Professional Documents
Culture Documents
Institute of Nursing
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is defined in clinical terms as a cough with sputum production on most
days for 3 months of a year, for 2 consecutive years. Chronic Bronchitis is hallmarked by
hyperplasia (increased in number) and hypertrophy (increased in size) of goblet cells (mucous
gland) of the airway, resulting in an increase in secretion of mucous which contributes to the
airway obstruction. Microscopically there is infiltration of the airway walls with inflammatory
cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that
thickens the walls resulting in narrowing of the small airway. Further progression leads to
metaplasia abnormal change in the tissue) and fibrosis (further thickening and scarring) of the
lower airway. The consequences of these changes are limitation of airflow.
is defined histologically as the enlargement of the air spaces distal to the
terminal bronchioles , with distruction of their walls. The enlarged air sacs (alveoli) of the lungs
reduces the surface area available for the movement of the gases during respiration. This
ultimately leads to dyspnea in severe cases. The exact mechanism for the development of
emphysema is not understood although it is known to be linked with smoking and age.
This type of emphysema affects single alveoli entering directly into the walls of terminal
and respiratory bronchioles.
m
M Smoking
M Genetic factors
M Allergies
M Nutrition
M Age, Gender
M Dyspnea
M Wheezing
M Chest pain
M Hemoptysis
M Cyanosis
M Swelling
M Respiratory failure
M Chest X-ray
V
M Bullectomy
M ðung Transplant
Y
A.M Past Health History
Patient JDC stated that he had chicken pox when he was 6 y/o and measles as
well in the same year. He also had mumps when she was on high school. He has
complete immunization. The patient had a motor vehicle accident because the
jeepney bumped him and his right finger was fractured as he stated. He
experienced to be hospitalized in 2001 because of difficulty of breathing and
diagnosed of COPD. The only medication she took previously was vitamins. On
1998, He travelled abroad, the government sent him in the US for military
schooling, and he stayed there for 10 months.
Patient is a diagnosed case of COPD since 2000 and was apparently able to
perform his tasks/ duties without significant symptoms.
2 days PTA, Patient had undocumented fever associated with productive cough
with mucopurulent sputum and slight difficulty of breathing. He sought consult
at CGEASH and was diagnosed to have UTI and given ofloxacin and was discharge
stable. At home, symptoms persisted now accompanied by dizziness. He went
back to CGEASH and was noted to be hypotensive. He was then referred to
AFPMC hence admission.
C.M Family History
His father has asthma and history of hypertension and was died because of
cardiac arrest at the age of 84. On his mother side, there was no hereditary
disease stated. His eldest brother has asthma and his brother Efren was just
recovered from TB.
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The client narrated that whenever he had problems, he will not tell it to anyone
until he can bear it. And if there͛s a problem within the family they talk about it
sincerely. He had a good atmosphere with his colleagues in the military.
HE currently lives at the barracks with his colleagues. Since the client is a military he
is assigned in different places, that͛s why he has a lot of friends in different places,
he just often sees his family.
The patient can read and write. He finished college in the course of Automotive
mechanic and joined the military on 1978.
The patient͛s wife said that his husband is a jolly person. They never see him sad.
Since he is a military, he always assigned in different places and far from his family
that͛s why he finds his happiness when he is with his family. He does not think of
his problems much and just laugh at it. His wife said that her husband never
complain even if he is not feeling well. He does not want to be a burden to his
family.
Interpretation: the client has a productive life. He doesn͛t waste his time on nonsense
things, the most important moment in his life was when he was with his family even
there is sometimes misunderstanding among the family members.
Analysis: MM
M
B.M Social Cultural Pattern
The client is an Ilocano, he said that he don͛t believe that ilocanos are ͞kuripot͟ but
rather thrifty. They also practiced Ilocano culture like ͞padasal͟ every year for their
loved ones who passed a away. They offer prayers together with a dead cow. He
smokes 3 packs of cigarette per day since he was 17 years old but stopped it 5 years
ago(2005). He also drinks alcoholic beverages occasionally.
