INTRODUCTION:

-COPD may include diseases that cause airflow obstruction

(e.g., Emphysema, chronic bronchitis) or any combination of
these disorders. Other diseases as cystic fibrosis,
bronchiectasis, and asthma that were previously classified as
types of chronic obstructive lung disease are now classified as
chronic pulmonary disorders.

-However, asthma is now considered as a separate disorder

and is classified as an abnormal airway condition characterized
primarily by reversible inflammation.

-COPD can co-exist with asthma. Both of these diseases have

the same major symptoms; however, symptoms are generally
more variable in asthma than in COPD.
CLASSIFICATION:

1.Chronic Bronchitis
- Lung damage and inflammation in the large airways
results in chronic bronchitis.
- Chronic bronchitis is defined in clinical terms as a
cough with sputum production on most days for 3 months of a
year, for 2 consecutive years.
- In the airways of the lung, the hallmark of chronic
bronchitis is an increased number (hyperplasia) and increased
size (hypertrophy) of the goblet cells and mucous glands of the
airway.
- Patients with advanced COPD that have primarily
chronic bronchitis rather than emphysema were commonly
referred to as "blue bloaters" because of the bluish color of the
skin and lips (cyanosis) seen in them.
People with chronic bronchitis may experience the
following symptoms:

-Long term cough

-Increased mucus production
-Dyspnea
-Frequent clearing of the throat
-Edema and weight gain (often occur as side effects of
medication)
-Wheezing
2. Emphysema
-Lung damage and inflammation of the air sacs (alveoli)
results in emphysema.
-
-Emphysema is defined as enlargement of the air spaces
distal to the terminal bronchioles with the destruction of their
walls.
-
-The effort made by patients suffering from emphysema
during exhalation, causes a pink color in their faces, hence
the term commonly used to refer to them, "pink puffers".
-
-
The Primary symptoms of emphysema
are:
-Shortness of breath
-Rapid breathing
-Wheezing
-Chronic cough, with or without sputum
-Decreased exercise tolerance
-Loss of appetite leading to weight loss
-Barrel chest
-
Causes of COPD:
1. Smoking
2. Occupational Exposures
3. Air pollution
4. Genetics
5. Other risk factors
- Inhaled irritants
- Bronchial hyperresponsiveness
-
Complications:
1.Cor Pulmonare
2.Acute Exacerbation of COPD
3.Pulmonary Hypertension
4.Pneumothorax
5.Secondary Polycythemia
6.Respiratory failure
Diagnosis:
-The diagnosis of COPD should be considered in anyone
who has dyspnea, chronic cough or sputum production,
and/or a history of exposure to risk factors for the disease
such as regular tobacco smoking. No single symptom or sign
can adequately confirm or exclude the diagnosis of COPD,
although COPD is uncommon under the age of 40 years.

1.History and Physical

2.Complete Blood Count
3.Arterial Blood Gas
4.Chest X-ray
5.Computerized Tomography (CT) Scan
6.Pulmonary Function Tests (PFTs)
7. Pulse Oximetry
8. Sputum culture
9. Lung Diffusion Studies

TREATMENT AND MANAGEMENT:

-There is currently no cure for COPD; however, COPD is

both a preventable and treatable disease.
-The major current directions of COPD management are to
assess and monitor the disease, reduce the risk factors,
manage stable COPD, prevent and treat acute exacerbations
and manage co-morbidity.
-The only measures that have been shown to reduce
mortality is smoking cessation and supplemental oxygen.
-
§Smoking Cessation
- Stopping smoking slows down the rate of
progression of the disease.
- Even at a late stage of the disease it can significantly
reduce the rate of deterioration in lung function and delay the
onset of disability and death. It is the only standard
intervention that can improve the rate of progression of
COPD.

§Supplemental Oxygen
- Supplemental oxygen can be given to people with
COPD who have low oxygen levels in the body.
- Supplemental oxygen does not greatly improve
shortness of breath but can allow people with COPD and low
oxygen levels to do more exercise and household activity.
§Bronchodilators
-Bronchodilators are medicines that relax
smooth muscle around the airways, increasing
the calibre of the airways and improving air
flow.

§β2 agonists
- β2 agonists stimulate β2 receptors on airway smooth
muscles, causing them to relax.

§Anti-cholinergic
-Anticholinergic drugs cause airway
smooth muscles to relax by blocking
stimulation from cholinergic nerves.
-
§Corticosteroids
- Corticosteroids act to reduce the inflammation in
the airways, in theory reducing lung damage and airway
narrowing caused by inflammation.
§Flu Shots

§Pneumonia Vaccine
- People with COPD are at greater risk for developing
pneumococcal pneumonia as are those with other chronic health
conditions. It is strongly recommend that you discuss getting vaccinated
with your health care provider if you have a chronic health condition like
COPD.

