Sjmc Copd Case

7/30/2019 Sjmc Copd Case

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Chapter I

Introduction

Chronic Obstructive Pulmonary Disease (COPD) ranks as one of the major causes ofdisability in the Philippines today. The natural history of COPD, namely emphysema and chronic

bronchitis, causes progressive irreparable structural pulmonary damage and diminishes the cardio-respiratory reserves.

COPD is a disabling illness that affects not only the physical well-being of an individual,

but his mental, emotional, socials and functional status as well. Reduced functional capacity

frequently leads to vocation displacement.

The chronic nature of the disease and the costs involved in the treatment and follow-up of

the patients conditionplaces his family under undue stress.

It is apparent that patients with COPD have multiple problems, and they require hours of

attention, education and training that no physician, however dedicated, can possibly spare due to abusy practice.

As a result, patients may be non compliant in using prescribed medications, causing

dyspnea to progress and limiting their activities. The consequence is often a cycle of

apprehension, fear and increasing inactivity.

Although the COPD rehabilitation program is aimed at providing good comprehensiverespiratory care to alleviate the symptoms of respiratory impairment, health education remains to

be a powerful tool in helping the patient gain the motivation and develop the skill to improvefunctional ability and prevent problems that undermine functional skills. Through education, thepatient achieves the optimal capability to carry out his activities in daily life.

The patient's health education involves helping the patient understand his condition, learn

how to prevent symptoms while carrying out everyday tasks, develop the skills to manage

episodes of breathlessness, and adopt measures to prevent problems. It builds his confidence thathe can, indeed, control his disease and accomplish his daily activities.

Patient education also involves helping the patient with the resources necessary to adhere

to the prescribed treatment, thereby strengthening the resolve of the patient and his family to

implement appropriate COPD management.


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Purpose and Objectives

This case study aims to present the nursing care of a patient with TB Meningitis.

Specifically, this study seeks to achieve the following objectives:

To the researchers,

Gain knowledge about the case of a patient with TB Meningitis which includes a systematic

study of the patients past and present history of illness and the nursing care directed to the

wellness of the patient. Be able to learn about the illness of the patient, its etiology and specific

treatments needed to improve the health status of the patient.

To the patient,

Improvement in the patients current condition and receive the appropriate nursing care that will

hasten his recovery and to prevent any hazards that may contribute to the progress and severity of

the disease.


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Scope and Limitations

The case is all about a patient with Chronic Obstructive Pulmonary Disease. The

researchers decided to pursue the studying of this case because it is apparent that patients with

COPD have multiple problems, and they require hours of attention, education and direct nursing

care.

The case study was conducted last September 20, 2011 the day when we had our second

day at the hospital. The patient was transferred to the surgical ward that day after being admitted

at the medical ward.

The client was admitted at the surgical ward in San Juan Medical Center. The area was

equipped with modern facilities and adequate resources sufficient enough for the needs of its

patients. Since the hospital is owned by the government, every patient should provide their own

supplies during their hospital stay.

The data presented in this case study was gathered for 2 days during a rotation of Related

Learning Experience. All of the patients information was gathered post-operatively.

Most of the data were collected through assessment and interview. Moreover, the patients

chart which includes all of the necessary information about the progress of the patients condition

has provided the researchers the data needed to further prove the case of the patient.

The group had a very limited time assessing the actual condition of the client. Since it was

only for two days the group was able to assess the patient, the group had to maximize the time

and make use of the opportunity while the patient is still there.


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Nursing Theoretical Framework

Among the different nursing theories, we found Florence Nightingales Environmental

theory very applicable to our case.

As to Florence Nightingale, her Environmental theory proposes that changing and

manipulating the environment can help the patient to be in the best possible condition through

hygiene. She believed that by nurturing environment, the body could repair itself.

Therefore, proper hygiene is very important in preventing an infection to develop before

surgery and complications to occur after surgery. We have observed that the patient needs to

observe proper hygiene since his illness was associated with an unsanitary living.


