Chronic Obstructive Pulmonary Disease

GRAND CASE PRESENTATION

Introduction PathophysiologyClient’s Profile NCP

Group 10Station 4

7-3PMCapitol University

Medical City

Chronic obstructivepulmonary disease

COPD, or chronic obstructive pulmonary disease, is defined by the National Heart Lung and Blood Institute as a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

Introduction Client’s Profile NCPPathophysiology


It can cause:coughing that produces large amounts

of mucus (a slimy substance)wheezingshortness of breathchest tightnessand other symptoms

Client’s Profile NCPIntroduction Pathophysiology


Cigarette smoking is the leading cause of COPD as evidenced by the smoking history or exposure of the COPD patients.



A smoker can be:•Active smoker - those who intentionally smoke using cigarettes and cigars

•Passive smoker - those who breathe in other people’s smoker hence called involuntary or secondhand smoker.



Types of smoker•Current smoker - has smoked 100 cigarettes in a lifetime and now smokes every day or some days.

•Former smoker - he has smoked 100 cigarettes in a lifetime and does not smoke at all.

•Never smoker - has not smoked a cigarette and has never smoked 100 cigarettes in a lifetime.

•Light smoker - smokes 5 or fewer cigarettes per day occasionally.

•Moderate smoker - smokes 6 to 21 cigarettes a day.•Heavy smoker - smokes more than 21 cigarettes a day.



There has been an Anti-Smoking Law in the country that prohibits everyone from smoking in public places and further prohibits the

minors from totally smoking.



•7 out of 10 Filipinos smokes

•5.5 million of them have the disease



COPD•8th leading cause of death in the country next to heart disease, vascular system diseases, cancer, accidents, and some other illnesses.

Philippines• 2nd country in Asia who has the highest

number of COPD cases next to Indonesia.



The main symptom of an exacerbation• Increased breathlessness often accompanied by:

wheezing, chest tightness, increased cough and sputum, and Fever

•may also be accompanied by non-specific complaints such as malaiseinsomniafatiguedepressionconfusion.



Client’s Profile NCP

•The group has decided to go deeper with this case for the following reasons:

•To enhance the group members’ knowledge about the entire case;

•To make people aware of the current health status in the Philippine setting most importantly the respiratory cases;

•To inform people, both current and non-smokers, on the ill-effects of smoking to our health and how it gradually leads to death;

Introduction Pathophysiology



•To strengthen and help in the promotion of the Anti-Smoking campaign mandated by the lawmaking body of the Philippine government;

•To encourage non-smokers and even current smokers to quit smoking as early as possible and relay to them the advantages of quitting and not engaging into it at all.




Capitol University Medical City7-3 pm shift

November 18, 2010 (Thursday)•Initial assessmentNovember 19-20, 2010 (Friday)•The group was able to render care to the patientNovember 21, 2010 (Sunday)•Reassessment of the patient•Last day of assessment



Patient’s ProfileAge: 71 years old Sex: MaleStatus: MarriedAddress: Balingasag, Misamis OrientalCitizenship: FilipinoReligion: Roman CatholicOccupation: Retired



Date of Admission: November 18, 2010Time of Admission: 12:25 amAttending physician: Dr. ObsiomaRoom: CUMC Station 4 - 436c/c: Fever and coughAdmission Diagnosis: Recurrent Chronic Obstructive

Pulmonary DiseasePrincipal Diagnosis: Recurrent Chronic Obstructive

Pulmonary DiseaseFinal Diagnosis: Recurrent Chronic Obstructive

Pulmonary Disease

Introduction NCP

Assessment

Client’s Profile Pathophysiology


History of Present IllnessA few hours PTA, patient experienced onset of high grade fever of 39.0 degrees Celsius associated with non-productive cough for a week. Patient already had Fluimucil for cough. Onset of fever prompted upon admission.



Patient’s special procedures include:

Introduction Client’s Profile NCP

Year Operation performed

2002 Quadruple heart bypass surgery

2003 Right eye retinal hemorrhage surgery

2005 Left eye removal of cataract

2008 Right leg below the knee amputation

2009 TURP with bilateral orchiectomy

Pathophysiology


•Smoker for 18 years•Alcoholic beverages drinker for 23 years•Had maintenance medications of

insulin, Humolin-R, ipatropium and amlodipine

•No known food or drug allergies.