§Surgery
-Surgery is sometimes helpful for COPD
in selected cases.
1. Bullectomy
2. Lung volume reduction
3. Lung transplantation
PREVENTION:
- Do not smoke, and, if you do smoke, quit.
- Eliminate your exposure to smoke by not allowing people
to smoke in your home and by sitting in designated non-
smoking areas when out in public. You should also avoid
wood smoke and cooking smoke.
- Limit air pollutants in your home.
- Try to avoid getting respiratory infections during cold and
flu season. You should also frequently wash your hands
because viruses can be passed through hand-to-mouth
contact.
-Fight for clean air to prevent those cases of COPD due to
air pollution.
Patient’s Profile
 Name: R.O.
Age: 59 years old
Address: Burot, Allacapan, Cagayan
Civil Status: Married
Religion: Roman Catholic
Dialect: Ilocano
Nationality: Filipino
PATIENT ’ s

Date of Birth: September 8, 1951

PROFILE :

Date of Admission: November 16, 2010

Time of Admission: 11:40 am
Admitting Institution: St. Paul Hospital
 Attending Physician: Dr. Delaila Reyes
Chief Complaints: Difficulty of Breathing
Admitting Diagnosis: COPD in Acute Exacerbation
Final Diagnosis: COPD in Acute Exacerbation

Diet: DAT
Weight: 52.2 kg
PATIENT ’ s

Initial Vital Signs:

PROFILE :

BP: 120/70 mmHg

Temp: 36.2 C
RR: 18 cpm
PR: 84 bpm
Nursing Health
History
History of Present Illness :
One day prior to admission, the patient experienced
difficulty of breathing with (+) productive cough, cyanosis
and body weakness. The patient verbalized “adda iti
tumtumarek idi ngem nabayagen a naibus. Itattan bigla
met lattan ah nasapasap ti bagik idi kagapgappok idjay
taltalonmi. Kasla agkuppit ti barukong ko ta marigatannak
ah aganges isu ah nagpa-ilot nak biit ken baket. Ti ammo
mi ah ken baket ket bannog ko lang ket inturogko pay
ngem talaga ah marigatan nak aganges isu ah intaray nak
da baket ittoy Tuguegarao”.
(I am taking medicines before but I run out of stock. I
suddenly felt pain all over my body when I got home from
the field. I also felt difficulty of breathing so I asked my
wife to massage me. At first, I thought that I’m just tired
so I got some sleep but still I had difficulty of breathing.
We decided to came here in Tuguegarao for consultation)
Because of this, his wife and daughter-in-law decided to
bring him to the hospital. His daughter-in-law said
“napusyaw metten ah medjo kasla agblue ti kolor ni
tatang idi”. Patient R.O was rushed to SPH where he was
admitted under Dra. Delaila Reyes at the Holy Family
Unit ward. The patient was given oxygen at 2 Lpm via
nasal cannulaupon admission at the emergency room.
History of Past Illness :
The patient received immunizations like BCG,
hepa B and measles vaccines. In year 1980, he
complained of stomach ache so he went to a Quack
Doctor and he said; “adda ti mangay-ayam kenka ket
masapol mo iti agdigus ti dangla ken uminom ti
naipaburek a bulong ti bayabas” (there is someone
playing you, so you must bathe with boiled guava leaves
and drink the extract of boiled lagundi leaves).
In the year 1986, His first hospitalization was in
Aparri due to stomach ache and was diagnosed of peptic
ulcer by Dr.Orio, he was subjected to operation however, it
was cancelled. “Haan ko malagip jay ibaga ni doctor nu
apay ah haan ah natuloy jay operasyon ko” Pt. R.O
added.
 In the same year, patient R.O experienced difficulty
of breathing accompanied with (+) productive cough. He
then consulted Dr. Delos Santos and was prescribed
medications. In 1990, the patient stopped smoking but still
continued farming which predisposed him in having the
disease.
After 20 years; September 3, 2010, he consulted
the Medical-Surgical Clinic and Diagnostic Laboratory of
Dr. Pagyatan in Aparri and was diagnosed to have
Bronchoectasis. Since Pt. R.O cannot remember when
and where he got the medications he’s been taking, we
will just enumerate those drugs. These includes:
Salbutamol Asmalin (100 mg), Salbutamol Venbun (100
mg), Esoneprazole Nexium (40 mg), Salbutamol 2 mg,
Prednisone 30 mg, Doxofylline 200 mg, Cimetidin 400 mg,
Buscopan plus 10 mg/500mg, Symdex-D 325 mg,
Chloramphenicol Antibacterial 500 mg.
 The patient said that COPD was his
childhood disease. Aside from COPD, there are no
other serious diseases noted. The patient
verbalized “ti pagsakitak lng met idi ket nu dadduma
sumakit tyan ko ngem sapasap lang diyay kunak.
Idi medjo marigatan nak nga umisbo ket napan nak
nagpa doctor ket awan kanu met ti kuna ni doctor
ah problema. Nu dadduma ada metlang pagsakitan
toy matak ngem nu patedteddak ti eye mo ket
sumayaat manen”.
FAMILY HEALTH HISTORY
According to patient R.O his father died of arthritis
and asthma. His two brothers were also diagnosed of
COPD. Aside from those diseases, there were no other
health problems noted in their family.