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Chapter II

Nursing Health History

1. Biographic Data

Name: Mr. JT

Age: 64

Civil Status: Married

Address: Angono, Rizal

2. Chief Complaint

The patient was admitted at the hospital due to the complaints of progressive

difficulty of breathing occurring even at rest.

Medical Diagnosis

Acute Respiratory Failure secondary to COPD

3. PastMedical History

The patient has been suffering from hypertension for 1 year with unrecalled

medications. The patient also has asthma and has been taking salbutamol PRN.

4. Present History

Four days prior to admission, patient was noted to have productive cough,

yellowish sputum with moderate grade fever. It was noted to have difficulty of breathing

on exertion and easy fatigability.


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One day prior to admission, patient was noted to have progressive difficulty of

breathing occurring even at rest. This prompted consult at a local hospital and was then

admitted as a case of Community Acquired Pneumonia. The patient then decided to

transfer. Hence the patient was admitted.

5. Socioeconomic History

The patient was a chronic smoker since when he was still young. He is also an occasional

drinker. The patient works as a driver at the Reliable Company for 25 years. He was earning a

monthly income of Php. 2,000 pesos only that can suit up their problems with regards to their

daily living. He is a High School graduate and has 5 children. All of his children are married and

sometimes they give a little amount for their allowances. They are renting a house amounting to

Php. 3,000 pesos only. They have their own Bathroom pale/flush system. Their house made up of

concrete near the market, mall and church. Their means of transportation are tricycle, jeep, and

bus.


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6. Family Health History


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As illustrated above, the patient has COPD, Hypertension and Asthma. He has 6 children and

among all of his children, only the fifth child acquired asthma.

A. Review of Systems

COPD

Asthma

MALE FEMALE

Hypertension


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a. Physical Assessment

Body

Appearance

Technique Actual

Findings

Interpretation Analysis

VITAL SIGNS

Temperature 36.0 C NORMALRespiratory 22 cpm NORMAL

Pulse Rate 82 bpm NORMAL

SYSTEMOFAPPEARANCE

Skin Inspectionand palpation

Patient has apoor skin

turgor

AB

N

O

RM

AL

Skin turgor is an

abnormality in the

skin's ability to

change shape and

return to normal

(elasticity).

Skin turgor is a sign

commonly used by

health care workersto assess the degree

of fluid loss or

dehydration. Fluidloss can occur from

common conditions,

such as diarrhea orvomiting. Infants and

young children withvomiting, diarrhea,

and decreased or nofluid intake can

rapidly lose a

significant amount offluid. Fever speeds

up this process.

Nose Inspection

and palpation

Presence of

nasogastric

tube at the

right nostrils.

A

B

N

OR

M

AL

A nasogastric tube is

a long, flexible

plastic tube inserted

into a person's noseand threaded into the

stomach to deliver

fluid that containsnutrients directly into

the stomach (tube

feeding). Anasogastric tube may


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also be used to

suction excessgastric fluids out of

the stomach and to

deliver medications

to a person whotemporarily cannot

swallow.

Neck Inspection

and palpation

Presence of

tracheostomy

tube at themidline of the

neck (trachea).

A

B

NO

R

MA

L

A tracheostomy is a

surgically created

opening in the neckleading directly to

the trachea (the

breathing tube).Atracheostomy is

usually done for one

of three reasons tobypass an obstructed

upper airway (an

object obstructingthe upper airway will

prevent oxygen from

the mouth to reach

the lungs); to cleanand remove

secretions from the

airway; and to more

easily, and usuallymore safely, deliver

oxygen to the lungs.

Chest Inspection

and

auscultation

Patient has a

barrel chest.

A

B

NO

R

MA

L

One sign of the

COPD is the barrel

chest. When thelungs become

enlarged, the

diaphragm isdisplaced downward

and is unable to

contract efficiently.Furthermore, the

chest wall is

enlarged, makingaccessory breathing

muscles (muscles in

the neck, upper

chest, and betweenthe ribs) less


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Presence of

adventitioussound

(wheezes)

efficient as well.

These changescontribute to

shortness of breath.

