MEDICAL SURGICAL NURSING

CASE STUDY

BIO-DATA OF THE PATIENT

 Name of the patient:-- Ganpat S/O Kalusingh

 Age/Sex:-- 64yr/male
 Occupation :-- labour
 Religion :-- Hindu
 Registration No:-- ipdno-20244996
 Ward :-- male medicine
 Bed No:-- 7
 Date of Admission:-- :-- 21/02/2024at 3pm
 Date of Discharge:-- 04/03/2023
 Diagnosis :-- chronic obstructive pulmonary disease

FAMILY HISTORY:- my patient leaves in joint family .his three son. 1 sun studied 10 th
class .he worked in sari shop as sales clerk . His 1 daughter law she studied 12 th studied. she
work in housewife. second son he studied B.A. class. Her wife is work in beauty parlour. 3
son studied 10th Class. he worked in factory .his wife is 12 th studied. she work in house as
wife.

FAMILY TREE

patient wife

cancer

1st son 2nd son 3rd son

FAMILY COMPOSITION

S.No. NAME OF THE FAMILY Relationship Age/Sex Occupation Education Health

MEMBERS Status
1. DEVBAI wife 57yr/female labour illiterate well
2. BAPULAL son 45yr/male labour illiterate well
3. KAMAL son 40yr/male labour illiterate well
4. RADHESHYAM son 38yr/male labour illiterate well

FAMILY ILLNESS:- no family illness

SOCIO-ECONOMIC CONDITION:- my patient socioeconomic condition is very

poor.my patient labour and his wife leave in home. his monthly income is 6000rs

HOUSING :- his home is kaccha house .and his house only two room one room is living
room and second room is kitchen .they takes water from tapwater.no elimination
facility .they went from elimination open area.

PERSONAL HISTORY: he used bidi smoke in last 25 year.

MEDICAL HISTORY

Past medical history-no

Present medical history my patient having difficulty in breathing during walking ang
sitting position patient may feeling weakness

Dietary history:- he is non vegetarian. he takes early morning tea . he takes four chapati
per day with vegetable.

Surgical history:-

MARITAL HISTORY:-his get married for 47year.

MENSTRUAL HISTORY:-x

PHYSICAL EXAMINATION
Height :-- 144cm

Weight :-- 52kg

CNS
Level of consciousness :-- conscious

Any convulsion :-- no

Headache :-- no

RESPIRATORY SYSTEM
Respiratory rate &rhythm :-- treachycardia

Bilateral air entry :--

Any breathlessness :--

Ronchi / crepts :--

CV SYSTEM
Pulse rate & rhythm :-- 96/m

Murmur or abnormal sound :-- yes both lung

Blood pressure :-- 130/70mmhg

Pallor /Jaundice/ Varicosevein :--no

GI SYSTEM
Tongue ( coating/ Dryness) :-- no

Teeth / Gums :-- no teeth

Dilated Veins :-- no

Liver :-- no

Heart Burn :-- yes

Constipation :-- 2 times in a day

Hemorrhoids:-- no

URINARY SYSTEM
Frequency :-- 8 -9 times a day

Amount :-- 600ml/day

ABDOMINAL EXAMINATION
Tone of abdominal muscle :--
Any scar :--

Height of fundus :--

INTRODUCTION:- :- copd is a common, preventable, and treatable disease that is

characterized by persistent respiratory symptoms and airflow limitation that is due to airway
and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or
gases. As with previous editions, the 2018 Global Initiative for Chronic Obstructive
Pulmonary Disease (GOLD) update seeks to provide comprehensive evidence-based
guidelines for the diagnosis, management, and prevention of COPD (Mirza et al., 2018).

COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms of

dyspnea, cough, sputum production, and exacerbations due to abnormalities of the airways
such as bronchitis and/or alveoli that cause persistent, often progressive, airflow obstruction,
such as in emphysema (Global Initiative for Chronic Obstructive Lung Disease.