SOCIAL HEALTH HISTORY

The patient verbalized “mannalon nak, ket agtaltalo ti
trabahok idjay bassit ah talon ti, nu malpas met ti panagaapit
ket aggagarden met a ti ubrak, tulungak met ni baket nga
agtaraken ken dagiyay manok mi ken dagiti maubra idjay
balay”. The patient’s wife said that her husband usually goes
to the farm as early as 5am and spends the whole day there.
He is indeed very hardworking.
 GORDON’s 11
Functional Health
Patterns
1.Health Perception
Before Hospitalization:
According to patient R.O “ti salun-at para kanyak ket
jay awan saksakitem kasjay.Nu ada man ti marikrik nak ah
madi ket agtumar nak a dagos ti biogesic nu haan ket alaxan
“. As far as he can remember, he already received
vaccinations like BCG, Hepa-B and measles when he was
still young.
The patient views health as having good condition of
one’s body and mind. He views health as a gift from God
and a gift that should not be deprived of the next generation.
According to him, he perceived himself as unhealthy person
because of his illness (COPD).
 He said so because of the many precautions that
must be followed. He believed that discipline and faith can
get you through any problem even those that concerns
health. He also said that when he gets sick, he takes OTC
drugs such as alaxan and biogesic.

During Hospitalization:
Patient R.O told us that his perception on health did
not change. He sees his self as unhealthy person. He said
also that he adheres to the doctor’s advice and said that he
takes the same drugs when he was confined. He said that
he does his best in managing his health and he just let God
do the rest.
2. Nutritional Metabolic Pattern
Before Hospitalization:
At his very young age (15y/o) he started to smoke
cigarette and work in the rice field. He consumes about
1pack of cigarette a day. The cigarette he used to smokes
are lakampana, champion, peak, future, mass and waray-
waray. Patient R.O eats 4 times a day. The patient said that
he loves to eat rice, chicken and pork. But most of the time
he eats vegetables like beans, squash, spinach etc. which
are usually found in their place. He has no allergy to any
food and medicine. He also said that he loves to drink water
and milk. He drinks approximately 8 to 10 glasses of water
every day and a glass of milk every morning. He hates
coffee, soft drink and alcoholic drinks. His BMI is 25 which is
under normal level.
During Hospitalization:
Upon admission his Physician Dra. Delaila Reyes
ordered DAT diet for him. He said that he consumes the
meal given by the hospital and a piece of apple fruit as
snack without difficulty. He drinks 8-10 glasses of water a
day. He has an IVF of 1L PNSS + 40meqs KCL regulated at
28gtts/min.

3. Elimination Pattern
Before Hospitalization:
Pt. R.O’s elimination pattern depends on how much
he eats and drinks. “mamin uppat nak nga mangan ti maysa
nga aldaw sakbay nak naospital ta nu dadduma gamin
mabibisin nak nga aggigyan idjay taltalon. Mamin duwa nak
met ah tumakki ti maysa nga aldaw basta agsapa ken rabii
nga ti kulay na ket adda ngisit-ngisit na bassit ngem brown.
Ti mainom
danum ti agmalem ket umabot ti duwa litro ah haan nga
nalamiis, usto lang met ti pudot nah ta madik ti nalamiis a
inumen. Mamin sangapulo nak met nga umisbo ti maysa
nga aldaw a nalibeg a yellow met ti kulor na”. His urine was
cloudy yellow in appearance, approximately 200-250 ml per
urination. According to him, he has no difficulty in defecating
but experiences pain when he is constipated. He said that
he defecates twice a day. His stool was semi-formed, brown
in color with small and dark particles.

During hospitalization:
During his hospitalization he says that he urinate 10-
12 times a day still without difficulty. His urine was yellow in
color and approximately 200ml per urination. He reported
difficulty in defecating “tallo nga aldaw nakun a haan
tinmakki ta mabain sa daytoy riknak a tumakki ditoy ospital”
he added.
4. Sleep-Rest Pattern
Before Hospitalization:
Patient R.O has difficulty with his sleep pattern. He
usually sleeps about 5-6 hours from 11 pm to 4 am. He said
that “ ababa lang ti turog ko ta kasla gamin madmadlaw ko
amin a garaw ditoy balay nu nakaturog nak.” He does not
take naps in the afternoon because he says that it will be
difficult for him to fall asleep at night.

During Hospitalization:
His favorite position when sleeping is left side-lying.
He prefers to use 1-2 pillows when sleeping. He told us that
he sleeps a lot during hospitalization. He sleeps from 8pm-
4am then 5am-6am. During afternoon he takes a nap from
1pm-2:30pm, for a total of 10 hours and 30minutes.
5. Activity-Exercise Pattern
Before Hospitalization:
Patient R.O performs some exercise like stretching
and walking every morning. He sometimes helps in some
household chores after farming. According to him, his work
(farming) was the form of his exercise.

During Hospitalization:
When asked of what he does during his
hospitalization he said that his activities are limited because
he was advised to have a bed rest. Patient R.O also said “
nu mabannog nak ket agtugaw nak met ah.”
6. Self-Perception Pattern
Before Hospitalization:
When asked about what Mr. R.O sees of himself he said
that he was a shy type, kind, helpful, loving, responsible father
and a big hearted person. Patient R.O has a high self esteem, he
believes on his capabilities to handle any situation. He also told us
that sometimes he is impatient, especially when he is sick. He still
sees himself as the head of the family.