Family history•Diabetes mellitus type 2•Hypertension•Asthma




Before confinement During hospitalizationNutrition/Metabolic Pattern No special diet Eats three times a day Good appetite Consumes 4 cups of dark

coffee No nausea and vomiting

Diabetic diet Eats three times a day Good appetite Does not drink coffee No nausea and vomiting

Pathophysiology



Elimination Pattern Defecates once a day Urinates about 500-800cc

in 8 hours Yellowish urine Urinates at the bathroom

Defecates every other day Urinates an average of

1600cc in 8 hours Yellowish urine Urinates at bedside

Before confinement During hospitalization

Pathophysiology



Activity/Exercise Pattern Talks with friends and

family Does household

chores as everyday exercise

Talks with friends and family

Does active ROM exercise on bed


Pathophysiology



Sleep-Rest Pattern Average of 8 hours of

sleep Does not take a nap Difficulty sleeping due to

coughing episodes

Average of 4 hours of sleep

Takes a nap in the morning and afternoon

Difficulty sleeping due to coughing episodes


Pathophysiology



Self-Perception/ Self-Concept Pattern“Kung unsa man ang naa sa ako, mag.enjoy ko…kung nay kwarta, mag.enjoy ra gihapon. Kay mao ramay kalipay” as verbalized.

Pathophysiology


Cognitive/ Perceptual Pattern•Conscious•Bit restless•Oriented to time, place, person•In calm emotional state•Exhibited appropriate behavior and response during conversation

•Verbalized no dizziness or tingling sensation



Role/Relationship Pattern•married• retired•has four children- all working

professionals and are in good physical condition

• live with his family in Balingasag



Coping/ Stress-Tolerance Pattern“Oo, stressful gyud kung naa sa hospital, ga.problema ka pirmi kung kanus-a na ka pwede mouli. Pati kwarta, gaproblema ko,” as verbalized.As for relaxation, he usually reads books and newspapers or watches television. His vital support group is his family and significant others.



Value/ Belief Pattern•Roman Catholic•Always goes to church and chats with his church mates a lot

•God is vital to everyone and he trusts in God on whichever turn his condition will be.

•He says that hospitalization truly interferes as he can’t go to church because of his illness.




Review of SystemsGeneral oriented to time, place, and person; a bit

restlessIntegumentary no rashes noted

EENT no epistaxisMusculo-skeletal no joint pain

Respiratory no hemoptysisCardiovascular chest pain noted

Gastrointestinal no diarrheaGenito-urinary no dysuria

Nervous no seizure

Pathophysiology



Review of SystemsSkin no rashes

Head-EENT dusky pulpebral conjunctiva,no lymphadenopathy

Lymph nodes no cervical lymphadenopathyLungs Symmetrical chest expansion, (+) crackles at

the left anterior and

right posterior lung base, (+) wheezing sound noted

Pathophysiology



Review of SystemsCardiovascular

enlarged shape, no murmur

Abdomen flat, soft, non-tender, no-organomegaly

Musculo-skeletal

no limitation of joint movement

Extremities right below knee amputated, no cyanosis

Pathophysiology



Impaired Vision due to retinal hemorrhage surgery

in 2002

Post Operative Scar (heart bypass surgery) in

2005

Below Knee Amputation

Crackles upon auscultation

Removed prostate

Crackles upon auscultation

Below Knee Amputation

NURSING SYSTEM REVIEW CHART

Pathophysiology

Laboratory



Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD), refers to chronic bronchitis and Asthma, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath.



COPD is caused by noxious particles or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung. The inflammatory response in the larger airways is known as chronic bronchitis, which is diagnosed clinically when people regularly cough up sputum. The natural course of COPD is characterized by occasional sudden worsenings of symptoms called acute exacerbations, most of which are caused by infections or air pollution.



Chronic bronchitis is defined in clinical terms as a cough with sputum production on most days for 3 months of a year, for 2 consecutive years. In the airways of the lung, the hallmark of chronic bronchitis is an increased number (hyperplasia) and increased size (hypertrophy) of the goblet cells and mucous glands of the airway.



As a result, there is more mucus than usual in the airways, contributing to narrowing of the airways and causing a cough with sputum. Microscopically there is infiltration of the airway walls with inflammatory cells. Inflammation is followed by scarring and remodeling that thickens the walls and also results in narrowing of the airways. As chronic bronchitis progresses, there is squamous metaplasia (an abnormal change in the tissue lining the inside of the airway) and fibrosis (further thickening and scarring of the airway wall). The consequence of these changes is a limitation of airflow.



