COMPREHENSIVE CASE STUDY ON

A CLIENT WITH
CHRONIC OBSTRUCTIVE
PULMONARY
 A. BACKGROUND OF THE STUDY
 Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic
morbidity and mortality throughout the world. Many people suffer from this
disease for years and die prematurely from it or its complications. It is an
insidious, progressive disease that causes airflow blockage and breathing
related problems, making it hard to breathe. "Insidious" means developing so
gradually as to be well established before becoming apparent and
"progressive" means the disease gets worse over time.
 Chronic obstructive pulmonary disease claimed 3.0 million lives in 2016 and
the third leading cause of deaths globally according to World Health
Organization Global Health estimates. COPD also affects the economic and
social aspects of an individual as it can limit him or her from doing extensive
work. In the Philippines , COPD is included as one of the leading causes of
mortality. It has a prevalence rate of 14% among Filipino adults aged 40 and
above. Only 2% of the cases are diagnosed by doctors in contrast to the
overall prevalence.
 COPD is treatable. With proper management, most people with COPD can
achieve good symptom control and quality of life, as well as reduced risk of
other associated conditions.
 Disease Condition

 Chronic obstructive pulmonary disease (COPD) is a chronic

inflammatory lung disease that causes obstructed airflow from
the lungs. Symptoms include breathing difficulty, cough, mucus
(sputum) production and wheezing. It's caused by long-term
exposure to irritating gases or particulate matter, most often
from cigarette smoke. People with COPD are at increased risk of
developing heart disease, lung cancer and a variety of other
conditions.
 Risk factors for COPD include:
 • Exposure to tobacco smoke. The most significant risk factor for
COPD is long-term cigarette smoking. The more years you smoke and
the more packs you smoke, the greater your risk. Pipe smokers, cigar
smokers and marijuana smokers also may be at risk, as well as people
exposed to large amounts of secondhand smoke. People with asthma
who smoke. The combination of asthma, a chronic inflammatory
airway disease, and smoking increases the risk of COPD even more.
 • Occupational exposure to dusts and chemicals. Long-term
exposure to chemical fumes, vapors and dusts in the workplace can
irritate and inflame your lungs.
 • Exposure to fumes from burning fuel. In the developing world,
people exposed to fumes from burning fuel for cooking and heating
in poorly ventilated homes are at higher risk of developing COPD.
 • Age. COPD develops slowly over years, so most people are at
least 40 years old when symptoms begin.
 • Genetics. The uncommon genetic disorder alpha-1-antitrypsin
deficiency is the cause of some cases of COPD. Other genetic factors
likely make certain smokers more susceptible to the disease.
 Emphysema and chronic bronchitis are the two most
common conditions that contribute to COPD. Chronic
bronchitis is inflammation of the lining of the bronchial
tubes, which carry air to and from the air sacs (alveoli) of
the lungs. It's characterized by daily cough and mucus
(sputum) production. Emphysema is a condition in which
the alveoli at the end of the smallest air passages
(bronchioles) of the lungs are destroyed as a result of
damaging exposure to cigarette smoke and other irritating
gases and particulate matter.
 Emphysema. This lung disease causes
destruction of the fragile walls and
elastic fibers of the alveoli. Small
airways collapse when you exhale,
impairing airflow out of your lungs.
Emphysema damages the inner walls
of the lungs' air sacs (alveoli), causing
them to eventually rupture. This
creates one larger air space instead
of many small ones and reduces the
surface area available for gas
exchange.
 Chronic bronchitis. In this
condition, your bronchial tubes
become inflamed and narrowed
and your lungs produce more
mucus, which can further block the
narrowed tubes. You develop a
chronic cough trying to clear your
airways. Bronchitis is an
inflammation of the lining of your
bronchial tubes, which carry air to
and from your lungs. People who
have bronchitis often cough up
thickened mucus, which can be
discolored.
Anatomy of the Respiratory System

The respiratory system (also referred to as the ventilator system) is a complex biological system
comprised of several organs that facilitate the inhalation and exhalation of oxygen and carbon
dioxide in living organisms (or, in other words, breathing).

For all air-breathing vertebrates, respiration is

handled by the lungs, but these are far from the
only components of the respiratory system. In
fact, the system is composed of the following
biological structures: nose and nasal cavity,
mouth, pharynx, larynx, trachea, bronchi and
bronchioles, lungs and the muscles of respiration.