During Hospitalization:
Pt. R.O told us that he sees himself as unhealthy.
According to Mr. R.O there was little changes on how he
perceived himself but he added that he became more optimistic in
order to cope with his situations. “ngem medjo madi ti nakem ko ta
gapo ken daytoy a sakit ko ket pinaritan nak a agtrabahon jay
talon mi” he added.
7. Role-Performance Pattern
Before Hospitalization:
“Siyak ket maikatlo kadagiti lima nga agkakabsat,
maikatengnga ngarud. Tattan addan asawak ket nabendisyunan
kami ti duwa ah anak nga puro met bulog. Ket agtaltalon nak
ngarud tapnu adda pangalaan mi ti pagbiag mi ti inaldaw. Tattan
nagsiasawa metten dagitoy annak mi ket duduwa kami lang
garuden ken baket jay balay” as verbalized by the patient.
Patient R.O lives with his wife. According to him, he and his wife
love each other so much. Even if they’re aging, they are still sweet
to each other. He is a good person not only to her family but also
to other people. He is very industrious. He said that he was the
head of the family. He stated that he was the one providing for his
family. He is a very responsible husband and father because he
sees to it that his family is in good condition. According to him, his
love to his family is constant.
During Hospitalization:
Patient R.O views himself as helpless when he was
admitted. He is very thankful that his family is always there for
him. During hospitalization, he proved how strong and important
his role as a husband and father and how important the
relationships he made based on trust and love.

8. Sexual-Reproductive Pattern
Before Hospitalization:
“Ipudnok kenkan ma’am ah nga haan nak pay nakugit ta
awan met agkugit idi idjay ah panwen mi, ngem makunak met ah
pudno nak a lalake ta adda met asawak ken duwa ah putot. Ti
inmuna ah panakidennak ket idi agtawen nak ti bente dos.
Nagkasar kami garud ken baket tawen 1994 bulan ti marso
sakbay ti panaggraduwar diyay ina-una mi” he verbalized.
 Patient R.O told us that he was not circumcised. However,
he still sees himself as a full-grown man. He got married when he
was 22 years old. He then had his coitus with his wife. According
to him he has two sons. “Haan kami unayen agdendenna ken
baket ta medjo marigatan kami metten”, he verbalized.

During Hospitalization:
Patient R.O told us that there were no changes on his
sexual-reproductive pattern.

9. Cognitive-Perceptual Pattern
Before Hospitalization:
“ Grade II lang ti naipalpas ko gapu garud ti kinarigat met ti
panagbiag mi idi. Ngem uray nu kasta ammok ken nasurwak met
ti agbasa ken agsurat.
Ngem gapon sa ta lumakay met dataon masapol agusarakon a ti
antyohos tapnu makabasa nak nga usto” as verbalized by
patient R.O. He also added that sometimes he can’t remember
things. According to him their dialect in their house is Ilocano.

During Hospitalization:
Pt. R.O. said that there were no changes in his
cognitive-perceptual pattern, it was still the same. “ket kastoy
met latta ah awan met mariknak ah nagbaliwan ti panagkitak kas
kada panangdengngeg ko” he added.
10. Coping-Stress Management
Before Hospitalization:
“Nu adda problemak ket ni baket ko a ti umuna a
pagtarayak ken pangkunsultaak ta duduwa kami lang idjay balay
tatta. Sinmina met gamin ti balay dagiyay duwa nga putot ko. No
panggep met ti salun-at ti problemak ket apan kami met dagus
agpadoktor ken baket. Nu mariknak a mabannog nak ket
aginana nak lang ket mayat to manen. Kasjay lang ti biag. Ngem
syempre haan ko met lattan malipatan ti agkarkararag ta dayta ti
umuna ti amin” he added. When faced with problems Pt. R.O
shares his feelings with his wife. He verbalized “nu ibagbagak
gamin ti problemak ket lumaglag-an ti riknak.” He told us that he
was the one doing actions to solve his problem, but before doing
it he confers it to his wife and also asks for suggestions. He also
added that his best weapon in facing his problem is through
praying.
During Hospitalization:
Patient R.O told us that he seeks advice from his wife.
Nothing was changed on how he copes with his problem.

11. Value-Belief Pattern

Before Hospitalization:
Patient R.O is a Christian by heart. He was baptized in
the Roman Catholic when he was 3yrs old. Before, he believed
in quack doctors (herbolario) but now his number 1 consultation
is a real doctor. According to patient R.O he didn’t believe in
superstitious belief because as he says as long as you love the
Lord and you obey his will, he will surely move you away from
evil spirit. He said that he has a strong faith in God and believes
that He is the source of everything.
He does not believe in any superstitions. “Idi ket mamati nak met
kadagita ah pammati ngem napag-amwak ah haan na met
maagasan daytoy saksakitek” he added.

