Case Pre Ppt

8/6/2019 Case Pre Ppt

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Patients Name: G.B.R

Age: 69 years old

Sex: MaleCivil Status: Married

Attending Physician: Dr. Valdez, Dr.

Arada, Dra. Toledo

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Chronic Obstructive Pulmonary

Disease possibly bladder

obstruction, s/p suprapubiccystostomy

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Chief Complaint/s:

Difficulty of Breathing

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NURSING HISTORY


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Anxiety

Relation of stress to anxiety

Sister Callista Roys Adaptation Model

Care of the client in the Obstetric ward

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oliguria

Decreased renal blood flow primary kidney disease

damage from other diseases urine overflowobstruction

Decreased GFR

Reduced clearance

Modifiable Risk Factor:

Cigarette smoking

Intake of Salty Foods Hypertension

Diabetes status

Non-Modifiable Risk Factor:

Age

Gender- women

Metabolic

acidosis,

hyponatremia

Urea, nitrogen and creatinine rise


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Electrolyte

imbalanceKidney lose their ability to concentrate urine

Functioning nephrons decline in number

GFR decreases further

Loss of kidney function

Renal Failure

Chronic Kidney Disease


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Muscle ContractionBronchial smooth

muscle cell hyperactivity

bronchospasm

Obstruction of airflow

Mucosal EdemaHypertrophy of

bronchial mucusglands

Mucus SecretionGoblet cell

hyperplasia

Narrowing of bronchiallumen

Squamous cellmetaplasia

Accumulationof secretions

yproductive cough with

thick and mucupurulent

sputum

yDecreased tactile fremitus

yNasal flaring and

use of accessory

muscle

y

Dyspnea

Ventolin nebule

Predisposing Factors

yOld age

ySocioeconomic status

Precipitating Factors

yExposure to chemical

irritants such cigarettesmoke

Mucosal Inflammation

CHRONIC OBSTRUCTIVE PUMLMONARY DISEASE


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Air trappingimpaired gas exchangeDecrease ventilation

Hypoxemia Hypercapnia

Mechanical Ventilator

COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to

breathe. "Progressive" means the disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing,shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to

smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may

contribute to COPD.

To understand COPD, it helps to understand how the lungs work. The air that you breathe goes

down your windpipe into tubes in your lungs called bronchial tubes or airways.

Within the lungs, your bronchial tubes branch into thousands of smaller, thinner tubes called

bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called

capillaries run through the walls of the air sacs. When air reaches the air sacs, the oxygen in the air passesthrough the air sac walls into the blood in the capillaries. At the same time, carbon dioxide (a waste gas) moves

from the capillaries into the air sacs. This process is called gas exchange.

The airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air

like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.

The walls of the airways become thick and inflamed.

The airways make more mucus than usual, which tends to clog them.


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Amlodipine

Calcium Gluconate

Hydrocortisone Itraconazole

Meropenem

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Medication


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MupirocinOmeprazole

Paracetamol

Piperacillin Tazobactam

VancomycinTranexamic Acid

Simvastatin

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Medication


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Nursing Priorities

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Problem No. Problem Date Identified

1 Thick bloody

secretions at ET tube

May 10, 2011

2 Bed sores at buttocks

area

May 10, 2011

3 Risk for Aspiration May 10, 2011


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NCP


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Ineffective airway clearance r/t thicktracheobronchial secretions 2 COPD

Impaired Skin Integrity related todecreased blood and nutrients to tissues

secondary to bedsore on the buttocks

area.

Risk for Aspiration related to excessive or

thick secretions secondary to COPD15


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DISCHARGE PLAN

> Compliance

Medication

> Diet

> Exercise

> Activity/ Lifestyle Changes

> Follow up/ Check up


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It is not how muchyou do but how

much love you put inthe doing.

- Mother Theresa

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