Chronic obstructive pulmonary disease

1,825 views

Published on

COPD the condition is also know as chronic obstructive pulmonary disorder case study. This is winning case study presentation for Just for hearts case study competition. Refer to these slides to know more about this case.

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,825
On SlideShare
0
From Embeds
0
Number of Embeds
28
Actions
Shares
0
Downloads
87
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Chronic obstructive pulmonary disease

  1. 1. Case Study On Chronic Obstructive Pulmonary Disease (COPD) By Mrittika Ganguly
  2. 2. PHYSICAL PARAMETERS OF PATIENT  Patient Name – Xyz  Sex-f  Age=77 Yrs  Height = 5ft  Weight=45kg  Bmi(kg/M2)= 19.48  Life Style= Sedentary  Date Of Admission=24.02.12  Duration Of Stay=24.02.12-04.03.12
  3. 3. CASE HISTORY  CHIEF COMPLAIN -  SOB since 21.02.12  SOB become very serious in 22.02.12 and she was admitted in SNPG where given nibulisation  Patient improving symptomatically.  Alert on 23.02.12 evening.  Since morning 24.02.12 patient was drowsy , responding 1-2 words on repeated asking.  Patient is admitted in this condition.  PAST ILLNESS - Known case of COPD since 2 yrs DM2 since 8 yrs HTN since 15 yrs.
  4. 4. DIAGNOSIS COPD CO2 NARCOSIS DM2 (DIABETES MELLITUS TYPE 2) HTN (HYPERTENSION)
  5. 5. COPD(CHRONIC OBSTRUCTIVE PULMONARY DESEASE) COPD is the co occurrence of chronic bronchitis and emphysema, a pair of commonly coexisting disease in which the airways become narrow. COPD is the preventable and treatable lung disease with some significant pulmonary and systematic features.
  6. 6. PULMONARY AND SYSTEMATIC FEATURES OF COPD
  7. 7. Signs and symptoms of COPD a) Cough and sputum production. a) Shortness of breath. b) In advace stage presence of oedema. a) Wheezing. b) Anorexia . c) Chest tightness.
  8. 8. CO2 NARCOSIS carbon dioxide (CO2) narcosis, a condition of confusion, tremors, convulsions, and possible coma that may occur if blood levels of carbon dioxide increase to 70 mm Hg or higher. Individuals with chronic obstructive pulmonary disease can have CO2 narcosis without these symptoms because they develop a tolerance to elevated CO2. The partial pressure of carbon dioxide is generally near 40 mm Hg.
  9. 9. Hypetension (HTN)  Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the artery is elevated.  Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole).  Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60- 90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.
  10. 10. DIABETES MELLITUS DM is the metabolic disorder characterized by decreased ability or total inability of tissue to utilize carbohydrates(glucose)as a result glucose level in blood is increased. Several form of diabetes have been identified. They are-  Type 1-Insulin Dependent DM(IDDM)  Type 2-Non Insulin Dependent DM(NIDDM)  Gestational diabetes  Impaired Glucose Tolerance.(IGT)
  11. 11. BIOCHEMICAL REPORTS BIOCHEMIC AL TESTS TIME OF ADMISSION DURING STAY TIME OF DISCHARG E NORMAL RANGE Hb RBC Neutrophil Basophil Eeosiphil Monocyte 9.7 4.22 86 00 02 01 9.7 89 00 04 00 11.9 00 4 2 12-15 00 2-8% 2-4% Na 123 133 137 135-138mEq K 2.9 2.2 3.1 3.5-5.5 Creatinine(m g/dl) 1.2 1 1 0.6- 1.1mm/Eq Urea(mg/dl) 50 18 23 10-30mgldl
  12. 12. BIOCHEMICAL REPORTS BIOCHEMI CAL TESTS TIME OF ADMISSION DURING STAY TIME OF DISCHARGE NORMAL VALUE Pa co2 100.6 90.3 41.8 35-45mm/Hg Pa o2 119.3 104.9 90 75-100mm/Hg HCo3 35 30 26 22-26mm/Hg HbA1C 7.5% 4-7%
  13. 13. CBG REPORT DATE TIME READING 24.02.12 9pm 1am 4am 298mg/dl 457 mg/dl 350mg/dl 25.02.12 6 am 12 noon 4 pm 8 pm 210mg/dl 74 mg/dl 125 mg/dl 180 mg/dl 26.02.12 7 am 12 noon 12 mid night 92 mg/dl 182 mg/dl 198 mg/dl 27.02.12 8 am 12 noon 9 pm 108 mg/dl 219 mg/dl 175 mg/dl
  14. 14. CBG REPORT Date Time Reading 28.02.12 6 am 12 am 12pm 124 mg/dl 210 mg/dl 195 mg/dl 29.02.12 8 am 2 pm 9 pm 310 mg/dl 195 mg/dl 170 mg/dl 01.03.12 6 am 2 pm 10 pm 247 mg/dl 160 mg/dl 140 mg/dl 02.03.12 7 am 12 pm 8 pm 210 mg/dl 160 mg/dl 130 mg/dl 03.03.12 9 am 7 pm 201 mg/dl 175 mg/dl 04.03.12(D/C) 7 am 200 mg/dl
  15. 15. Normal value of blood glucose-  Fasting :90-110 mg/dl  PP - :up to180 mg/dl  Random :up to 140 mg/dl Doses of Insulin H/A-(Human Atrapid)-  <70 = specialist concern  70-200 = no insulin  200-250 = 2 unit  251-350= 4 unit  301- 350 = 6 unit  351-400 = 8 unit  >400 = 10 unit