During Hospitalization:
Patient R.O said that his faith just grew stronger. He said
that he is still grateful with his situation now because God knows
that he can overcome his situation. He believes that a
continuous, steadfast, and strong faith can get you out of
everything.
 PHYSICAL
ASSESSMENT
Date: October 18, 2010
Time Assessed: 9:00am
Initial Vital signs:
Temperature: 36.6 C
BP: 120/80 mmHg
PR: 82 bpm
RR: 21 cpm

General Appearance:
Received sitting on bed with ongoing IVF of #4
PNSS 1L + 40 meqs KCL x 28 gtts/min at 650ml level,
patent and infusing well at left arm.
Patient is well groomed and dressed appropriately.
Area Method Normal Actual Analysis
Assessed
SKIN
Used Findings Findings
Color Inspection Light to deep Tan Normal
brown, tan

Temperature Palpation Warm to touch Warm to touch Normal

Snaps back When pinches,

Turgor Palpation immediately it slowly Due to aging
snaps back

Dry skin
Dry, Skin folds
Moisture Palpation/Insp are normally Due to aging
ection moist Smooth, elastic

Smooth, elastic Normal

Texture Palpation
Area Method Normal Actual Analysis
Assessed
NAILS
Used Findings Findings

Nail plate shape Inspection Convex Convex Normal

Nail bed color

Inspection Pink Pale Due to
decreased
peripheral
tissue
perfusion
Texture
Palpation Smooth Smooth Normal
Capillary refill
Palpation/ Returns to 4 seconds Due to
Blanch test normal decrease
immediately (2- peripheral
3 seconds) tissue perfusion
Area Method Normal Actual Analysis
Assessed
HAIR
Used Findings Findings

Color Inspection Black (varies) Black but Normal, due

slightly going to aging
to white

Distribution Inspection Evenly Evenly Normal

distributed distributed

Moisture Inspection Neither Neither Normal

excessively excessively
dry nor oily dry nor oily
Texture Inspection
Silky, resilient Silky, resilient Normal
Area Method Normal Actual FindingsAnalysis
Assessed Used Findings
HEAD

Scalp Inspection Symmetrical Symmetrical Normal

Texture Palpation Smooth Smooth Normal

Nodules/ Palpation Absence of Absence of Normal

Masses nodules and nodules and
masses masses
FACE

Symmetry Inspection Symmetrical Symmetrical Normal

Facial Inspection Equal Facial Equal Facial Normal

Movements Movements Movements
Area Method Normal Actual Analysis
Assessed Used Findings Findings
EYES:
EXTERNAL
STRUCTURES
Evenly
Hair Inspection Evenly distributed Normal
distribution distributed
Intact, smooth
Skin quality Palpation Intact, Normal
smooth
Blinks 17 times
EYELIDS per
minute
Ability to blink Inspection Blinks 15- 20
involuntarily and
Normal
times per
minute bilaterally
involuntarily and
bilaterally
Area Method Normal Actual FindingsAnalysis
Assessed Used Findings
SCLERA

Color Inspection White White Normal

CONJUNCTIVA Due to
Color Inspection Light pink Pale decreased
tissue
perfusion
PUPILS
Color Inspection Black Black Normal

Inspection Pupils EquallyL: Round, react to Normal

Reaction to Round and light
Light React to LightR: Round, react to
light
Inspection L: 3 mm Normal
Size Accommodation R: 3 mm
(PERRLA)
Equal
Area Method Normal Actual Findings Analysis
Assessed Used Findings

Shape Inspection Round and Round and constrict Normal

constrict briskly briskly

When looking Normal

Visual Fields Inspection straight ahead, When looking
client can see straight ahead,
objects in client can see
periphery objects in periphery

Smooth without Normal

EARS: lesion Smooth without
Texture Inspection lesion
Auricles are at Normal
AURICLES level with each Auricles are at level
Symmetry and Palpation other with each other
position
Area Method Normal Actual Findings Analysis
Assessed Used Findings
NOSE:

Symmetry Inspection Symmetrical Symmetrical Normal

Cilia Inspection Evenly Evenly distributed Normal

distribution distributed
Midline Normal
Nasal septum Inspection Midline
Symmetrical size Normal
Nares Inspection Symmetrical of opening
size of opening

Normal
MOUTH: Symmetrical Symmetrical
Symmetry Inspection Normal
Pink Pink
Color Inspection
Area Method Normal Actual Findings Analysis
Assessed Used Findings
MUCOUS
MEMBRANE: Inspection Pink to Red Pale -Due to
Color decreased
tissue
Inspection Moist Dry perfusion
Moisture -Due to
decreased
tissue
perfusion
LIPS Inspection Pink to Red Slightly black
Color -Due to
Palpation Smooth Smooth cigarette
Texture smoking
Inspection Moist Dry -Normal

Moisture Due to
decreased
tissue
perfusion
Area Method Normal Actual Findings Analysis
Assessed Used Findings
TONSILS:
Size Inspection Tonsils behind Tonsils behind the Normal
the tonsillar tonsillar pillars
pillars
Blackish
GUMS: Pinkish and Due to
Inspection moist nicotine
exposure
NECK: Symmetrical Symmetrical
Symmetry Inspection Normal
Moves freely Moves freely
Range of Inspection Normal
motion Centrally located at Centrally located at
the shoulder the shoulder
Position Palpation Normal
Not palpable Not Palpable
Lymph nodes Palpation Normal
Area Method Used Normal Actual Analysis
Assessed Findings Findings
HEART:
Heart rate Auscultation 60-100 bpm 82 bpm Normal
Heart sounds Auscultation No murmurs No murmurs Normal
heard heard
THORAX and
LUNGS:
Posterior Rounded,
Shape Inspection cylindrical Rounded, Normal
cylindrical
Symmetry Chest
Inspection symmetric Chest
symmetric Normal

