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.
Case Study On
Chronic Obstructive Pulmonary
By Mrittika Ganguly
Patient Name – Xyz
Height = 5ft
Life Style= Sedentary
Date Of Admission=24.02.12
Duration Of Stay=24.02.12-04.03.12
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.
COPD is the co occurrence of chronic
bronchitis and emphysema, a pair of commonly
coexisting disease in which the airways
COPD is the preventable and treatable lung
disease with some significant pulmonary and
Signs and symptoms of COPD
a) Cough and sputum
a) Shortness of breath.
b) In advace stage presence
b) Anorexia .
c) Chest tightness.
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
The partial pressure of carbon dioxide is
generally near 40 mm Hg.
Hypertension (HTN) or high blood pressure, sometimes
called arterial hypertension, is a chronic medical
condition in which the blood pressure in the artery is
Blood pressure involves two measurements, systolic
and diastolic, which depend on whether the heart
muscle is contracting (systole) or relaxed between
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.
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
Impaired Glucose Tolerance.(IGT)
Na 123 133 137 135-138mEq
K 2.9 2.2 3.1 3.5-5.5
1.2 1 1 0.6-
Urea(mg/dl) 50 18 23 10-30mgldl
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%
DATE TIME READING
25.02.12 6 am
26.02.12 7 am
12 mid night
27.02.12 8 am
Date Time Reading
28.02.12 6 am
29.02.12 8 am
01.03.12 6 am
02.03.12 7 am
03.03.12 9 am
04.03.12(D/C) 7 am 200 mg/dl
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
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.
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.
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.
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.
6.30 am : D-protein(2 scoops)(30gm)+water.
9.00 am : suji(30gm)+cheena(25gm)/
10.30am : ripe papaya(100gm)
12.30am : Rice raw(50gm)+
dal(15gm)+any soft veg(lauki/papaya)
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
Total kcal given to the patient is 1573.36kcal.
Total Protein given - 90.53gm
FOODS TO BE INCLUDED
High fibre foods as
increase potassium level.
Plenty of fluids. (should
drink 6 to 8, eight-ounce
glasses of non-
Gas producing foods
Fried or spicy foods
Simple sugars like jam
Oatmeal with milk Drink plenty of
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