This document provides background information on chronic obstructive pulmonary disease (COPD) and presents a case study of a 32-year-old male patient admitted with COPD exacerbation and pneumonia. It defines COPD and related terms, describes the patient's history and symptoms, reviews anatomy and physiology of the respiratory system, discusses the pathophysiology of COPD, and provides an assessment of the patient's condition upon admission. The key details are that the patient is a 32-year-old male smoker admitted with chest tightness, difficulty breathing, and a diagnosis of COPD exacerbation and pneumonia.

1. 1
I. Introduction
Chronic obstructive pulmonary disease (COPD) is a disease state characterized by
airflow limitation that is not fully reversible. This newest definition COPD, provided by the
Global Initiative for Chronic Obstructive Lung Disease (GOLD), is a broad description that
better explains this disorder and its signs and symptoms (GOLD, World Health Organization
[WHO] & National Heart, Lung and Blood Institute [NHLBI], 2004). Although previous
definitions have include emphysema and chronic bronchitis under the umbrella classification
of COPD, this was often confusing because most patient with COPD present with over
lapping signs and symptoms of these two distinct disease processes.
COPD may include diseases that cause airflow obstruction (e.g., Emphysema, chronic
bronchitis) or any combination of these disorders. Other diseases as cystic fibrosis,
bronchiectasis, and asthma that were previously classified as types of chronic obstructive lung
disease are now classified as chronic pulmonary disorders. However, asthma is now considered
as a separate disorder and is classified as an abnormal airway condition characterized primarily
by reversible inflammation. COPD can co-exist with asthma. Both of these diseases have the
same major symptoms; however, symptoms are generally more variable in asthma than
in COPD.
Currently, COPD is the fourth leading cause of mortality and the 12th leading cause of
disability. However, by the year 2020 it is estimated that COPD will be the third leading cause
of death and the firth leading cause of disability (Sin, McAlister, Man. Et al., 2003). People
with COPD commonly become symptomatic during the middle adult years, and the incidence of
the disease increases with age.
II. Objectives
General objective:
After the case presentation, I will be able to enhance our knowledge about the case,
acquire skills towards presenting the case study and develop self-confidence in reporting the case
of COPD to the class.
Specific objectives:
After the case presentation, I will be able to:
a) have broader knowledge about the COPD;
b) know the epidemiology, predisposing factors, precipitating factors , signs
and symptoms and pathophysiology about the said disease;
c) impart my knowledge to my fellow nursing student about my case;
d) expose myself on various illnesses, thus, the experience would help us to
overcome our doubts and boost our confidence in handling patient with
this disease; and
e) present the case clearly.

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III. Baseline Data
Name: N.A.F.
Adress: D.C.
Age: 32 years old
No. of dependent/s: none
Birthdate: January 13, 1979
Birthplace: D.C.
Gender: Male
Marital status: Single
Religion: Roman Catholic
Educational level: College level
Occupation: Restaurant helper and waiter
Nationality: Filipino
Person next to kin: Brother
Date and time of admission: July 15, 2011 10:20pm
Attending physician: Dr. C.
Hospital: MDH
Ward of admission: Medical Ward
Chief complaint: Chest tightness and DOB
Admitting Diagnosis: COPD with exacerbation –Pneumonia MR
Source: Patient
IV. Definition of terms
Chronic Obstructive Pulmonary Disease (COPD)- COPD may include diseases that cause
airflow obstruction
Exacerbation- an increase in the seriousness of a disease or disorder as marked by greater
intensity in the signs or symptoms of the patient being treated.
Emphysema is a chronic obstructive pulmonary. The small airways to collapse during forced
exhalation, as alveolar collapsibility has decreased.
Chronic bronchitis- effect of lung damage and inflammation in the large airways . Chronic
bronchitis is defined in clinical terms as a cough with sputum production on most days for 3
months of a year, for 2 consecutive years.