Respiratory Excursion is 3-
excursion Palpation 5 cm Excursion is 3- Normal
5 cm
Area Method Used Normal Actual Analysis
Assessed Findings Findings
Lung/Breath Auscultation Broncho- Crackles Due to
sound vesicular, presence of
vesicular, secretions
bronchial

Due to
Respiratory Inspection 16-20 cpm 21 cpm increased
Rate Chest oxygen
symmetric demand
Area Method Used Normal Actual Analysis
Assessed Findings Findings
ABDOMEN
Contour Inspection Flat Flat Normal

Texture Palpation Smooth Smooth Normal

Frequency and Auscultation Audible; soft Hypoactive – Due to

Character gurgling sound decreased constipation
(Bowel irregularly and motility
sounds) ranges from 5-
30 minutes.

UPPER
EXTREMITY: Tan
Skin Color
Inspection Equal Tan Normal
Size (Arms)
Inspection Equal Normal
Area Method Used Normal Actual Analysis
Assessed Findings Findings
Neurologic:

Level of Interview Can follow Can follow Normal

Consciousness Instructions Instructions
and commands and
commands
Makes eye
Behavior and contact with Makes eye
appearance Interview the examiner contact with Normal
the examiner
Expresses
feelings which Expresses
correspond to feelings which
Mood situation correspond to
Interview situation Normal
Area Method Used Normal Actual Analysis
Assessed Findings Findings
Mannerisms
and Actions:
(Language Interview Clear and Clear and Normal
Voice strong strong
inflection)

Manner and
speech Can give Can give
Interview appropriate appropriate Normal
answers to answers to
Mental Status questions questions

Oriented with Oriented with

time time
Interview Normal
ANATOMY AND
PHYSIOLOGY
OF THE
RESPIRATORY
SYSTEM
 Normal Breath Sounds:
Type Description Location Characteristics
Vesicular Soft- intensity, Over peripheral Best heard on
low pitched “ lung. Best inspiration : 2.5 times
gentle sighing” heard at the longer than the
sounds created base of the expiratory phase
by air moving lungs ( 5:2)
through smaller
airways.
( bronchioles and
alveoli)
Broncho- Moderate-intensity Between the Equal inspiratory
vesicular and moderate scapulae and and expiratory
pitched ‘ blowing” lateral to the phases (1:1)
sounds created by sternum at the
air moving through first and second
larger intercostals
airway(bronchi) spaces

Bronchial High pitched, loud, Anteriorly over Louder than

(Tubular) “harsh” sounds the trachea vesicle sounds:
created by air have a short
moving through the inspiratory phase
trachea. and long
expiratory phase.
(1:2)
 Adventitious Breath Sounds:
Name Description Cause Location
Crackles Fine, short, Air passing Most commonly
(rales) interrupted through fluid heard in the bases
crackling or mucus in of the lower lung
sounds any air lobes.
passage

Gurgles Continuous low Air passing Lung sounds can be

(Rhonchi) pitched, through narrowed heard over most
coarse, air passages as a
lung areas but
gurgling harsh, result of
predominate over
louder sounds secretions,
with a moaning swelling tumors. the trachea and
or snoring bronchi.
quality.
 Adventitious Breath Sounds:
Name Description Cause Location
Friction Superficial Rubbing Heard most often in
Rub grating or together of areas greatest
creaking sounds inflamed pleural thoracic expansion.
heard during surfaces.
inspiration and
expiration.

Wheezes Continuous high Air passing Heard over all lung

pitched, through a fields.
squeaky musical constricted
sounds. bronchus as a
result of
secretions,
swelling
tumors.
PATHOPHYSIOLOG
Y
OF
CHRONIC
BRONCHITIS
 LABORATORY
EXAMINATIONS
 SPIROMETRY TEST

Date Ordered: November 16, 2010

Results:
Interpretation: Moderate Obstruction
PURPOSE: Measures the forced expiratory volume
in one second (FEV1) which is the greatest
volume of air that can be breathed out in the first
second of a large breath. Spirometry also
measures the forced vital capacity (FVC) which is
the greatest volume of air that can be breathed out
in a whole large breath.
 Based %PredPost BD %Pred Min Pred Mat Units
FEVL %drange
1.72 66 Post 1.70 2.14 3.12 L
Bronchodilator
FVL 2.76 92 2.16 3.01 3.86 L
PEF 2.94 64 340 459 579 L/m
FER 62 81 65 77 89 %
IER
F50 1.12 28 1.85 4.02 6.19 L/s
F25 0.53 38 0.12 1.90 2.68 L/s
MEF 1.00 30 1.65 3.36 1.07
I50
R50
PIF
MVV
FET 0.03
3.88
 Chemistry Spec. Examination Report
Examination Regulated: ---
Requesting Physician: Dr. Delaila Reyes
Date Requested: November 17, 2010
Date Released: November 17, 2010

