ACKNOWLEDGEMENT

This case study report has been prepared during my clinical practice in
college of medical science. It is the practical requirements of the post
basic bachelor-nursing curriculum.
I got myself completely involved in the care and management of the
patient during the period. However, the work would not be having
accomplished successfully with my efforts alone, without the guidance
and support of a number of people in the endeavor.
I have a great pleasure to express my gratitude to the SMTC for providing
this kind of course of study and present them in systematic way. I would
like to express my gratitude to campus chief Ms.Sovana Nepal for her
good management and for making this hospital practicum possible.
I sincerely like to thank co-ordinator ms anu vk (lecturer) ms jyoti dakhal
for their valuable guidance, supervision, direction, and co-operation
during hospital practicum.
Iam also thankful to all my teachers for their guidance and supervision
and library family for providing essential book for the case study.
I am equally thankful to my colleagues, seniors as well as juniors and also
thankful to my patient his family for providing the necessary information
so kindly and co-operatively.
Lastly, I am thankful to all helping hands that encouraged and supported
directly or indirectly to give case study report in final shape.
Thanks
Rashika chapagain
PBBN 3rd year
SMTC Background
 CONTENT OF TABLE
1. background
2. Rational for the selection of case
3. Methodology for this case study
4. History taking and physical examination
5. Developmental tasks and crisis
6. Introduction about disease
7. Anatomy and physiology
8. Definition
9. Epidemiology
10. Pathophysiology
11. Causes
12. Signs and symptoms
13. Diagnostics
14. Management
15. Prognosis
16. Complications
17. Drugs profile
18. Nursing management
19. Application of nursing theory
20. Nursing care plan
21. Daily progress note Diversional therapy
22. Health education given during hospitalization
23. Discharge teaching
24. Learning from case study
25. Conclusion
26. References
BACKGROUND
A case presentation is the important method of specific educational activities. It
provides opportunity to read and discuss under specific problem.

For the fulfillment of bachelor degree in nursing, 3rd year curriculum , we have to
perform 1 case study in details. As suggested by curriculum, we have to take one
specific disease condition for case study and provide comprehensive and holistic
nursing care to the patient by applying knowledge of psychodynamic, basic science,
nursing theories and nursing process.

So, I have carried out this case study on case of “chronic obstructive pulmonary
disease” during the period of clinical assignment of cms Hopital. It is quite benefited
for my study. So, I have taken it as a golden opportunity. As a partial fulfillment of
post basic bachelor of nursing of Purvanchal University, where we student
individually have to complete 2case presentation individual. So I selected the case of
acute copds for study, which is most common disease in the world and during my
posting, there were many cases of acute copd.

Rational of my Case Study

•Copd is a more common disease in Nepal, especially to old aged . Its incidence is
increasing day by day. The predisposing factor of copd is preventable. Most of them
are due to smoking, poor environment and allergies. So we can minimize the
occurrences of copd by preventing the person from dust,irritants,smoking, allergies
etc. We can give health education about the preventive methods. The mortality rate is
increasing day by day so I choose this case study to go to depth and to know the
pathophysiology of copd and also to gain knowledge about how to manage the case at
hospital setting, how it effect on patient’s health, how to minimize morbidity and
mortality, to know about patient’s family environment, supporting system and
economic status and its effect in patient’s condition.

After gaining detail knowledge about copd, I can share my knowledge with my
patient’s family with confidently. This helps to prevent from complication and
provides supports to the patient and family
METHODOLOGY
The methodology adopted to produce this report was based on the observation,
examination and history taking of patient, discussion with teachers, senior’s staffs
and doctors and using various text books and reference of medicine.

OBJECTIVES OF MY CASE STUDY

• General objectives: the general objectives of case study of copd is is to get

practical,theoretical and clinical about the case.

• Specific objectives:

1. To gain detail information about the case copd by co-relating the book and
patient condition.

2. To do history taking and physical examination.

3. To gain knowledge about developmental task of old adult.

4. To provide nursing care to the patient through holistic approach.

5. To give health teaching about the patient and visitors related to disease
condition and care.

PART 1(PATIENT’S BIODATA)

• Patient’s Name :- Hari Bahadur Thapa

• Age/ sex :- 85Yrs/ male

• Marital status :- Married

• Education :- Illiterate

• Occupation :- farmer

• Religion :- Hindu

• Address :- Sindure 7 ,Lamgunj

• Diagnosis :- chronic obstructive pulmonary disease

 • Ward :- MICU

• Bed No. :- 09

• IP No. :- 1606150436

• Date of admission :- 2016-06-19

• Date of discharge :- 2016-06-24

• Attending physician :- Dr. Khush Raj Shrestha

• Informants :- Patient and his son

CHIEF COMPLAIN

Shortness of breath,cough with sputum production for 10 days

• History of present illness

According to patient he was feeling unwell for few days when he had developed
sob,coughing associated with the disease condition and then days he visited
chandreshwor primary health care (2016-06-17)and they administer tab
amoxicillin 500mg,tab azitro 500mg. Tab salbutamol 4mg,oxygen inhalation and
nebulization and

after that he was reffered to college of medical science for further treatment.He
arrived at emergency department on 016-06-19at 1pm.he was given inj hydrocort
100mg iv stat,inj pantium 40 mg iv stat,nebulization with asthalin and impravent
and oxygen inhalation. Investigation such as chest x-ray,laboratory (esr,cbc),
ECG,na,k+, urea,creatinine,ABG.then on 016-06-19 he was transferred to medical
intensive care unit.

PAST MEDICAL HISTORY

Patient history of copd since 10 years, patient taken salbutamol 4mg bd and
salbutamol inhalation.
Patient biodata

General examination:-

State of consciousness :- alert

Nutritional status :- poor

Vital sign-

Height :- 160cm

Weight :- 48kg

BP :- 130/80 mm of Hg

Pulse :- 120/min

Respiration :- 26/min

Temperature :- 98.6f

Spo2 :- 98%(with o2)

Body mass index (BMI) :- 18.7(normal weight)

 Past Medical History:he has history of COPD since 10 years

 Past surgical History:no any

 Birth History:
Place of delivery: Home delivery.
Mode of delivery: Normal delivery.
Birth weight: Could not be verified.
Any birth complication: No

 Status of Childhood illness:

No any history of childhood illness

 Personal history:
 Smoking: he used to smoke 2-3 sticks cigrattes /day for more then 30
years but left 5 year back.
 Alcohol:he occasionaly used to consume Alcohol on occsion but has
stopped 5 year back.
 Tobacco: NO
 Bowel habit: Normal(early in the morning)
 Appetite: Good
 Diet :Mixed (vegetarian +non veg) and there is no food which he
doesn’t like.

