I.

Introduction

a. Background of the study

COPD or Chronic Obstructive Pulmonary disease

- chronic lung conditions that obstruct the airways in your lungs

- refers to obstruction caused by CHRONIC BRONCHITIS and EMPHYSEMA
- there is a blockage within the tubes and air sacs that make up the
lungs which hinders the ability to exhale and even breath

Chronic bronchitis is defined in clinical terms as a cough with sputum

production on most days for 3 months of a year, for 2 consecutive years.
Chronic Bronchitis is hallmarked by hyperplasia (increased in number) and
hypertrophy (increased in size) of goblet cells (mucous gland) of the airway,
resulting in an increase in secretion of mucous which contributes to the
airway obstruction. Microscopically there is infiltration of the airway walls
with inflammatory cells, particularly neutrophils. Inflammation is followed by
scarring and remodeling that thickens the walls resulting in narrowing of the
small airway. Further progression leads to metaplasia abnormal change in
the tissue) and fibrosis (further thickening and scarring) of the lower airway.
The consequences of these changes are limitation of airflow.

Emphysema is defined histologically as the enlargement of the air

spaces distal to the terminal bronchioles , with distruction of their walls. The
enlarged air sacs (alveoli) of the lungs reduces the surface area available for
the movement of the gases during respiration. This ultimately leads to
dyspnea in severe cases. The exact mechanism for the development of
emphysema is not understood although it is known to be linked with smoking
and age.

Types of Emphysema

Paniobular (or panacinar) Emphysema

This type of emphysema is characteristic of a weakening and

inflammation of alveoli at the end of the bronchioles. When destruction is
very severe the affected acinus disappears and the lungs appear “spider
web-like” in x-rays. A mild version of this type of emphysema occurs as
aging progresses. In younger people, this panlobular emphysema is caused
by the body’s inability to produce sufficient amounts of alpha-1 antitypsin.

Centrilobular (or centriacinar) Emphysema

1
 This type of emphysema affects single alveoli entering directly into the
walls of terminal and respiratory bronchioles.

Risk Factors:

o Smoking

o Exposure to occupational and environmental pollutants

o Genetic factors

o Allergies

o Nutrition

o Age, Gender

Signs and Symptoms:

o Cough: productive or non-productive

o Dyspnea

o Wheezing

o Chest pain

o Hemoptysis

o Cyanosis

o Swelling

o Respiratory failure

Diagnostic Test

o Chest X-ray

o CT Scan (computerized Tomography)

o Arterial Blood Gas

Surgery:

o Bullectomy

o Lung volume Reduction Surgery (LVRS)

2
 o Lung Transplant

Nursing Care:

- Eliminate or minimize exposure to all pulmonary irritant

- Clear airways with postural drainage, clapping or vibrating and
suctioning as appropriate
- Administer oxygen at the prescribed percentage
- Encourage rest
- Assess for drug allergies especially to antibiotics before administering
- Also prescribed , administer bronchodilators, mucolytic agents and
corticosteroid
- Provide client and family teaching , covering disease process and
treatments, breathing restraining exercises, energy conservation, use
of inhalers and nebulizers medication administration and the
importance of compliance , prevention of complications and infections
by receiving influenza and medications prescribed

Special Instructions:

- Demonstrate the use of bronchodilator nebulizers

- Teach and demonstrate to the patients and caregiver and adaptive
breathing techniques : deep breathing exercise, coughing and
techniques , pursed lip breathing, abdominal breathing and position for
postural drainage
- Explain the need to avoid persons with infection like flu
- Instruct the patient and caregiver on cleaning of home respiratory
equipments
- Instruct the patient and caregiver on cleaning of all home respiratory
equipments
- Explain the need to avoid going out in cold temperatures which may
cause bronchospasms
- Stress the importance of not smoking and avoiding second hand
smoke
- Suggest avoiding clothing that restricts chest or abdominal expansion

For Activity:

- Advise the patient to exercise to tolerance and to avoid fatigue by

planning rest periods during the day
- Instruct the patient to breathe deeply and slowly during the periods of
a activity
- Instruct patients to avoid emotional stress

Types of Exercises for COPD

3
 These four types of exercises can help you if you have COPD. How much
you focus on each type of exercise may depend upon the COPD exercise
program your health care providers suggests for you.

