ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
NCM (RLE)
GROUP 4
Case Scenario No. 1
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Members:
HOCKSAN SEALZA
RINALYN TURBA
ORLAN VILLARUEL JR
VANIZ JANIN ZABALA
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
I. Introduction.
COPD is a lung disease that affects the small airways inside the lungs. It makes it hard to
breathe and causes symptoms like shortness of breath, constant coughing, wheezing,
and mucus production. Air travels from the nose or mouth through the trachea and
smaller airways (bronchi and bronchioles) to tiny air sacs called alveoli, where oxygen is
absorbed. COPD includes several conditions that block airflow and worsen over time. It
cannot be cured, only managed, and it's the third leading cause of death in the world.
II. Objectives
General Objectives:
At the end of the study, both audience and participants will have necessary knowledge
about Chronic Obstructive Pulmonary Disease (COPD) an to enhance the quality of life
and respiratory function of individuals with COPD through early diagnosis, effective
treatment, lifestyle modifications, and ongoing management, aiming to reduce
symptoms, prevent disease progression, minimize exacerbations, and decrease mortality
rates.
Specific Objectives
Necessary Information/Knowledge:
1. Assess the patient's situation and condition. Conduct a thorough assessment of
the patient’s current health status, medical history, and presenting symptoms.
2. Discuss their warning indicators or signs and symptoms. Identify early and
advanced signs of COPD such as chronic cough, shortness of breath (dyspnea),
wheezing, chest tightness, and increased sputum production.
3. Find the predisposing (e.g., smoking, family history, occupational exposure)and
precipitating factors (e.g., infections, air pollutants, cold weather) for the
discomfort and the causes.
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
Skills:
1. Identify the ideal nursing diagnosis depending on the needs of the patient.
Analyze the collected data to establish an appropriate and individualized nursing
diagnosis.
2. Use nursing techniques to manage the patient's symptoms and signs according to
the nursing care plan. Apply evidence-based nursing interventions to manage
symptoms.
3. Record the patient's status, nursing interventions, and evaluations accurately.
Consistent documentation supports continuity of care and helps evaluate the
effectiveness of interventions.
4. Implement actions in-order to prevent COPD like Health Promotion and Prevention
Strategies.
Attitude:
1. Utilize a proactive or comprehensive strategy to determine the patient's needs.
2. Provide the utmost confidence when handling the patient's bedside care.
3. To establish rapport with the patient as well as other family members.
III. Nursing Health and History
Biographic Data
Name: Avenlina Talla
Age: 60 years old
Sex: Female
Marital Status: Married
Occupation: Not Applicable
Religion: Not Stated
Address: Montemagapa, Janiuay, Iloilo
Source of Information: Cousin
Date and Time of Admission: Not Stated
Attending Physician: Not Stated
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
Admitting Impression / Final Diagnosis
● Ineffective Airway Clearance related to Dyspnea, as evidenced by wheezing upon
auscultating breath sounds.
Chief Complaint
“I am having difficulty breathing and I feel tightness in my chest, especially when I
move around.”
History of present Illness
Avenlina Talla, 60, was brought in for progressive shortness of breath and chest
tightness, worse with movement. Symptoms began a few days ago, with wheezing and
difficulty breathing. No known history of infection, or allergen exposure.
Past Medical History
Patient has a history of chronic smoking. No known COPD, hypertension, or diabetes.
No previous hospitalizations or surgeries reported.
Hospitalization for serious illness and Medications NA.
Family History of Illness
Current health status of immediate family and extended family: NA
Particular attention should be given to disorders such as heart dis., cancer, DM, HPN,
obesity, allergies, PTB and any mental health disorders: NA
Mother/Father and siblings living? If dead, when and why? Establish cause of death: NA
PHYSICAL EXAMINATION
Name of patient Avelina Talla Age- is 60 years old Sex is Female, her Weight- 38kg.
Her vital Signs are as of follows
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
T-36.5C°
RR- 28 bpm
PR- 112 Bpm
BP-110/70 mmHg
Her Oxygen Saturation is 88%
V. PATHOPHYSIOLOGY
A. Anatomy and Physiology of the target organ
STRUCTURE AND FUNCTION OF THE RESPIRATORY SYSTEM
The respiratory system is divided into two main parts:
1. Upper Respiratory Tract:
○ Nose and nasal cavity: Filters, warms, and moistens incoming air.
○ Pharynx (throat): A shared passageway for air and food.
○ Larynx (voice box): Contains the vocal cords and protects the lower airway.
2. Lower Respiratory Tract:
○ Trachea (windpipe): A rigid tube that conducts air to the lungs.
○ Bronchi: Two main branches (right and left) that enter each lung.
○ Bronchioles: Smaller branches that lead to the alveoli.
○ Alveoli: Tiny air sacs surrounded by capillaries where gas exchange occurs.
○ Lungs: Two spongy organs (right lung with 3 lobes, left with 2) protected by the
ribcage and covered by a membrane called the pleura.
The primary function of the respiratory system is gas exchange — supplying oxygen to the
blood and removing carbon dioxide. Here’s how it works:
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
1. Pulmonary ventilation (breathing): Air enters the lungs during inhalation and leaves
during exhalation.