 Status of Childhood illness:

No any history of childhood illness

 Diet :Mixed (vegetarian +non veg) and there is no food which he

doesn’t like.
 Usual meal pattern:milk in morning (7 to 8 am)

Lunch (9 to 10 am)

Snacks(2-3pm)

Dinner (7 to 8 pm)

 Sleep pattern: 9 to 10 hours at night, sound sleep

 Allergies: Patient has not any history of allergy from insects and
not any others food, medicines.
 Immunization:Not known.
 Injuries/Accidents –Not significant.
 Hospitalization –he has been admitted 10 year’s back for treatment
of COPD and has been hospitalized for several time for the same
case.
 Medication taken at home ( tab salbutamol 4mg po bd and nebulizer)
 FAMILY TREE

INDEX

Male

Female

Death Male

Death Female

Client
ENVIRONMENTAL HISTORY
 Type of drainage system - open
 Type of toilet used - water seal latrine
 Source of drinking water – government tap
 Kitchen style – separate
 Type of fuel used in cooking - wood

PHYSICAL EXAMINATION
While doing head to toe examination, I followed systematic approach of head to toe
examination and use following method for physical examination

 Inspection
 Palpation
 Percussion
 Auscultation
 Measurement

Before doing physical examination the vital sign of patient were;

VITAL SIGNS:
Temp: 98.6ºF
Pulse: 120/min
Resp.:26 /min
B.P:130/80mm of hg.
Height: 160cm
Weight: 48 kg

GENERAL APPEARANCE:
State of consciousness: oriented to time, place, and person.
Responses to the verbal commands, touch: normal
Gait: straight
Physical build: undernourished
Facial expression : lethargic.
Hygienic status: poorly groomed
Speech: spontaneous and audible but low in pitch.
Skin:
Examination Findings
Inspection
 All over the body for color  color uniform all over the body
Any patches or lesions or any  Skin free of lesion and abrasions
evidence of itching.  wrinkles present on face.
 Wrinkles  Edema absent
 Edema  Cyanosis absent
 cyanosis  Dry white in color uniform distribution
 Hair distribution
 Cleanliness  Dandruff hair
 Evidence of injury  No any evidence of injury
Palpation Temperature
 Edema  Warm skin, even temperature
 Dehydration  Edema absent
 Texture  Elastic skin: skin comes back to previous
state quickly
 Smooth skin
Lymph Nodes:
Examination Findings
Inspection
 Redness or enlargement of lymph  Lymph nodes not visible, no
nodes redness

Inspection
 Redness or enlargement of lymph  Lymph nodes not visible, no redness
nodes

Palpation
 Enlargement  Lymph nodes not palpable
 Tenderness  No tenderness

Head and face:

Examination Findings
Inspection
 Shape and size  Uniform size and shape
 Swelling, injury or infection on head  Swelling of face not present
 Face for movement of two sides  Easily movable

Palpation
 Swelling, tenderness and depression  Swelling not present on face
Percussion
 To sinuses for tenderness  No tenderness over maxillary and
frontal sinuses
Eye :

Examination Findings
Inspection
 Eye for bulges  No bulges
 Eyelids  No swelling, redness, drooping
 Palpebral  Pink in color, no discharge, foreign body, dryness
conjunctiva. or tear flowing.
 Bulbar conjunctiva  Transparent white in color
 Cornea  Transparent, no abrasions, or white spots
 Sclera  White in color with few small blood vessels
 Pupils  Round and uniform in size and shape , when light
approaches pupils constrict but
poor response as patient dosent open eye himself.
 Eye movement  Equal eye movements
Well movement

Ear:
Examination Findings
Inspection
 External ear for location  Top of pinna meets the
eye- occupit line.
 Pinna for any lump or lesion  No lump, lesion, smooth
rounded
 External auditory canal for any  No redness,but wax present
redness discharge, mass, foreign in both ear.
body, or cerumen.  No redness or swelling.
 Mastoid area for redness or
Swelling
Palpation
 Pinna  No tenderness
 Skin flap  No tenderness
 Mastoid area  No tenderness
Nose:
Examination Findings
Inspection
 Nose for location  Centrally located
 Nostrils  Nostrils are uniform in size and do
not flare.
 Nasal septum  No polyp or deviation
 Nasal canals  Dark pink in color, no discharge or
foreign body.
 Smelling  Good smelling capacity present.

Mouth and Throat:

Examination Findings
Inspection
 Lips  Slightly bluish in color moderately dry,
no cracks and ulcers, deviated to right side.
 Mucous membrane  No ulcers are present.
 Gums  Pink no swelling, redness or bleeding
 Teeth  White with black lines, 2nd molar teeth
 Tongue missing
 Throat/tonsils  Normal
 Swallowing difficulty  Normal
 No any problem in swallowing

Palpation
 Gums  No swelling, tenderness
 Teeth  No loose tooth
Smell  Foul odour, or smell of alcohol
Slightly present
Neck :
Examination Findings
Inspection
 The neck position  Centrally located
 For enlargement of thyroid gland  No enlargement
 Ability to move neck  able to move by self
 Back of neck for lump or
Tenderness  No swelling or lump

Palpation
 Back of neck for tenderness  No tenderness
 Thyroid gland for tenderness  Thyroid not palpable and non
tender

Chest and lungs:

Examination Findings
Inspection
 The shape and size  anterior posterior diameter wider
 Symmetrical shape, sternum is
 Symmetry centrally located
 Uneven expansion of chest
 Expansion during breathing  No intercostals retraction
 Intercostals spaces  Cough
 Cough
Palpation
 Chest wall for tenderness, mass  No tenderness, mass lumps
lumps,  Equal expansion of the chest on
 The chest for expansion both sides

Percussion
 The front and back of of the chest.  Hyperesonant sounds over the lungs.
Auscultation  Breath sounds with wheezing
 The front and back of chest. present
Heart :
Examination Findings

Palpation
 Heart to determine the size  Heart normal in size apex beat
palpable at 5th intercostals.

