.

6. INVESTIGATION –
Day- 1,2,3,4
S.no. Parameters Client valueNormal value Remark
1. Hb 12-14 gm 10.6gm/dl Below normal
2. Wbc 4-11u/dl 9000/u Normal
3. Lymph 20-40u/l 30u/dl Normal
4. Plt 150000-400000200000 Normal
5. Sodium 135-145meq/dl134meq/dl Normal
6 Potassium 3.5-5.5meq/dl4.5meq/dl Normal
7. Calcium 9-11 mg/dl 9mg/dl Normal
8. Hiv Negative
9. Troponin Negative
10. PTT 20sec 10-14sec Normal
11. Bleeding time 2mt 2.3-9.5sec Normal
12. Clotting time 5:30mt 5-10mt Normal

7. DIAGNOSIS:- BRONCHIAL ASTHMA
DEFINITION:-
Asthma is a chronic inflammatory disease of the airway that causes airway hyper responsiveness,
mucosal edema, & mucus production. This inflammation ultimately leads to recurrent episodes of asthma
symptoms: cough, chest tightness, wheezing & dyspnea.
ANATOMY & PHYSIOLOGY OF RESPIRATORY SYSTEM
The respiratory system consists of all the organs involved in breathing. These include the nose, pharynx,
larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it brings oxygen into
our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon dioxide,
which is a waste product of cellular function. The nose, pharynx, larynx, trachea and bronchi all work like a
system of pipes through which the air is funnelled down into our lungs. There, in very small air sacs called
alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air.
When something goes wrong with part of the respiratory system, such as an infection like pneumonia, it makes
it harder for us to get the oxygen we need and to get rid of the waste product carbon dioxide.
The upper airway and trachea
When you breathe in, air enters your body through your nose or mouth. From there, it travels down your
throat through the larynx (or voicebox) and into the trachea (or windpipe) before entering your lungs. All these
structures act to funnel fresh air down from the outside world into your body. The upper airway is important
because it must always stay open for you to be able to breathe. It also helps to moisten and warm the air before
it reaches your lungs.

8. THE LUNGS
Structure
The lungs are paired, cone-shaped organs which take up most of the space in our chests, along with the
heart. Their role is to take oxygen into the body, which we need for our cells to live and function properly, and
to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a left lung and a right
lung. These are divided up into 'lobes', or big sections of tissue separated by 'fissures' or dividers. The right lung
has three lobes but the left lung has only two, because the heart takes up some of the space in the left side of our
chest. The lungs can also be divided up into even smaller portions, called 'bronchopulmonary segments'.
These are pyramidal-shaped areas which are also separated from each other by membranes. There are about 10
of them in each lung. Each segment receives its own blood supply and air supply.
How they work
Air enters your lungs through a system of pipes called the bronchi. These pipes start from the bottom of
the trachea as the left and right bronchi and branch many times throughout the lungs, until they eventually form
little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the important work of gas
exchange takes place between the air and your blood. Covering each alveolus is a whole network of little blood
vessel called capillaries, which are very small branches of the pulmonary arteries. It is important that the air in
the alveoli and the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move
(or diffuse) between them. So, when you breathe in, air comes down the trachea and through the bronchi into
the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will travel across the walls of the
alveoli into your bloodstream. Travelling in the opposite direction is carbon dioxide, which crosses from the
blood in the capillaries into the air in the alveoli and is then breathed out. In this way, you bring in to your body
the oxygen that you need to live, and get rid of the waste product carbon dioxide.
ETIOLOGY :-
Chronic exposure to airway irritants or allergens e.g. Mold, dust, roaches or animal dander.
Exercise, stress or emotional upsets.
Sinusitis with postnasal drip.
Medications.
Viral respiratory tract infections.
Gastroesophageal reflux.

