Nueva Ecija Colleges

Cabanatuan City

Intensive Care Practicum

BSN IV-D, Group 3

Marcelo, May H.
Mascariñas, Jeremiah M.
Miranda, Carl Atlas V.
Miranda, Cherry Anne S.
Molina, Eleanor P.
Orpia, Djulie DR..
Palisoc, Jacquelyn N.
Patricio, Venus B.
Perez, Gladwin Jade L.
Peroz, Mark Kristoffer V.
Punsal, Madelyn Gale S.
Sardea, Bryan Omar D.

Ms. Sharon Feliciano R.N

(Clinical Instructor)
I. Introduction

Chronic obstructive pulmonary disease (COPD) is a lung disease in which

the lungs are damaged, making it hard to breathe. In COPD, the tubes that carry air
in and out of your lungs are partly obstructed, making it difficult to get air in and
out.

Cigarette smoking is the most common cause of COPD. Most people with
COPD are smokers of former smoker. Breathing in other kind of lung irritants, like
pollution, dust, or chemical, over a long period of time may also cause or
contribute to COPD.

COPD develops slowly, and it may be many years before you notice
symptoms like feeling short of breath. Most of the time, COPD is diagnosed in
middle-aged or older people.

COPD is a major cause of death and illness, and it is the fourth leading
cause of death in the United States and throughout the world.

There is no cure for COPD. The damage to your airways and lungs cannot
be reversed, but there are things you can do to feel better and slow the damage.
II. General Objectives

After 5 days of exposure at the Nueva Ecija Doctors Hospital, we will be

able to expand our knowledge and skills regarding chronic obstructive pulmonary
disease, as well as to develop and enhance our skills and attitudes in the delivery
of quality and effective nursing care on the patient through actual exposure.

III. Specific Objectives

This study was specifically aimed:

1. To interact politely, appropriate and effectively to the client while
applying our knowledge about Chronic obstructive pulmonary disease.
2. To identify the signs and symptoms of the disease and their
corresponding interventions.
3. To determine the past and present history of the client to know the
disease and to educate the patient more about her condition and to prevent
further complications.
4. To be aware of the diagnostic procedure performed; including the drugs
that patient is taking.
5. To develop a proper and effective nursing care plan necessary for the
health needs and health problems presented by the patient.
6. To provide proper care and appropriate education to the patient, and
allow her to comprehend with it.
IV. Personal Profile

Name : Mr. “Pogi”

Age : 69 years old
Birth date : March 22, 1939
Sex : Male
Civil Status : Married
Nationality : Filipino
Religion : Roman Catholic
Address : Purok I, Bagong Silang, San Miguel Bulacan

Date of Admission : August 13, 2009

Case # : 203929
Ward : MMW
Admitting Doctor : Dr. W. Villanueva
Attending Doctor : Dr. E. Paatan
Admitting Diagnosis: COPD in Acute Exacerbations
V. Physical Assessment

General Appearance – Conscious; Coherent, Dyspneic

Head – Normal; No noted Deformities
Scalp – No dandruff; no lice
Hair – His hair is unevenly distributed, black & white in color
Eye – Anicteric Sclera; with pinkish palpebral conjuctiva
Ear – No Discharge
Nose – Nasal flaring
Lips – With cyanosis, dry lips
Mouth – No lesions, with dry tongue
Teeth - No Dentures
Neck – No noted lymphadenopathy
Chest & Back – Symmetrical chest wall expansion; (+) wheezing sounds; Barrel
chest; (+) retractions; bibasal crackles
Abdomen – Globular soft; Normo Active Bowel Sound; (-) tenderness; abdominal
breather
Upper Extremities – (-) deformities; symmetrical in appearance
Lower Extremities – no edema; (-) deformities
Nail Beds – Clean, clubbing finger nails
Skin – Fair complexion
Heart – Tachycardeic; (-) murmur

Vital Signs
Date Temperature Pulse Respiration Blood Pressure
8-13-09 36.8 C/axilla 108 29 150/70mmHg
8-14-09 36.7 C/axilla 108 32 130/90mmHg
8-15-09 36.7 C/axilla 98 32 130/80mmHg
VI. Nursing History

Present History
Few hours to admission the patient experience difficulty of breathing,
oxygen inhalation via nasal cannula was administered consult done hence
admission for further observation.

Past History
According to his son, his farther was often confined in NEDHI since 2006
due to DOB.
And the last time he admitted was on February 2007. When he experienced
a lower right quadrant pain, low grade fever & nausea, vomiting & found out that
he was having a appendicitis and underwent appendectomy right after.

Health History
He was an active smoker since he was 20 years old; He can consume at
least 16 sticks to 1 pack of cigarette per day and an occasional drinker too. He
stopped smoking when he was complained DOB & after being admitted last 2005.

Occupational History
He was a Farmer in Bagong Silang, San Miguel Bulacan for 25 years. Her
wife and son only live in their house.

Family History
According to our patient, both of his parents have no any history of any disease,
but his older brother suffered form COPD, while his young sister suffered from UTI. His
daughter & son are all in good condition as well as his wife… only simple fever & cough
were their usual illness.
Environmental History
According to Mr. Pogi their house is located near the farm, made up of
concrete material, where in creek is beside their house. He spent most of his time
in the farm from morning till evening. During his stay, he used to clean all the
mess especially the dried leaves and burn after. He is the one responsible for
maintaining their farm including pesticides, fertilizer as well in harvesting.