Percussion
 Heart  Dull sound over heart from 2nd
to 5th intercostals.
Auscultation
 Heart sound in aortic ,pulmonary,  Lub dub sound present in all
tricuspid and bicuspid area areas.
Breast :
Examination Findings
Inspection
 Both breast for size, uniformity,  Breast and nipple are uniform in
color. size and shape, nipple point to same
 Any swelling, dimpling or direction.
retraction  No swelling , dimpling or
 Nipples retraction.
 No cracks or secretion present.
Palpation
 Breast to check for mass ,  No mass, swelling or tenderness
swelling or tenderness present.
Abdomen:
Examination Findings
Inspection
 Shape, size, scars, swelling,  Not distended , no scar,
and distended blood vessels Swelling absent.
Auscultation
 Bowel sounds  Bowel sounds are present in all
quadrants every 5-10 secs, gurgling
sounds.
Percussion
 In all areas  Tympany over stomach and intestines
whereas dull over liver, spleen and
 Kidneys for tenderness kidneys
 Non tender kidneys.
Palpation
 All areas of abdomen  Soft, non tender
 Liver  Non palpable
 Spleen  not palpable
 Kidneys  not palpable

Anus :
No any irritation , crack, fissure or enlarged vessels reported.
Genitalia:
No redness, swelling discharge.
Arms and legs:
Examination Findings
Inspection
 arms and legs for symmetry,  Symmetrical in size and shape,
edema or lesions. edema absent.
Palpation
 Arms and legs for edema  Edema absent.
Musculo skeletal system:
Examination Findings
Inspection
 Muscles and joints  No bone or joint deformity

 Joint movements  Good movement of joints

 Spine is midline slightly curved
 Patient’s spine out from neck and gradually curving
inward at the waist.
Palpation
 Patient’s neck, shoulder, elbows,  Warm to touch
knees ankle joints for swelling, tenderness
and temperature.

Nervous system:
Examination Findings
 Muscle strength  equal strength in both hands and feet
 Sensation  Good sensory intact
 Reflexes  Present

FINDINGS:
 Dyspnoea & use of accessory muscle for respiration

 NO Cynosis
 Cough : Productive moderate .
 B/L Wheeze sound on auscultation,hyperresonant sound on percussion and
barrel shaped chest on inspection.
 Wax (moderate amount ) present at B/L ear.
 Dental carreies present at 2nd molar teeth.
 DEVELOPMENTAL TASK:

Developmental tasks and crisis

Developmental task is a growth responsibility that arises at a certain time in the

course of development, successful achievement of which leads to satisfaction and
success and adjustment in life.

Likewise the developmental tasks and crisis of the elderly according to Erickson is
“Ego integrity versus despair” this means that the older adults must be convinced that

his\her life has had some purpose, meaning and self fulfillment; failure to esolve this
stage can lead to poor adaptation to advanced age fear of death.

The developmental tasks of elderly( HAVIGHURST) and comparison to that of my

patient are given below

Comparison of developmental tasks

According to book According to patient

1. Adjusting to decreasing health 1. My patient is has adjusted to

and physical strength decreasing health and physical
strength. he accepts that her
physical abilities are decreasing.
2. Adjusting to reduced or fixed 2. he has adjusted to reduced or
income fixed income.
3. he is happily staying with her
3. Adjusting to the death of spouse. family.
4. he has maintained a satisfactory
living arrangement. he stays with
4. Maintaining a satisfactory living her son.
arrangement 5. he has good relation with her
grandson.
5. Realigning relationships with 6. he has found a meaning in her life
adult children through her past experience.
6. Finding a meaning in life 8. he is not able to maintain interest
 in people outside the family and
7. Maintain interest in people in social civic and political
outside the family and in social responsibility due to illness as
civic and political responsibility well as weakness

THE ANATOMY AND PHYSIOLOGY OF RSPIRATORY SYSTEM

A. The Respiratory System

A person can live for weeks without food and a few days without water but only a few
minutes without oxygen. Every cell in the body needs a constant supply of oxygen to
produce energy to grow, repair or replace itself, and maintain vital functions. The
oxygen must be provided to the cells in a way that they can use. It must be brought
into the body as air that is cleaned, cooled or heated, humidified, and delivered in the
right amounts.
The respiratory system is the body's link to this supply of life-giving oxygen. It
includes the diaphragm and chest muscles, the nose and mouth, the pharynx and
trachea, the bronchial tree, and the lungs, each of which is discussed below. The
bloodstream, the heart, and the brain are also involved. The bloodstream takes oxygen
from the lungs to the rest of the body and returns carbon dioxide to them to be
removed.
The respiratory system is susceptible to damage caused by inhaled toxic materials and
irritants because the surface area of the lungs exposed to air is so large and the body's
need for oxygen so great. The ability of the respiratory system to function properly
has a great impact on the body. Disease in any one of its parts can lead to disease or
damage to other vital organs.
CHRONIC OBSTRUCTIVE PULMONARY DISEASES

Also known as chronic obstructive lung diseases. It refers to several disorders that
affect the movement of air in and out of the lungs. It occurs as a result of an increased
airway resistance secondary to bronchial mucosal edema or smooth muscle
contraction. COPD is the combination of chronic bronchitis and pulmonary
emphysema.

Chronic bronchitis : the lining of the airway is constantly irritated and inflamed,this
causes the linig to thicken lot of thick mucous forming in airway making it hard to
breath.
Emphysema:the walls between many of the air sac are damaged due to excess mucus.
As the result ,the air saces lose their shape and the amount of gas exchange in the
lungs is reduced.

Incidence

Globally, 10%–20% of the population older than 40 years (an estimated 80 million)
are COPD sufferers, resulting in more than 3 million deaths each year(2012). COPD
is projected to be the third leading cause of death by the year 2020. According to
surveys by the Asian Pacific Society of Respiratory Diseases, 6.2% of the global
COPD burden is born by 11 Asian countries. In Nepal, COPD accounts for 43% and
2.56% of hospitalizations.
 PATHOPYSIOLOGY

Causative factor

Chronic inflammation and irritants

Increase no of goblet cell and mucus secretion

Increase size(hypertrophy) and number(hyperplasia) of submucus gland in bronchi

Increase mucus production

Decrease ciliary function reduce mucus clearance

Broncho constriction

Airflow obstruction and airway limitation

CAUSES OF COPD

A/C to Book A/C to patient

 Cigerattes smoking  Cigarette smoking

 Occupational hazards and dust.
 Air pollution
 Air pollution
 Firewood smoke.  Firewood smoke.

 Chronic respiratory infection  chronic respiratory infection

 Allergic factors
 Alpha-1 antityrpsin (ATT)
deficiency
CLINICAL FEATURES
According to book According to client
Shortness of breath Shortness of breath
Wheezing (adventitious sound) Expiratory wheezing
Cough Cough
Purulent sputum Purulent sputum
Crackles, ronchi
Weight loss and anorexia Thin body built (48 kg)
Increased anterior-posterior diameter Barrel shaped chest
of chest

Fatigue fatigue
Cyanosis Cyanosis
Pursed lip breathing Pursed lip breathing
Dyspnea Dyspnea
Extertional dyspnea Extertional dyspnea

Diagnostic procedure

 History taking
 Physical examination  History taking
 Arterial blood gases.  Physical examination
 Sputum culture: to identify  ABG: PH7.36,
organisms if sputum is persistently Paco2:42.7, Pao2:103,
present and purulent. SCO3:23.6
 Sputum AFB =negative
 Routine blood test- TC, DC, ESR,  Spirometry
HB, Urea.  Complete blood count :
 Chest X-Ray  Chest x-ray:B/L decreased
 ECG: to assess cardiac status if there entry
are features of cor pulmonale.  ECG
 Echocardiogram: to assess cardiac  ECHO
 status if there are features of cor  Bio-chemistry
pulmonale.  RBS monitoring.