9. PATHOPHYSIOLOGY:-
Clinical Manifestation :-
In book In patient
Three most common symptoms of asthma are
Cough
Dyspnea
Wheezing
Asthma attack often occur at night or
early in the morning, possibly due to
circadian variations that influence airway
receptor thresholds.
Cough & dyspnea is present in client
since 10 days.
Has asthma attack early morning.
cough with mucus production is present.

10. Cough with or without mucus production
Generalised chest tightness & dyspnea
occurs
Diaphoresis
Tachycardia
Widened pulse pressure may occur along
with hypoxemia & ventral cyanosis
Tachycardia is present heart rate is-
102/mt
MEDICAL MANAGEMENT
In book In patient
Two general classes of asthma medications are
used they are:
1.Long acting control medications.
2.Quick relief medications.
Long acting control medications
Corticosteroids
Cromolyn sodium &nedocromil are
mild to moderate anti inflammatory
agents.
Long acting beta2 adrenergic agonists.
methylxanthines are mild to moderate
bronchodilators.
Quick relief medications
Short acting beta adrenergic agonists are
the medication of choice for relieving
acute symptoms.
Anticholinergics e.g. Ipratropium
bromide may bring added benefits in
severe exacerbations.
Long acting control medication is not
given.
Quick relief medications are
administered such as injderiphylline 2ml
iv every 8 hourly.

11. MEDICATIONS
S
.n
o
Trade
name
Pharmce
utical
name
Rou
te
DoseTimeAction Adverse
effect
Nursing responsibility
1.TaximCefotaxi
m
sodium
Iv1gmQ12hAnti-
Biotic
A third
generation
cephalospo
rin that
binds to
bacterial
cell
memebrane
s& inhibits
cell wall
synthesis.
Frequent
Oral
candidiasis,
mild diarrhea,
abdominal
cramps.
Occasional
Nausea,
serum
sickness like
reaction.
Rare
Allergic
reaction,
thrombophleb
itis.
Determine allergy to
cefotaxime.
Use caustiouly in
patient with renal
impairment or gi
disease.
Reconstitute drug.
Administer iv push
over 3 to 5 min.
Monitor intake &
output.
2.AmikaAmikaci
n
Iv500m
g
Q12hAntibiotic-
an
aminoglyc
osides
antibiotic
that
irreversibly
binds to
protein on
bacterial
ribosomes
&
interferes
with
protein
synthesis
of
microorgan
ism.
Frequent
Pain,
induration
phlebitis.
Occasional
Hypersensitiv
e reactions
Rare
Neuromuscul
ar blockade.
Monitor intake &
output to maintain
hydration.
Monitor peak serum
amikacin levels.
Alert for ototoxic &
neurotoxic side
effects.
Inspect skin for
rashes.
Use cautiously in
patient with 8
th
cranial nerve
impairment,
myasthenia gravis.

12. 3.Inj.
Deriph
ylline
Theophy
lline &
theophyl
line
Iv3.2m
g/ml
Q8hBronchodil
ators
Frequent
Fatigue,
dizziness
Occasional
Diarrhoea,
bradycardia,
rhinitis, back
pain.
Rare
Orthostatic
hypertension,
uti, viral
infection.
Assess bp& apical
pulse before giving
drug.
Teach patient to take
with food.
Urge client to limit
alcohol & salt
intake.
Assess clients
tolerance to drug.
4.AcilocRanitidi
ne
hydrochl
oride
IV50mgQ12hAntiulcer
agent
It inhibits
histamine
action at h2
receptor of
gastric
parietal
calls &
inhibits
gastric acid
secretion
when
fasting at
night or
when
stimulated
by food
caffeine or
insulin.
Occasional
Diarrhoea
Rare
Constipati
on,
headache.
Use cautiously in
elderly patient &
those with impaired
hepatic & renal
function.
Give regard to
meals.
Do not administer
with in 1 hour of
magnesium or
aluminium
containing antacids.
Infuse iv infusion
over 24 hrsim.
5.MetronMetroni
dazole
Iv500m
g
Q8hAntibacteri
al
It disrupts
bacterial
&protozoal
dna
inhibiting
Frequent
Anorexia,
nausea, dry
mouth,
uterine
cramps.
Occasional
Determine
hypersentivity.
Use cautionsly in blood
dyscrasias, cns
disorders, hepatic
failure.
Use without regard to