Diet
Our patient said that, he often eat vegetables and large amount of rice,
where in boiled vegetable is their usual menu, but because of financial problems
they can only eat meat & fish when occasions came.
 VII. Course in the Ward
08 – 13 – 09 Thursday
10:40 A.M - pls admit to ROC
BP: 150/70
BT: 37 - Secure consent
PR: 107 - soft diet c aspiration precaution
RR: 29
- TPR shift q record
- Dx: CBC: RBS: TFR
- Secure old chart
- IVF: ① D5W 500 x KVO
- Meds:
 Pharmacort 250mg IV stat then 125mg IV q 8hours
 Ranitidine 50 mg IV q 8hours
 Combivent neb now then q 15 minutes x 2 doses then q 2
hours
- O2 inhalation @ 5 lpm per nasal cannula
- Monitor V/S and record q 4 hours
- Cont. pt. meds
- Pls inform AP
- Refer

Dr. Paatan

- Continue meds:
 Diltiazem 30 mg 1 tab TID
 Salbutamol 1 cap TID
 Amlodipine 10 mg 1 tab OD
 Diamide, 1 tab OD
Dr. Paatan
12:45 PM: - for serum electrolytes
- Lasix 1 tab IV now
- Increased Pharmacort to IV q 6 hours
- Heraclene Forte 1 tab OD
- Domperidone 10 mg 1 tab TID AC
04: 00 PM: - Fluimucil neb q 12 hours
Tel. order by Dr. Paatan

08 – 14 – 09 Friday
06:00 PM - D5W 500cc x KVO
- D/C Fluimucil
- Asmavent neb q 12 hours
Dr. Paatan

08 – 15 – 09 Saturday
09:00 AM: - MGH.
- Take home meds.
 Kalium Durule 1 tab 2x a day
 Diamide – K 1 tab OD
 Diltiazem 30 mg 1 tab 3x a day
 Duavent neb 4x 3 days
 Budesonide 2x 3 days
 Amlodipine 10mg 1 tab a day
 Ranitidine 10mg 1 tab 2x 4 day
 Heraclene Forte once a day
 Domperidone 10 mg 1 tab 3x a day BEFORE MEALS x 5
days
 - To settle bill
Dr. Paatan
VIII. Laboratory Result
Complete Blood Count
August 13, 2009
Parameter Results Normal Values
Hematocrit % 43.1 40.0 – 54.0 %
Platelets(x10 /L) 240 140.0 – 440.0
WBC (x10 /L) 12.1 4.0 – 10.0
Granulocytes % 75 44.2 – 80.2 %
(x10 /L) 9.2 2.0 – 8.8 %
Lymphocytes/ % 25 28.0 – 48.0 %
Monocytes (x10 /L) 2.9 1.2 – 5.3
Hemoglobin g/dl 13.8 14.0 – 18.0 g/dl

Random Blood Sugar

August 13, 2009
Tests Results Normal Values
RBS 146 90 – 145 mg/dl

Special Chemistry
August 13, 2009
Tests Results Normal Values
Serum Potassium 2.56 3.6 – 5.3 mEq/L
Serum Sodium 133.9 136.0 – 145.0 mEq/L
Serum Chloride 98.1 96.0 – 110.0 mEq/L
X. Pathophysiology
XIII. Recommendation

To the patient:
• To have proper care regarding disease
• To monitor blood pressure regularly.
• To increase self-esteem and over all body integrity.
• Strict compliance of drugs that was being prescribed.
• To modify lifestyle.

To Health Care Provider:

• To continue helping the patient to fully understand the disease process
and educate the patient on how to prevent certain complications.
• To continue educate the patient & relatives in performing all aspects of
treatment regimen (ex. Metered dose inhaler) with return demonstration
from pt. & relatives before discharge.
• To follow up for further evaluation of patient condition.

To Family/ Relatives
• To provide continuous moral support to the patient could help him
lessen the anxieties. The family is the primary support of the client who
could help him improve his self-esteem towards himself and be able to
alleviate his stress. The family is also the one who could give him all
needs.
XIV. Evaluation

After 3 days of exposure at the Nueva Ecija Doctors Hospital . We the nursing
students were able to develop our knowledge regarding Chronic Obstructive
Pulmonary Disease. Through this, we were able to understand the disease process
and were able to comply with the needs of our patient being cared. The
knowledge, attitude, the quality and effectiveness of our nursing care rendered
were well conveyed well to the patient and relatives.

We were able to teach our client on how to properly monitor his blood
pressure, diet, and the right medications. He was able to understand certain things
regarding the different health educations that would help him in understanding the
disease.

We were able to identify the different complications that are related to

COPD throughout our patient. And through this, we were able to give the best
health education to the best health education to the client to prevent further
complications that may arise to his disease.

Through this study, we the nursing student able to comply with new
knowledge understanding and experience to those who need effective, efficient,
and quality nursing care in the future.
XIV. References
- http://www.Wikipedia.org/wiki/COPD
- http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html
- http://www.mayoclinic.com/health/copd/DS00916
- Brunner and Suddarth's Textbook of Medical-Surgical Nursing
- Mims.com
- http://www.youtube.com/watch?v=bwXvqSqAgKc
- http://www.youtube.com/watch?v=ps64D3Juv5A&feature=related
- http://www.youtube.com/watch?v=aktIMBQSXMo
-