ARELLANO UNIVERSITY

Legarda, Manila

CASE STUDY

COPD
(Chronic Obstructive Pulmonary Disease)

Medical Ward 2

FBGH

SUBMITTTED BY:

Salazar, Anne Mizchelle

Soon, Faida Riza

Sulit, Michelle

Sumadsad, Jennifer

Ta-a, Juna Angelica

Tarronas, Venice Mae

Usana, Ma. Kristina

Vicente, Rose Anne

Yabao, Rickson

Vilanueva, Xylon

BSN III-1

Jan.

SUBMITTED TO:

Josephine Agcaoili R.N.

TABLE OF CONTENTS
INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a progressive disorder

characterized by expiratory airflow limitation that is not fully reversible.It is a preventable
and treatable disease state that encompasses both emphysema (pathological
accumulation of air in tissues or organs) and chronic bronchitis (inflammation of a
bronchus or bronchi). Around 90% of cases of COPD are caused by cigarette smoking;
other strong risk factors include more advanced age (may be related to longer period of
smoking) and genetic factors (e.g., alpha-1 antitrypsin deficiency). Typical symptoms
include cough (usually productive) and shortness of breath; common signs of COPD
include barrel chest, hyper-resonance, distant breath sounds, poor air movement,
wheezing, and hypoxia.
OBJECTIVES

General Objectives:

The significance of the study is for us third year students to apply the principles and
concepts that we have learned in the NCM 102( medical surgical) in our rotation at Fort
Bonifacio Medical Hospital, with the following specific learning objectives:

 To be able to understand the causes of the disease.

 To be able to understand what COPD really mean.
 To be able to describe the development, pathophysiology, medical-surgical
management, and nursing care for the patient with COPD
 To be able to design a Nursing Care Plan for the patient.
 To be able to provide information and heath teachings for the progress of patient.
 To be able carry-out hospital routines and the treatment prescribed to the patient.
 To be able to perform nursing procedures and nursing considerations for a client
 To be able to implement the nursing care plan.
 To be able to establish therapeutic relationship with the patient and his family.
 To be able to help the patient cope with his condition.
NURSING THEORY

ENVIRONMENTAL THEORY

Florence Nightingale, often considered the first nurse theorist, defined nursing over
100 years ago as "the act of utilizing the environment of the patient to assist him in his
recovery". She linked health with five environmental factors:

A. Pure and fresh air

B. Pure water

C. Efficient drainage

D. Cleanliness

E. Light, especially direct sunlight

Nightingale's environmental factors attain significance when one considers that

sanitation conditions in hospitals of the mid-1800s were extremely poor and that women
working in the hospitals were often unreliable, uneducated, and incompetent to care for
the ill.

In addition to those factors, Nightingale also stressed the importance of keeping the
client warm, maintaining a noise-free environment, and attending to the client's diet in
terms of assessing intake, timeliness of the food, and its effect on the person.

Nightingale set the stage for further work in the development of nursing theories. Her
general concepts about ventilation, cleanliness, quiet, warmth, and diet remain integral
parts of nursing and health care today.
PHYSICAL ASSESSMENT

BODY PART ACTUAL FINDINGS ANALYSIS

 Pink skin
Integumentary  Even hair
distribution NORMAL
 Moist, warm, smooth
 No edema
 No lesions
 Evenly distributed
HEAD -----Hair  Moist scalp
 Intact skin NORMAL
 No lesions
 No edema
 White sclera NORMAL
Eyes  Evenly distributed
hair lashes -the patient is 61y/o and he
 Pupils – PERRLA is wearing eye glasses due
 Wearing eye glasses to aging
(L-250: R-150)
 Symmetrical
Ear (hearing)  No discharge NORMAL
 No lesions
 Good hearing
 Nose are patent
Nose  Nose in the midline NORMAL
 No drainage
 No blockages
 Pink lips
Mouth (throat)  Good oral hygiene NORMAL
 Swallows easily
 No lesions
Neck  No edema NORMAL
 No swollen lymph
nodes
 No masses
Thorax (chest) NORMAL
  Skin is intact
 Pulse can be
palpated ABNORMAL
 Cardiac rate of 96 -maybe due to aging and
due to his asthma

NORMAL
 Clear Breath sounds ABNORMAL
 With productive -due to his COPD and
cough asthma (when the patient
 Slight difficulty of smells perfume or dust, his
breathing asthma will attacks him
them patient will manifest
difficulty of breathing)
 Full ROM
 No lesions, swelling NORMAL
(Musculo-Skeletal) and edema
 Skin is intact
Upper extremities  Straight posture
 Scars in left forearm ABNORMAL
-scars from ambush during
the operation
 Full ROM
Lower extremities  No lesions, swelling NORMAL
and edema
 Skin is intact
 Straight posture
 No palpable masses
 Scars in the thigh ABNORMAL
part -scars from ambush during
the operation
 Urine continent
Elimination  Clear urine
 Everyday urination NORMAL
 Everyday bowel
movement
 LOC-alert
Neuro  Oriented (person,
place, time) NORMAL
 No sign of weakness
 Clear / effective
communication
GORDON’S FUNCTIONAL PATTERN