Asthma on the other hand is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.

Symptoms include wheezing, coughing, and shortness of breath. Treatment of acute symptoms is usually with an inhaled Ipratropium + Tiptropium. Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids.


COMPLETE BLOOD COUNT

TEST Result11/18/2010

Result 11/20/2010

Reference Value Unit

Hgb 10.2 10.3 11.7 – 14.5 g/L

Hct 30.0 31.0 34.1 – 44.3 gm%

WBC Count 14,906 16,100 5,000 – 10,000 Cell/mm3

Segmenters 86.0 76.0 45-70 %

Lymphocyte 10 15.0 18-45 %

Monocyte 0.4 5.0 4-8 %

Eosinophil 4.0 4.0 2-3 %

RBC 3.38 3.53 4.2 – 5.4 10*6/µL

Introduction PathophysiologyClient’s Profile NCP


Hemoglobin (Hgb)

This test measures the grams of hemoglobin found in a deciliter of whole blood. It correlates closely with the RBC count and affects the Hgb-RBC ratio.




Purpose: To measure hemoglobin if there is any indication of organ ischemia occurs and to monitor response to therapy.Lab Result : Hgb Indication/s: Low hemoglobin concentration indicates impaired renal function.

Pathophysiology


Hematocrit (Hct)It measures the percentage by volume of packed RBC in a whole blood.Purpose: To assess the extent of a patient’s blood loss.Lab Result : Hct Indication/s: Low Hct suggests hemodilution.



Red Blood Cells (RBC)also known as erythrocyte count, reports the number of RBC’s found in a microliter of whole blood.



Purpose: To supply figures for computing the erythrocyte indices which reveal RBC size and hemoglobin contents and to support other hematologic tests.Lab Result: RBC Indication/s: A depressed count may indicate fluid overload, alcohol abuse, and impaired renal function.



White Blood Cells (WBC)- part of the complete blood count, count reports the number of WBC found in a microliter of whole blood.Purpose: To determine infection or inflammation or to determine the need for further test, such as WBC differential or bone marrow biopsy.



Lab Result: WBC Indication/s: An elevated WBC count commonly signals infection such as his infection in his respiratory tract due to chronic bronchitis.



Segmenters (Segs)also known as Segs count, reports the number of segmenters found in a microliter of whole blood expressed in cell percentage.



Purpose: To determine infection or inflammation or to determine the need for further testLab Result: Segs Indication/s: An elevated segs count commonly signals severe infection, due to chronic bronchitis.



LymphocyteLab Result: LymphocyteIndication/s: Caused by corticosteroid therapy



MonocyteLab Result: MonocyteIndication/s: Caused by corticosteroid therapy



EosinophilLab Result: EosinophilIndication/s: May be increased by allergic reactions, and skin infection.



CLINICAL CHEMISTRY

TEST Result

11/18/2010

Reference

Value

Unit

Creatinine 2.00 0.60 – 1.30 mg/dL

Potassium 3.27 3.5 – 5.3 mmol/L



Creatinineis a nonprotein end product of creatinine metabolism. Serum creatinine test provides a more sensitive measure of renal damage than blood urea nitrogen levels because renal impairment is virtually the only cause for creatinine elevation.



Purpose: To assess renal glomerular filtration and to screen for renal damage.Lab Result: CreatinineIndication/s: Elevated serum creatinine levels generally indicates renal disease that has seriously damaged 50% or more of the nephrons.



Potassium (K+)is the major intracellular cation. It is important in maintaining cellular electrical neutrality. Evaluation of serum potassium measures the extracellular levels of this electrolyte.



Purpose: To evaluate clinical signs of potassium excess or depletion; to monitor renal function, acid-base balance and glucose metabolism; to detect the origin of arrythmias; to evaluate neuromuscular and endocrine disorders.



Lab result: PotassiumIndication/s: Occurs with depletion of total body potassium caused by shifts from extracellular fluid to intracellular fluid. Renal disorders also cause hypokalemia.



Nursing Implication/s: Observe patient for decreased reflexes, mental confusion, hypotension, muscle weakness.