 (CT scan) of chest: CT scan of the

thorax:to investigate symptoms that
seem disproportionate to the
spirometric impairment, investigate
abnormalities seen on a CXR and
assess suitability for surgery.

FINDINGS
Parameters Findings Unit Referred range
Biochemistry
Blood urea 59.3 Mg/dl 15-40
Hematological
WBC count 3510 Mm3 4,000-11,000
Differential count
Neutrophil 88 % 40-70
Lymphocyte 09 % 20-45
Monocyte 02 % 2-10
Eosinophil 01 % 1-6
Basophil 00 % 0-1
Platelets 155000 Cells/cumm 1,50,000-4,00,000
Hemoglobin 13.8 Gm/dl 13.5-16.0
RBC 4.74 Million/cumm 3.5-5.5
MCH 30.8 Pg 27-32
MCV 90 Fl 76-96

MCHC 34.1 g/dl 32-36

PCV 37.50 % 39-52
Bio chemistry

Parameter result Ref range

Creatinine 0.8 0.6-1.5mg/dl

Sodium 154 135-145meq/l

Potassium 3.8 3.5-5.5meq/l

TREATMENT

A/C TO BOOK A/C TO PATIENT

 Smoking cessation. 1. Smoking cessation
 If,oxygen need supplementation. O2 Inhalation (2 liter)
 Exercise:deep breathing & coughing 2. Deep breathing &
exercise. coughing exercise.
 Postural drainage and chest .
physiotherapy. 3. Pharmacotherapy:
 Pharmacologic Therapy: - Bronchodilator
a. Bronchodilator: Salbutamol is (Asthaline:NS(1:2)
commonly used - 8 hourly though
bronchodilator. nebulization.)
b. Corticosteroid: Inhaled and - Corticosteroid
systemic corticosteroids may hydrocort 100mg iv
be used in COPD. tds.)
c. Anticholinergic - Anticholinergic:
Agent:Ipratropium (Atrovent) Ipratropium (Atrovent)
d. Beta/Agonists:(to improve :NS(1:2) Through
dysnoea) nebulization.
It is a second choice of - inj clavum 1.2 gm iv bd
therapy for COPD - tab azithromycin
management Commonly use : 500mg po od.
Albuterol; Salmeterol; - Syp brica –bm 2tsf po
Terbutaline tds
e. Methylxanthines as - Tab doxobid 400mg po
theophylline hs.
 Antibiotics: In the presence of - Tab. Frusal half Tab
purulent,sputum.Taking medications (OD)
to dilate airways
(bronchodilators, Corticosteroids ,
mucolytic , expectorants).
 Vaccination: against flu influenza and
pneumonia
DRUGS PROFILE
1 . Injection clavum
Generic Name: Amoxyclline + Clavuanate Pot
Brand Name: Clavum
Mechanism of action
Potassium clavulanate is a beta lactamase resistant betalactam. By inihibiting beta
lactamses produced by some micro organisms, potassium clavulanate makes them
susceptible to amoxicillin which itself is hydrolyzed by beta lactamases. Many
betalactamase producing strains of staph aureus and coagulase negative
staphylococcus species are made sensitive. Among Gram negative pathogens some
strains of E.coli, proteus mirabilis, salmonella spp, shigella spp, Yersinea
enterocolitica, H.influenzae, H.ducreyi, Moraxella catarrhalis are rendered sensitive.

Indications and dosage:

Oral
-Infections caused by Beta-lactamase producing strains of organisms indicated: Adult:
Amoxycillin (250 mg) + Calvulanate potassium(125mg).

-Upper and lower respiratory tract – streptococci, H.influenzae, Moraxella

Catarrhalis; Adult: One tablet every 8 hrs. In severe infections 2 tablets every 8 hrs.

-Otitis media- H. influenza, M.catarrhalis: Adult: One tablet every 8 hrs. In severe
infections 2 tablets every 8 hrs.

Intravenous
-Infections caused by Beta-lactamase producing strains of organisms indicated: Adult:
Amoxycillin sodium1.0g + Calvulanate potassium200mg injections given every 6 or 8
hrs.

-Upper and lower respiratory tract – streptococci, H.influenzae, Moraxella

Catarrhalis; Adult: Amoxycillin sodium1.0g + Calvulanate potassium200mg
injections given every 6 or 8 hrs.
-Otitis media- H. influenza, M.catarrhalis: Adult: Amoxycillin sodium1.0g +
Calvulanate potassium200mg injections given every 6 or 8 hrs.

-Sinusitis-H.influenza, M.catarrhalis:Adult: Amoxycillin sodium1.0g + Calvulanate

potassium200mg injections given every 6 or 8 hrs.

Contraindication:
Penicillin allergy

Special precaution:
History of allergy especially to cephalosporins, infectious mononucleosis, severe
renal impairment

Adverse reactions:
Nausea, vomiting, diarrhea, indigestion, rash and urticaria, candida superinfection.

Nursing consideration:
 Teach patient and family to report sore throat, fever, fatigue ( may indicate
super infection or aggranulocytosis).
 Adequate intake of fluids (2 liters) during diarrhea episodes.
 To use alternative contraceptive measures if using oral contraceptives.
 Perform scratch test to assess allergy after securing order from prescriber
usually done when penicillin is only product of choice.
 Shake suspension before each dose may be used alone or mixed in drinks, use
immediately.
 Discard unused portion of suspension after 14 days.
 Perform or provide adrenaline, suction, tracheostomy set, ET intubation
equipment on unit so that it can be used in case of emergency.
2. Injection Hydrocortisone

Category: Glucocorticoid

Mechanism of action

 An adrenocotical steroid that inhibits accumulatic of inflammatory cells at

inflammation site, phagocytosis, lysosomal enzyme release and synthesis and
release of mediators of inflammation. It suppresses cell mediated immune
reactions. Decreases or prevents tissue response to inflammatory process.

Indications and dosages

 Acute adrenal insufficiency

Adults: 100mg I/V bolus then 300mg/day in divided dose 8 hourly

Children: 1-2mh/kg I/V bolus then 150-250mg/day in divided

doses 6-8 hourly.

Infants: 1-2mg/kg I/V bolus then 25-150mg/day in divided doses

6 -8 hourly.