1. Stretching exercises
Lengthen your muscles, increasing your flexibility. Stretching can also
help prepare your muscles for other types of exercise, decreasing your
chance of injury.

2. Aerobic exercises
Use large muscle groups to move at a steady, rhythmic pace. This type
of exercise works your heart and lungs, improving their endurance by
working your respiratory muscles. This helps your body use oxygen
more efficiently and, with time, can improve your breathing. Walking
and using a stationary bike are two good choices of aerobic exercise if
you have COPD.

3. Strengthening exercises
Involve tightening muscles repeatedly to the point of fatigue. When
you do this for the upper body, it can help increase the strength of
your breathing muscles.
Helps you strengthen breathing muscles, get more oxygen, and
breathe with less effort. Here are two examples of breathing exercises
you can begin doing for five to 10 minutes, three to four times a day.

4. Breathing exercises for COPD

Use pursed-lip breathing while exercising. If you experience shortness
of breath, first try slowing your rate of breathing and focus on
breathing out through pursed lips.

Pursed lip breathing:

1. Relax your neck and shoulder muscles.
2. Breathe in for two seconds through your nose, keeping your mouth
closed.
3. Breathe out for four seconds through pursed lips. If this is too long for
you, simply breathe out twice as long as you breathe in.

Diaphragmatic breathing:
1. Lie on your back with knees bent. You can put a pillow under your
knees for support.
2. Place one hand on your belly below your rib cage. Place the other hand
on your chest.
3. Inhale deeply through your nose for a count of 3. (Your belly and lower
ribs should rise, but your chest should remain still.)
4. Tighten your stomach muscles and exhale for a count of 6 through
slightly puckered lips.
4
 Diet:

- Explain the need to maintain high-calorie diet as indicated

- Encourage fluid intake at 2000-3000 mL/day to keep secretions clean
- Suggest small, frequent meals to avoid abdominal distention
- Avoid gas-producing foods

b. Significance of the study

This study will enable us, students, to understand better about Chronic
Obstructive Pulmonary Disease and will explain the different risk factors
developing the disease process like smoking, pollutants/irritants and
environment.

Also this study can help us to have enough knowledge on how to help
patients to control, lessen and/or eradicate this kind of disease.

c. Objectives

General objective

This study aims to fully understand the underlying disease process of

COPD.

Specific objective

o To gather and determine the past and present clinical history of the client.
o To perform physical assessment and to obtain Gordon’s patterns of
functioning.
o To obtain the developmental history of the client.
o To show the laboratory examination results with the corresponding normal
values, actual result from the client, and its interpretation.
o To understand the anatomy and physiology of Respiratory System.
o To trace and understand the pathophysiology of Chronic Obstructive
Pulmonary Disease.
5
o To learn the basic principle of medical management of Chronic Obstructive
Pulmonary Disease.
o To use the nursing process to identify nursing problems from the client and
provide the appropriate nursing care plan.
o To understand the pharmacological management set on the client and
provide nursing interventions.

6
d. Theoretical Framework

The Nightingale’s Environmental Theory

Environment - concepts of ventilation, warmth, light, diet, cleanliness and

noise. She focus o the physical aspect of environment.

She believed that "Healthy surroundings were necessary for proper nursing
care."

5 essential components of healthy environment:

1. pure air
2. pure water
3. efficient drainage
4. cleanliness
5. light

Concerns of Environmental Theory

1. Proper ventilation focus on the architectural aspect of the hospital.
2. Light has quite as real and tangible effects to the body. Her nursing
intervention includes direct exposure to sunlight.
3. Cleanliness and sanitation. She assumes that dirty environment was the
source of infection and rejected the "germ theory". Her nursing interventions
focus on proper handling and disposal of bodily secretions and sewage,
frequent bathing for patients and nurses, clean clothing and hand washing.
4. Warmth, quiet and diet environment. She introduce the manipulation of
the environment for patient's adaptation such as fire, opening the windows
and repositioning the room seasonally, etc.
5. Unnecessary noise is not healthy for recuperating patients.
6. Dietary intake.
7. Petty management proposed the avoidance of psychological harm, no

7
upsetting news. Strictly war issues and concerns should not be discussed
inside the hospital. She includes the use of small pets of psychological
therapy.