COPD is a progressive disease that affects the lungs and is associated with chronic
inflammation and abnormal inflammatory responses to harmful particles or gases. It leads to
narrowing of the airways and changes in lung parenchyma and pulmonary vasculature. In the
airways, there are increased mucus production, thickening of the airway wall, and overall
narrowing. In the lung parenchyma, alveolar wall destruction and loss of elastic recoil occur.
Imbalances of substances in the lung, such as proteinases, can further contribute to airflow
limitation. These changes can be influenced by factors like chronic inflammation,
environmental exposures, and genetic factors like alpha1-antitrypsin deficiency

DEFINITION:-
Asthma: Also known as chronic reactive airway disease, asthma is characterized by
reversible inflammation and constriction of bronchial smooth muscle, hypersecretion of
mucus, and edema. Precipitating factors include allergens, emotional upheaval, cold weather,
exercise, chemicals, medications, and viral infections.

Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of

airways, increased production of mucoid sputum and marked cyanosis.

Emphysema: A most severe form of COPD, characterized by recurrent inflammation that

damages and eventually destroys alveolar walls to create large blebs or bullae (air spaces) and
collapsed bronchioles on expiration (air-trapping).

Using Clinical Information to Classify the Patient in a GOLD COPD Group

Grou Description Symptoms By Risk

p mmMRC By FEV1 By exacerbation
frequency
A Low symptoms, mMRC 0–1 ≥ 50% 0–1 outpatient or
low risk (grades 1–2) 0 hospitalized
 exacerbation
B High symptoms, mMRC 2–4 ≥ 50% 0–1 outpatient or
low risk (grades 1–2) 0 hospitalized
exacerbation
C Low symptoms, mMRC 0–1 < 50% ≥ 2 outpatient or
high risk (grades 3–4) ≥ 1 hospitalized
exacerbations
D High symptoms, mMRC 2–4 < 50% ≥ 2 outpatient or
high risk (grades 3–4) ≥ 1 hospitalized
exacerbations

ANATOMY AND PHYSIOLOGY OF ASSOCIATED ORGAN:-

ETIOLOGY
S.NO. IN BOOK IN PATIENTS
1. smoking Smoking
2. Air pollutants/other irritants
3. Genetics Alpha-1-antitrypsin (AAT) deficiency age

4. Occupational exposure
5. asthma
6. age
7. Chemical exposure

CLINICAL MANIFESTATION
S.No. IN BOOK IN PATIENTS
1. Chronic cough breathing difficulty

2. fatigue
cough
3. Dyspnea Dyspnea
4. Production of mucus Shortness of breath
5. Shortness of breath fatigue
6. Chest discomfort Weight loss
7. Weight loss
8. Ankle swelling

DIAGNOSIS EVALUATION

S.No. Date Parameter Patients Value Normal Value

1 26-02- CBC
2024
2 26/3/24 HEMOGLOBIN 13.9gm/dl (m-12.5-14.5)gm/dl
(f-11.5-13.5)gm/dl
3 26/3/24 HCT 46.7% (40-59)%
4 26/3/24 TOTAL ETHROCYTES 5.0610^6/mice (M-4.5-5.5)
COUNT 10^6/nenol
(f-3.8-4.8)10^6/
nenol
5 26/3/24 MCV 92.6FL (80-96)fl
6 26/3/24 MCH 27.5PH (26-37)g/dl
7 26/3/24 MCHC 29.8G/DL (11-14)%
8 26/3/24 Total leucocytes count
9 26/3/24 neutrophil 13.1%
10 26/3/24 lymphocytes 17.8.9% (20-45)%
11 26/3/24 monocytes 9.6% (2-10)%
12 26/3/24 eosinophil 0.9% (1.6)%
13 26/3/24 basophil 0.4% (>1)%
14 26/3/24 Platlets count 32510^3/6 (150-450)
10^3/nenol
 15 26/3/24 PDW 10.3 (8.3-25.0)fl
16 26/3/24 MPV 9.9fl (8-9.5)fl
17 26/3/24 PCT .32% (0.15-0.62)%
18 26/3/24 CRP 11.03MG/DL upto5mg/dl
19 26/3/24 WINTROBE METHOD
20 26/3/24 OBSERVATION 16MM mo-9mmcr
AFTER1HR. f-o-20mmafter 1hr
21 26/3/24 LIVER FUNCTION
TEST
22 26/3/24 SERUM BILIRUBIN 0.23mg/dl (0.2-1.0)mg/dl
(TOTAL)
23 26/3/24 SERUM 0.13mg/dl (<0.3)mg/dl
BILIRUBIN(DIRECT)
24 26/3/24 INDIRECT BILIRUBIN 0.10mg/dl (<0.7mg/dl

