Nueva Ecija Colleges

Cabanatuan City

Intensive Care Practicum

BSN IV-D, Group 3

Marcelo, May H.Mascariñas, Jeremiah M.

Miranda, Carl Atlas V.Miranda, Cherry Anne S.

Molina, Eleanor P.Orpia, Djulie DR..

Palisoc, Jacquelyn N.Patricio, Venus B.

Perez, Gladwin Jade L.Peroz, Mark Kristoffer V.Punsal, Madelyn Gale S.Sardea, Bryan Omar D.

Ms. Sharon Feliciano R.N(Clinical Instructor)

I. Introduction

Chronic obstructive pulmonary disease (COPD) is a lung disease in which

the lungs are damaged, making it hard to breathe. In COPD, the tubes that carry air

in and out of your lungs are partly obstructed, making it difficult to get air in and

out.

Cigarette smoking is the most common cause of COPD. Most people with

COPD are smokers of former smoker. Breathing in other kind of lung irritants,

like pollution, dust, or chemical, over a long period of time may also cause or

contribute to COPD.

COPD develops slowly, and it may be many years before you notice

symptoms like feeling short of breath. Most of the time, COPD is diagnosed in

middle-aged or older people.

COPD is a major cause of death and illness, and it is the fourth leading

cause of death in the United States and throughout the world.

There is no cure for COPD. The damage to your airways and lungs cannot

be reversed, but there are things you can do to feel better and slow the damage.

II. General Objectives

After 5 days of exposure at the Nueva Ecija Doctors Hospital, we will be

able to expand our knowledge and skills regarding chronic obstructive pulmonary

disease, as well as to develop and enhance our skills and attitudes in the delivery

of quality and effective nursing care on the patient through actual exposure.

III. Specific Objectives

This study was specifically aimed:

1. To interact politely, appropriate and effectively to the client while

applying our knowledge about Chronic obstructive pulmonary disease.

2. To identify the signs and symptoms of the disease and their

corresponding interventions.

3. To determine the past and present history of the client to know the

disease and to educate the patient more about her condition and to prevent

further complications.

4. To be aware of the diagnostic procedure performed; including the drugs

that patient is taking.

5. To develop a proper and effective nursing care plan necessary for the

health needs and health problems presented by the patient.

6. To provide proper care and appropriate education to the patient, and

allow her to comprehend with it.

IV. Personal Profile

Name : Mr. “Pogi”

Age : 69 years old

Birth date : March 22, 1939

Sex : Male

Civil Status : Married

Nationality : Filipino

Religion : Roman Catholic

Address : Purok I, Bagong Silang, San Miguel Bulacan

Date of Admission : August 13, 2009

Case # : 203929

Ward : MMW

Admitting Doctor : Dr. W. Villanueva

Attending Doctor : Dr. E. Paatan

Admitting Diagnosis: COPD in Acute Exacerbations

V. Physical Assessment

General Appearance – Conscious; Coherent, Dyspneic

Head – Normal; No noted Deformities

Scalp – No dandruff; no lice

Hair – His hair is unevenly distributed, black & white in color

Eye – Anicteric Sclera; with pinkish palpebral conjuctiva

Ear – No Discharge

Nose – Nasal flaring

Lips – With cyanosis, dry lips

Mouth – No lesions, with dry tongue

Teeth - No Dentures

Neck – No noted lymphadenopathy

Chest & Back – Symmetrical chest wall expansion; (+) wheezing sounds; Barrel

chest; (+) retractions; bibasal crackles

Abdomen – Globular soft; Normo Active Bowel Sound; (-) tenderness; abdominal

breather

Upper Extremities – (-) deformities; symmetrical in appearance

Lower Extremities – no edema; (-) deformities

Nail Beds – Clean, clubbing finger nails

Skin – Fair complexion

Heart – Tachycardeic; (-) murmur

Vital Signs

Date Temperature Pulse Respiration Blood Pressure

8-13-09 36.8 C/axilla 108 29 150/70mmHg

8-14-09 36.7 C/axilla 108 32 130/90mmHg

8-15-09 36.7 C/axilla 98 32 130/80mmHg

VI. Nursing History

Present History

Few hours to admission the patient experience difficulty of breathing,

oxygen inhalation via nasal cannula was administered consult done hence

admission for further observation.

Past History

According to his son, his farther was often confined in NEDHI since 2006

due to DOB.

And the last time he admitted was on February 2007. When he experienced

a lower right quadrant pain, low grade fever & nausea, vomiting & found out that

he was having a appendicitis and underwent appendectomy right after.

Health History

He was an active smoker since he was 20 years old; He can consume at

least 16 sticks to 1 pack of cigarette per day and an occasional drinker too. He

stopped smoking when he was complained DOB & after being admitted last 2005.

Occupational History

He was a Farmer in Bagong Silang, San Miguel Bulacan for 25 years. Her

wife and son only live in their house.

Family History

According to our patient, both of his parents have no any history of any disease,

but his older brother suffered form COPD, while his young sister suffered from UTI. His

daughter & son are all in good condition as well as his wife… only simple fever & cough

were their usual illness.

Environmental History

According to Mr. Pogi their house is located near the farm, made up of

concrete material, where in creek is beside their house. He spent most of his time

in the farm from morning till evening. During his stay, he used to clean all the

mess especially the dried leaves and burn after. He is the one responsible for

maintaining their farm including pesticides, fertilizer as well in harvesting.