A properly functioning respiratory system is a

vital part of our good health. Respiratory
infections can be acute and sometimes life
threatening. They can also be chronic, in which
case they place tremendous long term stress on
the immune system, endocrine system, HPA axis,
and much more.
 B. OBJECTIVES
General Objectives:
To apply concepts and theories in the care of a client with Chronic Obstructive
Pulmonary disease utilizing the Nursing Process.
Specific Objectives:
At the end 40 hours nursing care, the nurse practitioner will be able
to;
1. Assess the client systematically and holistically utilizing appropriate
nursing assessment tools and Self-Care Deficit Theory developed by Dorothea
E. Orem.
2. Prioritize the identified problems of the client using Maslow’s
Hierarchy of Needs.
3. Formulate a comprehensive Nursing Care Plan using Nursing
Intervention Classification (NIC) and Nursing Outcome Classification (NOC)
based on the prioritized problem.
4. Implement the articulated plan of care integrating Self-care deficit
nursing theory.
5. Evaluate the effectiveness of the nursing care rendered as specified
in the nursing system design.
 SIGNIFICANCE OF THE STUDY

 The study was conceived to effectuate client’s with

respiratory problems to invoke changes towards betterment
and effective health promotion. Using complete nursing
assessment and assessment tools for client’s with chronic
obstructive pulmonary disease including factors which affects
the client’s overall condition. It is also includes the
implementation of a specific, measurable, attainable, realistic
and time-framed nursing care plans utilizing the concepts of
Self-Care Deficit Theory developed by Dorothea Orem,
Gordon’s 11 Functional Health Patterns, and Maslow’s
Hierarchy of Needs that manages the client’s health needs
holistically.
Hence, this study is set to benefit the following:
 The Client: The study can facilitate awareness for the client
regarding the disease process, the changes it cause to the client’s
body system and impending symptoms that may bring about
Chronic obstructive pulmonary disease . So, this will inspire the
client to be more involve and noticeable in developing a better self
towards her recovery and more importantly improving her state of
health.
 To the Professors: The study may be beneficial in both
didactic and practicum classes as it can provide documentations on
how the integration of Self-Care Deficit Theory developed by
Dorothea Orem with the NANDA International, NIC-NOC in nursing
care plans can enhance the health of clientele across every lifespan
with altered respiratory health conditions.
 To the Graduate Students: The study can help the graduate students
being a reference in preparation for a clinical comprehensive clinical
case study in rendering nursing care for a client with respiratory
problem utilizing the nursing process, nursing theories, and nursing
assessment guidelines.
 To the Nursing Knowledge: The study may serve as an initiator to
further improve the quality of nursing care in the country. The results
of this study can serve as an example in the ease of access and ease
of understanding in using Self-Care Deficit Theory developed by
Dorothea Orem.
 To Nursing Practice and Nursing Research: This study helps the
researchers identify health problems with the use of Self-Care Deficit
Theory developed by Dorothea Orem and the Maslow’s Hierarchy of
needs. The study can also further support the utilization of the
NANDA International, Nursing Intervention Classification (NIC), and
Nursing Outcome Classification (NOC) in the care of a client with
Chronic obstructive pulmonary disease. The findings of this study may
benefit them in the application of this information to their own clinical
practices.
 THEORETICAL BACKGROUND
The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward
her goal of improving the quality of nursing in general hospitals in her state. The model inter
relates concepts in such a way as to create a different way of looking at a particular phenomenon.
The theory is relatively simple, but generalizable to apply to a wide variety of patients. It can be
used by nurses to guide and improve practice, but it must be consistent with other validated
theories, laws and principles.

The major assumptions of Orem's Self-Care Deficit Theory are:

 People should be self-reliant, and responsible for their care, as well as others in
their family who need care.
 People are distinct individuals.
 Nursing is a form of action. It is an interaction between two or more people.
 Successfully meeting universal and development self-care requisites is an
important component of primary care prevention and ill health.
 A person's knowledge of potential health problems is needed for promoting self-
care behaviors.
 Self-care and dependent care are behaviors learned within a socio-cultural context
Orem's theory is comprised of three related parts: theory of self-care; theory of
self-care deficit; and theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities that an individual
initiates and performs on his or her own behalf to maintain life, health, and well-being; self-
care agency, which is a human ability that is "the ability for engaging in self-care,"
conditioned by age, developmental state, life experience, socio-cultural orientation, health,
and available resources; therapeutic self-care demand, which is the total self-care actions to
be performed over a specific duration to meet self-care requisites by using valid methods
and related sets of operations and actions; and self-care requisites, which include the
categories of universal, developmental, and health deviation self-care requisites.

