Chronic Obstructive Pulmonary Disease Care Conference

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Chronic Obstructive Pulmonary Disease Care Conference

  1. 1. At the end of this session, you will be able to :  State the definition of COAD.  List the etiology of COAD.  Identify the pathophysiology of COAD.  State the sign & symptom of COAD.
  2. 2. LEARNING OBJECTIVES cont.  Identify the complication of COAD.  Understand regarding treatment of COAD.  Identify the nursing intervention & appreciate the nursing care for COAD patient.
  3. 3. PATIENT’S PROFILE  MR. L  MALE  70 YEARS OLD  UNEMPLOYED
  4. 4. PATIENT’S PROFILE  WHEEL CHAIR  CALM  ALLERGICS - NIL  D.O.A 30/6/13 @ 1210 Hrs
  5. 5. Doctor = Dr AB Diagnosis 1.COAD 2.Old PTB 3.? 2˚ dehydration
  6. 6. Mr. L was admitted to 5XX-1 with complaint of unwell, giddiness, nausea, poor appetite, shortness of breath, coughing for 5/7 and loose stool on and off X 2-3 months.
  7. 7. CURRENT MEDICATION      Aldactone 100mg TDS Lasix 40mg BD Ciprofloxacin 500mg BD Maxalon 10mg PRN Lomotil 2 PRN
  8. 8. PATIENT’S PROFILE MEDICAL HISTORY  COAD  Old PTB  Hepatitis B with multicentric hepatoma (under palliative care)  HPT 
  9. 9. PATIENT’S PROFILE SURGICAL HISTORY  Nil   FAMILY MED HISTORY  Unknown
  10. 10. VITAL SIGN  TEMPERATURE : 36.4 ˚C  BLOOD PRESSURE : 140/80mmHg  PULSE : 76 bpm  RESPIRATION : 26 breath/min  SPO2 : 92%  PAIN SCORE : 0  Weight : 64 kg
  11. 11. ACTIVITY DAILY LIVING  Having difficulty in breathing (chest tightness)  Loss of appetite and nauseated  Having loose stool on and off 2-3 months  Quit smoking > 15 years ago
  12. 12. PHYSICAL EXAMINATION
  13. 13. S/B Dr AB in A&E  Run IV drip Hartman over 1 – 2 hours  Then IV drip 3 pint Normal saline over 24 hours  IV Maxalon 10mg TDS  IV Parentrovite 1 pair OD  Tab Ciprofloxacin 500 (1/2) BD  Oxygen 2 liter via nasal prong
  14. 14. INVESTIGATION  Ultrasound abdomen  CXR  FBC, LFT, BUSE, creatinine
  15. 15. • A disease state characterised by airflow limitation that is not fully reversible • May include diseases that causes airflow obstruction e.g. emphysema, chronic bronchitis or a combination of both. • Can co exist with asthma
  16. 16. CHRONIC BRONCHITIS • Irritation of airway causes mucus secreting glands and goblet cells to increase in numbers and ciliary function is reduced and more mucus is produced.
  17. 17. EMPHYSEMA • Impaired of gas exchange results from destruction of the walls of our distended alveoli.
  18. 18. RISK FACTORS • • • • • Cigarette smoking Air pollution Recurrent infection Aging 2˚ smoking
  19. 19. COMPLICATION • • • • • • Pneumonia Atelectasis Pneumothorax Cor Pulmonale Pulmonary hypertension Respiratory insufficiency or failure
  20. 20. FBC • Lymphocyte - 18.7% (20-45%) • Monocyte - 16.6% (1 – 11%)
  21. 21. LFT • Total protein - 55 g/L (3.0 – 9.2) • Albumin - 23 g/L (34 - 48) • A/G Ratio - 0.7 (1.0 – 2.0) • Total bilirubin - 53.2 umol/L (2.0 – 28.0)
  22. 22. LFT • SGOT/AST - 182 u/L (7 – 44) • Alkaline phosphatase - 306 u/L (40 - 128) • Gamma-GT - 567 u/L (7 – 55)
  23. 23. BUSE/ Creatinine • Urea - 15.2 mmol/L (3.0 – 9.2) • Sodium - 123 mmol/L (135 - 155) • Creatinine - 273 umol/L (60 – 150)
  24. 24. CHEST X-RAY • Emphysematous lungs. Bilateral upper lobe fibrosis
  25. 25. ULTRASOUND ABDOMEN • Changes are suggestive of liver cirrhosis with ascites.
  26. 26. DRUGS IN WARD DATE ORDERED DATE OFF IV Parentrovite 1 pair Daily IV Maxalon 10mg TDS 30/6/13 1/7/13 30/6/13 1/7/13 Tab Ciprofloxacin 500 (1/2) BD 30/6/13 1/7/13 Tab Lomotil ll/ll STAT 1/7/13 1/7/13 Tab Lasix 40mg OD 1/7/13 1/7/13
  27. 27. DRUGS ON DISCHARGE DATE ORDERED Tab Lasix 40mg OD 1/7/13 Tab Aldactone 50mg BD 1/7/13 Tab Ciprofloxacin 500 (1/2) BD 1/7/13
  28. 28. BULLECTOMY • A removal surgical option for certain patient with bullous emphysema. • Bullae (enlarged air space in thorax) that do not contribute to ventilation but occupy space in the thorax.
  29. 29. LUNG VOLUME REDUCTION SURGERY • Treatment option for end-stage COAD (stage lll) with a primary emphysematous. • Removal of a portion of the diseased lung parenchyma. This allows the lung functional tissue to expand, resulting in improved elastic recoil of lungs and improved chest wall and diaphragmatic mechanics.
  30. 30. LUNG TRANSPLANTATION • For end-stage emphysema. • Rarely done and most patient died while waiting for donor.
  31. 31. NURSING DIAGNOSIS  Ineffective breathing pattern related to reduced lung expansion and occlusive airflow.
  32. 32. NURSING DIAGNOSIS  Impaired gas exchange and airway clearance due to obstruction of airway and ventilation-perfusion inequality.
  33. 33. NURSING DIAGNOSIS  Alteration in bowel habit related to loose motion.
  34. 34. NURSING DIAGNOSIS  Alteration in ADL related to fatigue, ineffective breathing and hypoxemia.
  35. 35. NURSING DIAGNOSIS  Potential infection related to intravenous cannulation.
  36. 36. NURSING DIAGNOSIS  Potential alteration in nutritional status less than body requirement related to nausea and loss of appetite.
  37. 37. NURSING DIAGNOSIS  Knowledge deficit related to home management.
  38. 38. • Improving gas exchange and breathing pattern - DBE • Improving activity intolerance by mild exercise • Avoid pollution and 2˚ smoking • Avoid extreme temperature (cold or hot) • Modifying lifestyle • Relaxation and stress management

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