13. nucleic
acid
synthsis.
Diarrhoea,
constipation.
Rare
Transient
leucopenia,
thrombophleb
itis.
food.
Explain to patient that
urine may become
reddish brown during
metronidazole therapy.
NURSING MANAGEMENT
According to book Done for the patient
Administers medications as
prescribed.
Fluid may be administered if
dehydrated.
If the patient requires intubation
because of respiratory failure, the
nurse assist with intubation
procedure.
Administered medications as
prescribed.
Client was well hydrated.
Nil significant.
NURSING CARE PLAN
NURSING DIAGNSIS
1.Ineffective airway clearance, dypnea related to inflammatory process as manifested by observation.
2.Pain related to disease condition as manifested by observation.

14. 3.Activity intolerance related to confinement to bed as manifested by observation.
4.Imbalance nutrition pattern less than body requirement related to loss of appetite as manifested by
observation.
5.Disturbed sleeping pattern related to unfamiliar environment as evidenced by patient verbalization.
6.Excess Fluid volume related to decreased organ perfusion (renal) as evidenced by
increased sodium/water retention in patients reports.
7.Ineffective therapeutic regimen related to complexity of treatment as evidenced by verbalization by
patient that he or she did not follow prescribed regimen.
8.Anxiety related to hospitalization as evidenced by patient asking too many questions.
ASSESSMENT
Subjective Data:
Client stated that she is having difficulty in breathing.

15. Objective Data: -
Client is looking restless & irritated.
Day 1,2,3,4,5
Nursing DiagnosisGoal Planning Implementation Evaluation
1.Ineffective
airway clearance,
dypnea related to
inflammatory
process as
manifested by
observation.
Client will
have
effective
airway
clearance as
evidenced by
verbalization.
Assess the general
condition of the
patient.
Provide comfort
devices such as
pillows.
Provide propped up
position.
Advice to take
adequate rest &
sleep.
Administer
bronchodilator drug
as prescribed.
Assessed the
general condition of
the patient.
Provided comfort
devices such as
pillows.
Provided propped
up position.
Adviced to take
adequate rest &
sleep.
Administered
bronchodilator drug
as prescribed.
Client stated
that his pain
is reduced.
ASSESSMENT
Subjective Data: -
Client stated that she is having pain in the whole body.
Objective Data: -

16. Client is looking restless & irritated.
Nursing DiagnosisGoal Planning ImplementationEvaluation
2.Pain related to
disease condition
as manifested by
observation.
client will have
adequate comfort
as evidenced by
verbalization.
Assess the
condition.
Provide
comfort
devices such as
pillows.
Provide
comfortable
bed.
Provide
comfortable
position.
Advice to take
adequate rest &
sleep.
Administer
analgesic drug
as prescribed.
Assessed the
condition.
Provided
comfort
devices such as
pillows.
Provided
comfortable
bed.
Provided
comfortable
position.
Adviced to take
adequate rest &
sleep.
Administered
analgesic drug
as prescribed.
Client stated that
his pain is reduced.
ASSESSMENT
Subjective Data:
Client stated that she is having not able to do her activities.