This becomes

apparent when aperson with COPD

tries do somethingwith the arms raised

above the head, such

as changing a light

bulb in a ceilingfixture, and becomes

short of breath.

Wheezes is high

pitched sound and

continuous. It occursin severe expiration

and inspiration

because of theblocked airflow,

infection and foreign

body obstruction.

b. Diagnostic Procedure

Complete Blood Count (CBC)


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The CBC is a basic screening test and is one of the most frequently ordered laboratory

procedures. The findings in the CBC give valuable diagnostic information about the hematologic

and other body systems, prognosis, response to treatment and recovery. The CBC consists of a

series of tests that determine number, variety, percentage, concentrations and quality of blood

cells.

Date:

Sept. 3, 2011

NORMALFINDINGS

ACTUALFINDINGS

INTERPRETATION

NEUTROPHILS 0.38 0.68 0.89 Neutrophils are the primarywhite blood cells responsible

for ingesting and killing

bacteria and provide animportant defense against

infection. Thus, increase level

of neutrophils indicates the

presence of infection.LYMPHOCYTES 0.22 0.53 0.02 These white blood cells

responsible for fighting

infection and also develop

antibodies to protect the body

against future attacks. . Low

levels can indicate viral

infections, stress and use of

medications.

Reference: Medical Surgical Nursing by Bruner Suddarth

BLOOD UREA NITROGEN


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NORMAL VALUE ACTUAL

FINDINGS

INTERPRETATION

5 - 23 29 Increased BUN levels suggestimpaired kidney function. This

may be due

to acuteorchronickidney disease,damage, or failure. It may also be

due to a condition that results in

decreased blood flow to thekidneys, such as congestive heart

failure, shock, stress, recent heart

attack, or severe burns, toconditions that cause obstruction

of urine flow, or todehydration.

Reference: Medical Surgical Nursing by Bruner Suddarth

XRAY RESULT:

Impression: presence of pneumonia on the right lower lobe of the lungs
http://labtestsonline.org/glossary/acutehttp://labtestsonline.org/glossary/acutehttp://labtestsonline.org/glossary/chronichttp://labtestsonline.org/glossary/chronichttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/chfhttp://labtestsonline.org/understanding/conditions/chfhttp://labtestsonline.org/understanding/conditions/heart-attackhttp://labtestsonline.org/understanding/conditions/heart-attackhttp://labtestsonline.org/glossary/dehydrationhttp://labtestsonline.org/glossary/dehydrationhttp://labtestsonline.org/glossary/chronichttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/chfhttp://labtestsonline.org/understanding/conditions/chfhttp://labtestsonline.org/understanding/conditions/heart-attackhttp://labtestsonline.org/understanding/conditions/heart-attackhttp://labtestsonline.org/glossary/dehydrationhttp://labtestsonline.org/glossary/acute


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B. Comprehensive Definition and Description of Terms

1. Anatomy Physiology

The Respiratory System

The function of the respiratory system is to give us a surface area for exchanging gasesbetween the air and our circulating blood. It moves that air to and from the surfaces of the lungs

while it protects the lungs from dehydration, temperature changes and unwelcome pathogens. It

also plays a part in making sounds such as talking, singing, other nonverbal sounds and workswith the central nervous system for the ability to smell.

Upper Respiratory Anatomy

The upper respiratory system consists of the nostrils (external nares), nasal cavity, nasal

vestibule, nasal septum, both hard and soft palate, nasopharynx, pharynx, larynx and trachea.

Within the nostrils, course hairs protect us from dust, insects and sand. The hard palate serves toseparate the oral and nasal cavities. There is a protective mucous membrane that lines the naval

cavities and other parts of the respiratory tract. It is secreted over the exposed surfaces and then

the cilia sweeps that mucus and any microorganisms or debris to the pharynx, so it is swallowedand then destroyed in stomach acids.