Nursing Metaparadigm
Nursing
Nursing is very essential for everybody's well-being. Notes on nursing focus
on the implementation and rendering efficient and effective nursing care.

Person
The patient is the focus of the environmental theory. The nurse should
perform the task for the patient and control environment for easy recovery.
She practice nurse-patient passive relationship.

Health
Health is the being well and using every power that the person has to the
fullest extent. A healthy body can recuperate and undergo reparative
process. Environmental control uplifts maintenance of health.

Environment
People would benefit form the environment.

Importance of Environmental Theory

1. Disease control
2. Sanitation and water treatment
3. Utilized by modern architecture in the prevention of "sick building
syndrome" applying the principles of ventilation and good lighting.
4. Waste disposal
5. Control of room temperature.
6. Noise management

8
II. Medical history

i. Patient’s profile

Name: G.J.V.

Age: 63 y/o

Sex: Male

Civil Status: Married

Religion: Roman Catholic

Nationality: Filipino

Room No.: 555

Hospital: CMC

Hospital #: 555555

Attending Physician: Dr. Dalupang/Babaran

Chief Complaint: difficulty of breathing

ii. History of present illness

Two days prior to admission, patient was noted to have productive

cough with whitish phlegm, he also complained difficulty of breathing,
shortness of breath on exertion and easy fatigability. No fever, chest pain,
and orthopnea. Patient took maintenance medication which afforded
temporary relief.

Due to persistence of symptoms, patient sought consult at the

emergency room and was subsequently admitted.

9
iii. Past medical history

o Hospitalization due to:

 Aortic Aneurysm

 S/P Cataract Surgery

o No known allergies on foods and medications

o Known hypertensive

 Highest BP: 150/80

 Lowest BP: 110/70

iv. Family history

o Diabetes Mellitus; none

o Hypertension; paternal side

v. Social and Environmental history

o Environment: urban

o Type of housing: owned house

o Living arrangement: living with his wife and children

o Drinks mineral water

o Occasional alcoholic beverage drinker

o Smoker since 16 y/o and stopped smoking 20 yrs ago

o Consumes 2 ½ pack of cigarette a day

10
a. Gordon’s pattern of functioning

Pattern of Before Hospitalization During Analysis /

Functioning Hospitalization Interpretation
Health -takes maintenance -prefers medical Compliance with the
Perception/ medication and if signs assistance diagnostic
Health and symptoms worsen, procedures,
-listens and follows
Management they tend to seek for pharmacologic
instruction; complies
medical assistance. management and
with the diagnostic
therapeutic regimen
procedures,
leads to prognosis
pharmacologic
and wellness.
management and
therapeutic regimen.

Nutritional/ -The patient is on regular The patient is on low salt His nutritional and
Metabolic diet. low fat diet. metabolic status has
Pattern been changed from
-He always eats pork, beef
regular diet to low
and chicken.
salt low fat diet
-He seldom eats fruits and because he is known
vegetable. hypertensive.

-He drinks 8 glasses of Low salt low fat is

water a day. the diet of choice for
11
 -He drinks alcohol hypertensive
beverages occasionally. patients.

Sleep and Rest The patient usually sleeps The patient usually The length of his
Pattern 6-8 hours a day. sleeps 8-10 hours a day. sleep and rest
pattern has
increased.

Exercise/ The patient can perform The patient performs Pharmacological

Activity Pattern activities of daily living but activities of daily living management and
he experienced difficulty of and no difficulty of enough rest help
breathing, shortness of breathing, shortness of alleviate difficulty
breath on exertion and breath on exertion and on breathing.
easy fatigability. easy fatigability noted.

Coping Stress -the patient can handle -the patient can handle Stress or problems
Pattern stress or problem with the stress with the help of can be handled with
help of his available his available support the assistance and
support systems; wife, systems; wife, children, advice of your
children, friends and friends and relatives. family members,
relatives. friends and
relatives.
-the patient has the ability
to control or manage
situations.

12
Elimination The patient urinates 5-7 The patient urinates 5-7 There was no
Pattern times and defecates once times and defecates change in his
a day. once a day. elimination pattern.

Cognitive The patient is conscious The patient is conscious The patient is alert
and coherent. and coherent. and responsive.