The client is married for 36 years to Ms. Susana Salvador. They have 5 children and 3
of them had already their own family. He also has his ͞barkadas͟ inside the military.
The client͛s past time is cleaning and assembling his guns ͞yan ang paborito kong
gawin ang mangalikot͟ as he stated. He also jogs inside the barracks thrice a week.
And in terms of family they fond of going to beaches. And with barkadas he drink.
4.M Environment
He currently lives at barracks in ðibis Quezon city. He described that their barracks is
located along the highway, at the back of target rails, beside of Marikina River and
near eastwood.
5.M Economic
The client stated that his salary (Php30,000 with deduction) is enough for him and
for her family since all her children was already graduated. He also has Philhealth
that͛s why he has no problem in financing his medications.
Interpretation: The client attains integrity at this point of his life. It is evidenced
by how he views his life. The client shows optimism and has a feeling of happiness
in every way in his daily living.
Analysis: According to Erikson, the developmental task at this time is ego integrity
versus despair. People who attain ego integrity view life with a sense of wholeness
and derive satisfaction from past accomplishments.(Kozier and Erb͛s Fundamental
of Nursing 8th edition p.422
C.M Spiritual Pattern
The client values his family so much. Their family was belonging to a religion of Seventh
day Adventist. They go to church every Saturday. Their religion believe that pigs are
dirty that͛s why they don͛t eat pork.
Analysis: Elders take their faith and religious practice very seriously, and display a high
level of spirituality. It would be a mistake, however, to assume that religiousity increase
with age.(Kozier and Erb͛s Fundamental of Nursing 8th edition p.419)
1.M m
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Conscious, Coherent, weak looking, not in cardiopulmonary distress.
2.M
Supple neck, (-) cervical lymphadenopathies
3.M
Pink palpebral conjunctiva, anicteric sclera
4.M
No tragal tenderness, no discharge
5.M Y
Nasal septum midline, no nasal discharge
6.M
Moist buccal mucosa
7.M
No denture, with dental caries
8.M
No tonsillopharyngeal congestion
9.M
Adynamic precordium, tachycardic, regular rhythm, no murmur
10.M ð
Symmetrical chest expansion, no retractions, decreased breath sounds at Right
lower lung field, (+) occasional crackles.
11.M
Flat, NABS, soft, non tender
12.M !
Pulse fulland equal, (-) edema
13.M Y
Oriented to 3 spheres,(-) sensory deficit
14.M V
Warm and moist
15.M ð
(- ) lymphadenopathies
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In the case of our patient, he had COPD due to his lifestyle specifically heavy smoking
and drinking for years.
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ͻHost
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- 56 years old
- ðifestlye (smoking and alcoholic drinker)
ͻAgent
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I therefore conclude that my client is suffering from COPD or chronic pulmonary
disease due to her lifestyle specifically heavy smoking and drinking.M
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Discharge Plan
'M Advised patient to adhere and complete the medication regimen to ensure complete healing.
'M Stress to the patient the importance of following the prescribed regimen so that the healing
process can continue uninterrupted.
'M Advised patient to adhere medication regimen even if he/she is feeling better.
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'M Encouraged patient to do relaxation technique such as deep breathing exercise.
'M Encouraged patient to do physical activities within his tolerance.
'M Instruct significant others to assist the patient if needed.
'M Encouraged patient to follow treatment as prescribed and to continue medication as prescribed.
'M Encouraged patient to follow physician͛s prescription for her own fast recovery.
'M Advised patient to stop smoking/alcohol intake.
'M Advised patient to eat nutritious foods like fruits and vegetables.
'M Encouraged patient to have proper hygiene every now and then.
'M Advised patient to reduced environmental stress and to have a good rest.
'M Encouraged patient to eat foods rich in vitamins and minerals like fruits and vegetable.
'M Informed patient to refrain from drinking alcoholic beverages.
V
'M Encourage patient to strengthen his belief to our God Almighty.
'M Encourage patient and family members to have faith in God and asked for guidance.