3. 3
Breathing – the process of respiration, during which air is inhaled into the lungs through the
mouth or nose due to muscle contraction and then exhaled due to muscle relaxation
Young adult- a person age 18-35 years old.
Ventilation- an exchange of air between the lungs and the atmosphere so that oxygen can be
exchange for carbon dioxide in the alveoli.
Alveoli- tiny sacs of the lungs.
Pneumonia- infection of terminal airways and alveoli caused by various agent and causes
infection.
V. Health History
Past health History
N.A.F. a 32 year old male, had fever and take BioFlu 1 tab every 4 hours without
prescription. Everytime he have cough he drinks ½ glass water mixed with 10 pieces of
calamansi. He had his circumcision at the age of 9.
History of present illness
N.A.F. a 32 year old male, has been smoking for 15 years. 2 days prior to admission,
N.A.F. experienced dry cough and drinks a glass of water but still continue to smoke a pack of
cigarette a day. A night prior to admission, N.A.F. experienced difficulty of breathing and chest
tightness. N.A.F. was rushed to the nearest hospital via van by his brother.
N.A.F. was seen and examined in the MDH Emergency room by Dr. C. Started IVF of
PLRS 1 liter + 1 ampule Vit. B complex inserted as venoclysis at the right cephalic vein and
regulated to KVO. Administered the following medication as ordered: Initial dose of furosemide
20 mg. IVTT, hydrocortisone 200 mg. IVTT, and salbutamol 1 nebule inhalation. Oxygen
inhalation given of 2 Lpm as nasal cannula. Request for CBC with platelet count, Sodium
chloride, Creatinine, Chest X-ray PA, urinalysis. ECG 12 leads done and Foley Catheter was
inserted. Skin test for piperacillin + tazobactam 0.1cc at the left inner forearm.
Psychosocial Profile
N.A.F wakes up 5:oo in the morning, fixes his bed and put on his slippers and walk
almost 1 km every day. After his morning exercise he rest for about 10 minutes and take a bath
after. At breakfast, he eats 1 egg, ½ cup of rice and a cup of coffee. Then off to his work as a
waiter and helper in his brother’s restaurant. He buys a pack of cigarette(20 sticks) and consume
2 sticks after breakfast. At lunch, he eats 2 slices of fish in tinolang isda with kangkong and
labanos, 2 cups of rice and a glass of water. Then after meal he lights up almost 3 sticks. After
work, he often goes to his friends and drink beer, approximately he consume more than half of
the pack. At dinner he eats 1 slice of fish a 1 cup of rice. Approximately he consumed 9 glasses
of water the whole day. Before he sleeps he light up his cigarette while watching television or
talking to his family. N.A.F sleeps around 9 in the evening.

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VI. Anatomy and Physiology
The respiratory system consists of all the organs involved in breathing. These include the
nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very
important things: it brings oxygen into our bodies, which we need for our cells to live and
function properly; and it helps us get rid of carbon dioxide, which is a waste product of cellular
function. The nose, pharynx, larynx, trachea and bronchi all work like a system of pipes through
which the air is funneled down into our lungs. There, in very small air sacs called alveoli, oxygen
is brought into the bloodstream and carbon dioxide is pushed from the blood out into the air.
When something goes wrong with part of the respiratory system, such as an infection like
pneumonia, chronic obstructive pulmonary diseases, it makes it harder for us to get the oxygen
we need and to get rid of the waste product carbon dioxide. Common respiratory symptoms
include breathlessness, cough, and chest pain.
The Upper Airway and
Trachea
When you breathe
in, air enters your body
through your nose or
mouth. From there, it
travels down your throat
through the larynx (or
voicebox) and into the
trachea (or windpipe)
before entering your
lungs. All these structures
act to funnel fresh air
down from the outside
world into your body. The
upper airway is important
because it must always
stay open for you to be
able to breathe. It also
helps to moisten and warm the air before it reaches your lungs.
The Lungs
Structure
The lungs are paired, cone-shaped organs
which take up most of the space in our chests,
along with the heart. Their role is to take oxygen
into the body, which we need for our cells to live
and function properly, and to help us get rid of
carbon dioxide, which is a waste product. We each
have two lungs, a left lung and a right lung. These
are divided up into ‘lobes’, or big sections of
tissue separated by ‘fissures’ or dividers. The right
lung has three lobes but the left lung has only two,
because the heart takes up some of the space in the
left side of our chest. The lungs can also be
divided up into even smaller portions, called

5. 5
‘bronchopulmonary segments’.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.
How they work
Air enters your lungs through a system of pipes called the bronchi. These pipes start from
the bottom of the trachea as the left and right bronchi and branch many times throughout the
lungs, until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The
alveoli are where the important work of gas exchange takes place between the air and your
blood. Covering each alveolus is a whole network of little blood vessel called capillaries, which
are very small branches of the pulmonary arteries. It is important that the air in the alveoli and
the blood in the capillaries are very close together, so that oxygen and carbon dioxide can move
(or diffuse) between them. So, when you breathe in, air comes down the trachea and through the
bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Traveling in the opposite direction is
carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.
Blood Supply
The lungs are very vascular organs, meaning they receive a very large blood supply. This
is because the pulmonary arteries, which supply the lungs, come directly from the right side of
your heart. They carry blood which is low in oxygen and high in carbon dioxide into your lungs
so that the carbon dioxide can be blown off, and more oxygen can be absorbed into the
bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary veins
into the left side of your heart. From there, it is pumped all around your body to supply oxygen
to cells and organs.
The Work of Breathing
The Pleurae
The lungs are covered by smooth membranes that we call pleurae. The pleurae have two
layers, a ‘visceral’ layer which sticks closely to the outside surface of your lungs, and a ‘parietal’
layer which lines the inside of your chest wall (ribcage). The pleurae are important because they
help you breathe in and out smoothly, without any friction. They also make sure that when your
ribcage expands on breathing in, your lungs expand as well to fill the extra space.

