Chronic Obstructive Pulmonary Disorder

Running header: CHRONIC OBSTRUCTIVE PULMONARY DISORDER 1
Chronic obstructive pulmonary disorder
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Case presentation
a. Subjective data
Mr. X is a 50-year-old Caucasian male. He is married with six children and eight
grandchildren who all stay together in a rental house in the rural village. He was brought to
the emergency department with shortness of breath, wheezing and chest tightness. His
symptoms started three days before and have been progressively worsening with no relieving
or aggravating factors. Two years ago he was diagnosed with an acute obstructive pulmonary
disease which required immediate hospitalization. He was prescribed albuterol, nicotine
patches, and aminophylline. He denies abdominal pain, nausea, vomiting, and diarrhea. His
family history includes diabetes and prostate cancer. He has a positive social history of
smoking. He currently smokes eight cigarettes per day and drinks 6-8 bears per day.
b. Objective data
Physical examination
Vital signs: temperature 36.4 degrees Celsius, blood pressure 112/72mm/Hg, respiratory rate
32, a pulse of 68 beats/min and lastly oxygen partial saturation 80% on room air. Cardiovascular:
there is a regular rhythm and normal heart sounds with no murmurs. There is a strong pulse in all
four extremities. Respiratory: the client presents with tachypnea, wheezing, reduced air
movements bilaterally and bilateral rhonchi. The client is unable to finish a full sentence due to
dyspnea. Skin: the skin is very dry. ECG result indicated reduced voltage in lead I, III, aVL, aVR
and IVF. Chest X-ray showed bibasilar airspace disease indicating the presence of alveolar
edema. Lastly, there is the presence of small bilateral pleural effusions.

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Medication
Ipratropium bromide is used in the treatment of COPD. It is administered nasally to prevent
dyspnea, coughing and chest tightness. Ipratropium is classified as a bronchodilator. It acts by
widening constricted airways, thereby reducing airflow resistance (Neilsen, Biisgard and
Ifversen 2013, pp 2105-2109).
i. The rationale for the route of administration
Ipratropium is administered through nasal inhalation. It acts by blocking the action of
acetylcholine on bronchi and nasal passages. Ipratropium is administered nasally because it acts
directly on the airways at the lungs that are constricted. The nerves use acetylcholine to
communicate with muscle cells. In COPD, cholinergic nerves located in the nerves causes
constriction of airways by causing the muscles close to the airways to contract. The
anticholinergic effect of ipratropium is preventing the effect of cholinergic nerves that cause the
dilation of airways and relaxation of airways (Neild and Cameron 2014, pp 671-680). Nerves that
use acetylcholine also control mucus glands in the nose. By blocking acetylcholine, the drug
facilitates the symptoms of allergies by stopping the mucus glands from producing mucus.
ii. Indication for administration
Ipratropium bromide is used in the treatment or prevents symptoms such as shortness of
breath or wheezing associated with chronic obstructive pulmonary diseases such as emphysema
and chronic bronchitis. It also used in the treatment of rhinorrhea which is mostly caused by non-
allergic or allergic perennial rhinitis (More, Wenzel and Meyers 2016, pp 315-323).

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iii. Safety requirement during an administration
Care must be taken not to allow the medication to get into the eyes. If the spray gets into the
eyes it may cause eye discomfort, mydriasis, blurred vision, and lastly corneal congestion. In
case the drugs are accidentally sprayed into the eyes, the patient is advised to consult their
physician. The client should stop taking the medication in case hypersensitivity reactions such as
skin rash, angioedema and laryngospasms occur (Rebuck, Chapman and Wolkove 2014, pp 59-
64).
iv. Patient education
Educate the client on how to use the intranasal route. The patient should blow the nose before
administration. Prior to use, pump by releasing the spray three times into the air. The drug should
also be stored at 25°C and avoid freezing. Discuss with the client on the specific use of the drug
and its side effects. The client may experience headache, pharyngitis and dry nose. Ask the client
to report immediately to the physician in case vision changes occur. Advice the patient to use
sugar-free gum so as to help with dry mouth, keep delivery devices clean and lastly taking a
missed dose the moment he remembers unless the time for the next dose is near (Restrepo 2015,
pp 833-851).
v. Contraindication
Driving or operation of machines
The common side effects of ipratropium are dizziness and blurred vision. Individuals who
drive or use heavy machines should take precaution in case they start experiencing these
symptoms (Westby, Gibson and Benson 2017, pp 56-60).