 Anti-inflammation, immunosupression.
Adults: 150-240mg 12hourly.

Children: 1-5mg/kg/day in divided doses 12 hourly.

 Shock
Adults: Elderly, children 12yrs and older 100mg 6hourly.

Children younger than12yrs: 50mg/kg.May repeat in 4 hours then 24 hours as

needed.

Contraindication

 Tuberculosis of viral skin lesions. Serious infections.

Side effects

 Frequent: Insomnia, heartburn, nervousner, abdominal distension, diaphoresis,

acne, increased appetite, facial blushing, delayed wound healing, increased
susceptibility to infection, diarrhea or constipation.
 Occasional: Headache, edema, change in skin colour, frequent urination.
 Topical: Itching, redness, irritation.
 Rare: Tachycardia, allergic reaction, psychological changes, hallucinations,
depression.
 Serious reaction :
-Long term therapy may cause hypocalcaemia, hypokalemia, muscle wasting,
osteoporosis, spontaneous fractures, amenorrhea, cataracts, glaucoma, peptic ulcer
disease and CHF.

-Abruptly withdrawing the drug after long term therapy may cause anorexia,
nausea, fever, headache, sudden severe joint pain, rebound inflammation, fatigue,
weakness, lethargy, dizziness

Nursing consideration

 Examine the patient for edema, weight gain and advise patient to report fever,
muscle aches, sore throat.
 Monitor the patients for signs and symptoms of hypocalcaemia, hypokalemia.
 Determine if the patient has diabetes mellitus and anticipate and increase in
his/her antidiabetic drug because of raise blood glucose level.
 Hydrocortisone crosses the placenta and is distributed in breast milk. Patients
taking hydrocortisone should not breast feed.
 Prolonged hydrocortisone use during first trimester of pregnancy may produce
cleft palate in the neonate.
3. Asthaline

Generic Name: Salbutamol

Category: Selective beta – 2 agonist antihistamine

Mechanism of action

 An adrenergic agonist that stimulates beta-2 adrenergic receptors in the lung,

resulting in relaxation of bronchial smooth spasm and reduce airway resistance.

Indication and dosages

 Oral
Bronchospasm in patients with reversible obstructive airway disease:

Adults: 2-4mg TDS for QID.

Children: 2mg three or four times a day.

 Inhalation
Bronchospasm in patients with reversible obstructive airway disease:

Adults: 100-200 mcg Aerosol three or four times a day or

200-400 mcg Rota caps dry power three or four times a day or 2.5mg nebulizer
solution three or four times a day.

Children [6-12yrs] : 100mcg Aerosol or 200mcg Rota caps dry powder three or four
times a day.

Contraindication

 Thyrotoxicosis, hypersensitivity, precaution in cardiac dysarrhymias.

Side effects

 Occasional: Ischemia with ECG changes.

 Others: Fine skeletal muscle tremor especially hands, tachycardia, palpitation,
nausea, headache, hypokalemia.
 In administration: In high doses nausea, vomiting, adverse cardiac and metabolic
effects.
 Inhalation dry powder: Slight cough and irritation.

Nursing Considerations

 Monitor the patient’s 12 lead ECG, pulse rate, respiratory rate, depth, rhythm and
type and ABG and serum potassium levels.
 Auscultate the patient’s breathe sounds for wheezing and for crackles.
 Encourage patient to take plenty of fluids.
 Urge patient to avoid excessive use of caffeinated products, such as chocolate,
cococola, and tea.

4 Ipravent

Generic name: Ipratropium Bromide

Trade name: Ipravent
Mechanism of action:
 An anticholinergic that blocks the action of acetylcholine at parasympathetic sites
in bronchial smooth muscle.

Indications and dosages:

 Bronchospam; acute treatment.
 Inhalation- adults, elderly, and children: 4-8 puffs as needed
 Nebulization- adults, elderly, and children 12 yrs and older: 500 mcg q30 min for
3 doses then q2-4 h as needed

Contraindications:
 History of hypersensitivity to atropine
 Drug interaction; Cromolin inhalation solution

Adverse effects:
 Frequent : Cough, dry mouth, headache, nausea., nasal irritation
 Occasional: Dizziness, transient increased bronchospasm
 Rare: Hypotension, insomnia, metallic taste, palpitation, urine retention etc.

Nursing consideration
 Monitor vitals and breathe sounds.
 Monitor the patient’s ABG levels.
 Instruct patients not to take more than 2 inhalations at a time because excessive
use decreases the drugs effectiveness and may cause paradoxical
bronchoconstriction.
 Advise the patient to rinse his\her mouth with water immediately after inhalation
to prevent mouth and throat dryness.
 Encourage the patient to drinks plenty of fluids.
 Urge the patient to avoid excessive use of caffeinated products like chocolate,
coca cola, coffee and tea.
6. Tablet pantop
Generic Name: Pantoprazole
Brand Name: Pantop
Drug class and Mechanism

 Pantoprazole is in a class of drugs called proton pump inhibitors (PPI) that block
the production of acid by the stomach.. Proton pump inhibitors are used for the
treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD)
which are caused by stomach acid. Pantoprazole, like other proton-pump
inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By
blocking the enzyme, the production of acid is decreased, and this allows the
stomach and esophagus to heal.

Availability

 Tablets : 20-40mg
 Powder for injection : 40 mg
Storage

 Capsules should be stored at 15°-30°C (59°-86°F) and tablets at 20°-25°C (68°-

77°F). They should be kept away from moisture and light.

Dosages

 For ulcers, GERD, erosive esophagitis and eradication of H. pylori the

recommended dose for adults is 20-40 mg daily. Ulcer healing usually occurs
within 4-8 weeks. H. pylori infections are treated for 10-28 days. The usual dose
for prevention of upper gastrointestinal bleeding in critically ill patients is 40 mg
daily for 14 days.

Contraindication

 Not known

Side effects

 The most common side effects are diarrhea, nausea, vomiting, headaches, rash and
dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps,
and water retention occur infrequently.

Nursing Consideration

 Assess the patient for GI discomfort and nausea.

 Evaluate the patient for therapeutic response
 Warm the patient to notify the physician if headache occurs during pantoprazole
therapy.
 Instruct the patient to swallow tablets whole and not to open, chew or crush them.

 Teach the patient to take tablets before eating meal

6 tab azithromycin 500mg po

Generic name: AZITHROMYCIN
Trade name:zithromax
Azithromycin

is used to treat a wide variety of bacterial infections. It is a macrolide-type antibiotic.

It works by stopping the growth of bacteria.