17. Objective Data: -
Client is not able to do activities of daily living.
Nursing DiagnosisGoal Planning Implementation Evaluation
3. Activity
intolerance related
to confinement to
bed as manifested
by observation.
client will be able
to do some of her
daily activity as
evidenced by
verbalization.
Assess the
condition
Assist the
client in
activities of
daily living.
Promote
ambulation.
Change
position
timely.
Encourage
client
participation
in daily
activities.
Assessed the
condition
Assisted the
client in
activities of
daily living.
Promoted
ambulation.
Changed
position
timely.
Encouraged
client
participation in
daily activities.
client is able to do
some of her daily
activities.
ASSESSMENT
Subjective Data: -

18. Client stated that she is not feeling to eat food.
Objective Data: -
Client is looking weak & tired.
Nursing DiagnosisGoal Planning Implementation Evaluation
4.Imbalancenutrition
pattern less than
body requirement
related to loss of
appetite as
manifested by
observation.
Client will have
normal nutritional
pattern as
evidenced by
observation.
Asses the
condition.
Provide small
& frequent
feed.
Provide of
food items of
likings.
Provide neat &
clean
environment
for eating.
Promote
hydration.
Teach about
importance of
nutritious diet.
Assessed the
condition.
Provided small
& frequent
feed.
Provided of
food items of
likings.
Provided neat
& clean
environment
for eating.
Promoted
hydration.
Taught about
importance of
nutritious diet.
Client started taking
food orally & has
normal appetite.
ASSESSMENT
Subjective Data:-

19. Patient is complaining of inability to perform daily activities.
Objective Data:-
On the close observation it was observed that patient is unable to perform daily activity.
ASSESSMENT
Nursing
Diagnosis
Goal Planning Implementation Evaluation
5.Activity
Intolerance
related to
disease
condition as
evidenced by
patient unable
to perform
activity.
Patient
will be
able to
perform
certain
level of
activity.
Assess the level of
activity that can be
performed by patient.
Assist in performance
of daily activities.
Provide alternate
periods of activity and
rest.
Provide hygienic care
to then patient.
Provide balance diet
to the patient.
Encourage patient to
perform range of
motion exercises.
Assessed the level of
activity that can be
performed by patient.
Assisted in performance
of daily activities.
Provided alternate
periods of activity and
rest.
Provided hygienic care
to then patient.
Provided balanced diet
to the patient.
Encouraged patient to
perform range of motion
exercises.
Expected
outcome
partially met
as evidenced
by patient is
able to
perform
certain daily
activities.

20. Subjective data:
Patient is complaints of not able to sleep.
Objective data:
On the assessment it was found that patient is unable to sleep and looks dull.
Nursing
Diagnosis
Goal Planning Implementation Evaluation
6.Disturbed
sleeping pattern
related to
unfamiliar
environment as
evidenced by
patient
verbalization.
Patient’s
sleeping
pattern will
be improved
Assess the condition
of patient.
Provide comfort
devices to the patient.
Provide quiet and
calm environment.
Provide well
ventilated room to
the patient.
Provide one glass
milk before sleep.
Assessed the
condition of
patient.
Provided comfort
devices to the
patient.
Provided quiet and
calm environment.
Provided well
ventilated room to
the patient.
Provided one glass
milk before sleep.
Expected outcome
is partially met as
evidenced by
patients sleeping
pattern is
improved.
ASSESSMENT
Subjective data:
Patient is having less confidence about him.

21. Objective data:
On the assessment it was found that patient has low confidence level.
Nursing
Diagnosis
Goal Planning Implementation Evaluation
8.Risk of
situational low
self-esteem
related to
disease
condition.
To
increase
the self-
esteem of
patient.
Assess the condition of
patient.
Help patient to identify
environmental factors which
increase risk for low self-
esteem.
Encourage patient to
verbalize thoughts and
feelings.
Encourage client to create a
sense of competence
through short term goal
setting and goal
achievement.
Assessment was
done.
Helped the patient to
identify
environmental
factors.
Encouraged patient
to verbalize thoughts
and feelings.
Encouraged client to
create a sense of
competence through
short-term goal
setting and goal
achievement.
Expected outcome
is partially met as
evidenced by self-
esteem is
increased as
patient
verbalization.
ASSESSMENT
Subjective Data: -
Client stated that she is not aware of her disease condition.
Objective Data: -