Self perception The patient feels nothing The patient feels special People make the
unusual. because of people patient feel special
showing care to him and loved.
especially his wife.

Role and - The patient works as - The patient can’t works The patient was
relationship engineering aide at Dept. as engineering aide at unable to perform
of Agrarian Reform. Dept. of Agrarian his role as
Reform. engineering aide
- The patient has a good
because of his
relationship with his wife, - The patient has a good
hospitalization.
children, friends and relationship with his
relatives. wife, children, friends
and relatives.

13
Value beliefs The patient is a religious The patient can’t attend The patient can’t
Roman Catholic and mass at the church but make it to the mass
attends mass every he is aware that he can at the church due to
Sunday at the church. go to chapel for his his hospitalization.
spiritual needs.

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b. Physical Assessment

General Health

• Conscious and Coherent

• Alert

• Comfortable

• Responsive

• No weight gain noted

• No weight loss noted

• No weakness noted

• Afebrile

V/S

o Temp: 36.2°c

o PR 76

o RR 23

o BP 90/60

15
 Body Normal Findings Method Actual Findings Analysis/Interpre
Part used tation

Skin -Sus-tanned areas Inspection -Sus-tanned areas The patient’s skin

is normal.
-Pinched-up skin returns -Pinched-up skin returns
immediately immediately

-Smooth and soft -Smooth and soft

Hair -Evenly distributed and Inspection - Grayish Hair The patient’s hair
covers the whole scalp was normal for his
- Thin age.
-Maybe thick or thin, coarse
or smooth - No dryness noted

-Neither brittle nor dry

Scalp -No scars noted Inspection -No scars noted The patient’s scalp
was normal.
-Free from lice, nits and -Free from lice and dandruff
dandruff
-No lesions noted
-No lesions should be noted

Face No wound Inspection No wound noted The patient’s face

 was normal.

Eyes -Pink palpebral, anicteric Inspection -Pink palpebral, anicteric The patient’s eye
sclera sclera was normal.

Nose -No discharges Inspection -No nasal discharge The patient’s nose
is normal.
-Both nares are patent -Both nares are patent

-Nasal septum is in the -Nasal septum is in the

midline midline
Mouth -Pinkish in color gums Inspection -Dark-pink in color gums Smoking causes
and lips yellow teeth as the
yellow-tinted
-Moist lips - Blackish lips
nicotine passes
through the mouth,
-With visible margin -With visible margin it stains the teeth;
dark gums and lips
are also some
-No sore, lesions -No sore and lesions effect of nicotine.

-No dentures -No dentures

-White color teeth -Yellowish teeth

Thorax -quiet, rhythmic and Inspection -occasional wheezes noted Wheezes are
significant as they
and effortless respiration Auscultatio imply decreased
Lungs n Wheezes are continuous airway lumen
diameter either due
musical tones that are most
to thickening of
commonly heard at end reactive airway
inspiration or early walls or collapse of
airways due to
expiration. They result as a
pressure from
collapsed airway lumen surrounding
gradually opens during pulmonary disease.
inspiration or gradually
closes during expiration.

Abdomen -Skin color is uniform, no Inspection -Skin color is uniform, no The patient’s
lesions lesions abdomen is normal.

-No venous engorgement -No venous engorgement

-Contour maybe flat or -Flabby abdomen

rounded

Upper -Symmetrical Inspection -Symmetrical The patient’s upper

Extremiti Palpation extremities are
es -Equal color and no -Equal color and no symmetrical and no
 discoloration discoloration tenderness.

-No tenderness noted -No tenderness

Lower -Symmetrical Inspection -Symmetrical The patient’s lower
Extremiti -Equal color and no Palpation -Equal color and no extremities are no
es discoloration discoloration tenderness and no
edema.
-No edema -No edema

-No tenderness noted -No tenderness noted

c. Laboratory, diagnostic procedures

Chest Physical Assessment

>Comparison is made with the prior chest x-ray dated 04/01/2010

>Present exam shows stable cardiomegaly and aneurismal dilation of

descending thoracic aorta

>Both lungs are again hyperaerated and shows unchanged appearance of

the previous seen chronic interstitial changes in the left lower lung,
representing pulmonary fibrosis

>No new active parenchymal infiltrates are identified in either lungs

>Pulmonary vascularity within normal limits

>Blunting of right costophrenic sulcus is now appreciated, which may due to

interval development of minimal pleural fluid

>Left costophrenic sulcus remain intact

Analysis:

Pulmonary Fibrosis indicates chronic obstructive pulmonary disease.