This medication will not work for viral infections (such as common cold, flu).
Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.
Azithromycin is also used to treat lung and other respiratory infections, such
as bronchitis, sinusitis, community acquiredpneumonia, some cases of chronic
obstructive pulmonary disease (COPD), andwhooping cough (pertussis).

CONTRAINDICATION

 Are allergic to azithromycin or any of its inactive ingredients

 Have a form of jaundice known as cholestatic jaundice, in which bile backs up

into the liver and causes a yellowing of the skin, eyes, or nails

 Are taking pimozide (Orap)

Before taking azithromycin, talk to your doctor if you:

 Have an irregular or slow heartbeat

 Have liver problems, including hepatitis

 Very severe kidney problems

 Have myasthenia gravis

COMMON SIDE EFFECTS

 Nausea

 Vomiting

 Diarrhea

 Gas

 Loose stools

 Stomach discomfort
Some people may also experience cramps and yeast or vaginal infection.

Serious Side Effects

Get emergency medical help right away if you experience any of the following:

 Chest pain

 Seizures

 Swelling of the feet or ankles

 Inflammation of the colon (symptoms may include abdominal pain, severe

diarrhea, fatigue)

 Fluid build-up between the lungs and the chest wall (symptoms may include
chest pain or heaviness, or difficulty breathing difficulties)

NURSING IMPLICATIONS
Assessment & Drug Effects
 Monitor for and report loose stools or diarrhea, since pseudomembranous colitis
(see Appendix F) must be ruled out.
 Monitor PT and INR closely with concurrent warfarin use.
Patient & Family Education
 Direct sunlight (UV) exposure should be minimized during therapy with drug.
 Take aluminum or magnesium antacids 2 h before or after drug.
 Report onset of loose stools or diarrhea.
 Do not breast feed while taking this drug without consulting physician.
7 tab doxobid 400mg po hs
Generic name: Doxofylline
Trade name: doxobid

Doxobid (Doxofylline) is a medicine that has been derived from methylxanthine

which is used extensively for the control and management of asthma and COPD
(chronic obstructive pulmonary disease). Its mechanism of action involves
functioning as a phosphodiesterase inhibitor, while also exhibiting bronchodilator
effects.

Side effects
Treatment with the bronchodilator Doxobid (Doxofylline) could trigger side effects in
some patients. You must inform your physician if this occurs. Possible examples
include:

 Sickness
 Headaches
 Stomach discomfort
 Problems sleeping properly
 Changes in behavior or mood
Other reactions may also occur. If you experience any side effects which are serious
in nature, it will be necessary for you to attend the hospital immediately or to see your
physician.

Precautions
Doxobid (Doxofylline) is not a cure for asthma or any other breathing condition. It is
only used to treat the symptoms.

If this medicine does not work for your symptoms, your physician may advise
alternative treatments.
SURGICAL MANAGEMENT :

1. Bullectomy

A bullectomy is the surgical removal of a bulla, a large air-filled space that can squash
the surrounding, more normal lung.

2. Lung Transplantations.:

COPD is the most frequent indication for lung transplantation. The survival rate
following transplantation for emphysema is the highest of any patient population with
lung disease. There is still debate as to when a transplant should be offered.

3. Lung Volume Reduction Surgery

It is a surgical procedure for patients with severe emphysema. The hyper inflated
portion of the lungs is removed so that the patient’s chest wall and diaphragm can
return to normal positions, there by easing breathing, most often it is used as a bridge
to transplantation that improves respiratory function for patients during the prolonged
waiting time for donor organs

 None of the surgical treatment methods were used in my patient.

 (Prognosis)

COPD is a long-term (chronic) illness. The disease will get worse more quickly if you
do not stop smoking.Patients with severe COPD will be short of breath with most
activities and will be admitted to the hospital more often. These patients should talk
with their doctor about breathing machines and end-of-life care.

COMPLICATION:

1. Respiratory infection
2. Acute respiratory failure
3. Spontaneous Pneumothorax
4. Lung cancer
5. Hypoxemia
6. Corpulmonale
7. Depression
NURSING MANAGEMENT:

 Assist in ventilation and respiration.

 Deep breathing and coughing exercise.
 Postural drainage.
 Encourage for steam inhalation and oral care
 Maintain nutrition and fluid balance
 Administered prescribed medicine in time and monitor for possible adverse
reaction.
 Assess the condition-respiration, cyanosis, wheezing, resonance.
 Patient is kept in propped position to provide low pressure to the diaphragm
and to ease breathing.
 Nebulization is given to reduce difficulty in breathing.
 Ongoing assessment of breathing patterns, colour of skin, vital signs is
important.
 Report natures of breathing difficulty, accessory muscle are used or not.
 Administered oxygen as necessary and maintained humidify of oxygen.
 Avoid allergens and smoking , one goal of COPD management is avoidance of
an exacerbation. Teach how to avoid allergens, smoking ,pollution
 Advice not to exposed with pollution, smoking and ingestion alcohol.
 Maintain health to prevent complication.
 Promote normal activities.
 Avoid bronchial irritation.
 Provide psychological support to patient and his family.
APPLICATION OF NURSING THEORY
she graduated in 1921. She died March 19, 1996, when she was 98 years old. The
definition of nursing is the fundamental part of Henderson's theory of nursing.
Henderson also enumerated the 14 functions she believed to be part of basic nursing
care. The nurse should help the patient to perform the following functions.

 Henderson’s 14 basic needs:

14. Learn, 1. Normal breaths 2. Adequate eat and

drink
Discover satisfy
3. Elimination of
13 .Participate in
body wastes
recreations.
4. Desirable
12. Work sense
14 Basic movement.
accomplishments.
Needs.
5. Sleep and rest
11.Worship in faith

6. Suitable dress and

10.Proper undress.
Communication
8. Clean and 7. Maintaining body
9. Avoid dangers. grooming temperature

