Chronic Obstructive Pulmonary Disorder

This document provides information on Chronic Obstructive Pulmonary Disorder (COPD), including its symptoms, medication, safety requirements, and nursing interventions. It discusses the case presentation of a 50-year-old male with COPD, objective data from physical examination, medication administration, contraindications, adverse effects, and nursing interventions. The document also covers national safety and quality health standards related to medication safety and patient identification. References are provided for further reading.

Running header: CHRONIC OBSTRUCTIVE PULMONARY DISORDER 1
Chronic obstructive pulmonary disorder
Student’s name
Students ID number
Specialty area

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Case presentation
a) Subjective data
Mr. X is a 50-year-old male. He is married with 3 children and five grandchildren who all live
together in rental accommodation in a rural village. Mr. X was brought in by air ambulance at
0800hrs from the local hospital near his village with chronic obstructive pulmonary disease. He
complained of difficulty in breathing, wheezing, chronic cough, and chest tightness. He has a
past medical history of type two diabetes mellitus, hypertension and rheumatic fever as a child.
He has been prescribed nicotine patches, metformin, furosemide, atorvastatin, acetylsalicylic
acid, perindopril, and glibeclamide by his doctor, however, he is non-compliant. Mr. X has no
allergy to any medication and currently smokes 10 cigarettes per day and drinks 5-8 bears per
day.
b) Objective data
Physical examination
Vital signs: blood pressure 128/74mm/Hg, respiratory rate 32, pulse 68 and temperature
36.8 degrees Celsius. The client is unable to speak in a full sentence, audible wheezing, and
uses accessory muscles during breathing. On inspection, the client has clubbed nails, and the
chest is increased in anteroposterior diameter and reduced cricosternal distance. On
percussion, there was hyper-resonance on both lungs with a loss of cardiac and liver dullness.
On auscultation, the heart is regular and no murmurs. Plain chest radiograph revealed
hyperinflation of the chest on the seventh rib crossing the diaphragm. Ipratropium bromide
was administered to control and prevent symptoms of shortness of breath and wheezing.

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Medication
Ipratropium inhalation is used to prevent chest tightness, wheezing, dyspnea and coughing in
people with COPD and emphysema. Ipratropium is classified as a bronchodilator. It works by
dilating the airways, thereby reducing airflow resistance (Neilsen, Biisgard and Ifversen 2013, pp
2105-2109).
a) The rationale for the route of administration
Ipratropium is administered through oral inhalation. Is an anticholinergic agent which blocks
the acetylcholine receptors mostly the muscarinic receptors. This action results in a decreased
level of cyclic guanosine monophosphate (cGMP). Reduced levels of cGMP cause
bronchodilation. In the respiratory tract, this leads to reduced contractility of the smooth muscles,
as a result of actions of cGMP on intracellular calcium (Neild and Cameron 2014, pp 671-680).
b) Indication for administration
Ipratropium medication is mainly prescribed for patients with chronic obstructive pulmonary
disease. COPD is a group of diseases which impair the normal functioning of lungs and airways.
These conditions include chronic bronchitis, an inflammation of the airway passages causing
overproduction of mucus, leading to difficulty in breathing and coughing (More, Wenzel and
Meyers 2016, pp 315-323).
c) Safety requirement during the administration
During the administration of ipratropium bromide, care must be taken not to allow the
solution to get into the eyes. Nebulizer solution must be administered via a mouthpiece. If the

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nebulizer solution is unavailable, a nebulizer mask is recommended (Rebuck, Chapman and
Wolkove 2014, pp 59-64). Patients may be made susceptible to glaucoma if the drug gets into the
eyes.
d) Patient education
Educate the client how to use the inhaler following this steps: before using, hold the inhaler
with the clear end pointing upwards, takeout the protective dust cap from the end of the
mouthpiece, if the inhaler is new, press down the canister two times to release sprays into the air
and away from your face, breath in slowly and deeply through the mouthpiece, hold your breath
for ten seconds and lastly replace the protective cap into the inhaler (Restrepo 2015, pp 833-
851).
e) Contraindication for administration
Cardiac arrhythmias
Ipratropium should be used in caution for clients at risk for cardiac arrhythmias. Active usage
of anticholinergic medication was linked with arrhythmia risk compared to non-active users.
Operation of machinery
The side effects of ipratropium include dizziness and blurred vision. The patient should be
cautious of possible danger if he experiences these symptoms and he is engaged in activities such
as driving (Westby, Gibson and Benson 2017, pp 56-60).
Pregnancy
Teratogenesis has been reported for patients using ipratropium bromide.