Pulmonary hyperaeration is attributed to distention of alveoli due to its
altered function to recoil and deflate leading to retention of carbon dioxide
and thus crowding of C02 and 02 in the alveoli occurs. Bronchitic changes
occurred as a result of the disease process wherein progressive narrowing of
the bronchial tree happened.
 Arterial Blood Gas

Actual Result Normal Range

pH (Acid – Base 7.394 7.35 – 7.45 Low (Acidosis)

Balance)

PaCO2 ( Partial 47.9 mmHg 35 - 45 mmHg High (Acidosis)

pressure of
Arterial Carbon
Dioxide)
67.5 mmHg 75 – 100 mmHg Low
PaO2 ( Partial
pressure of
Arterial Oxygen) 28.6 mmol/L 22 – 26 mmol/L High (Alkalosis)

HCO3
( Bicarbonate ion) 93.2% 95 - 100% Low

SaO2 (Arterial
oxgen saturation)

Analysis:

Compensated Respiratory Acidosis

ECG

>Atrial Fibrilation with rapid ventricular response

III. Clinical discussion

a. Anatomy and physiology

In humans it is the two main bronchi that enter the roots of the lungs. The
bronchi continue to divide within the lung, and after multiple divisions give
rise to bronchioles. The bronchial tree continues branching until it reaches
the level of terminal bronchioles, which lead to alveolar sacks. Alveolar sacs
are made up of clusters of alveoli, like individual grapes within an inch. The
individual alveoli are tightly wrapped in blood vessels, and it is here that gas
exchange actually occurs. Deoxygenated blood lungs, where oxygen in the
hemoglobin of the erythrocytes. The oxygen-rich blood returns to the heart
via pulmonary veins to be pumped back into systemic circulation.

Human lungs are located in two cavities on either side of the heart. Though
similar in appearance, the two are not identical. Both are separated into
lobes on the right and two on the left. The lobes are further divided into
lobules hexagonal divisions of the lungs that are the smallest subdivision
visible to the naked eye. The connective tissue that divides tubules is often
blackened in smokers and city dwellers.

The medial border of the right lung is nearly vertical, while the left lung
contains a cardiac notch. The cardiac notch is a concave impression molded
to accommodate the shape of the heart. Lungs are to a certain extent
overbuilt and have a tremendous reserve volume as compared to the oxygen
exchange requirements when at rest. This is the reason that individuals can
smoke for years without having a noticeable decreased in lung function while
still or moving slowly; in situations like these only a small portion of the lungs
are actually perfuse with blood for gas exchange. As oxygen requirements
increased due to exercise, a greater volume if the lung is perfuse allowing
the body to match its CO2/o2 exchange requirements

b. Pathophysiology
 IV. Drug Study

DRUG INDICATION CONTRAINDICATI ADVERSE NURSING

ON REACTION CONSIDERATIONS

Drug name: essential -hypersensitivity to -diarrhea -special precaution in

hypertension the drug patients with impaired
-telmisartan, -anorexia
hepatic and renal
hydrochlorothiazide ACTION -2 and 3
nd rd

-loss of appetite impairment

trimester of
Brand name: -blocks the
pregnancy -gastric irritation -special precaution with
vasoconstrictive
-micardis plus volume and/or Na-
and aldosterone- -lactation -constipation depleted patients
Doctor’s order: secreting effects of
angotensin II by
-40mg 1tab OD binding angiotensin
II to the AT I
receptor in many
tissue.

Drug name: -angina pectoris -sick-sinus -nausea -monitor v/s especially

syndrome the BP
-diltiazem ACTION-inhibits ca -swelling/edema
ion influx across -2nd and 3rd AV -should be administered
Brand name: -arrhythmia
cell membrane block with food or after eating
-cordazem during cardiac -headache
-severe
depolarization,
Doctor’s order: hypotension -rash
produces relaxation
of coronary -pregnancy
-90mg 1tab BID -fatigue
arteries, slows
SA/AV node
 conduction times,
dilates peripheral
arteries.