Test ResultColor Yellow

Transp TurbidReaction 6.0Sp gravity 1.015

Sugar NegativeProtein +3

Coarse granular cast 1-2 cells/ hpf

URINALYSIS (11/18/10)

Pathophysiology



Yeast yellow RareAmorphous urates Few

Pus cells 1-5 cells/ hpfRbc 0-2 cells/hpf

Epithelial cells FewSquamous epithelial Few

Bacteria Abundant

Pathophysiology


ProteinThe urinalysis is a routine

screening test which is usually done as a part of a physical examination, during preoperative testing and upon hospital admission.



It is used in the diagnosis of infectious of the kidney and urinary tract and also in the diagnosis of diseases unrelated to the urinary system.



In general, if the urine sample is left standing too long bacteria begin to split urea into ammonia, resulting in alkaline urine, should this occur, test results regarding protein and the microscopic examination of casts will be inaccurate.



A delay in testing may also result in falsely low glucose, ketone, bilirubin abd urobilinogen values and falsely elevated bacteria levels.



Indication: the result shows that there is increase in protein it indicates DM, Emotional stress, malignant hypertension and orthostatic proteinuria.



Coarse Granular CastThe cellular material in

epithelial cells and WBC break down, the resulting granular particles form granular casts.



Lab Result: granular castIndication: the result show that there is increase in granular cast indicates acute and chronic renal failure and malignant hypertension.



Red Blood CellsRed blood cells, aggregates of cells

formed in the renal tubules, may also be found in the urine their presence usually indicates the blood is of glomerular origin, something which may occur in patients with variety of conditions.



Lab Result: in RBCIndication: the result show that there is an increase in RBC, indicates benign prostatic hypertrophy and urinary tract infection.



Bacteria Bacteria may also be noted via the

microscopic examination of the urine. Should bacteria be found during a routine urinalysis, culture and sensitivity testing of the urine should be done to determine the organism and to provide assistance in determining appropriate antimicrobial therapy.



Lab Result: presence of bacteriaIndication: the result shows that there is presence of bacteria in urine indicating urinary tract infection.


ASSESSMENT DATA (Subjective & Objectives

Cues)

NURSING DIAGNOSIS

(Problem and etiology)

GOALS AND OBJECTIVESNURSING INTERVENTIONS AND RATIONALE EVALUATION

Subjective Cues:“Galisod ko ug ginhawa” as verbalized by the patient.Objective Cues: Crackles heard

upon auscultation 02 Sat – 93% RR: 32 cpm Restlessness Orthopnea Shortness of

breath noted Ineffective

coughing Dyspnea Capillary refill - 4

seconds

Impaired gas exchange R/T altered oxygen supply

At the end of 5-10 minutes of nursing intervention, the patient will be: Able to improve

ventilation by increasing the oxygen saturation to 95% and above.

Decrease signs of restlessness

Show decreased respiratory rate from 32 cpm to 27 cpm.

Independent:1) Re-Monitored level of consciousness. Note for any

changes.R: Restlessness and anxiety are common manifestations of hypoxia. Worsen ABG’s accompanied by confusion are indicative of cerebral dysfunction due to hypoxemia.

2) Re-Assessed respiratory rate, depth. Note use of accessory muscle and pursed lip breathing.

R: Useful in evaluating the degree of respiratory distress.3) Re-Monitored cardiac status and rhythm.

R: Tachycardia, dysrhythmias and change in blood pressure can reflect systemic hypoxemia on cardiac function.

4) Positioned patient to semi-Fowlers or position of comfort.

R: To promote maximum lung expansion.5) Performed chest tapping after nebulization.

R: To get rid of mucus secretions imparing the efficacy of the respiratory pattern.

6) Instructed to perform deep breathing exercises such as pursed lip breathing.

R: To promote maximum lung expansion.Dependent:7) Administered oxygen therapy via nasal canula of 2

LPM.R: To correct hypoxemia

8) Administered hydrocortisone 100 mg, IVTT q 4 hours as prescribed.

9) Administered Combivent 1 nebule, OD as prescribed by physician.

R: To aid in normalization of respiratory pattern10) Administered Senetide 250 mg discuss inhaler BID as

prescribed by physicianR: To aid in normalization of respiratory pattern

Goals met. After 10 minutes of nursing intervention, the patient was able to: Show signs of

improved ventilation and adequate oxygenation of tissues as evidenced by increased oxygen saturation of 96%.

He also showed signs of decreased restlessness.

However, his respiratory rate was decreased to 27 cpm only.