6. 6
The Diaphragm and Intercostal Muscles
When you breathe in (inspiration), your muscles need to work to fill your lungs with air.
The diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage,
does much of this work. At rest, it is shaped like a dome curving up into your chest. When you
breathe in, the diaphragm contracts and flattens out, expanding the space in your chest and
drawing air into your lungs. Other muscles, including the muscles between your ribs (the
intercostal muscles) also help by moving your ribcage in and out. Breathing out (expiration) does
not normally require your muscles to work. This is because your lungs are very elastic, and when
your muscles relax at the end of inspiration your lungs simply recoil back into their resting
position, pushing the air out as they go.

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VII. Pathophysiology
Fever, chills, productive or dry cough, crackles
Predisposing Factors
Age: Elderly and
children
Precipitating Factors
Environment exposure
to allergens
Smoking
Bacteria, irritants other foriegn matter
Routes of entry(oral, inhalation, Intravenous)
Activation of defense mechanism (cough reflex)
Loses effectiveness of defense mechanism
Penetrate the sterile lower respiratory tract lungs. The alveoli greatly distend,
diminished lung capacity. Colonization of bacteria.
Damage bronchial mucous membranes and alveolo capillary membranes:
Acini and terminal bronchioles filled with infective debris and exudate.
If treated
 Antibacterial Therapy completed
 Bronchodilators
 Mucolytics
 Chest physical therapy
 Adequate hydration
 Oxygen inhalation
If Untreated
 Difficulty of breathing
 Increased respiratory rate
 Cyanosis
 Retraction of the chest
Recovery
Complications

8. 8
VIII. Assessment
I. GENERAL APPEARANCE:
N.A.F is awake sitting on bed with #3 PLRS 1L+ 1 amp Vit B complex 40cc/hr at the level of
200cc at the Right Cephalic vein patent and infusing well. Oriented to date, time, place and
person. Responsive to verbal and painful stimuli.
II. SKIN, HAIR, AND NAILS
Skin:
Skin is dry, warm to touch. Hair evenly distributed, black i color. With good skin turgor.
No edema noted..
Hair:
Hair is not evenly distributed, black in color. Hair is thick in texture and dry. No scalp
lesions noted. No presence of lice and dandruff. No discharges identified. Negative for
tenderness, lesions, and deformities on scalp.
Nails:
Nails shape is convex curvature. Nails are cleaned and trimmed. Nail angle is 160.
Negative for clubbing or cyanosis. Capillary refill of 1 second after blanched test.
III. HEAD, FACE, AND LYMPHATIC
Rounded (normocephalic and symmetric with frontal, parietal, and occipital
prominences). Rough skull contour, no nodules or masses noted. With wrinkles due to dryness.
Symmetrical facial expression.
IV. EYES, EARS, NORSE, MOUTH
Eyes:
Eyebrow is black, evenly distributed, symmetrically aligned and skin intact. Eyelashes
equally distributed and curled slightly outward. Lids closely symmetrically. Pale conjunctiva of
the eyes noted. Sclera appears white. Palpebral conjuntiva are nshiny, smooth and pink. Cornea
is transparent,shiny and smooth. Client blinks 16 times for 1 minute and voluntary blinks when
the cornea is tried to touch. Iris is flat and round. Pupils is equally rounded and reactive to light
and accomodation and dilated 3mm in diameter.
Ears:
Color same as facial skin. Ear is line with the outer corner of the eye and ears looks
symmetrical.
Nose:
External nose symmetric, straight, and uniform in color. Nasal septum intact and in
midline position.
Mouth and throat:

9. 9
Lips are pinkish, symmetrical and without lesions. Oral mucosa is pale. Gums are moist
with one tooth below. No unusual odor noted. No sores or other lesions noted.Totalof 30 teeth.
V. NECK
Neck: Head centered. Trachae is in the midline.
VI. CHEST, BREAST AND AXILLA
Chest is brown in color and skin is intact. Chest movement is symmetric without impairment. No
lesion on chest noted. Hair is evenly disrtibuted and thick in texture.
VII. RESPIRATORY SYSTEM
Presence of stridor upon auscultation during admission and rales during care. Chest movement is
symmetric without impairment. Presence of productive cough with whitish to yellowish
secretions noted. Respiration rate is 23 breaths per minute.
VIII. CARDIOVASCULAR SYSTEM
The carotid artery appears to have a brisk, localized pulsation. Blood Pressure is 130/80 mmHg.
Cardiac Rate is 83 beats per minute.
IX. Abdomen
Flabby abdomen. Rash, lesions, tenderness not noted. Spleen is not felt. Bladder not palpable. No
pain or tenderness in four quadrant regions. Able to have regular bowel movement.
X. GENITO-URINARY SYSTEM
With foley catheter attached to urobag with adequate urine output.
XI. Upper and lower extremities
Performs active range of motion in bpth upper and lower extrimities.
IX. Laboratory and Radiology
A. Hematology
July 16, 2011
Name and date of
Examination
Result Normal Values Significance of the abnormal result
WBC 10.1 10^9/L 5-10
Indicates infection from most of
bacteria, death of tissue
Hemoglobin 16.3:0 g/L Male: 14-16 g/L Increased
Platelet 387 x 10^9/L
150-350 x
10^9/L Increased
Lymphocytes 45 % 20-25 %
Increased level indicates bacterial
infection.

10. 10
B. Urinalysis
July 15, 2011
Urinalysis Result
Normal
Values
Significance of the abnormal result
Macroscopic
Color Straw
Amber
yellow
Presence of bacteria
Transparency
Slightly
hazy
Reaction pH 5.0 4.5-8 normal
Specific
gravity
1.010 1.010-1.020 normal
Microscopic
RBC/hpf
0-2
Absent May indicate infection
Pus cells
0-3 hpf
Absent May indicate infection
Epithelial cells
Few
occasional May indicate infection
Bacteria few May indicate infection
C. Chest Xray
July 18,2011
Infiltrates are seen in the right lung field.
IMPRESSION: Pneumonia right lung field.

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12. 12

13. 13

14. 14
XI. Drugs
1. furosemide 20 mg. IVTT q 12h as diuretics to increase urine output.
2. hydrocortisone 100 mg. IVTT q8h as immunosuppresor to decrease inflammation and
suppresses immune system.
3. salbutamol+ ipatropium 1 neb q4h as bronchodilator.
4. acetylcysteine 600 mg/tab dissolve in ½ glass of water OD as mucolytic. This is indicated
to the patient because it liquefies mucus secretions in the tracheobronchial tree.
5. pipercillin + tazobactam 2.25 gms IVTT q8h as antibiotic use to treat bacterial infection.
XII. Health Teaching and discharge planning
Medications:
 Instruct the folks and patient to comply with the prescribe medications.
 Review information about medications to be taken at home including name, dosage,
route, frequency, possible side effects and the administration in correct dosage, route
and time.
 Discuss the importance of continuing taking medications even signs and symptoms
have decreased or subscribed.
 Home medications:
1. furosemide 40mg 1 tab OD x 5 days
2. acetylcysteine 600 mg/tab dissolve in ½ glass of water OD x 7 days
3. Kalium Durule 1 tab TID x 6 doses
4. Levofloxacin 750mg 1 tab OD x 4 days
5. Cefpodoxime 200mg 1tab BID x 7 days
Exercise:
 Encourage patient to do normal activities as tolerated and avoid doing strenuous one
until treatment is complete.
 Continue walking as a form of exercise.
Treatment:
 The patient to eat three regular meals a day in relaxed setting.
 Instruct patient to slowly quit smoking by substituting cigarette smoking into chewing
gum or by omitting one stick per day until smoking is stop.
Hygiene:
 Advice the patient to observe proper hygiene practices.
 Emphasize the importance of frequent hand washing as the universal precaution.
Out patient:
 Advice the patient to follow strictly the prescribed medications for the patient.
 Instruct the patient to visit his doctor for follow-up check up on July 26. 2011.
Diet:
 Small frequent feeding
 Instruct patient to eat non-irritating foods and avoid skipping meals.
 Advice to eat nutritious foods.


15. 15
Spiritual:
 Advice folks to pray for the fast relief of the patient. Remind folks to give adequate
moral support to comfort the patient
XIII. Prognosis
If the patient completes the prescribed medication and follow the health teaching he weill
recover faster and coughing will be minimize.
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