2. 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.

3. LEARNING OBJECTIVES cont.
 Identify the complication of COAD.
 Understand regarding treatment of
COAD.
 Identify the nursing intervention &
appreciate the nursing care for
COAD patient.

5. PATIENT’S PROFILE
 MR. L
 MALE
 70 YEARS OLD
 UNEMPLOYED

6. PATIENT’S PROFILE
 WHEEL CHAIR
 CALM
 ALLERGICS - NIL
 D.O.A 30/6/13 @ 1210 Hrs

7. Doctor = Dr AB
Diagnosis
1.COAD
2.Old PTB
3.? 2˚ dehydration

8. 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.

9. CURRENT MEDICATION





Aldactone 100mg TDS
Lasix 40mg BD
Ciprofloxacin 500mg BD
Maxalon 10mg PRN
Lomotil 2 PRN

10. PATIENT’S PROFILE
MEDICAL HISTORY
 COAD
 Old PTB
 Hepatitis B with multicentric
hepatoma (under palliative care)
 HPT


11. PATIENT’S PROFILE
SURGICAL HISTORY
 Nil

 FAMILY MED HISTORY
 Unknown

13. 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

14. 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

15. PHYSICAL EXAMINATION

16. 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

17. INVESTIGATION
 Ultrasound abdomen
 CXR
 FBC, LFT, BUSE, creatinine

25. • 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

31. 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.

32. EMPHYSEMA
• Impaired of gas exchange results
from destruction of the walls of our
distended alveoli.

48. RISK FACTORS
•
•
•
•
•
Cigarette smoking
Air pollution
Recurrent infection
Aging
2˚ smoking

50. COMPLICATION
•
•
•
•
•
•
Pneumonia
Atelectasis
Pneumothorax
Cor Pulmonale
Pulmonary hypertension
Respiratory insufficiency or failure

52. FBC
• Lymphocyte
- 18.7% (20-45%)
• Monocyte
- 16.6% (1 – 11%)

53. 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)

54. LFT
• SGOT/AST
- 182 u/L (7 – 44)
• Alkaline phosphatase
- 306 u/L (40 - 128)
• Gamma-GT
- 567 u/L (7 – 55)

55. BUSE/ Creatinine
• Urea
- 15.2 mmol/L (3.0 – 9.2)
• Sodium
- 123 mmol/L (135 - 155)
• Creatinine
- 273 umol/L (60 – 150)

56. CHEST X-RAY
• Emphysematous lungs. Bilateral
upper lobe fibrosis

57. ULTRASOUND ABDOMEN
• Changes are suggestive of liver
cirrhosis with ascites.

61. 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

62. 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

64. 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.

65. 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.

66. LUNG TRANSPLANTATION
• For end-stage emphysema.
• Rarely done and most patient died
while waiting for donor.

68. NURSING DIAGNOSIS
 Ineffective breathing
pattern related to reduced
lung expansion and
occlusive airflow.

71. NURSING DIAGNOSIS
 Impaired gas exchange
and airway clearance due
to obstruction of airway
and ventilation-perfusion
inequality.

72. NURSING DIAGNOSIS
 Alteration in bowel habit
related to loose motion.

73. NURSING DIAGNOSIS
 Alteration in ADL related
to fatigue, ineffective
breathing and hypoxemia.

74. NURSING DIAGNOSIS
 Potential infection
related to intravenous
cannulation.

75. NURSING DIAGNOSIS
 Potential alteration in
nutritional status less than
body requirement related
to nausea and loss of
appetite.

76. NURSING DIAGNOSIS
 Knowledge deficit related
to home management.

78. • 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