Lower Respiratory Anatomy

The trachea branches off into what is known as the bronchi (more commonly called bronchial

tubes). These two main bronchi have branches forming the bronchial tree. Where it enters the

lung, there is then secondary bronchi. In each lung, the secondary bronchi divides into tertiarybronchi and in turn these divide repeatedly into smaller bronchioles. The bronchioles control the

ratio of resistance to airflow and distribution of air in our lungs. The bronchioles open into the

alveolar ducts. Alveolar sacs are at the end of the ducts. These sacs are chambers that are

connected to several individual alveoli, which makes up the exchange surface of the lungs.

The Lungs

The human respiratory system has two lungs, which contain lobes separated by deep fissures.

Surprisingly, the right lung has three lobes while the left one has only two lobes. The lungs are

made up of elastic fibers that gives it the ability to handle large changes in air volume. The pleuralcavity is where the lungs are located. The diaphragm is the muscle that makes up the floor of the


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thoracic cavity and plays a major role in the pressure and volume of air moving in and out of the

lungs.

Breathing and Lung Mechanics

Ventilationis the exchange of air between the external environment and the alveoli. Airmoves by bulk flow from an area of high pressure to low pressure. All pressures in the

respiratory system are relative to atmospheric pressure (760mmHg at sea level). Air will

move in or out of the lungs depending on the pressure in the alveoli. The body changes the

pressure in the alveoli by changing the volume of the lungs. As volume increases pressure

decreases and as volume decreases pressure increases. There are two phases of ventilation;

inspiration and expiration. During each phase the body changes the lung dimensions to

produce a flow of air either in or out of the lungs.

The Pathway of Air

When one breathes air in at sea level, the inhalation is composed of different gases. These

gases and their quantities are Oxygen which makes up 21%, Nitrogen which is 78%,Carbon Dioxide with 0.04% and others with significantly smaller portions.

Diagram of the Pharynx

In the process of breathing, air enters into the nasal cavity through the nostrils and is filtered

by coarse hairs (vibrissae) and mucous that are found there. The vibrissae filter macroparticles,

which are particles of large size. Dust, pollen, smoke, and fine particles are trapped in the mucous

that lines the nasal cavities (hollow spaces within the bones of the skull that warm, moisten, andfilter the air). There are three bony projections inside the nasal cavity. Thesuperior, middle, and

inferior nasal conchae. Air passes between these conchae via the nasal meatuses.

Air then travels past the nasopharynx, oropharynx, and laryngopharynx, which are the

three portions that make up the pharynx. Thepharynx is a funnel-shaped tube that connects our

nasal and oral cavities to the larynx. The tonsils which are part of the lymphatic system, form a
http://en.wikipedia.org/wiki/pharynxhttp://en.wikipedia.org/wiki/pharynxhttp://en.wikibooks.org/wiki/File:Illu_pharynx.jpghttp://en.wikipedia.org/wiki/pharynx


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ring at the connection of the oral cavity and the pharynx. Here, they protect against foreign

invasion of antigens. Therefore the respiratory tract aids the immune system through this

protection. Then the air travels through the larynx. The larynx closes at the epiglottis to prevent

the passage of food or drink as a protection to our trachea and lungs. The larynx is also our

voicebox; it contains vocal cords, in which it produces sound. Sound is produced from the

vibration of the vocal cords when air passes through them.

The trachea, which is also known as our windpipe, has ciliated cells and mucous secreting

cells lining it, and is held open by C-shaped cartilage rings. One of its functions is similar to the

larynx and nasal cavity, by way of protection from dust and other particles. The dust will adhere

to the sticky mucous and the cilia helps propel it back up the trachea, to where it is either

swallowed or coughed up. Themucociliary escalator extends from the top of the trachea all the

way down to the bronchioles, which we will discuss later. Through the trachea, the air is now able

to pass into the bronchi.

Inspiration is initiated by contraction of the diaphragm and in some cases the intercostals

muscles when they receive nervous impulses. During normal quiet breathing, the phrenic nerves

stimulate the diaphragm to contract and move downward into the abdomen. This downward

movement of the diaphragm enlarges the thorax. When necessary, the intercostal muscles also

increase the thorax by contacting and drawing the ribs upward and outward.

