Chronic obstructive pulmonary disease
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Transcript of Chronic obstructive pulmonary disease
Case Study On Chronic Obstructive Pulmonary Disease (COPD)
By Mrittika Ganguly
PHYSICAL PARAMETERS OF PATIENT
Patient Name – Xyz Sex-f Age=77 Yrs Height = 5ft Weight=45kg Bmi(kg/M2)= 19.48 Life Style= Sedentary Date Of Admission=24.02.12 Duration Of Stay=24.02.12-04.03.12
CASE HISTORY
CHIEF COMPLAIN - SOB since 21.02.12 SOB become very serious in 22.02.12 and she was admitted in
SNPG where given nibulisation Patient improving symptomatically. Alert on 23.02.12 evening. Since morning 24.02.12 patient was drowsy , responding 1-2
words on repeated asking. Patient is admitted in this condition.
PAST ILLNESS -
Known case of COPD since 2 yrs
DM2 since 8 yrs
HTN since 15 yrs.
DIAGNOSIS
COPDCO2 NARCOSISDM2 (DIABETES MELLITUS TYPE 2)HTN (HYPERTENSION)
COPD(CHRONIC OBSTRUCTIVE PULMONARY DESEASE)
COPD is the co occurrence of chronic bronchitis and emphysema, a pair of commonly coexisting disease in which the airways become narrow.
COPD is the preventable and treatable lung disease with some significant pulmonary and systematic features.
PULMONARY AND SYSTEMATIC FEATURES OF COPD
Signs and symptoms of COPD
a) Cough and sputum production.b) Shortness of breath.c) In advace stage presence of oedema.d) Wheezing.e) Anorexia .f) Chest tightness.
CO2 NARCOSIS
carbon dioxide (CO2) narcosis, a condition of confusion, tremors, convulsions, and possible coma that may occur if blood levels of carbon dioxide increase to 70 mm Hg or higher. Individuals with chronic obstructive pulmonary disease can have CO2 narcosis without these symptoms because they develop a tolerance to elevated CO2.
The partial pressure of carbon dioxide is generally near 40 mm Hg.
Hypetension (HTN)
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the artery is elevated.
Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole).
Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.
DIABETES MELLITUS
DM is the metabolic disorder characterized by decreased ability or total inability of tissue to utilize carbohydrates(glucose)as a result glucose level in blood is increased.
Several form of diabetes have been identified. They are-
Type 1-Insulin Dependent DM(IDDM) Type 2-Non Insulin Dependent
DM(NIDDM) Gestational diabetes Impaired Glucose Tolerance.(IGT)
BIOCHEMICAL REPORTS
BIOCHEMICAL TESTS
TIME OF ADMISSION
DURING STAY
TIME OF DISCHARGE
NORMAL RANGE
HbRBCNeutrophilBasophilEeosiphilMonocyte
9.74.2286000201
9.7
89000400
11.9
0042
12-15
002-8%2-4%
Na 123 133 137 135-138mEq
K 2.9 2.2 3.1 3.5-5.5
Creatinine(mg/dl)
1.2 1 1 0.6-1.1mm/Eq
Urea(mg/dl)
50 18 23 10-30mgldl
BIOCHEMICAL REPORTS
BIOCHEMICAL TESTS
TIME OF ADMISSION
DURING STAY
TIME OF DISCHARGE
NORMAL VALUE
Pa co2 100.6 90.3 41.8 35-45mm/Hg
Pa o2 119.3 104.9 90 75-100mm/Hg
HCo3 35 30 26 22-26mm/Hg
HbA1C 7.5% 4-7%
CBG REPORT
DATE TIME READING
24.02.12 9pm1am4am
298mg/dl457 mg/dl350mg/dl
25.02.12 6 am12 noon4 pm8 pm
210mg/dl74 mg/dl125 mg/dl180 mg/dl
26.02.12 7 am12 noon12 mid night
92 mg/dl182 mg/dl198 mg/dl
27.02.12 8 am12 noon9 pm
108 mg/dl219 mg/dl175 mg/dl
CBG REPORT
Date Time Reading
28.02.12 6 am12 am12pm
124 mg/dl210 mg/dl195 mg/dl
29.02.12 8 am2 pm9 pm
310 mg/dl195 mg/dl170 mg/dl
01.03.12 6 am2 pm10 pm
247 mg/dl160 mg/dl140 mg/dl
02.03.12 7 am12 pm8 pm
210 mg/dl160 mg/dl130 mg/dl
03.03.12 9 am7 pm
201 mg/dl175 mg/dl
04.03.12(D/C) 7 am 200 mg/dl
Normal value of blood glucose- Fasting :90-110 mg/dl PP - :up to180 mg/dl Random :up to 140 mg/dlDoses of Insulin H/A-(Human Atrapid)- <70 = specialist concern 70-200 = no insulin 200-250 = 2 unit 251-350= 4 unit 301- 350 = 6 unit 351-400 = 8 unit >400 = 10 unit
DIETARY MODIFICATION
When patient was admitted in hospital she was unable to take food through mouth. Hence ryles tube was initiated.
After 4 days when she was improving. her diet was changed to soft diet.
On 04.02.12 patient was discharged.Salt restricted soft diabetic diet was
prescribed to her.