25 26/3/24 SGOT(AST) 18.92 (5-38

)iu/l
26 26/3/24 SGPT(ALT) 15.60iu/l 5-40)iu/l
27 26/3/24 SERUM ALKALINE 95.65iu/l (30-306)iu/l
PHASPHATE
28 26/3/24 SERUM ALBUMIN 7.30gm/dl (6.4-7.8)gm/dl
30 26/3/24 serum protein 3.78gm/dl (3.7-5.3)gm/dl
26/3/24 serum globulin 3.52gm/dl (2.3-3.6)gm/l
31 26/3/24 a/g ratio 1.o7 (1.0-3.6)

Patient Name: GANPATJI

Study Date 2/28/2024

NCCT SCAN OF THORAX

OBSERVATIONS:

 Both lung fields are hyperinflatted showing areas of focal air trapping - S/o COPD
changes.
 Multiple centriacinar paraseptal emphysematous bullae are seen in both lung fields,
predominantly bilateral apical segments.
 Mild bronchial dilatation with bronchial wall thickening and peribronchial cuffing
 are noted in the bilateral lung parenchyma suggestive of bronchitis changes. Few pre,
paratracheal, subcarinal, AP window lymphnodes are seen, subcentimetric in size.
 Trachea is central. Tracheal bifurcation is normally seen with normal bronchial
segmental divisions. No obvious intraluminal pathology noted.
 Mediastinal soft tissue characterization would require contrast study evaluation.
  No evidence of pleural / pericardial effusion.
 Esophagus appears normal in appearance without evidence of any abnormal
thickening or mass lesion with collapsed lumen.
 Atherosclerotic changes with calcified plaques noted in aorta.
 Degenerative changes seen in visualized spine.
 IMPRESSION:
 Both lung fields are hyper inflatted showing areas of focal air trapping - S/o COPD
changes.
 The CT Scan findings represent only a diagnostic possibility, which has to be
correlated with clinical findings, other relevant investigations & if needed a follow u
 examination. This report is based on digital DICOM images provided via internet
without identification of patient, not on the films/platas provided to the patient

MANAGEMENT

MEDICAL MANAGEMENT

s.no. drug route dose indication Side effect nursing

responsibility
1 cefotaxime i/v 1gm genitourinary Pseudomembranous Observe site
tract, centralColitis. closely for
nervous system,  Headache. extravasation
intra-abdominal  Elevation in liver during
infections, bone enzymes. administration.
and joint Elevation in BUN
infections, and creatinine.
 Hematologic:
Neutropenia,
leukopenia,
2 Pantopraz I/V 4OM short-term headaches and  assess the
ole G treatment (7-10 diarrhoea. patient's
days) of patients medical history.
having ...
gastroesophageal  Monitor for
reflux disease side effects. ...
(GERD) with a  Evaluate the
history of erosive patient's
esophagitis, symptoms. ...
 Monitor for
drug
interactions. ...
  Evaluate the
patient's
nutritional
status.
3 ondansetro 4mg sos nausea and Constipation Assess
n vomiting caused Blurred vision dizziness and
by cancer drowsiness drowsiness that
chemotherapy, might affect
radiation therapy gait, balance,
and other
functional
activities
4 5omg to treat asthma Headache nausea this drug
deriphyllin and chronic vomiting s dizziness exactly as
e obstructive restlessness prescribed. ·
pulmonary Avoid
disorder excessive intake
of coffee, tea,
cocoa, cola
beverages, and
chocolate. ·
Smoking
cigarettes or
other tobacco ...