CONCEPT USED BY HENDERSON:

o Human being: The patient as an individual who requires assistance to achieve
health and independence or peaceful death. The mind and body are
inseparable. The patient and his family are viewed as a unit.
o Health: The quality of health rather than life itself, that margin of mental
physical vigor that allows a person to work most effectively and to reach his
highest potential of satisfaction in life.
o Environment: She used Webster Dictionary, which defines environment as
“the aggregate of all the external conditions and influences affecting the life
and development of an organism.”
Nursing: “The unique function of the nurse is assist the individual, sick or well.
NEEDS
o Breath Normally
o Eat, drink adequately
o Elimination of bodily waste
NURSING CARE
o The patient have difficulty in breathing so
saturated o2 was administered&spo2 was
monitotred.
o patient was kept in upright position.
o Nebulization with asthalin+ipravent 8 hourly
was given.
o deepbreathing &coughing along with purse lip
breathing was taught..
o parents were taught about avoidance of triggers
factors i.e cold enviroment,smoke,bad odors
,cotton dust etc and use of mask in
crowed&polluted area..
o Encouraged for oral care& floshing before
eating.
o food was served in a small amount in an
attractive way frequently as tolerated.
o Forceful feeding was avoided.
o Easily digestible food such as jaulo was
encouraged, fried & spicy food was discouraged.
o Encouraged to take sodium free& cholestrol free
diet & Restricted in excess fluid intake.
o Encouraged to supplementation with vitamin
B1,B6 C, vitamin E, magnesium and fish oil
have to improve immunity.
o patient was encourged for intake roughage food
such as vegetables & plenty of fliuds intake.
o Importance of frequent urination and regular
emptying of bowel and bladder.
o Advised to take her adequate fluids and roughage
diet to prevent constipation.
 NURSING PROCESS
A nursing process is a series of steps or components leading to a goal, or is a
guidelines for Nurses to carryout effective nursing care.”It can be defined as a
scientific method of exploring and analyzing data of clients to arrive at logical
conclusion& and rational solution to their problems.”which includes the
following.
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

 Assessment:
- Increased shortness of breath
- Productive cough
- Wheezing respiration
- Activity intolerance
- reduced socialization
- Loss of appetite
 Nursing diagnosis:
1. Activity intolerence related to imbalance between oxygen supply & demand
evidenced by fatigue and weakness.
2. Ineffective coping related to long-term illness, separation from accustomed
routine and support system, unfamiliar surroundings as evidenced by anxious
mood and reduced socialization.
3. Deficient knowledge regarding disease condition, treatment self-care and
discharge needs related to lack of information.
4. Risk for infection related to ineffective pulmonary function.
5. Risk for Imbalance nutrition: less than body requirement related to reduced
appetite decreased energy level and dyspnea.
 NURSING CARE PLAN

S.N Nursing Diagnosis Goal Plan of action Rational Evaluation

1. Imbalanced nutrition; less than body Patient’s nutritional Nutritional intake is assessed Identifies deficits in nutritional Patient was able to
requirement related to anorexia. intake will be through taking history a. intake eat and drink
increased within 2 adequately.
(Related to nursing problem no.6:- days Oral hygiene maintained. Reduces unpleasant taste and
To facilitate the maintenance of increases appetite
nutrition of all body cells.) Advised to offer small Promotes appetite positive
frequent meal in pleasant environment for intake.
environment.
Advised for nutritious diet Provides Encouragement for
and its importance. eating

Instructed to limit fluid intake Reduces satiety

1 hour before and after and
before meal.
S.N Nursing Goal Plan of action Rational Evaluation
Diagnosis

2. Ineffective breathing pattern To maintain  Assessed the It helps for further Patient felt
related to hypoxia as evidence by effective way of general condition of intervention. easy
shortness of breath. breathing. patient breathing
It helps for further
(Related to nursing problem no. 5:-  Assessed the after nursing
intervention.
To facilitate the maintenance of a respiratory intervention.
supply of oxygen to all body cells.) status.(rate and
depth)
Helps for easy
 Kept the patient in
breathing.
prop –up position.
 Open window & It helps cross

door ventilation for patient

 Advice to drink hot It helps in broncho

water dilation and promotes
in easy cough expel
S.N Nursing Diagnosis Goal Plan of action Rational Evaluation
Potential for infection related to Patient will be  Involve the family  It helps to make Good personal
3. Poor personal hygiene. clean within 1 member and clean body clean hygiene was
hour. the patient & maintained and no
surroundings chance of
 It helps to
( Related to nursing problem no.1:-  Advice to change infection.
maintain cleanliness
To maintain good hygiene and dirty clothes
and prevent from
physical comfort.)
cleanliness
 Advice to maintain c
 It promotes
leanliness daily.
cleanliness daily and
in future
 It provides
knowledge about
hygiene and will be
motivated to maintain
hygiene
S.N Nursing Goal Plan of action Rational Evaluation
Diagnosis

4. Knowledge deficit regarding home The patient‘s

care and preventive health measures. family will  Assessed the level of  It helps to
verbalize understanding of family. communicate the
(Related to nursing problem no.21 :- understanding information in
To understand the role of social of disease effective way.
problems as influencing factors in the treatment,
case of illness.) prevention and  Explained about disease.  It helps to fulfill
home care. curiosity of family
which helps in full
cooperation for
treatment and
management.

 Explained about  It helps to reduce

medicine schedule and anxiety of patient
follow up. and family regarding
home treatment.
 Provided information
about essential home  It helps to maintain
care and preventive health status and
measures about disease prevent further
infection and
complication.
Daily progress
Day 1st 016-06-19

 Client was admitted from emergency ward at 3:30 pm with oxygen @

2litre/min
 Investigations were send and reports were collected
 Vitals were stable
 Intravenous and oral medicine continue
 Nebulization 8hourly
 Oxygen therapy continue

Day-2 016-06-20

 Client relieved more than yesterday

 Oxygen @ 2litre/min continue
 Vitals were stable
 Intravenous and oral medicine continue
 Nebulization 8hourly
 Echo done
 Sputum for AFB I send

Day-3

 Client stable
 Oxygen therapy
 Vitals stable
 Intravenous and oral medicine continue
 Sputum for AFB II send
 Shift to medicine ward
 Tab doxobid 40mg po hs.

Day-4

 Client stable
 Sputum for AFB III send
 Reports collected; AFB negative
 Oxygen inhalation intermitted
 Spo290% without 02.

Day 5th

 Patient’s stable
 Vital sign stable
  Spo2 90% without oxygen
 Pt is ni noramal diet
 Plan for discharge.

Discharge Medication

Tab- Clavum 625mg×TDS×5 days

Tab- Pantop 40 Mg OD×1 week

Syrup- Brica/BM 2 TS×TDS×1 week

1
Tab- Frusal OD×Coninue….
2

Tab- Doxobid 400mg×HS continue………

HEALTH TEACHING IN HOME ENVIRONMENT

Health teaching is very important to promote health, prevent and to cure disease more
quickly without complications. As a good nurse we should deliver patient health
education. Health education can be given in the following topics:-