DIETARY MODIFICATIONS
Ryles Tube • 24.02.12 – 29.92.12
Salt restricted Soft diabetic diet
• 01.02.12- 04.0312
Discharge diet (salt restricted soft diabetic diet)
• 04.03.12
Ryles tube(special form)(24.02.12-29.02.12)
Fluid allowances= 120mlx10feed x 2 hrly 6 am : Pulmocare(30gm)+water
8 am : bread (2pcs)+ milk(100ml)
10 am :D-protein(30gm)+water
12 noon: Rice(raw 25 gm)+milk(200ml)+ OV(50gm)+fish(50gm)
2 pm : do
4 pm : bread(2pcs)+milk(100ml)
6 pm : D-protein(30gm)+water
8 pm : Rice(raw)(25gm)+milk(200ml)
+one egg white(25gm)
10 pm : DO
12 midnight : pulmocare(30gm)+water
Hospital diet (01.03.12-03.03.12)
Diagnosis – COPD,CO2 Narcosis,DM2,HTN Diet code – S/R,S/D/D INV Menu planning- 6am : D-protein(20gm)+water. 8am : Suji(30gm)+papaya(200gm)+ milk(200ml). 10am : D-protein (20gm)+water. 12 noon : Rice raw(40gm)+dal(15gm)+
cucumber(30gm)/g.papaya(30gm)/ pumpkin(30gm)+Fish
stew(75gm).
MENU OF HOSPITAL DIET
2 pm : D-protein(20gm)+water 4 pm : Tomato soup 6 pm : D-protein(20gm)+water 8 pm : Roti(2pcs)+Dal(15gm)+ lauki(15gm)/ pumpkin(15gm)/ papaya(15gm)/ cucumber(15gm)+Egg(50gm) 10 pm : D-Protein(20gm)+water
NUTRITIONAL MANAGEMENT OF COPD
Good nutrition helps the body to fight infections. Chest infection is common on COPD pateints.So it is important to reduce risk of infection by following a healthy diet.
Diet Principle-Moderate fat, low carbohydrate moderate protein feeding in patient with hypercapnia.
DISCHARGE DIET PRESCRIPTION (04.02.12)
Energy –Energy intake should be increased.Energy intake can be estimated at 35kcal/kg body weight.I suggest to give her 1600 kcal diet.
Carbohydrate – Carbohydrate intake should be restrict because it increased CO2 production.55% carbohydrate of total kcal is suggested.As pateint have DM2 simple sugars are avoided.
Protein – 2gm/kg body weight protein is recommended.It helps to restore lung and muscle strength and promote immune function.
Fat –. Fat kilocalorie produce less co2 than carbohydrate,so high fat diet is prescribed. But patient also have DM2 so I suggest to give her 22% of fat.
Vitamins An adequate intake of vitamin A and C essential for prevent pulmonary infections. Foods with high vitamin A as milk, GLV,egg,some breakfast cereals should be included in diet. Vitamin C rich foods like citrus fruits should also be included.
Minerals- Water balance and phosphorus level should be monitored. Fluid restriction is needed in case of presence of edema. As my patient is suffering from HTN so sodium restriction is needed. So I suggest her salt restricted diet(S/R).
NOTE- Sources of vitamin A and C should be carefully choosen to ensure that they do not produce gas.
MENU PLANNING
6.30 am : D-protein(2 scoops)(30gm)+water.
9.00 am : suji(30gm)+cheena(25gm)/ milk(100ml)+ oats. 10.30am : ripe papaya(100gm) 12.30am : Rice raw(50gm)+ dal(15gm)+any soft
veg(lauki/papaya) Mix veg(100gm) (pumpkin,r,jhinga)
+Fish(75gm)jhol.
4.00pm : leaker tea 1 cup w/o sugar
6.00pm : D-Protein(2 scoops)(30gm)+water
9.30pm : Roti(2pcs)+dal(15gm) any soft veg(100gm)
+Fish(75gm)jhol. 10.30pm: D- protein(2 scoops)(30gm)
+water.
Carbohydrate = 213.22 gm = 852.88 Kcal Protein = 90.53 gm = 362.12 kcal Fat = 39.84 gm = 358.56 kcal Total kcal
=(852.88+362.12+358.56)kcal =1573.56 kcalTotal kcal given to the patient is
1573.36kcal.Total Protein given - 90.53gm
FOODS TO BE INCLUDED OR EXCLUDED
High fibre foods as vegetables,whole grain foods,cereals etc.
Add oranges, musambi,tomato to increase potassium level.
Plenty of fluids. (should drink 6 to 8, eight-ounce glasses of non-caffeinated beverages daily. )
Include complex sugar.
Gas producing foods like beans,brocoli,sprouts, cabbage,cauliflower, corn,raddish, soyabeans,onions etc.
Carbonated beverages.
Fried or spicy foods Salt(Na)in food. Simple sugars like
jam jelly etc.
INCLUDED EXCLUDED
CONCLUSION
Eat cornflakes Oatmeal with
milkDrink plenty of fluids
Use herbs.Better than salt
Protein Booster
Go for potassium
Avoid caffine
Drink milk
Avoid gas producing food Fresh
vegetables
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