BEFORE
PATTERN DURING ANALYSIS
HOSPITALIZATIO
HOSPITALIZATIO
N
N

 HEALTH The patient is The patient knows The patient is

PERCEPTION – healthy with no his problem and aware of his
HEALTH other health the need to sustain condition. He
MANAGEMENT problems except for his medication. He knows what to do,
his asthma. He just is dependent with when to go to
takes his medicine medicine. hospital and when
when asthma to take his
attacks him. medicines.

 NUTRITIONAL – The patient has an The patient still try The patient’s
METABOLIC order to avoid to eat chicken and intake of foods has
eating chicken and fish even if it is been changed. He
fish without scale restricted but now do / practice small
but he doesn’t he is practicing frequent feeding
follow the order. He small frequent because of his
drinks enough feeding. condition. Too
water, he also much intake of
drinks alcohol foods will trigger
occasionally. His his asthma.
metabolism was
normal.

 ELIMINATION The patient’s bowel The patient still The patient’s

movement is every has an everyday bowel movement
day. He urinates bowel movement has no problem.
everyday but and there is no His condition
sometimes it excessive or less doesn’t affect his
depends on how or difficulty in elimination.
many fluids he urinating.
takes on that day.
 ACTIVITY – The patient was The patient’s
EXERCISE restricted to do activity was
that activity restricted due to
The patient is a because there are his condition. He
sport-minded possibilities that cannot do those
person. He loves to his asthma will ballgames that
play badminton, attack him. The may trigger his
basketball, table patient stays only asthma that will
tennis, lawn tennis, in his room and result to difficulty of
etc.. He is also with limited breathing.
doing his everyday activities that will
exercises. not trigger his
asthma to attack
him.

 SLEEP – REST The patient’s sleep There are no

The patient usually
pattern was the changes in
sleeps at 9pm but
same. He sleeps sleeping pattern of
sometimes 9pm up
for 2-3hrs then will the patient before
to 12am/1am ( 2-
wake up and then and during he was
3hrs of sleeping)
go to sleep again. admitted, only on
only then will wake
Sleeping is his way of resting.
up because of DOB
considered as his He would rather
then sleeps again.
resting activity. sleep because of
Listening to music
his condition rather
was one of his
than listening to
resting activities.
music while in pain
on breathing.

 COGNITIVE – The patient has a The patient can There are no

PERCEPTUAL good memory and communicate well changes before
he is responsive. to others. Good and during the
With a good sensory and motor patient was
sensory and motor coordination with admitted. There is
coordination. Able good memory, no impact on the
to communicate or alert and patient whether he
response. responsive. is hospitalized or
not.

 SELF- The patient feels The patient’s hope The patient has a
PERCEPTION – okay with regards to recover/ to be good self-esteem.
SELF-CONCEPT to his attitude and cured was still His condition
characteristic. An remained because doesn’t affect his
active person he knows that this self-perception. He
(church, work, and is just trials of just think / look this
 GOD. There is still event as a trials of
no feeling of GOD.
sports). There is no
loneliness
feeling of loneliness
because of the
because of his
support of his
family and friends.
family and friends.

 ROLE – The patient’s The patient’s The condition of

RELATIONSHIP relationship with his relationship with the patient doesn’t
wife and children his wife and affect the
was ok. There is children was still relationship
sometimes a the same. Since between him, his
problem and they the patient’s wife and his
easily resolved it. children are in children because
Even in his busy abroad, he says he accepts his
work, he is still that he is always condition and he
supporting his available for them. doesn’t mind to be
family. affected by it.

 SEXUALITY – The patient is not The patient is not There are no

REPRODUCTIVE sexually active due sexually active and changes on
to his busy work he doesn’t think of sexuality and
and activities and that thing while reproductive
he has already six hospitalized. before and during
children and he the patient was
thinks that’s hospitalized
enough. because of busy
life.

 COPING – STRESS The patient’s main Now that the

TOLERANCE The patient is stressor was his patient was in the
usually suffering hospitalization and hospital, his main
stress from his with the help of his stressor was the
family especially family and friends, reason of being
when they talk he can able to hospitalized
about drinking cope with the because his
alcohol. stressor. activity has been
The patient just restrained. While in
goes and makes the hospital, the
himself busy to support of his
cope with the family and friends
stressor. never stop that is
why he can cope
with the stress.
 VALUE - BELIEF The patient is a The patient still The patient’s belief
Roman Catholic does not believe in stills the same. He
and he is also a any superstitious just can’t attend
Lay minister. He beliefs and their activity in the
doesn’t believe to practices everyday church due to his
any superstitious praying. The condition because
beliefs. He is patient cannot anytime his asthma
praying every day. attend their may attacks.
He is active in their activities in the
church. church.
ANATOMY PHYSIOLOGY

Respiratory System

The respiratory system is an intricate arrangement of spaces and passageways that

conduct air from outside the body into the lungs and finally into the blood as well as
expelling waste gasses. This system is responsible for the mechanical process called
breathing, with the average adult breathing about 12 to 20 times per minute.