  16. 16. DIETARY MODIFICATION When patient was admitted in hospital she was unable to take food through mouth. Hence ryles tube was initiated. After 4 days when she was improving. her diet was changed to soft diet. On 04.02.12 patient was discharged. Salt restricted soft diabetic diet was prescribed to her.
  17. 17. DIETARY MODIFICATIONS Ryles Tube • 24.02.12 – 29.92.12 Salt restricted Soft diabetic diet • 01.02.12- 04.0312 Discharge diet (salt restricted soft diabetic diet) • 04.03.12
  18. 18. Ryles tube(special form) (24.02.12-29.02.12) Fluid allowances= 120mlx10feed x 2 hrly 6 am : Pulmocare(30gm)+water 8 am : bread (2pcs)+ milk(100ml) 10 am :D-protein(30gm)+water 12 noon: Rice(raw 25 gm)+milk(200ml)+ OV(50gm)+fish(50gm) 2 pm : do 4 pm : bread(2pcs)+milk(100ml) 6 pm : D-protein(30gm)+water 8 pm : Rice(raw)(25gm)+milk(200ml) +one egg white(25gm) 10 pm : DO 12 midnight : pulmocare(30gm)+water
  19. 19. Hospital diet (01.03.12-03.03.12)  Diagnosis – COPD,CO2 Narcosis,DM2,HTN  Diet code – S/R,S/D/D INV  Menu planning- 6am : D-protein(20gm)+water. 8am : Suji(30gm)+papaya(200gm)+ milk(200ml). 10am : D-protein (20gm)+water. 12 noon : Rice raw(40gm)+dal(15gm)+ cucumber(30gm)/g.papaya(30gm)/ pumpkin(30gm)+Fish stew(75gm).
  20. 20. MENU OF HOSPITAL DIET 2 pm : D-protein(20gm)+water 4 pm : Tomato soup 6 pm : D-protein(20gm)+water 8 pm : Roti(2pcs)+Dal(15gm)+ lauki(15gm)/ pumpkin(15gm)/ papaya(15gm)/ cucumber(15gm)+Egg(50gm) 10 pm : D-Protein(20gm)+water
  21. 21. NUTRITIONAL MANAGEMENT OF COPD Good nutrition helps the body to fight infections. Chest infection is common on COPD pateints.So it is important to reduce risk of infection by following a healthy diet. Diet Principle-Moderate fat, low carbohydrate moderate protein feeding in patient with hypercapnia.
  22. 22. DISCHARGE DIET PRESCRIPTION (04.02.12)  Energy –Energy intake should be increased.Energy intake can be estimated at 35kcal/kg body weight.I suggest to give her 1600 kcal diet.  Carbohydrate – Carbohydrate intake should be restrict because it increased CO2 production.55% carbohydrate of total kcal is suggested.As pateint have DM2 simple sugars are avoided.  Protein – 2gm/kg body weight protein is recommended.It helps to restore lung and muscle strength and promote immune function.  Fat –. Fat kilocalorie produce less co2 than carbohydrate,so high fat diet is prescribed. But patient also have DM2 so I suggest to give her 22% of fat.
  23. 23.  Vitamins An adequate intake of vitamin A and C essential for prevent pulmonary infections. Foods with high vitamin A as milk, GLV,egg,some breakfast cereals should be included in diet. Vitamin C rich foods like citrus fruits should also be included.  Minerals- Water balance and phosphorus level should be monitored. Fluid restriction is needed in case of presence of edema. As my patient is suffering from HTN so sodium restriction is needed. So I suggest her salt restricted diet(S/R).  NOTE- Sources of vitamin A and C should be carefully choosen to ensure that they do not produce gas.
  24. 24. MENU PLANNING 6.30 am : D-protein(2 scoops)(30gm)+water. 9.00 am : suji(30gm)+cheena(25gm)/ milk(100ml)+ oats. 10.30am : ripe papaya(100gm) 12.30am : Rice raw(50gm)+ dal(15gm)+any soft veg(lauki/papaya) Mix veg(100gm) (pumpkin,r,jhinga)+Fish(75gm)jhol.
  25. 25. 4.00pm : leaker tea 1 cup w/o sugar 6.00pm : D-Protein(2 scoops)(30gm)+water 9.30pm : Roti(2pcs)+dal(15gm) any soft veg(100gm)+Fish(75gm)jhol. 10.30pm: D- protein(2 scoops)(30gm)+water.
  26. 26.  Carbohydrate = 213.22 gm = 852.88 Kcal  Protein = 90.53 gm = 362.12 kcal  Fat = 39.84 gm = 358.56 kcal  Total kcal =(852.88+362.12+358.56)kcal =1573.56 kcal Total kcal given to the patient is 1573.36kcal. Total Protein given - 90.53gm
  27. 27. FOODS TO BE INCLUDED OR EXCLUDED  High fibre foods as vegetables,whole grain foods,cereals etc.  Add oranges, musambi,tomato to increase potassium level.  Plenty of fluids. (should drink 6 to 8, eight-ounce glasses of non- caffeinated beverages daily. )  Gas producing foods like beans,brocoli,sprouts, cabbage,cauliflower, corn,raddish, soyabeans,onions etc.  Carbonated beverages.  Fried or spicy foods  Salt(Na)in food.  Simple sugars like jam jelly etc. INCLUDED EXCLUDED
  28. 28. CONCLUSION Eat cornflakes Oatmeal with milk Drink plenty of fluids Use herbs.Better than salt Protein Booster Go for potassium Avoid caffine Drink milk Avoid gas producing food Fresh vegetables
  29. 29. Get info from: info@justforhearts.org Helpline Number: 09266802992 Skype Id: justforhearts Contact Us for Any Query:

×