Expiration During quiet breathing, expiration is normally a passive process and does not

require muscles to work (rather it is the result of the muscles relaxing). When the lungs are

stretched and expanded, stretch receptors within the alveoli send inhibitory nerve impulses

to the medulla oblongata, causing it to stop sending signals to the rib cage and diaphragm

to contract. The muscles of respiration and the lungs themselves are elastic, so when the

diaphragm and intercostal muscles relax there is an elastic recoil, which creates a positive

pressure (pressure in the lungs becomes greater than atmospheric pressure), and air moves

out of the lungs by flowing down its pressure gradient.

When under physical or emotional stress, more frequent and deep breathing is needed, and

both inspiration and expiration will work as active processes. Additional muscles in the rib cage

forcefully contract and push air quickly out of the lungs. In addition to deeper breathing, when

coughing or sneezing we exhale forcibly. Our abdominal muscles will contract suddenly (when

there is an urge to cough or sneeze), raising the abdominal pressure. The rapid increase in

pressure pushes the relaxed diaphragm up against the pleural cavity. This causes air to be forced

out of the lungs.


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Right and Left Lungs

The Right Primary Bronchus is the first portion we come to, it then branches off into

the Lobar (secondary) Bronchi, Segmental (tertiary) Bronchi, then to the Bronchioleswhich

have little cartilage and are lined by simple cuboidal epithelium (See fig. 1). The bronchi are lined

by pseudostratified columnar epithelium. Objects will likely lodge here at the junction of the

Carina and the Right Primary Bronchus because of the vertical structure. Items have a tendency to

fall in it, where as the Left Primary Bronchus has more of a curve to it which would make it hard

to have things lodge there.

The Left Primary Bronchus has the same setup as the right with the lobar, segmental bronchi

and the bronchioles.

The lungs are attached to the heart and trachea through structures that are called the roots of

the lungs. The roots of the lungs are the bronchi, pulmonary vessels, bronchial vessels, lymphatic

vessels, and nerves. These structures enter and leave at the hilus of the lung which is "the

depression in the medial surface of a lung that forms the opening through which the bronchus,

blood vessels, and nerves pass" (medlineplus.gov).There are a number ofterminal bronchioles connected to respiratory bronchioles which

then advance into the alveolar ducts that then become alveolar sacs. Each bronchiole terminates

in an elongated space enclosed by many air sacs called alveoli which are surrounded by blood

capillaries. Present there as well, are Alveolar Macrophages, they ingest any microbes that reach

the alveoli. The Pulmonary Alveoli are microscopic, which means they can only be seen through
http://en.wikibooks.org/wiki/File:Illu_bronchi_lungs.jpg


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a microscope, membranous air sacs within the lungs. They are units of respiration and the site of

gas exchange between the respiratory and circulatory systems.

Cellular Respiration

First the oxygen must diffuse from the alveolus into the capillaries. It is able to do this because

the capillaries are permeable to oxygen. After it is in the capillary, about 5% will be dissolved in

the blood plasma. The other oxygen will bind to red blood cells. The red blood cells contain

hemoglobin that carries oxygen. Blood with hemoglobin is able to transport 26 times more

oxygen than plasma without hemoglobin. Our bodies would have to work much harder pumping

more blood to supply our cells with oxygen without the help of hemoglobin. Once it diffuses by

osmosis it combines with the hemoglobin to form oxyhemoglobin.

Now the blood carrying oxygen is pumped through the heart to the rest of the body. Oxygen will

travel in the blood into arteries, arterioles, and eventually capillaries where it will be very close to

body cells. Now with different conditions in temperature and pH (warmer and more acidic than in

the lungs), and with pressure being exerted on the cells, the hemoglobin will give up the oxygen

where it will diffuse to the cells to be used for cellular respiration, also called aerobic respiration.

Cellular respiration is the process of moving energy from one chemical form (glucose) into

another (ATP), since all cells use ATP for all metabolic reactions.