When engaged in strenuous activities, the rate and depth of breathing increases in
order to handle the increased concentrations of carbon dioxide in the blood. Breathing is
typically an involuntary process, but can be consciously stimulated or inhibited as in
holding your breath.
Upper Respiratory Tract

 Nose

 Sinuses

 Pharynx

 Larynx

1. Nostrils/Nasal Cavities

Regions of the nose include the external nose and the nasal cavity.

During inhalation, air enters the nostrils and passes into the nasal cavities where
foreign bodies are removed, the air is heated and moisturized before it is brought further
into the body where it exits through the posterior nares.

The function of the nasal cavity is to clean, warm and dampen the air that enters
so that it can travel throughout the body. And it is this part of the body that houses our
sense of smell.

2. Sinuses
 The sinuses are small
cavities that are lined with
mucous membrane within
the bones of the skull.

3. Pharynx

Air
moves
into the
nasal
cavity
through
the
nostrils (
nasophar
ynx). The

oropharynx opens into the oral cavity which encloses

the lips, teeth, cheek, hard and soft palates, tongue
and tonsils.

Extending from the tip of the epiglottis to the glottis and the esophagus is the
laryngopharynx and positioned in the anterior neck is the larynx.The pharynx, or throat
carries foods and liquids into the digestive tract and also carries air into the respiratory
tract.

4. Larynx
The larynx or voice box is located between the pharynx and trachea. It is the location of
the Adam's apple, which in reality is the thyroid gland and houses the vocal cords.

The larynx is a passageway between the pharynx and the lower airway
structures. It is a short tube made up of supportive cartilage, ligaments, muscle and
mucosal lining. The supportive cartilage prevents food and drink from entering the
larynx while swallowing.

 Lower Respiratory Tract is located in the chest and makes up the:

 Trachea
 Lungs
 Bronchial tree

Air passes from the larynx to the lungs (trachea).The trachea divides into the right
and left primary bronchi (bronchial tree) and the large pair of spongy organs (lungs) are
used for respiration.

1. Trachea
The trachea or windpipe is a tube 10-12cm that extends from the lower edge of the
larynx to the upper part of the chest and conducts air between the larynx and the lungs.

The wall of the trachea is made of hyaline cartilage which enables the trachea to
stay open so that air can be conducted between the larynx and primary bronchi.

Trachea divides into the right and left primary bronchi.

2. Lungs
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.

Bronchial tree:
 The bronchial tree consists of a primary, secondary (lobar) and tertiary bronchi
(segmental bronchi).

The trachea splits into the right and left bronchi at the level of the sternal angle.
The secondary bronchi forms when the primary bronchus enters the lung; and conducts
air directly to one of the five lobes within the lung.

Tertiary bronchi derive from the secondary bronchi and conduct air to and from
the bronchial segment. There are 8 bronchial segments in the left lung and 10 in the
right lung.

The bronchi subdivide creating a network of smaller branches, with the smallest
one being the bronchioles. There are more than one million bronchioles in each lung.

Avleoli 

The alveoli are tiny air sacks that are enveloped in a network of capillaries. It is here
that the air we breathe is diffused into the blood, and waste gasses are returned for
elimination.

 
 Mechanics of Breathing

To take a breath in, the external intercostal muscles contract, moving the ribcage up

and out. Thediaphragm moves down at the same time, creating negative pressure
within the thorax. The lungs are held to the thoracic wall by the pleural membranes, and
so expand outwards as well. This creates negative pressure within the lungs, and so air
rushes in through the upper and lower airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if
they are not held against the thoracic wall. This is the mechanism behind lung collapse
if there is air in the pleural space (pneumothorax).

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-

divides to form very narrow terminal bronchioles,
which terminate in the alveoli. There are many
millions of alveloi in each lung, and these are the
areas responsible for gaseous exchange, presenting
a massive surface area for exchange to occur over.

Each alveolus is very closely associated with a

network of capillaries containing deoxygenated
blood from the pulmonary artery. The capillary and
alveolar walls are very thin, allowing rapid exchange
of gases by passive diffusion along concentration
gradients. 
CO2 moves into the alveolus as the concentration is
much lower in the alveolus than in the blood, and
O2 moves out of the alveolus as the continuous flow
of blood through the capillaries prevents saturation
of the blood with O2 and allows maximal transfer
across the membrane.