At the end of this session, you will be able to :

State the definition of COAD. List the etiology of COAD. Identify the pathophysiology of

COAD. State the sign & symptom of COAD.

LEARNING OBJECTIVES cont.

Identify the complication of COAD. Understand regarding treatment of

COAD. Identify the nursing intervention &

appreciate the nursing care for COAD patient.

PATIENT’S PROFILE

MR. L

MALE

70 YEARS OLD

UNEMPLOYED

PATIENT’S PROFILE WHEEL CHAIR

CALM

ALLERGICS - NIL

D.O.A 30/6/13 @ 1210 Hrs

Doctor = Dr AB

Diagnosis 1.COAD2.Old PTB3.? 2˚ dehydration

Mr. L was admitted to 5XX-1 with complaint of unwell,giddiness, nausea, poor

appetite, shortness of breath, coughing for 5/7 and loose stool

on and off X 2-3 months.

CURRENT MEDICATION

Aldactone 100mg TDS Lasix 40mg BD Ciprofloxacin 500mg BD Maxalon 10mg PRN Lomotil 2 PRN

PATIENT’S PROFILE MEDICAL HISTORY COAD Old PTB Hepatitis B with multicentric

hepatoma (under palliative care) HPT

PATIENT’S PROFILE SURGICAL HISTORY Nil

FAMILY MED HISTORY Unknown

VITAL SIGN TEMPERATURE : 36.4 ˚C BLOOD PRESSURE : 140/80mmHg PULSE : 76 bpm RESPIRATION : 26 breath/min SPO2 : 92% PAIN SCORE : 0 Weight : 64 kg

ACTIVITY DAILY LIVING Having difficulty in breathing (chest

tightness)

Loss of appetite and nauseated

Having loose stool on and off 2-3 months

Quit smoking > 15 years ago

PHYSICAL EXAMINATION

S/B Dr AB in A&E Run IV drip Hartman over 1 – 2 hours Then IV drip 3 pint Normal saline over

24 hours IV Maxalon 10mg TDS IV Parentrovite 1 pair OD Tab Ciprofloxacin 500 (1/2) BD Oxygen 2 liter via nasal prong

INVESTIGATION

Ultrasound abdomen

CXR

FBC, LFT, BUSE, creatinine

• A disease state characterised by airflow limitation that is not fully reversible

• May include diseases that causes airflow obstruction e.g. emphysema, chronic bronchitis or a combination of both.

• Can co exist with asthma

CHRONIC BRONCHITIS

• Irritation of airway causes mucus secreting glands and goblet cells to increase in numbers and ciliary function is reduced and more mucus is produced.

EMPHYSEMA

• Impaired of gas exchange results from destruction of the walls of our distended alveoli.

• Cigarette smoking• Air pollution• Recurrent infection• Aging• 2˚ smoking

RISK FACTORS

• Pneumonia• Atelectasis• Pneumothorax• Cor Pulmonale• Pulmonary hypertension• Respiratory insufficiency or failure

COMPLICATION

• Lymphocyte- 18.7% (20-45%)

• Monocyte- 16.6% (1 – 11%)

FBC

• Total protein- 55 g/L (3.0 – 9.2)

• Albumin- 23 g/L (34 - 48)

• A/G Ratio- 0.7 (1.0 – 2.0)

• Total bilirubin- 53.2 umol/L (2.0 – 28.0)

LFT

• SGOT/AST- 182 u/L (7 – 44)

• Alkaline phosphatase- 306 u/L (40 - 128)

• Gamma-GT- 567 u/L (7 – 55)

LFT

• Urea- 15.2 mmol/L (3.0 – 9.2)

• Sodium- 123 mmol/L (135 - 155)

• Creatinine- 273 umol/L (60 – 150)

BUSE/ Creatinine

• Emphysematous lungs. Bilateral upper lobe fibrosis

CHEST X-RAY

• Changes are suggestive of liver cirrhosis with ascites.

ULTRASOUND ABDOMEN

DRUGSIN WARD

DATEORDERED

DATE OFF

IV Parentrovite 1 pair Daily

30/6/13 1/7/13

IV Maxalon 10mg TDS 30/6/13 1/7/13

Tab Ciprofloxacin 500 (1/2) BD

30/6/13 1/7/13

Tab Lomotil ll/ll STAT 1/7/13 1/7/13

Tab Lasix 40mg OD 1/7/13 1/7/13

DRUGSON DISCHARGE

DATEORDERED

Tab Lasix 40mg OD 1/7/13

Tab Aldactone 50mg BD 1/7/13

Tab Ciprofloxacin 500 (1/2) BD

1/7/13

BULLECTOMY

• A removal surgical option for certain patient with bullous emphysema.

• Bullae (enlarged air space in thorax) that do not contribute to ventilation but occupy space in the thorax.

LUNG VOLUME REDUCTION SURGERY

• Treatment option for end-stage COAD (stage lll) with a primary emphysematous.

• Removal of a portion of the diseased lung parenchyma. This allows the lung functional tissue to expand, resulting in improved elastic recoil of lungs and improved chest wall and diaphragmatic mechanics.

LUNG TRANSPLANTATION

• For end-stage emphysema.

• Rarely done and most patient died while waiting for donor.

Ineffective breathing pattern related to reduced lung expansion and occlusive airflow.

NURSING DIAGNOSIS

Impaired gas exchange and airway clearance due to obstruction of airway and ventilation-perfusion inequality.

NURSING DIAGNOSIS

Alteration in bowel habit related to loose motion.

NURSING DIAGNOSIS

Alteration in ADL related to fatigue, ineffective breathing and hypoxemia.

NURSING DIAGNOSIS

Potential infection related to intravenous cannulation.

NURSING DIAGNOSIS

Potential alteration in nutritional status less than body requirement related to nausea and loss of appetite.

NURSING DIAGNOSIS

NURSING DIAGNOSIS

Knowledge deficit related to home management.

• Improving gas exchange and breathing pattern - DBE

• Improving activity intolerance by mild exercise

• Avoid pollution and 2˚ smoking• Avoid extreme temperature (cold or

hot)• Modifying lifestyle• Relaxation and stress management