SURGICAL MANAGEMENT :-no

DIETARY MANAGEMENT:-
 Fruits – such as apples, avocados and berries
 Vegetables – particularly cruciferous vegtables and leafy greens
 Whole grains – such as whole grain bread, brown rice and oatmeal
 Nuts and seeds – such as almonds, walnuts, flax seeds, chia seeds
 Legumes – such as beans and chickpeas
 Fatty fish – fish such as salmon, tuna and mackerel
 Low-fat dairy – such as milk and yogurt
 Lean proteins – such as poultry, fish
 Extra-virgin olive oil – for cooking

FOODS TO LIMIT ON A COPD DIET

 Junk foods: fast food and potato chips

 Refined carbohydrates: white bread, pasta, crackers, flour tortillas, biscuits
 Fried foods: french fries, donuts, fried meats
  Sugar-sweetened beverages: soda, tea with added sugar, sports drinks
 Processed meats: bacon, canned meat, salami, sausages
 Trans fats: vegetable oil and margarine

NURSING MANAGEMENT WITH NURSING CARE PLAN

NURSING PROBLEM PRIORITIES

The following are the nursing priorities for patients with COPD:

1. Maintain airway patency.

2. Assist with measures to facilitate gas exchange.
3. Enhance nutritional intake.
4. Prevent complications, slow progression of condition.
5. Provide information about disease process/prognosis and treatment regimen.

NURSING NURSING EXPECTED INTERVENTION EVALUATION

DIAGNOSIS OUTCOME
ASSESSMENT

SUBJECTIVE 1. Ineffective Maintaining  Assess general Patient airway

DATA :- patient breathing Patent condition of the pattern is patent.
told me that he pattern related to Airway patient
having difficulty Clearance
alveolar  Assess the vital
Beathing and
weakness and hypoventilation, sign of the
restlessness anxiety, chest patient such as
wall alterations, respiratory rate,
OBJECTIVE and pulse,rate,spo2
DATA :-I hyperventilation level,
observe patient .  temperature.
Respiratory rate
is increase.  Advice client to
quit smoking.

SUBJECTIVE 2.Ineffective  Auscultate lung Maintaining

DATA:- airway clearance sounds to assess patient adequate
To Maintain presence of
related to oxygen
Patient told me airway adventitious
expiratory saturation.
that he having clearance lung sound.
airflow
coughing  Encourage slow
obstruction, deep breathing,
ineffective turning, and
 cough, coughing to
decreased ensure
airway mobilization of
secretions.
OBJECTIVE humidity, and
 Assist client in
DATA:- tenacious
steam inhalation
secretions. as needed.
Patient having
difficulty in  Monitor client
breathing, for dyspnea and
hypoxemia.
fatigue,
dizziness.  Administer
bronchodilators
and
corticosteroids
as prescribed.

SUBJECTIVE 3.Impaired gas To promote  Monitor pulse

DATA:- exchange related adequate tissue oximetry and
to alveolar oxygenation. regularly send
Patient told me ABG sample for
hypoventilation
that he having gas tissue oxygen
problem of gas exchange analysis.
 Eliminate strong
exchange related to
odors and
pattern alveolar smoke from
hypoventil patient's room.
OBJECTIVE Patient gas
ation  teach relaxation
DATA:- I exchange pattern
techniques such
observe patient as meditation. is improve.
 Advise and
Respiratory rate teach the use of
is increase. he is spirometry.
anxious .

SUBJECTIVE 4.Impaired sleep Patient  Assess sleep Patient sleep

DATA:- pattern due sleep pattern of the pattern is
breathing pattern is patient maintain
Patient told me difficulty such improve  Give advice
that his sleep is as patient to take
disturb he feel
proper eating
drowsiness and coughing
food
 To provide quite
restlessness and calm
environment.
OBJECTIVE
 To avoid late
DATA:- I
night awakening
observe patient

Looking
lethargy

SUBJECTIVE 5.Activity To improved  Assess the vital Patient tolerance

DATA:- intolerance activity sign of the activity is
related to tolerance patient improved
Patient told me inadequate temperature ,spo
that he having oxygenation and 2 level,
lethargy during dyspnea Respiration
walking. he feel
rate .
weakness.  Encourage
patient to daily
OBJECTIVE activity such as
DATA:- coughing and
breathing
I observe patient
exercise.
Is Looking
lethargy,  Advise patient
restlessness. do daily
meditation..
 Teach client
energy saving
practices for
activity of daily
living.
ONE – DAY MENU PLANNING

S.NO. TIME FOOD ITEMS AMOUNT

1. 1 cup black tea 1 bowel

8 am

2. Chapati with pulse

11am

3. 1 bowel rise, fry vegetables

LUNCH
1 pm

4. 1 cup tea 100ml

4 pm

5. Chapati,1/2 rise, pulses

8 pm

COMPLICATION
S.N0. IN BOOK IN PATIENTS

• Exacerbations of COPD Shortness of breath

1. • Acute respiratory failure

• Depression/anxiety
• Acute respiratory failure • Depression/anxiety
2.

