INTRODUCTION Chronic Obstructive Pulmonary Diseases (COPD) ranks as one of the major causes of disability in the Philippines today. The natural history

of COPD, namely emphysema and chronic bronchitis, causes progressive irreparable structural pulmonary damage and diminishes the cardio-respiratory reserves. Emphysema is commonly associated with bronchitis and chronic bronchitis. Since it is difficult to delineate “pure” cases of emphysema or chronic bronchitis, they are generally grouped together as Chronic Obstructive Pulmonary Disease (COPD).

Emphysema is a long-term, progressive disease of the lung(s) and occurs when the alveolar walls are destroyed along with the capillary blood vessels that run within them. This lessens the total area within

the lung where blood and air can come together, limiting the potential for oxygen and carbon dioxide transfer. (Medicine Net, Inc, 2009)

Globally, few data are available on the prevalence of chronic obstructive pulmonary disease (COPD) worldwide, but it is

likely higher than in the United States. In addition, the rates are rising as more than 1.2 billion humans are exposed to the

ravages of cigarette smoking. (Nursing Journal,2007)

Emphysema is commonly associated with bronchitis and chronic bronchitis. Since it is difficult to delineate "pure"

cases of emphysema or chronic bronchitis, they are generally grouped together as chronic obstructive pulmonary disease

(COPD).

Cigarette Smoking is by far the most dangerous reason that people develop emphysema, and it is also the most

preventable cause. Other risk factors include a deficiency of an enzyme called alpha-1-antitrypsin, air pollution, airway

reactivity, heredity, male sex, and age.(Nursing Journal,2007)

OBJECTIVES

GENERAL OBJECTIVES

To the patient to understand that diagnosis of emphysema is not a death sentence. Rather, it is a medical condition that should prompt you to take an active role in the management of his disease.

To stop smoking is the best first step, together with regular visits to your doctor and taking medications as prescribed are also very important.

SPECIFIC OBJECTIVESTo understand the pathogenesis, common manifestations,

and possible complications of the disease. To familiarize ourselves with the appropriate nursing

interventions for a patient with COPD, specifically Emphysema, in order to ensure a quality and effective nursing care.

To gain knowledge regarding the effectiveness and

adverse effects of, and nursing responsibilities with the medications and learn other treatment modalities used to treat Emphysema.

Patient Profile

Name: L.H.Gender: MaleAge: 57 years oldB-day: August 13, 1951Civil status: MarriedReligion: CatholicOccupation: Retired FiremenAddress: Sto. Nino, Bulacan

Chief Complain

“Nahihirapan akong huminga” as verbalized by patient LH when he brought to the Gregorio Del Pilar District Hospital last February 13,

2009 at Bulacan, Bulacan.

History of Present Illness

Morning of February 13, 2009, When Mr. LH felt shortness of breath. But disregard it thinking that he came from a long walk as his exercise every day. Afternoon of that day, while waiting to finish his wife preparing their lunch, He felt difficulty of breathing, that situation alarmed his wife to bring him to the hospital.

Past Medical History

The patient doesn’t remember any serious illness, reason for him to be hospitalized.

Family History

The Father of Mr. LH has a history of hypertension, while his mother has history of

asthma. Their family live in the province of Cagayan, They grow up using herbal plants as

their source of medicine, when one of the members of the family is sick.

Physical Assessment

Activities of daily living

Developmental Task

Mr. LH, At the age of 57 years old falls under the psychosocial development theory of Erik Erikson’s ego integrity vs. despair it is the last stage in the theory. The patient

expresses his regret of the things that he does before he was hospitalized. Before he doesn’t see life as important it

is as he sees it right now. The patient feels that he just wasted his time because all that he does was just to drink

alcohol and to smoke, he didn’t value himself and his family. But now he expresses that he wanted to change and doesn’t want to be hospitalized because he fears of death and want to correct the things that he have done wrong. He promises to himself that he would stop smoking and

drinking alcoholic beverages anymore. He also wanted to spend more time with his family when he will be

discharged from the hospital. He doesn’t want to be a burden for his family so he wants to get well as soon as possible. The patient deepest realization was that life is

short and need to spend it wisely so that he wouldn’t have a feeling of despair.