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2. Pathophysiology

Cigarette smoking, Respiratory Tract

Infection (Pneumonia) and Asthma

Impaired ciliary action and macrophage

function

Mucus plugs and narrowing of the airway

Increased mucus production and destruction of alveolar

septa

Inflammation of the airway

Airway obstruction

Enlargement of the lungs Barrel chest

Recurrent

decrease in the area of the lungs

available for gas exchangeAlveolar hypoventilation

Hypoxemia, Increased Heart

Rate, Diminished breath

Difficulty of breathing


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Chapter IV Implementation

Medical Management

Drug Study

Drug Generic/ Trade Name Lactulose / Lactulose PSE

Route, Dose and Frequency 300cc ODHS

Classifications Functional Classifications: Laxative; ammonia detoxicant(hyperosmotic)

Chemical Classifications: lactose synthetic derivative

Mechanism of Action Prevents absorption of ammonia in colon; increases water in stool.

Indication * Treatment of constipation

* Prevention and treatment of portal-systemic encephalopathy.

Contraindication * Contraindicated with allergy to lactulose, low-galactose diet.

* Use cautiously with diabetes, pregnancy and lactation.

Side Effects GI: transient flatulence, distention, intestinal cramps, belching,

diarrhea, nausea

OTHER: acid-base imbalances, electrolyte imbalance


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Nursing Responsibilities Warning : Do not freeze laxative form. Extremelydark or cloudy

syrup may be unsafe; do not use.* Give laxative syrup or orally with fruit juice, water, or milk to

increase palatability.

* Administer retention enema using a rectal balloon catheter. Do not

use cleansing enemas containing soapsuds or other alkaline drugsthat counteract the effects of lactulose.

* Do not administer other laxatives while using lactulose.* Monitor serum ammonia levels.

* Monitor with long term therapy for potential electrolyte and acid-

base imbalances.* Carefully monitor blood glucose levels in diabetic patients.

Drug Generic/ Trade Name Isosorbide Monohydrate Nitrate/ ISMN

Route, Dose and Frequency 30mg/tab 1 tab OD

Classifications AntianginalNitrate

Vasodilator

Mechanism of ActionRelaxes vascular smooth muscle with a resultant decrease in venous

return and decrease in arterial BP, which reduced left ventricular

workload and decreases myocardial oxygen consumption.

Indication *prevention and treatment for angina pectoris.

*Used with nadolol to prevent recurrent variceal bleeding.

Contraindication * Contraindicated with allergy to nitrates, severe anemia, head

trauma, cerebral hemorrhage, hyperthrophic cardiomyopathy, narrow-angle glaucoma, orthostatic hypotension.

*Use cautiously with pregnancy, lactation, acute MI, heart failure.

Side Effects CNS: headache, apprehension, restlesness, weakness

CV: tachycardia, retrosternal discomfort, palpitation, hypotension,syncope, collapse, orthostatic hypotension, angina, rebound


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hypertension

GI: nausea and vomiting, incontinence of feces,a bdominal painGU: dyuria, impotence,urinary frequency

Nursing Responsibilities *Give sublingual preparations under the tounge or in buccal pouch;

discourage the patient from swallowing.

*Create a nitrate-free period to minimize tolerance*Give chewable tablets slowly, because severe hypotension can

occur;ensure the patient doesn't chew or crush ER preparations.

*Keep life support equipment readily available if overdose occurs orcardiac condition worsens.

*Gradually reduce dose if anginal treatment is being terminate; rapid

discontinuation can lead to problems of withdrawal.

Drug Generic/ Trade Name Pantoprazole, Pantonix, Protonix IV

Route, Dose and Frequency 40 mg tab PO, ODClassifications Anti secretory drug, Proton pump inhibitor

Mechanism of Action Gastric acid-pump inhibitor: Suppresses gastric acid secretion by

specific inhibition of the hydrogen-potassium ATPase enzyme system

at the secretory surface of the gastric parietal cells; blocks the finalstep of acid production.

Indication Long term treatment of GERD, Maintenance healing of erosive

esophagitis, treatment of duodenal ulcer, treatment of pathological

hyper secretory conditions like Zollinger-Ellison syndrome and otherneoplastic conditions

Contraindication Hypersensitivity to any proton pump inhibitor any drug components,Use cautiously with pregnancy and lactation.