1stDay :--22/08/2024 my patient having breathing problem he takes medicine routinely

he takes medicine bronchodilator and nebulization in three time a day his condition was
worse.

2ndDay :-23/02/2024 my patient health condition slowed improved .physician give advice
to him takes rest and medicine .as well as do coughing and breathing exercise slowly your
health is improve.

3rd Day :--

24/02/2024 my patient health condition is improve breathing pattern normal he takes a
medicine regularly and he doing breathing and coughing exercise. his health condition is
Improved

4th Day :--

25/02/2024 my patient health condition is well. He takes medicine proper time .breathing
pattern is improve he is avoiding food which is producing cough.

5thDay :--26/02/2024 patient condition is improve he takes healthy food and look
my
warm water. he goes early walking in morning. he doing deep breathing exercise and pursue
lip breathing exercise.

HEALT EDUCATION
Instruct and reinforce the rationale for pulmonary rehabilitation, such as breathing exercises, coughing
effectively, and general conditioning exercises.
Discuss the importance of medical follow-up care, periodic chest x-rays, and sputum cultures.

Identify individual factors that may trigger or aggravate conditions (excessively dry air, wind,
environmental temperature extremes, pollen, tobacco smoke, aerosol sprays, and air
pollution).
Discuss the importance of medical follow-up care, periodic chest x-rays, and sputum cultures.
Stress the importance of oral care and dental hygiene.
Review oxygen requirements and dosage for a client who is discharged on supplemental
oxygen. Discuss the safe use of oxygen and refer to the supplier as indicated.
Encourage the client and caregivers to explore ways to control triggering factors in and
around the home and work setting.

 If you smoke, get help to quit.

 Eat a healthy diet rich in calcium and vitamin D.
 Do weight-bearing exercise, such as walking, lifting weights, or working out with
stretch bands — these activities stimulate bones to rebuild and become denser.
 Talk to your doctor about taking daily calcium and vitamin D supplements.

THEORY APPLICATION –. Virginia Henderson

Virginia Henderson: Nursing Need Theory

 Nursing Need Theory

 Focuses on the importance of increasing the patient’s independence to hasten their

progress in the hospital.

 Emphasizes the basic human needs and how nurses can assist in meeting those needs.
 “The nurse is expected to carry out a physician’s therapeutic plan, but individualized care
is the result of the nurse’s creativity in planning for care.
This theory apply my patient and this theory beneficiary my patient. he adopt healthy healthy
life style and his health is improved.

RESEARCH/ ADVANCE TECHNOLOGIES –] Nursing Research on Patients

with Chronic Obstructive Pulmonary Disease and Respiratory Failure Based on Big Data
Academic Editor: Fazlullah Khan

Published29 Sept 2021

Abstract

This work organically integrates a systematic and individualized nursing plan with big data
technology and applies it to the care of patients with chronic obstructive pulmonary disease
(COPD) and respiratory failure (RF) and explores the continuous care model based on
modern big data technologies to improve COPD and RF. It aims to relieve the symptoms of
COPD and RF, reduce the number of acute episodes of COPD and RF and the number of
hospitalizations, and improve the quality of life of patients. One hundred COPD and RF
patients hospitalized in the respiratory medicine department of a tertiary hospital were
selected and were categorized into control and experimental group. The nursing mode of the
patients in the control group was the original telephone follow-up in the department, and the
contents of the follow-up were determined according to the questions of the patients on the
telephone at that time. Based on the original nursing in the department, the experimental
group adopted individualized continual nursing plans based on the Internet and big data
techniques for patients to conduct a pulmonary rehabilitation-related functional assessment,
functional exercise guidance, and health guidance. Experimental results show that, compared
with traditional continuous care, individualized continuous care combined with big data
techniques can improve the lung function of patients with stable COPD and RF, reduce the
number of acute COPD and RF attacks and the number of readmissions, and improve self-
management ability and quality of life. The method can be applied and implemented in