Course in the ward

This is the case of Patient LH, 57 years old male live at Roca Village Sto.Nino, Bulacan was admitted February 13, 2009 at 1:30 pm with disease emphysema. Oxygen administration 2L/min. via nasal cannula was given .Medication given D5W, FUROSEMIDE, HYDROCORTISONE, CEFUROXIME, SALBUTAMOL.

In the rounds of the doctor in the patient’s room on February 14, 2009 the doctors ordered with IV of D5w at 10-15 gtts. Medication of Azithromycin 500 once a day 3 doses continue IV Cefuroxime T/C Hdrocortisol after 4 doses Lozartan 500mg.

• On February 15 2009 at 7:30 am patient is ordered on low salt, low fat diet. Maintain on IVF at 10-15gtts/min. BP taken with 150/100. Ordered to continue medication and facilitate all Laboratories requested. Ordered to continue medication. For BP monitoring every 1 hour till stable. At 10:45 am ordered to be on NPO by 1 hour. The doctor instructed the patient to avoid sweets, cold drinks, and fatty foods. Medications given are stay Cefuroxime 100mg twice a day.

• On February 16 2009 the patients BP is 140/100 and Chest x-ray, Blood chemistry and ABG analysis were done.

Anatomy and Physiology

Main Parts of the Lower Respiratory Tract

The "lower respiratory tract" consists of the lower part of the respiratory system. This consists of the larynx (voice box), trachea

(wind pipe), bronchial tubes, bronchioles, and lungs.

Function of the Lower Respiratory

Tract

LARYNX

located in the anterior throat and it is continuous superiorly with the pharynx and

inferiorly w/ the trachea. The larynx isn’t just our voice box; it also serves as a protection

for our trachea.

TRACHEA

or windpipe is a membranous tube that consists of connective tissue and smooth muscle reinforced with 16-20 C-shaped pieces of

cartilage.

BRONCHI

The trachea divides into the left and right main (primary) bronchi each of which connects to

the lungs. The left main bronchus is more horizontal than the right main bronchus

because it is displaced by the heart.

LUNGS are the principal organs of respiration. Each lung is cone-shaped,

with its base resting on the diaphragm and its apex extending superiorly to a point about 2.5 cm above the clavicle. The right lung has three lobes called the superior, middle and inferior lobes. The left lung has two lobes called superior and inferior lobes. The main

bronchi branch many times to form the tracheobronchial tree. Each main bronchus divides into lobar bronchi as they enter their

respective lungs. The lobar (secondary) bronchi, two in the left lung and three in the right lung, conduct air to each lobe. The lobar bronchi in turn give rise to segmental (tertiary) bronchi which

extend to broncho pulmonary segments of the lungs. The bronchi continue to branch any times finally giving rise to bronchioles. The

bronchioles also subdivide into numerous times to give rise to terminal bronchioles which then subdivide into respiratory bronchioles. Each respiratory bronchiole subdivides to form

alveolar ducts which are like long, branching hallways with many open doorways. The doorways open into alveoli which are small air

sacs and where the actual site of gas-exchange takes place.

Vital System

The lower respiratory tract is a vital system. This tract is responsible for receiving oxygen, and

distributing it thought-out our whole body. All of our organs are dependent on this system, such as

the brain. This is a key organ that is dependent on oxygen. If the lower respiratory tract shuts down, the body can’ receive this vital oxygen, and organs that are deprived of oxygen shut

down like the brain, which leads to severe brain damage, and death.

Discharge Planning

E – xerciseM- edicationsP – roper breathing techniquesH – ealthy foodsY – es to LifeS – moking cessationE – ducationM – odifications of lifestyleA – lways wear mask