Diet

Our patient said that, he often eat vegetables and large amount of rice,

where in boiled vegetable is their usual menu, but because of financial problems

they can only eat meat & fish when occasions came.

VII. Course in the Ward

08 – 13 – 09 Thursday

10:40 A.M - pls admit to ROC

- Secure consent

- soft diet c aspiration precaution

- TPR shift q record

- Dx: CBC: RBS: TFR

- Secure old chart

- IVF: ① D5W 500 x KVO

- Meds:

Pharmacort 250mg IV stat then 125mg IV q 8hours

Ranitidine 50 mg IV q 8hours

Combivent neb now then q 15 minutes x 2 doses then q 2

hours

- O2 inhalation @ 5 lpm per nasal cannula

- Monitor V/S and record q 4 hours

- Cont. pt. meds

- Pls inform AP

- Refer

Dr. Paatan

- Continue meds:

Diltiazem 30 mg 1 tab TID

Salbutamol 1 cap TID

Amlodipine 10 mg 1 tab OD

Diamide, 1 tab OD

Dr. Paatan

BP: 150/70BT: 37PR: 107RR: 29

12:45 PM: - for serum electrolytes

- Lasix 1 tab IV now

- Increased Pharmacort to IV q 6 hours

- Heraclene Forte 1 tab OD

- Domperidone 10 mg 1 tab TID AC

04: 00 PM: - Fluimucil neb q 12 hours

Tel. order by Dr. Paatan

08 – 14 – 09 Friday

06:00 PM - D5W 500cc x KVO

- D/C Fluimucil

- Asmavent neb q 12 hours

Dr. Paatan

08 – 15 – 09 Saturday

09:00 AM: - MGH.

- Take home meds.

Kalium Durule 1 tab 2x a day

Diamide – K 1 tab OD

Diltiazem 30 mg 1 tab 3x a day

Duavent neb 4x 3 days

Budesonide 2x 3 days

Amlodipine 10mg 1 tab a day

Ranitidine 10mg 1 tab 2x 4 day

Heraclene Forte once a day

Domperidone 10 mg 1 tab 3x a day BEFORE MEALS x 5

days

- To settle bill

Dr. Paatan

VIII. Laboratory Result

Complete Blood Count

August 13, 2009

Parameter Results Normal Values

Hematocrit % 43.1 40.0 – 54.0 %

Platelets(x10 /L) 240 140.0 – 440.0

WBC (x10 /L) 12.1 4.0 – 10.0

Granulocytes %

(x10 /L)

75

9.2

44.2 – 80.2 %

2.0 – 8.8 %

Lymphocytes/ %

Monocytes (x10 /L)

25

2.9

28.0 – 48.0 %

1.2 – 5.3

Hemoglobin g/dl 13.8 14.0 – 18.0 g/dl

Random Blood Sugar

August 13, 2009

Tests Results Normal Values

RBS 146 90 – 145 mg/dl

Special Chemistry

August 13, 2009

Tests Results Normal Values

Serum Potassium 2.56 3.6 – 5.3 mEq/L

Serum Sodium 133.9 136.0 – 145.0 mEq/L

Serum Chloride 98.1 96.0 – 110.0 mEq/L

X. Pathophysiology

XIII. Recommendation

To the patient:

To have proper care regarding disease

To monitor blood pressure regularly.

To increase self-esteem and over all body integrity.

Strict compliance of drugs that was being prescribed.

To modify lifestyle.

To Health Care Provider:

To continue helping the patient to fully understand the disease process

and educate the patient on how to prevent certain complications.

To continue educate the patient & relatives in performing all aspects of

treatment regimen (ex. Metered dose inhaler) with return demonstration

from pt. & relatives before discharge.

To follow up for further evaluation of patient condition.

To Family/ Relatives

To provide continuous moral support to the patient could help him

lessen the anxieties. The family is the primary support of the client who

could help him improve his self-esteem towards himself and be able to

alleviate his stress. The family is also the one who could give him all

needs.

XIV. Evaluation

After 3 days of exposure at the Nueva Ecija Doctors Hospital. We the nursing

students were able to develop our knowledge regarding Chronic Obstructive

Pulmonary Disease. Through this, we were able to understand the disease process

and were able to comply with the needs of our patient being cared. The

knowledge, attitude, the quality and effectiveness of our nursing care rendered

were well conveyed well to the patient and relatives.

We were able to teach our client on how to properly monitor his blood

pressure, diet, and the right medications. He was able to understand certain things

regarding the different health educations that would help him in understanding the

disease.

We were able to identify the different complications that are related to

COPD throughout our patient. And through this, we were able to give the best

health education to the best health education to the client to prevent further

complications that may arise to his disease.

Through this study, we the nursing student able to comply with new

knowledge understanding and experience to those who need effective, efficient,

and quality nursing care in the future.

XIV. References

- http://www.Wikipedia.org/wiki/COPD

- http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html

- http://www.mayoclinic.com/health/copd/DS00916

- Brunner and Suddarth's Textbook of Medical-Surgical Nursing

- Mims.com

- http://www.youtube.com/watch?v=bwXvqSqAgKc

- http://www.youtube.com/watch?v=ps64D3Juv5A&feature=related

- http://www.youtube.com/watch?v=aktIMBQSXMo

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