CONCLUSION :-

The best way to slow down the progression of the disease is to stop smoking if you smoke.
Also, avoid second hand smoke or other irritants such as air pollution, dust, or chemicals. If
you’re underweight, it’s helpful to maintain a healthy weight with good nutrition and
techniques to increase food intake, such as eating small, frequent meals. Learning how to
improve breathing with exercises such as pursed lip breathing will also help. You may also
want to participate in a pulmonary rehabilitation program. You’ll learn about exercises,
breathing techniques, and other strategies to maximize your health. And while exercise and
physical activity may be challenging with a breathing disorder, it’s one of the best things you
can do for the health of your lungs and the rest of your body. Talk with your doctor about a
safe way to start exercising. Learn the warning signs of breathing problems and what you
should do if you notice a minor flare-up. You’ll want to follow any COPD medication
therapy prescribed to you by your doctor
 BIBLIOGRAPHY
1.Lippin cott william and wilkins manual of nursing practice ,eight edition,Chapter11,page
no 286-288.

2.lewis’s medical surgical nursing assessment and management clinical problem,11 th

edition,marian m.page no554-555.

3.brunner and suddarth’s textbook of medical surgical nursing,12edition,pageno 452-453

4.ross and wilson textbook anatomy and phsiology,10edition page no.249-252

 https://nurseslabs.com
 MEDICAL SURGICAL NURSING

EVALUATION CRITERIA FOR CASE STUDY

s. no. Criteria Marks

1. Selection of case 5

2. Family history and family tree 5

3. Health and medical history 5

4. Clinical assessment/Physical examination 10

5. Anatomy and physiology 5

6. Disease condition and its correlation with patient. 15

7. Medical/surgical management 10

8. Nursing Care plan and need assessment 20

9. Dietary management and menu planning 10

10. Health education and advices 10

11. Prognosis report 5

Total 100

Signature of supervisor
 MEDICAL SURGICAL NURSING
EVALUATION CRITERIA FOR CASE PRESENTATION

s. no. Criteria Marks

1. Selection of case 5

2. Family history and family tree 5

3. Health and medical history 5

4. Clinical assessment/Physical examination 10

5. Disease condition and its correlation with patient. 15

6. Medical/surgical management 10

7. Nursing Care plan and need assessment 20

8. Dietary management and menu planning 10

9. Health education and advices 15

10. Prognosis report 5

Total 100

Signature of supervisor
1. LEWIS’S MEDICAL -SURGICAL NURSING ASSESSMENT AND MANAGEMENT
OF CLINICAL PROBLEM,EDITION11TH,2020 publish by MARIANN
M.HARDING,PAGE NO.1225-1227.

2.LIPPIONCOTT WILLIAM AND WILKINS MANUAL OF NURSING

PRACTICE ,EDITION 8TH ,PAGE NO.859-860.

3.ROSS AND WILSON ANATOMY AND PHSIOLOGY IN HEALTH AND ILLNESS,

10TH EDITION, PG NO. 447.

4.BRUNNER AND SIDDARTH TEXT OF MEDICAL SURGICAL NURSING,WOLTER

KLUWER 2022,SECOND SOUTH EDITION,PAGE NO 912-107O.
 GOVERNMENT COLLEGE OF NURSING
UJJAIN(M.P.)

SESSION :-2022-2023
SUBJECT :-NURSING EDUCATION
CASE STUDY TOPIC ON:- CHRONIC OBSTRUCTIVE
PULMONARY DISEASE

Submitted To:- Submitted By:-

Mrs. Aradhna Mishra Mrs. Sonam Chouhan
Academic Counsellor M.Sc. Nursing Previous Year
Government College Of Government College Of Nursing
Nursing Ujjain (M.P.) Ujjain (M.P.)
 GOVERNMENT COLLEGE OF NURSING
UJJAIN(M.P.)

SESSION :-2022-2023
SUBJECT :-ADVANCE NURSING PRACTICE
SEMINAR TOPIC ON:- MANAGEMENT OF
MULTISYSTEM ORGAN
DYSFUNCTION

Submitted To:- Submitted By:-

Dr. Asha Dubey Mrs. Sonam Chouhan
Professor M.Sc. Nursing Previous Year
Hod Department Of Medical Government College Of
Surgical Nursing Nursing Ujjain (M.P.)
Government College Of