 Nutrition: - Good nutritious food is very essential for all type of sick persons. I
advised her to take nutritious food with high protein and more vegetables and
fruits to increase the immune system to protect the patient from several diseases
and tissue repair. Education was also given about low sodium, low fat &
cholesterol diet) with high calcium and magnesium containing diet to prevent the
increase of blood pressure. Importance of frequent urination and regular emptying
of bowel and bladder. I advised to take her adequate fluids and roughage diet to
prevent constipation.
 Rest and sleep: - Without proper sleep and rest it is difficult to recover from the
diseases. I strongly told her to take complete rest and sleep which will help
patient’s body to recover from the diseases. It helps to decrease oxygen demand
also. Follow your provider's recommendations for physical activity. Exercise
helps strengthen your heart and body and improves your blood flow and energy
level. Avoid outdoor exercise if it is very hot, cold or humid; consider indoor
activities on these days. Balance exercise with rest.so encourage to do gradual and
light exercises that demand less oxygen.
 Prevention from infection:- I aware her about the disease to prevent from further
spread of infection. Patient should also focus on the proper disposal of used
objects, urine, stools and proper hand washing before and after use. I gave health
education regarding the proper cleanliness of the utensils used by the client eg
sputum mug and proper disposal of the sputum to prevent the risk of infection.
 Medication :Instruction about medication (its continuation & side effects).
 Personal hygiene and safe environment:I encouraged patient to maintance of
hand hygine & importance of wearing clean clothes,keeping short nails.I also
encouraged patient to stay away from pollution,smoke,wood fires etc.
 Activity & exercise, maintenance of weight: Weigh yourself and write down
your weight every day. Weigh yourself in the morning after you use the bathroom
but before eating breakfast. Tell your healthcare provider as soon as possible if
 you gain weight, or if you keep gaining weight over weeks to months. Weight
gain may mean your body is having trouble getting rid of extra fluid.
 Breathing exercise:I taught & encouraged patient to imporatance of deep
brathing & coughing exercise & purse lip breathing.
 Avoid mental tension: Get enough rest, shorten your working hours if possible,
and try to reduce the stress in your life. Anxiety and anger can increase your heart
rate and blood pressure. If you need help with this, ask your healthcare provide
mental tension & any kinds of the stress can agreevate disease process.
 Never start smoking again:Avoiding noxious agents such as alcohol,smoking &
participating in activites/exercise all aid in preventing extacerbation of cardaic
failure.
 when to seek medical help imediately:
You have chest pain or pressure.
You feel dizzy or faint or pass out.
You are having trouble breathing.
Your pulse is racing (very fast heart rate).
 Follw up visit:Importance of regular follow up.

 To avoid smoking ,smoke filled rooms ,persons with respiratory infection

Diversional Therapy
Diversional Therapy “is a client centered practice [that] recognizes that leisure and
Recreational experiences are the right of all individuals.”
These are often quite diverse and can range from: Games, outings, computers gentle
exercise, music, arts and craft.

Diversional Therapy
According to book According to my Clients
Games, outings, computers, gentle • Individual emotional and
exercise, music, arts and crafts. Individual social support
emotional and social support • Gentle exercise.
Sensory enrichment, activities like • Relaxation technique
massage and aromatherapy, pet therapy • Talking with other Client
Discussion groups, education sessions like • Listening folk music by mobile
grooming, beauty care, cooking phone.
WHAT I LEARNED FROM MY CASE STUDY

Case study is the effective method of learning about the related disease in depth and
practice. case study gives the comprehension with book and real situation.

I learned and experience many things from my case study of COPD and which are
listed below.
1) About patient:
During case study I was completely involved and attached with my
patient. I know the emotional status and medical reaction of the patient
about the treatment and disease.
2) About family and Environment:
I also get opportunity to learn general attitude of family and their
environment, socio-cultural educational, religious and economical
status.
3) About nursing care:
I applied nursing theory while giving care to patient. It is the scientific
method of caring the patient
4) About diversional therapy and management
I got chance to detect the stressful factor and different therapy to
overcome from stress
5) About Documentation:
During the case study I develop further skills in documentation in a
more revised manner.
CONCLUSION
In 4 weeks posting in CMS, I selected a case COPD with Corpulmonale. I tried my
best to provide good nursing care to my patient during hospitalization. I maintained
good relationship with the patient and her family and they also co-operate me as well.
I got an opportunity for comprehensive study and provide holistically quality care.

I am fully satisfied with my case study because I got an opportunity to learn about the
patient’s disease condition, its causes, signs and symptoms, management also
prevention of disease.

And lastly, I am satisfied with my case study because I got an opportunity to learn
about application of nursing theory, nursing process and Therapeutic Relationship,
rehabilitation process,counseling technique in detail. I also counseled the patient
about diet, rest and personal hygiene.

This case study benefited me as well as my patient a lot.

Research on copd:

Epidemiology of chronic obstructive pulmonary disease by international journal of

chronic obstructive pulmonary disease.
 REFERENCES
1. Basavanthappa BT (2003). Medical Surgical Nursing, 1st edition, Jaypee
Brothers Medical Publishers (p) Ltd., New Delhi, PP. 95-97.

2. Brunner & Suddarth (2008). Textbook of Medical- Surgical Nursing, 11th

edition, Wolters Kluwer (India) Pvt. Ltd., New Delhi, volume 2, PP. 660-
661,702-708.

3. Fauci et al. (2008) Harrison’s Principle of Internal Medicine, 17th edition, MC

Graw Hill, New York, vol II, PP. 1453-1455.

4. Mcphee SJ, Papadakis MA, Tierney LM (2008). Current Medical Diagnosis

and Treatment, 47th edition, MC Graw Hill, New York, pp. 364-365.

5. Phipps WJ, Monahan FD & et al (2003). Medical Surgical Nursing, 7th edition,
Mosby, Missouri, PP. 574-580.

6. potter and perry(2005),fundamental of nursing,6th edition, mosby inc.all right

reserved publisher p.p454-456.
7. Lippincott Williams and wilkins(2006) ,Lippincott manual of nursing
practice,8th edition, Lippincott publisher pp1012-1034
8. lewis Dirksen heitkemper bucher camera (2011), MEDICAL SURGICAL
NURSING(assessment and management of clinical problems ), 8th Elsevier
mosby.pp656-657.
9. Shirley P.hoeman(1996), rehabilitation nursing process and application,2nd
edition, publisher mosby-year book,inc.pp 120-123.
10. marilynne.doenges,mary francesmoorhouse,alice c.murr(1994), nursing care
plans, 3td edition,F.D davis company526-529
11. Lippincott Williams and wilkins(2005),nursing druge guide,1st edition,
publisher Lippincott.723-745.
12. Davis’s (2003), davis’s druge guide for nurses,8th edition,davis company.PP-
623.
13. Ruth Beckmann murry.judith proctor zentner. Richard yakimo(2009),health
promotion strategies through the life span,8th edition,juli Levin Alexander
PP456-457.
14. HLMC(2006) text book of adult nursing ,1st edition,HLMC TU,institute of
medicine PP.145-148.
15. Lalita Rai(2010),nursing concepts Theories and principles,1st edition,nabin
kumar Rai publisher PP.124-146.