ASSESSMENT DATA(Subjective and Objective Cues)

Nursing Diagnosis(Problem and Etiology)

GOALS AND OBJECTIVES NURSING INTERVENTIONS AND RATIONALE EVALUATION

Subjective: “ Dili kayo ko kaginhawa tungod sa akong ubo nga dili kayo gakaluwa" as verbalizedObjectives: Crackles heard upon

auscultation Productive cough:

yellowish color Dyspnea Use of trapezius

muscle when breathing

Nasal flaring Restlessness RR- 32cpm O2- 93% Orthopnea

Ineffective airway clearance related to retained mucus secretion

After 5-10 minutes of nursing patient will be able to: Improve airway

patency. Expectorate mucus

secretion Decrease

respiratory rate from 32 to 27 cpm

Show 02 saturation increased from 93% to 95%

INDEPENDENT:1. Re-monitored respirations and breath

sounds, noting rate and soundsR: indicative of respiratory distress and accumulation of secretions.

2. Positioned the patient into semi-fowlers or position of comfort.

R: To provide maximum lung expansion.3. Increased fluid intake into 2-3L per day

unless contraindicated.R: Hydration helps decrease viscosity off secretions facilitating expectoration.

4. Encouraged pursed- lip breathing exercises.

R: Provide client with some means to cope dyspnea and reduced air trapping.

5. Performed chest tapping after administration of nebulization.

R: To aid in expectoration of phlegm.DEPENDENT:1) Administer oxygen therapy via nasal

canula of 2 LPM.R: To correct hypoxemia

2) Administer Combivent 1 nebule every 8 hours as ordered.

R: Helps to dilate and smoothen bronchioles.3) Administer Fluimucil 600mg 1tab in 1/3

glass of water O.D as ordered.R: To liquefy secretions.

4) Administered Senetide 250mg discuss inhaler BID 8am, 6pm.

R: Helps dilate and smoothen bronchial area.

Goals partially met.After 10 minutes of nursing care patient was able to: Improved airway

patency as evidenced by expectoration of mucus secretion.

However, rales were still noted upon auscultation.

Respiratory rate was only decreased to 27 cpm.

02 Saturation was increased to 96%.


Cues)

NURSING DIAGNOSIS



Subjective Cues:“Paspas kayo akong ginhawa” as verbalized by the patient.Objective Cues: Crackles heard upon

auscultation 02 Sat – 92% Tachypnea; RR: 32 cpm Dyspnea Restless Nasal Flaring Shortness of breath Use of trapezius

muscle to breathe Orthopnea

Ineffective breathing pattern R/T respiratory muscle weakness

At the end of 15-30 minutes of nursing intervention, the patient will be able to: Improve ineffective

respiratory pattern by normalization of the respiratory rate from 32 cpm to 27 cpm.

Long term goal: Show and maintain

progressive normalization of breathing pattern within the range of 12-24 cpm.

Independent:1) Re-Auscultated chest periodically, notify

absence and equality of breath sounds.R: To evaluate presence/character of breath sounds/secretion.

2) Re-Assessed respiratory rate, depth. Note use of accessory muscle and pursed lip breathing.

R: Useful in evaluating the degree of respiratory distress.

3) Encouraged slower and deep respirations, use of pursed-lip technique.

R: To provide client with some means to cope dyspnea and reduce air trapping.

4) Positioned patient to semi-Fowlers or position of comfort.

R: To promote maximum lung expansion.5) Performed chest tapping after nebulization.

R: To get rid of mucus secretions imparing the efficacy of the respiratory pattern.

6) Provided rest periods betweenscheduled activities and treatments.

R: To limit fatigueDependent:7) Administered oxygen therapy via nasal



R: To aid in normalization of respiratory pattern9) Administered Senetide 250 mg discuss

inhaler BID as prescribed by physicianR: To aid in normalization of respiratory pattern

Goals partially met. After 30 minutes of nursing intervention, the patient: Has shown

improved effective respiratory pattern as evidenced by a slower rate in breathing of 27 cpm from 32 cpm.

Long term goal: However, the

group has not evaluated the long term goal for the patient as we had only taken care of the patient for 2 days.


