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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.
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LEARNING OBJECTIVES cont.
Identify the complication of COAD. Understand regarding treatment of
COAD. Identify the nursing intervention &
appreciate the nursing care for COAD patient.
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PATIENT’S PROFILE
MR. L
MALE
70 YEARS OLD
UNEMPLOYED
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PATIENT’S PROFILE WHEEL CHAIR
CALM
ALLERGICS - NIL
D.O.A 30/6/13 @ 1210 Hrs
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Doctor = Dr AB
Diagnosis 1.COAD2.Old PTB3.? 2˚ dehydration
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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.
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CURRENT MEDICATION
Aldactone 100mg TDS Lasix 40mg BD Ciprofloxacin 500mg BD Maxalon 10mg PRN Lomotil 2 PRN
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PATIENT’S PROFILE MEDICAL HISTORY COAD Old PTB Hepatitis B with multicentric
hepatoma (under palliative care) HPT
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PATIENT’S PROFILE SURGICAL HISTORY Nil
FAMILY MED HISTORY Unknown
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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
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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
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PHYSICAL EXAMINATION
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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
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INVESTIGATION
Ultrasound abdomen
CXR
FBC, LFT, BUSE, creatinine
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• 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
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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.
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EMPHYSEMA
• Impaired of gas exchange results from destruction of the walls of our distended alveoli.
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• Cigarette smoking• Air pollution• Recurrent infection• Aging• 2˚ smoking
RISK FACTORS
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• Pneumonia• Atelectasis• Pneumothorax• Cor Pulmonale• Pulmonary hypertension• Respiratory insufficiency or failure
COMPLICATION
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• Lymphocyte- 18.7% (20-45%)
• Monocyte- 16.6% (1 – 11%)
FBC
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• 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
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• SGOT/AST- 182 u/L (7 – 44)
• Alkaline phosphatase- 306 u/L (40 - 128)
• Gamma-GT- 567 u/L (7 – 55)
LFT
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• Urea- 15.2 mmol/L (3.0 – 9.2)
• Sodium- 123 mmol/L (135 - 155)
• Creatinine- 273 umol/L (60 – 150)
BUSE/ Creatinine
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• Emphysematous lungs. Bilateral upper lobe fibrosis
CHEST X-RAY
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• Changes are suggestive of liver cirrhosis with ascites.
ULTRASOUND ABDOMEN
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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
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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
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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.
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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.
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LUNG TRANSPLANTATION
• For end-stage emphysema.
• Rarely done and most patient died while waiting for donor.
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Ineffective breathing pattern related to reduced lung expansion and occlusive airflow.
NURSING DIAGNOSIS
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Impaired gas exchange and airway clearance due to obstruction of airway and ventilation-perfusion inequality.
NURSING DIAGNOSIS
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Alteration in bowel habit related to loose motion.
NURSING DIAGNOSIS
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Alteration in ADL related to fatigue, ineffective breathing and hypoxemia.
NURSING DIAGNOSIS
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Potential infection related to intravenous cannulation.
NURSING DIAGNOSIS
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Potential alteration in nutritional status less than body requirement related to nausea and loss of appetite.
NURSING DIAGNOSIS
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NURSING DIAGNOSIS
Knowledge deficit related to home management.
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• 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
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