22. Client is not knowing about her disease condition.
Nursing DiagnosisGoal Planning Implementation Evaluation
9.Knowledge deficit
related to disease
condition as
manifested by
verbalization.
Client will have
adequate knowledge
as evidenced by
verbalization.
Assess the
condition.
Explain about
diseaseconditio
n.
Mention about
its management
& its preventive
measures.
Explain about
complications
& its
preventions.
Clarify all
doubts of client
& relatives.
Assess the
condition
Explain about
disease
condition.
Mention about
its management
& its preventive
measures.
Explain about
complications &
its preventions.
Clarify all
doubts of client
& relatives.
Client & relatives
understood about
the disease
condition & its
management.
ASSESSMENT
Subjective Data: -
Client stated that she is worried about her disease
Objective Data: -

23. Client is looking frightened & tensed.
Nursing DiagnosisGoal Planning Implementation Evaluation
10.Fear& anxiety
related to disease
condition as
manifested by
observation &
verbalization.
Client will be
relieved from fear
& anxiety as
evidenced by
verbalization.
Assess the
condition.
Provide
psychological
support.
Provide calm
and healthy
environment
to the patient.
Clarify all
doubts.
Explain about
disease
condition in
detail.
Assessed the
condition.
Provided
psychological
support.
Provided calm
and healthy
environment
to the patient.
Clarifiedall
doubts.
Explained
about disease
condition in
detail.
clients said that her
fear & anxiety is
reduced.
COMPLICATION:-
According to book Developed in the patient.
Status asthmaticus.
Respiratory failure
Pneumonia
Atelectasis
Status asthmaticus.
Respiratory failure
Pneumonia
Atelectasis

24. HEALTH EDUCATION
Personal hygiene
Personal hygiene has an important role to prevent infection.
Patient have to take a through bath, brush teeth, cut short nails & change cloth daily.
Diet therapy
Advice to take well balanced diet of good nutritive value.
Explain importance of balanced diet.
Rest & sleep
Advice to take adequate rest & sleep.
Ask to do active & passive exercise.
Disease condition: - bronchial asthma
Definition
Causes
Pathophysiology
Clinical manifestations
Diagnosis
Management
Care & prevention
Follow up
Advice to take medicine in time.
Do not discontinue medicine without doctors.
Advice for timely follow up checkups.
SUMMARY
Case study on Chronic Obstructive Pulmonary Disease was great learning experience for me. I learned about
the disease condition of the client & also how to take care of client with Chronic Obstructive Pulmonary
Disease. I thank my patient & his relatives for their valuable cooperation & also staffs of Era Hospital .
CONCLUSION
COPD is a progressive and (currently) incurable disease, but with the right diagnosis and treatment, there are
many things you can do to manage your COPD and breathe better. People can live for many years
with COPD and enjoy life.

25. Bibliography
Suzanne c. Smeltzerbrenda g. Bare, medical surgical, eighth edition, pb-lippincott
Brunner and suddarth.medical surgical nursing, 8th edition,
Luckmen,” medical surgical nursing”pbsaunders
Joyce m. Black,“ medical surgical nursing”, clinical management for positive outcome,vol.1,
pbsaunders, 7
th
edition.
C.r.w. edwards,” davidson’s principal and practice of medicine”, pbchurchilllivingstone 3
rd
edition.
Barbara c. Long “medical surgical nursing” ,mosby, 3th edition
ERA UNIVERSITY
ERA COLLEGE OF NURSING

26. CARE PLAN ON :-CHRONIC OBSTRUCTIVE PUL MONARY DISEASE
SUBMITTED TO: SUBMITTED BY:
Ms.Swastika Das Priyanka Yadav
Assistant professor M.Sc. Nursing 1
st
Year
Era College Of Nursing Era College Of Nursing
Submitted on-13/08/18