Cues)

NURSING DIAGNOSIS (Problem

and etiology)


Subjective Cues:“Diri ra ko gapangihi sa bedside kay dali ra kayo ko kapuyon kung mu.adto pa ko ug CR” as verbalized by the patient.Objective Cues: Tachypnea upon

exertion RR: 32 cpm Dyspnea Easy fatigability O2 Saturation: 93%

Activity intolerance related to exhaustion associated with imbalance between oxygen supply and demand

At the end of 1-2 days of nursing intervention, the patient will be able to: Demonstrate

improved activity tolerance without dyspnea and fatigue

Long term goal: Participate in

activities of daily living more importantly in toilet transfer and ambulation.

Independent:1) Re-evaluated client’s response to activity.

Note reports of dyspnea, increased weakness/fatigue, and changes in vital signs during and after activities.

R: Establishes client’s capabilities/needs and facilitates choice of interventions.

2) Assisted in passive range of motion exercises.R: Promotes blood circulation.

3) Provided a quiet environment and limit visitors during acute phase as indicated. Encourage use of stress management and diversional activities as appropriate.

R: Reduce stress and excess stimulation, promoting rest.

4) Assisted client to assume comfortable position for rest/sleep.

R: Client may be comfortable with head of bed elevated, sleeping in chair, or leaning forward on overbed table with pillow support.

5) Provided a quiet environment and limit visitors during acute phase as indicated.

R: Reduces stress and excess stimulation, promoting rest.

Dependent:6) Administered oxygen therapy via nasal



R: To aid in normalization of respiratory pattern8) Administered Senetide 250 mg discuss

inhaler BID as prescribed by physicianR: To aid in normalization of respiratory pattern

Goals partially met. Patient

showed and demonstrated an improved activity tolerance such as ambulation around the room and sitting upright but dyspnea was still noted upon exertion.

Long term goal: However, we

were not able to evaluate whether the goal of participating in activities of daily living were met.

ASSESSMENT DATA (Subjective & Objectives Cues)

NURSING DIAGNOSIS


GOALS AND OBJECTIVES NURSING INTERVENTIONS AND RATIONALE

EVALUATION

Subjective Cues:“Sa isa ka adlaw, daghan kayo kog gakakaon pero ganiwang gihapon” as verbalized by the patient.Objective Cues: Type 2 Diabetes Mellitus Polyuria - 1600 mL/8

hours Polydipsia - more than

2.5 liters per day Polyphagia Poor muscle strength -

3/5 HGT - 236 mg/dL; Taken

on November 19, 2010 Weight: 67 kgs. (upon

admission) Weight: 65 kgs

(November 20, 2010) Weight loss = 2 kgs.

Imbalanced nutrition: less than body requirements related to insulin deficiency

After 3-4 hours of nursing intervention, patient will be able to: Ingest appropriate

amounts of calories Display

usual/increased energy level

Display normalization of blood glucose levels from 236 mg/dL to 120 mg/dL or lower.

Verbalize adherence to medication regimen.

Long term goal: Maintain normal

glucose levels from 80-120 mg/dL.

Independent:1) Weighted daily as indicated.

R: Assess adequacy of nutritional intake.

2) Ascertained client’s dietary program and usual pattern; compare with recent intake.

R: Identifies deficits and deviations from therapeutic needs.

3) Adviced to eat foods low in sugar and low in carbohydrates.

R: To lessen increased blood glucose level.

4) Encouraged compliance to treatment regimen.

R: For faster recovery and prevent further complications.

Dependent:5) Performed fingerstick glucose

testing.R: To monitor blood glucose levels and check for hyperglycemia or hypoglycemia.

6) Administered Humulin R, 10 units, subcutaneous, STAT as prescribed.

R: To correct high glucose level. 7) Administered Galvus 50 mg, 1

tab, OD as prescribed.R: To correct high glucose level.

8) Administed Januvia 25 mg, 1 tab, OD as prescribed.

R: To correct high glucose level.

Goals partially met. Patient was able to show

appropriate amounts of ingested calories as indicated in his diabetic diet.

He has also shown signs of maintained usual energy level as evidenced by resumed ADLs such as walking around the room for exercise, clothing, and eating.

He has also verbalized adherence to the treatment regimen by stating that he needs to constantly monitor his glucose level and take his medications as prescribed.

However, his blood glucose level has only decreased to 186 mg/dL after 4 hours of care.

Long term goal: However, the group has not

evaluated the long term goal for the patient as we had only taken care of the patient for 2 days.

Drugs


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Documents

Chronic Obstructive Pulmonary Disease