DRUG INDICATION CONTRAINDICATI ADVERSE NURSING

ON REACTION CONSIDERATIONS

Drug name: -angina pectoris -cardiogenic shock -headache -may be taken with or
without food
-nicorandil ACTION- Nicorandil -hypotension -flushing dizziness
dilates arterioles -monitor v/s especially
Brand name: -left ventricular -n&v
and large coronary the BP
failure with low
-aprior arteries by opening -weakness
filling pressure -may impair ability to
the potassium
Doctor’s order: -hypotension drive or operate
channels, and -lactation
machineries
stimulates
-10mg/tab; 1tab BID
guanylate cyclase
causing venous
vasodilatation. It
therefore reduces
preload and
afterload, and
improves coronary
blood flow.

Drug name: -reduction of -active liver disease -Gi disturbance -avoid intake of alcohol
elevated total
-atorvastatin -pregnancy -headache -monitor creatinine
cholesterol & LDL
phosphokinase and
Brand name: ACTION -lactation -myalgia transaminase elevation
-selectively HMG-
-lipitor -insomnia -history of liver disease
CoA reductase
Doctor’s order: which converts -pruritus -monitor v/s especially
HMG-CoA to the BP
-80mg 1tab HS mevalonate, a -muscle cramps
precursor of sterols. -should be administered
with food or after eating
-lowers cholesterol
& lipoprotein levels

DRUG INDICATION CONTRAINDICATI ADVERSE NURSING

ON REACTION CONSIDERATIONS

Drug name: -hypertension -low BP -headache -monitor v/s especially

the BP
-amlodipine ACTION -CHF -edema
-should be administered
Brand name: -inhibits influx of -hypersensitivity -dizziness
with food or after eating
calcium ion across
-vasalat -hepatic -flushing
cell membranes to
impairment
Doctor’s order: produce relaxation -palpitation
of coronary
-5mg 1tab OD vascular smooth -fatigue
muscle, decrease
-nausea
peripheral vascular
resistance of -abdominal pain
smooth muscle
(↓BP)
Drug name: -atrial fibrillation -hypersensitivity -anorexia -monitor v/s especially
the PR
-digoxin ACTION -intermittent -GI disturbance
complete heart -should be administered
Brand name: -(+) inotrophic -atrial tachycardia
block with food or after eating
effect more
-lanoxin -gynecomastia
available calcium -2nd heart block -watch out for the
Doctor’s order: promotes increase -CNS effect adverse reaction of drug
forces to increase
-0.25mg 1tab OD cardiac output

DRUG INDICATION CONTRAINDICATI ADVERSE NURSING

ON REACTION CONSIDERATIONS

Drug name: -relieve acid -hypersensitivity to -abdominal pain -should be taken on an

indigestion pantoprazole Na empty stomach (take 1
-pantoprazole Na -diarrhea
and its components hour before meal)
ACTION
Brand name: -constipation
-inhibits both basal
-pantoloc -flatulence
& stimulated
Doctor’s order: gastric acid -nausea
secretion
-40mg OD -headache

-dizziness

Drug name: -prophylaxis & -hypersensitivity to -abdominal pain -watch out for the
treatment of montelukast and its adverse reaction of the
-montelukast -thirst
asthma, including component drug
prevention of day &
Brand name: night time -headache
symptoms
-singulair -vomiting
ACTION-
Doctor’s order:
Montelukast is a
-10mg 1tab OD selective
leukotriene
receptorantagonist
that blocks the
effects of cysteinyl
leukotrienes in the
airways.

DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING

CONSIDERATIONS
Drug name: -maintenance -hypersensitivity to -dry mouth -do not take more
treatment for tiotropium Br and its than there
-tiotropium Br -constipation
patients with COPD component recommended dose
Brand name: -cough & local irritation
ACTION
-spiriva -tachycardia
-By binding to the
Doctor’s order: muscarinic receptors -urinary retention
in the bronchial
-OD at HS smooth
musculature,
tiotropium bromide
inhibits the
cholinergic
(bronchoconstrictive
) effects of
acetylcholine,
released from
parasympathetic
nerve endings. It
has a similar affinity
to the subtypes of
muscarinic receptors
M1-M5. In the
airways, tiotropium
bromide
competitively and
reversibly
antagonises the M3-
receptors, resulting
in relaxation
V. NCP