Side Effects CNS: Headache, dizziness, vertigo, insomnia

GI: diarrhea, abdominal pain, nausea and vomiting

Respiratory: URI symptoms, coughOther: back pain, fever, B12 deficiency

Nursing Responsibilities Give drug everyday full course

Do not crush the tablet

Explain to the client that he may experience some side effects like

nausea and vomiting

Report severe headache and worsening of any symptoms.

Drug Generic/ Trade Name Digoxin, Lanoxin, Digitek

Route, Dose and Frequency 0.25 mg tab PO, OD


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Classifications Cardiac glycoside, Cardiotonic

Mechanism of Action Increases intracellular calcium and allows more calcium to enter themyocardial cell during depolarization via sodium-potassium pump

mechanism; this increases force of contraction (positive inotropic

effect), increases renal perfusion (diuretic effect), decreases heart rate

(negative chronotropic effect), and decreases AV node conductionvelocity.

Indication Heart failure and Atrial fibrillation

Contraindication Allergy to cardiac glycosides, ventricular tachycardia, ventricular

fibrillation, heart block and acute MI

Side Effects CNS: headache, weakness, drowsiness, visual disturbances and

mental status change

CV: ArrhythmiasGI: Gi upset and anorexia

Nursing Responsibilities Check dosage and preparation carefullyMonitor apical for 1 full minute before administering the medication

hold dose if pulse is lower than 60 beats per minute and notify

physician.Avoid giving this drug with meals may alter absorption

Have emergency drugs ready in case of toxicity like lidocaine,

phenytoin and atropine sulfate.


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Surgical Management

Tracheostomy

A tracheotomy or a tracheostomy is an opening surgically created through the neck into

the trachea(windpipe) to allow direct access to the breathing tube and is commonly done in an

operating room under general anesthesia. A tube is usually placed through this opening to provide

an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy

tube rather than through the nose and mouth.

Nebulization Therapy

Nebulization therapy is the process of dispensing particles of medication in a fine spray or mist by

way of a nebulizer. The medications frequently used during this process are bronchodilators.Nebulized aerosols work by relieving spasms in the lungs, decreasing swelling, and making your

secretions easier to cough up.
http://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomyhttp://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomyhttp://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomyhttp://www.hopkinsmedicine.org/tracheostomy/resources/glossary.html#Tracheotomy


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Chapter V Evaluation

Medications

Our client should comply with his daily medications as ordered by the physician such as:

fluimucil 600mg/tab once a day 8PM

Partoprazole 40mg/tab once a day 8PM

doxophylline 400mg/tab once a day 8PM

Lactulose 30cc 9PM or Hours of sleep for treatment of constipation;

ISMN 30mg/tab once a day 8PM

Arcoxia 120mg/tab PRN - for pain

Combivent Neb every 8 hours (6AM, 2PM, 10PM) for bronchospasm

Lanoxin 0.25mg/tab tab once a day

bambuterol 10mg/tab once a day 8AM

Exercise

The client should condition his body by doing the deep breathing exercise to promote

relaxation and to enable the client to gain control of the dyspnea and reduce feelings of panic.

Since the client has decreased exercise tolerance due to bronchial secretions, the nurse should

reduce these limitations by planning self care activities. These includes bathe, dress, and rest to

avoid fatigue and excessive dyspnea or difficulty in breathing. Taking short walks can also help

him prevent further complications and maintain his functional activities.

Health teachings

In order to prevent infection, proper tracheostomy care should be done daily with the use

of hydrogen peroxide. Frequent hand washing can also help to prevent further complications. The

client should not smoke since it will aggravate his condition. He has to comply with his

medications most especially to the combivent nebulation that should be given every 8 hours.


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Out-patient follow up

The patient has to visit his doctor on September 22, 2011 at 9AM in the medicine office

located at the second floor of San Juan Medical Center. He is required to consult his doctor

immediately if symptoms persists.

Diet

The client is on soft diet and strict aspiration precaution should be observed. Increasing

oral fluid intake also helps him to easily expel the secretions.

Sjmc Copd Case

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