Universal self-care requisites are associated with life processes, as well as the
maintenance of the integrity of human structure and functioning. Orem identifies these
requisites, also called activities of daily living, or ADLs, as:
• the maintenance of sufficient intake of air, food, and water
• provision of care associated with the elimination process
• a balance between activities and rest, as well as between solitude and social
interaction
• the prevention of hazards to human life and well-being
• the promotion of human functioning
 Developmental self-care requisites are associated with
developmental processes. They are generally derived from a
condition or associated with an event.
 Health deviation self-care is required in conditions of illness,
injury, or disease. These include:
 • Seeking and securing appropriate medical assistance
 • Being aware of and attending to the effects and results of
pathologic conditions. Effectively carrying out medically prescribed
measures
 • Modifying self-concepts to accept oneself as being in a
particular state of health and in specific forms of health care
 • Learning to live with the effects of pathologic conditions.
 The second part of the theory, self-care deficit, specifies when nursing is needed.
According to Orem, nursing is required when an adult is incapable or limited in the provision of
continuous, effective self-care. The theory identifies five methods of helping: acting for and
doing for others; guiding others; supporting another; providing an environment promoting
personal development in relation to meet future demands; and teaching another.

The theory of nursing systems describes how the patient's self-care needs will be met by
the nurse, the patient, or by both. Orem identifies three classifications of nursing system to meet
the self-care requisites of the patient: wholly compensatory system, partly compensatory system,
and supportive-educative system.

Orem recognized that specialized technologies are usually developed by members of the
health care industry. The theory identifies two categories of technologies.

The first is social or interpersonal. In this category, communication is adjusted to age and
health status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the
coordination of efforts. The nurse should also maintain a therapeutic relationship in light of
pscyhosocial modes of functioning in health and disease. In this category, human assistance
adapted to human needs, actions, abilities, and limitations is given by the nurse.
 The second is regulatory technologies, which maintain and promote life processes. This
category regulates psycho- and physiological modes of functioning in health and disease. Nurses
should promote human growth and development, as well as regulating position and movement in
space.

Orem's approach to the nursing process provides a method to determine the self-care
deficits and then to define the roles of patient or nurse to meet the self-care demands. The steps
in the approach are thought of use the technical component of the nursing process. Orem
emphasizes that the technological component "must be coordinated with interpersonal and social
pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which collects
data to determine the problem or concern that needs to be addressed. The next step is the
diagnosis and creation of a nursing care plan. The third and final step of the nursing process is
implementation and evaluation. The nurse sets the health care plan into motion to meet the goals
set by the patient and his or her health care team and, when finished, evaluate the nursing care by
interpreting the results of the implementation of the plan.
B. Conceptual Framework
 Nursing Process Flow Chart
The Nursing Process Flow Chart describes the five systematic processes in the
care of patient diagnosed with Chronic Obstructive pulmonary disease. The initial part of
the Nursing Process is the Assessment Phase using assessment tools and the theory of
Self-Care Deficit theory in order to gather relevant information about the client’s
perspectives on all areas comprising the human system and collects data to determine the
problem or concern that needs to be addressed, a complete health history must be
accomplished with the identification of the problem utilizing Maslow’s hierarchy of needs.

After the comprehensive assessment, the next step is the Nursing Diagnosis Phase. In this
phase, problem prioritization is established utilizing Maslow’s Hierarchy of Needs. The
subsequent step is the Planning Phase. The Nursing Standard Languages, which are the
Nursing Outcome Classification (NOC) and the Nursing Intervention Classification (NIC),
will be utilized to identify the appropriate intervention and desired outcome to achieve
goals. Design a nursing system that is wholly or partly compensatory or supportive-
educative.
The fourth phase is the Implementation Phase where the planned nursing interventions
will be applied accordingly, production and management of the nursing systems. There will
be a consecutive 10-day nursing intervention implemented during this phase and proper
documentation of the progress and improvement must be observed throughout the
period.
Finally, the Evaluation Phase, where the judgment of whether the goals were met or not
are distinguished in each of the identified problems. These are measured accurately with
its corresponding rates/scales. Evaluate results achieve against results specified in the
nursing system design.