UMALI, CHARMAINE KAYZHEL R.

DECEMBER 09, 2017

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CASE STUDY: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN ACUTE
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EXACERBATION

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I. ANATOMY AND PHYSIOLOGY

Anatomically, the human respiratory system is divided into two: the upper respiratory tract - Formatted: Justified, Indent: Left: 0.25", First line:
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composed of the nose, pharynx, larynx, and the lower respiratory tract – composed of trachea,
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bronchi together with their smaller branches, and the lungs which contain the alveoli. The Formatted: Font: (Default) Times New Roman
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mentioned system is mainly responsible in supplying oxygen to the body and getting rid of carbon
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dioxide. Formatted: Font: (Default) Times New Roman
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The exchange of gases, also known as respiration, between the circulatory system and the Formatted: Font: (Default) Times New Roman
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environment is made possible through four distinguished events namely: pulmonary ventilation,

external respiration, respiratory gas transport, and internal respiration. First, in the pulmonary Formatted: Font: (Default) Times New Roman

ventilation the air must move into and out of the lungs so that gasses in the air sacs are

continuously refreshed through the breathing process. Second, gas exchange between the

pulmonary blood and alveoli must take place known as external respiration. Third, transportation

of oxygen and carbon dioxide to and from the lungs and tissue cells in the body via the blood

stream takes place in respiratory gas transport. And lastly, gas exchanges at the systemic Formatted: Font: (Default) Times New Roman

capillaries must be made between blood and tissue cells takes place in internal respiration. Formatted: Font: (Default) Times New Roman

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PATOPHYSIOLOGY

II. PATHOPHYSIOLOGY Formatted: Font: Bold

History of chronic smoking
Airway and air sacs get damaged
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Chemicals and smoke enters the damaged airway

Airway inflammation induced

Increased mucus production

Cough Increased sputum production

Decreased oxygen supply Plugging of smaller airways

Hypoxemia Increased airway resistance

Chest tightness Breathlessness Wheezing

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III. SIGNS AND SYMPTOMS Formatted: List Paragraph, Justified, Line spacing: 1.5
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The following signs and symptoms were experienced by my patient were as follows: … + Start at: 1 + Alignment: Left + Aligned at: 0.25" +
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 Difficulty of breathing Formatted: Font: (Default) Times New Roman
 Desaturation – oxygen saturation of 89% Formatted: Justified, Indent: First line: 0.5", Line
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 Increased respiratory rate – 29 cpm
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 Restlessness spacing: 1.5 lines
 Chest pain Formatted: Font: (Default) Times New Roman
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  Productive cough
 Frothy rusty sputum
 Fine rales at mid to base and apex of both lungs
I.IV. LABORATORIES DONE Formatted: Font: (Default) Times New Roman, Bold

LABORATORY RESULT RATIONALE

EXAM
WBC 11.5 Increased due to infection and
inflammatory response of the
patient.
CHEST X RAY  Pneumonia, both lower lung The CXR noted an infection in the Formatted: Space After: 0 pt, Line spacing: 1.5 lines,
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fields lung on both lower parts of the
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 Minimal pleural fluid, right lungs. This can be correlated to the
increase in WBC. There was also Formatted: Font: (Default) Times New Roman
accumulated fluid noted on the right
lung. This caused the patient’s
symptoms like chest pain, shortness
of breath and cough.
ABG pH 7.49 Respiratory alkalosis was reflected
pCO2 32.9 by the increased in pH and decrease
pO2 178.7 in pCO2. Due to hyperventilation as
reflected by the increased
respiration of the patient, more
carbon dioxide (CO2) is exhaled in
the body. As a compensatory
mechanism to the desaturation of
the patient, there was a greater
increase in the oxygen level
dissolved in the blood as reflected
by the partial pressure of oxygen
(pO2) greater than the normal
range.
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V. MEDICAL MANAGEMENT
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No. MEDICATIONS DOSAGE RATIONALE
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1 A corticosteroid used in acute exacerbations of
Hydrocortisone 100mg TIV q6h COPD by reducing the inflammation of the
airways thus improving the airflow into the lungs
2 Levofloxacin 500mg tab OD Antibiotic for the infection
3 Cefixime 200mg tab BID Antibiotic for the infection
4 A mucolytic that decreases mucus viscosity of
600mg tab in half
n-Acetylcysteine lung secretions by breaking down the mucus into
glass water OD
thinner units that is easier to get rid of the body
5 A potent bronchodilator that relaxes the smooth
Doxofylline 200mg tab BID muscles of the airways to the lungs that improves
and increase airflow in the lungs
6 A loop diuretic that rids the body of excess and
Furosemide 20mg TIV q8h
unwanted fluids
7 A bronchodilator that relaxes the smooth muscles Formatted: Font: (Default) Times New Roman, Bold
Combivent Neb 1 neb q6h of the airways to the lungs that improves and Formatted: Font: (Default) Times New Roman
increase airflow in the lungs Formatted: Justified, Line spacing: 1.5 lines
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VI. NURSING INTERVENTION DURING SHIFT Indent at: 0.75"
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The following are the nursing interventions I have done in my shift:
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 Patient was placed in the most comfortable position for him. Formatted: List Paragraph, Justified, Line spacing: 1.5
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 Patient was maintained on oxygen support. at: 0.5"

 Proper deep breathing and coughing exercises was taught to the patient. Formatted: Font: (Default) Times New Roman
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 Therapeutic communication and encouragement of verbalization of feelings and concerns was
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done.
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 Safety was ensured at all times by maintaining the side rails up.
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 Due nebulizations were rendered and chest physiotherapy was done after each nebulization.
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 Ensured on time giving and proper administration of medications. Formatted: Font: (Default) Times New Roman
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