ASSESSMEN DIAGNOSIS INFERENCE PLANNIN INTERVENTIO RATIONALE EVALUATI

T G NS ON
Subjective Readiness for Difficulty of Short-term 1. Assess 1. Provides
“Makakaalis enhanced breathing goal: client’s level of opportunity to
na daw ako therapeutic ↓ understanding assure After 30-60
dito sa regimen Hospitalizatio After 30- of therapeutic accuracy & mins of
hospital sabi management n 60 mins of regimen. completeness nursing
ng doctor” as ↓ nursing of knowledge interventio
verbalized by -A pattern of Medical Mngt interventio base for future n, the
the client. regulating & ↓ n, the 2. Discuss learning. client
integrating Nursing Mngt client will present 2. To note assumes
Objective: into daily ↓ assume resources used whether responsibili
-no living a Good responsibil by client. changes can be ty for
unexpected program for Prognosis ity for arranged. managing
acceleration treatment of ↓ managing 3. Identify steps treatment
of illness illness & its Restoration treatment necessary to 3. regimen.
symptoms sequelae that of Health regimen. reach desired Understanding
is sufficient ↓ health goals. the process
-no difficulty for meeting MGH enhances
of breathing health- ↓ commitment &
noted related goals Readiness for achievement of
& can be enhanced 4. Accept goals.
-no pain strengthened therapeutic client’s 4. Promote
noted . regimen evaluation of sense of self-
management own strength/ esteem &
limitation while confidence to
working continue effort.
together to
improve
abilities. 5. To promote
5. Promote wellness.
client/SO
choices &
involvement in
planning.
VI. Discharge Planning

Medication

 Encourage strict medication compliance and to take medications

as directed to attain therapeutic effects.
 Instruct patient and significant others to keep a list of
medications with their respective dosage and frequency of intake to
prevent medication errors and their purpose.
o telmisartan + hydrochlorothiazide (Micardis Plus) 40mg 1tab
OD
o diltiazem (Cordazem) 90mg 1tab BID
o nicorandil (Aprior) 10mg 1tab BID
o atorvastatin (Lipitor) 80mg 1tab HS
o amlodipine (Vasalat) 5mg 1tab OD
o digoxin (Lanoxin) 0.25mg 1tab OD
o pantoprazole (Pantoloc) 40mg OD
o montelukast (Singulair) 10mg 1tab OD

 Inform patient regarding side effects of medication to alleviate

patient anxiety if said side affects manifest.
Exercise

 Adequate rest periods must be given in between exercises to prevent

straining.
 Always bear in mind that one has to start on easy-to-do exercises first and
must rest frequently, building up strength is essential as one goes on until
hard exercises are tolerated.
 Moderate exercise such as walking should be encouraged.
Treatment

 tiotropium bromide (Spiriva); 1cap spray at HS

Health Teachings

 Provide patient and relative written and verbal information regarding the
following:
 o Contacting the healthcare provider when signs of recurrence or
complications of the disease appear, especially shortness of breath
and chest tightness.

o Seek medical advice from healthcare provider for immediate

treatment of upper respiratory system, and oral cavity infections.

o Providing support. The patient and family need assistance,

explanation, and support every time patient requires treatment to
prevent serious complications and improve condition.

o Indicate enough bed rest to reduce exertion and to avoid all

strenuous activities that has not been approved by the physician.

Out-Patient Follow-up

 Assert importance of follow up visits to physician.

 Advise patient and family to report to the physician if any recurrence or
severity of symptoms, any adverse effects of the medication, and any
development of complication.
Diet

 Alcohol use should be discouraged.

 Depending on the health care provider a diet that is low in sodium
content, about 2 grams per day is recommended.
 It is advisable that cholesterol intake be limited
 Sources of fiber are to be added to the diet to aid in digestion.
 Protein intake is recommended but must not be from fatty sources.
Fish, chicken and beans are good sources of protein so long as it is not
contraindicated by the patient’s physician.
 Intake of vitamin supplements and other sources of minerals are
recommended.
 Excessive fluid intake should be discouraged, but fluid restriction is
rarely indicated.
Spiritual

 Encouraged the client to always pray to God and also provide spiritual
tools for the client if necessary.