2. External respiration: In the alveoli, oxygen from inhaled air diffuses into the blood, and
carbon dioxide from the blood diffuses into the alveoli to be exhaled.
3. Transport of gases: The circulatory system transports oxygen to cells and brings back
carbon dioxide to the lungs.
4. Internal respiration: Oxygen is delivered from the blood to body cells, and carbon
dioxide is collected from them.
5. Voice production (via the larynx), olfaction (smell via nasal receptors), and acid-base
balance (by regulating CO₂ levels) are also important functions.
B. Pathophysiology of the disease process
Chronic Obstructive Pulmonary Disease (COPD) is a progressive and irreversible lung condition
characterized by airflow limitation. It begins with exposure to noxious particles or gases, most
commonly from cigarette smoke, which triggers an abnormal inflammatory response in the
lungs. This inflammation damages the airway lining and the alveolar walls. Over time, the
chronic inflammation leads to airway remodeling, mucous gland hyperplasia, and
destruction of alveolar walls (emphysema), resulting in loss of lung elasticity.
The narrowing of the small airways (chronic bronchitis) and the destruction of alveolar walls
(emphysema) reduce the ability of the lungs to fully exhale air, causing air trapping and
hyperinflation. This leads to increased work of breathing and poor gas exchange, especially
decreased oxygen (hypoxemia) and increased carbon dioxide levels (hypercapnia). The chronic
hypoxia can also lead to pulmonary hypertension and eventually right-sided heart failure
(cor pulmonale
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
A chest X-ray of a patient with COPD often shows hyperinflated lungs with flattened
diaphragms, which are signs of air trapping and loss of lung elasticity. There may be
increased anterior-posterior diameter (barrel chest appearance), especially in lateral
views. The intercostal spaces may appear widened, and the lungs may look more
radiolucent(darker) due to overdistension. In cases of emphysema, bullae or blebs may
be seen, indicating areas of destroyed alveoli. The pulmonary vasculature may also
appear attenuated or reduced, particularly in the peripheral lung fields. The heart may
appear narrow and elongated in the vertical axis, especially in cases dominated by
emphysema.
Predisposing factors of COPD
● Cigarette smoking is the most significant predisposing factor, as it causes chronic
inflammation and damage to the airways and alveoli.
● Environmental and occupational exposure to dust, chemical fumes, and air pollution
increases the risk of lung damage over time.
● Genetic predisposition, such as alpha-1 antitrypsin deficiency, can lead to early-onset
COPD, especially in non-smokers.
● Advancing age contributes to decreased lung function and increased susceptibility to
chronic respiratory conditions.
Precipitating factors of COPD
● Acute respiratory infections, particularly viral or bacterial, can trigger COPD
exacerbations.
● Exposure to cold air, pollutants, or allergens can irritate the airways and lead to
worsening symptoms.
● Smoking or secondhand smoke exposure remains a potent precipitant even after
diagnosis.
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
● Physical exertion without adequate oxygenation or rest may precipitate
breathlessness and fatigue.
VI. DIAGNOSIS AND LABORATORY PROCEDURE
Sputum culture and sensitivity showed presence of Haemophilus influenzae. Color of
sputums range from yellow to green, an indicator of bacterial infection.
Result Normal Value
Sodium 134 mmol/L 135-144 mmol/L
Glucose 159 mg/dL 79-99 mg/dL
ALT (SGPT) 58 unit/L 7-52 unit/L
Lipase 9 U/L 0-160 U/L
Hematocrit 38.0% 39-50%
Neutrophils 83% 45-80%
Lymphocytes, 8.5% 12-45%
Relative
Lymphocytes, 0.79 K/mcL 1.00-3.50K/mcL
Absolute
Diagnostic Impression: Chronic progressive respiratory condition characterized by
persistent airflow limitation that is not fully reversible.
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
VII. NURSING CARE PLAN
VIII. DRUG STUDY
VIII. DRUG STUDY
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
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ILOILO DOCTORS’ COLLEGE
West Avenue, Molo, Iloilo City, Iloilo 5000, Philippines
College of Nursing
IX. DICHARGE PLAN/ HEALTH TEACHING
● Encourage patients to continue taking prescribed bronchodilators and medications at
home.
● Advised patient for follow up with a physician in 1–2 weeks.
● Stop smoking strongly advised; refer to cessation support.
● Encourage folks to avoid dust,respiratory irritants; keep home smoke-free.
● Practice deep breathing exercise and proper inhaler use
● Increase activity gradually; rest as needed.
● Return if breathing worsens or new symptoms appear.
● Monitor for signs of worsening dyspnea, wheezing, or chest pain and seek care if
needed.
XI. REFERENCES
https://www.mayoclinic.org/diseases-conditions/viral-gastroenteritis/diagnosis-
treatment/drc-20378852
NANDA International & Herdman, T. H. (2012). NANDA International Nursing diagnoses:
Definitions and classification 2012-14. Wiley-Blackwell. NANDA International and T.
Thebmj. Acute gastroenteritis in children. (2007). Retrieved February 6, 2023 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079
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