Test: HBA1C
Result: 6.0 %
Normal Value: 4.2%- 6.5%
Interpretation: NORMAL

PURPOSE:
The HbA1c test measures the amount of glycosylated
hemoglobin in the blood, or, more simply put, this test shows
how much glucose is sticking in the red blood cells.
 Urinalysis Report
Date Ordered: November 16, 2010
Date Released: November 17, 2010
Actual Results Normal Results Analysis
Color Yellow Straw – Amber Normal

Character Slightly Clear Normal

Turbid
pH 5.0 4.6 – 6.5 Normal

Specific Gravity 1.025 1.002 – 1.030 Normal

Albumin Trace Negative Normal

Sugar Negative Negative Normal

 Microscopic Examination
Actual Results Normal Results Analysis
WBC/hpf 1-2hpf 0 – 5hpf Normal
RBC/hpf 2 0 – 4hpf Normal
Epithelial positive Negative Due to
Cells infection
Bacteria negative Negative Normal
Mucus positive positive Normal
thread

PURPOSE:
It’s a routine procedure for patients undergoing
hospital admission.
It is useful indicator of a healthy or disease
state. To screen for metabolic and kidney disorders and for
urinary tract infections.
 Chest X-ray (AP View)
Date ordered: November 16, 2010
Results:
Mild accentuation of pulmonary vascular markings
Trachea is slightly shifted to right
The heart is slightly enlarged transversely
Aortic knob is calcified
Hemidiaphragms are smooth
Costophrenic sulci are intact

Impression:
Mild cardiomegaly with pulmonary congestive changes
Atherosclerotic aorta

PURPOSES:This is done to visualize structures in the chest

such as lungs, heart, and blood vessels.
 Blood Gas and Acid Base Report
Exam requested: ABG
Date ordered: November 16, 2010
Normal Value Result and Analysis Interpretation
7.35-7.45 PH- 7.29 Blood pH decreases, becoming more
acidic because of increased amounts
of carbon dioxide (PCO2) and other
acids.

34-45 PCO2- 49.29 mmHg -Due to impaired gas exchange.

-Due to impaired gas exchange.
80-100 PO2- 71.54 mmHG -Normal

22-27 HCO3- 25.42 mmol/L -Due to impaired gas exchange

22-27 TCO2- 28.88 mmol/L or vol% -Due to decrease of

hemoglobinthat carrying oxygen
O2 sat- 75
90-120%
PURPOSE:
To determine if your lungs are functioning well
enough to exchange oxygen and carbon dioxide if
you are having symptoms of a respiratory problem.
 HEMATOLOGY REPORT
November 14, 2007
Result Normal Findings Actual Findings Analysis

WBC 5-10 x 10 ^ 9/L 10.8 x 10^9/L Due to the migration of

neutrophils in response
HGB: Hemoglobin 13-18 g/dL 22g/dL to inflammationact:
Compensatory
Increase Production of
Red Blood Cells due to
HTC: Hematocrit 39.0-54.0 % 59% decrease P02 act:
Compensatory
Differential Count Increase Production of
Red Blood Cells due to
Segmenters 0.60 – 0.70 0.76 decrease P02
IDue to the migration of
neutrophils in response
to inflammation
DRUG
STUDY
NEXIUM
Class:

 Antacids, Antireflux Agents, Anti-Ulcerants
 Mechanism of Action:
 The drug has a proton pump inhibitors which

block the production of acid by the stomach.

Proton pump inhibitors are used for the
treatment of conditions such as stomach and
duodenal ulcers, gastroesophageal reflux
disease and the Zollinger-Ellison syndrome which
is all caused by stomach acid. PPI 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 esophagusto heal.



 Indications:

 -Long-term management of patients with

healed esophagitis
-Symptomatic treatment of GERD

-Adult Treatment of upper GI symptoms

associated with NSAID therapy.

-Healing of gastric ulcers associated with NSAID

therapy.  Prevention of gastric & duodenal ulcers

associated with NSAID therapy in patients at
risk.
-Maintenance of hemostasis & prevention of

rebleeding of gastric or duodenal ulcers following

treatment with IV esomeprazole.

 Preparations:

Capsules : 20mg/40mg

Intravenous : 20 mg/40mg

Powder for Oral suspension:

10mg/20mg/40mg
 Contraindications:
Hypersensitivity to substituted

benzimidazolesand those who are taking

other Esomeprazole

 Administration:
 May be taken with or without food (For patients
with swallowing difficulties, the tab may also be
dispersed in a glass containing 15 mL of non-
carbonated water. No other liquids should be
used. Stir gently & leave for a few minutes to
thicken. Stir again & drink the liquid with the
pellets immediately or within 30 mins. Rinse the
glass w/ 15 mL of water & drink. Do not
chew/crush the tab or the pellets. The dispersion
may also be administered via a nasogastric
tube.).

 Adverse Drug Reactions: 

Headache, Abdominal pain, Diarrhea,

Flatulence, Nausea, vomiting, constipation

 Nursing Considerations
-Maintain Supportive treatment test and

monitor periodically during the therapy

-Establish safety precaution

-Teach that the drug is taken before meals


LACTULOSE 30cc @ H.S
 Class:
Hyperosmotic Agent, Laxative

 Mechanism of Action:
Drug passes unchanged into the colon where

bacteria break it down to organic acid that

increases the osmotic pressure in the colon
and slightly acidifies the colonic contents,
resulting in an increase in stool water
contents, stool softening.

 Indications:
-Treatment of Constipation

- Prevention and treatment of portal

sysytemicencephalopathy, including stages

of hepatic precoma and coma.
 Contraindications:
 Galactosaemia, intestinal obstruction.

Patients on Low Galactose diet.


 Adverse Drug Reactions:
Diarrhea (dose-related), nausea, vomiting,

hypokalemia, bloating, abdominal cramps.

Potentially Fatal: Dehydration and

Hyonatremia on aggressive treatment.

 Drug Interactions: 
Neomycin, other antiinfectives; May interfere

with desired degradation of lactulose and

prevent acidification of colonic contents.
 Nursing Considerations
-Assessed allergy to lactulose, galactose

-Give the drug with fruit juice , water or milk

to increase palatability
-Do not give the other laxative while the

patient is taking the drug

-Do not freeze , extremely dark cloudy syrup

may be unsafe
-Monitor for potential dehydration and

electrolyte imbalances

DUAVENT 1 nebule q4
Class:

Antiasthmatic & COPD Preparations

 Dosage:
  Each pulmoneb contains 2500 mcg (2.5 mg)

of salbutamol base (with each drop

containing 50 mcg)
 Mechanism of Action:
Acts relatively selectively at beta2-adrenergic

receptors to cause bronchodilation




 Indications:
-Management of reversible bronchospasm

associated with obstructive airway diseases

-For patients with chronic obstructive disease

(COPD) on regular inhaled bronchodilator

who continue to have evidence of
bronchospasm and who require a second
bronchodilator.

 Contraindications:
Hypersensitivity to soya lecithin or related

food products eg: Soybeans or peanuts; and

to any component of Duavent or to atropine
and its derivatives. Hyoertrophic obstructive
cardiomyopathyor tachyarrhythmia.
 Adverse Drug Reactions:
Headache, pain, influenza, chest pain.


 Drug Interactions: 

-Beta-Receptor Blocking Agents: Salbutamol

and a B-receptor blocking agent inhibit each

other’s effect.
-Beta-Adrenergic Agents: Co-Administration

with other sympathomimetic agents may

increase risk of adverse cardiovascular
events.



 Nursing Considerations
-Ask the patient if he or she have an allergy

on soy and peanuts

-Position the patient in a high back rest

-Do back tapping after you nebulized the

patient
-Do not give food immediately because it can

cause vomiting

SILGRAM 1.5 g IV q6
Contents:

Per 1.5 g vial, Ampicillin 1 g, sulbactam 500

mg
 Dosage:
Adult: 1.5-3 g q6h

 Mechanism of Action:
Inhibits synthesis of cell wall causing cell

death



 Indications:

Treatment of upper and lower respiratory tract

infections, gynecologival infections and as

prophylaxis to reduce the risk of infections
following caesarianand birth.
 Contraindications:
Hypersensitivity

 Adverse Drug Reactions:

Serious anaphylactoid reactions.


 Drug Interactions: 
Probenecid, Allopurinol, Aminoglycosides.

 Nursing Considerations
-Before administration, ask the patient if he

has allergy on penicillin

-Tell the patient to take the entire amount of

drug exactly as prescribed

-Advise patient to notify prescriber if rash

develops or signs and symptoms

 Of super infection appear



SOLU-CORTEF 100mg IV q8
 Dosage:
Adult: 100-500 mg IV over a period of 30 sec

to 10 min.
 Mechanism of Action:
Enters target cells and binds to cytoplasmic

receptors, initiates many complex reactions

that are responsible for its anti inflammatory,
immunosuppressive and salt retaining
actions

 Indications:
Endocrine, hematologic, rheumatic and collagen

disorders; dermatologic, GI, respiratory and

neoplastic diseases edematousstates, control of
severe incapacitating allergic conditions; TB
meningitis w/ subarachnoid block or impending
block when used concurrently w/ appropriate
anti-TB chemotherapy; shock secondary
to adrenocortical insufficiency or shock
unresponsive to conventional therapy when
adrenocortical insufficiency may be present.

 Contraindications:

 Systemic fungal infection ,Lactation

 Administration of live or live attenuated

vaccines.
 Adverse Drug Reactions:
Fluid and electrolytes disturbances; decreased

carbohydrate tolerance; impaired wound healing,

thin fragile skin; muscle weakness, steroid
myopathy, osteoporosis, aseptic necrosis; peptic
ulceration w/ possible perforation; cataracts,
increased intraocular & intracranial pressure;
growth retardation; Cushingoid state; protein
catabolism; psychic derangements,
exophthalmos, masking of infections, gasping
syndrome, seizures, menstrual irregularities.

 Drug Interactions: 
Efficiency may be reduced by phenytoin.

phenobarb, and rifampicin. Corticosteroids

may reduce the effects of diuretics,
hypoglycemics, anticholinesterases,
salicylates. Decrease clearance by
troleandomycin & ketoconazole.

 Nursing Considerations
-Taper doses when discontinuing high dose or

long term therapy

-Give the drug exactly as prescribed

-Do not give if the patient received live virus

vaccines
-Teach that the drug is taken with meals or

snacks

 Nursing
Care Plans