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Breastfeeding
Ipratropium secretion into breast milk is not known. There is a possibility when inhaled, would
reach the infant through breastfeeding and cause significant damage.
Geriatric patients
Anticholinergic drugs should be used cautiously in old patients. The aged are at a greater risk
of complications due to ipratropium bromide side effects.
f) Adverse effects
Severe adverse effects include visual impairment, angioedema, arrhythmias, bronchospasms,
and lastly anaphylactic shock (Roughead and Lexchin 2013, pp 315-316).
Moderate side effects include hypotension, palpitations, conjunctivitis, urinary retention, oral
ulceration, blurred vision, sinus tachycardia and constipation (Roughead and Lexchin 2013, pp
315-316).
Mild side effects include vomiting, epistasis, ocular irritation, headache, mydriasis, back pain,
throat irritation, nasal dryness, rash, rhinitis, nausea, dizziness, diarrhea, nasal congestion,
hoarseness and tremors (Roughead and Lexchin 2013, pp 315-316).
Nursing intervention
Nursing intervention Rationale
i. Educate the client on the use of
diaphragmatic and pursed lip
breathing.
It assists the client to lengthen expiration time
and reduce air trapping. These techniques
help the client breath efficiently and

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ii. Promote alternating exercise with a
rest period for relaxation. Allow the
client to decide on care based
tolerance level (James, Donaldson and
Nazareth 2015, pp 100-105).
iii. Provide physical support to the client
in setting up a systematic plan for
therapy such as walking, and
Exercycle (James, Donaldson and
Nazareth 2015, pp 100-105).
iv. Administer a metered dose inhaler of
ipratropium bromide.
v. Educate the client on the correct use of
the medication and the safety
measures.
vi. Administer influenza vaccine and
pneumococcal vaccine.
effectively.
Regulating activities with rest allows the
client to carry out activities without distress.
Muscles that have lost physical condition tend
to use more oxygen thereby overworking the
lungs. By ensuring a regular and graded
exercise, these muscles become physically fit
and the client can work more without getting
dyspnea (James, Donaldson and Nazareth
2015, pp 100-105).
Ipratropium bromide alleviates
bronchospasms and decreases airway
obstruction improving alveolar ventilation.
During administration, care must be taken not
to allow the drug to get into the eyes making
the client susceptible to glaucoma.
Administration of this vaccines prevent
complications such as influenza or
pneumonia, it is significant because the lung
is already overworking to balance the oxygen

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and CO2 level, pneumonia infection may
complicate the client's ability to breath
(James, Donaldson and Nazareth 2015, pp
100-105).
National safety and quality health standards
The standards ensure a national order and uniformity on measures of safety and quality across
the healthcare services. The standards address the following areas, this is medication safety and
patient identification and procedure matching.
i. Medication and safety standard
The criteria used to attain medication safety standard include the following;
Governance for medication safety
Health service organization have come up with a successful action of solving a problem
during manufacturing, storing, dispensing, prescribing and administering drugs. These actions
include authorization of clinical workforce to order, distribute and administer drugs. This action
is taken aims at increasing the effectivity of the medication authority system. Taking quality
improvement activities to facilitate safe drug use. (Endacot, Kidd and Chaboyer 2013, pp 100-
105).
Documentation of client’s information

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This ensures that the nurse accurately records client medication history and history are
accessible during care. This action is implemented to decrease the risk of adverse reaction.
Drug management process
The nurse ensures that the recent drug information is readily available to the clinical
workforce and also ensure that the drugs are distributed and stored safely. This action is done to
improve the accessibility of information and decrease the risk linked to storage and distribution
of drugs (Buist, Moore and Anderson 2013, pp 137-141).
ii. Patient identification and procedure matching
This standard intends to ensure that all clients get the correct care and intended treatment. The
criteria used to accomplish the client’s identification standard include the following;
Identification of individualized clients
The nurse ensures that the patient identification band is used, this action is done to decrease
mismatching events during drug administration.
Matching clients with their care
The nurse should ensure patient care, intended procedures and treatment are documented. This
action is taken to improve effectivity of the process for matching clients to their designated
procedure and treatment.
Information acquired from the case study

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From the above case study, I have learned that COPD includes emphysema and chronic
bronchitis. It is mostly caused by exposure to cigarette smoke which damages the lungs and
airways. Symptoms include dyspnea, wheezing, and production of mucus. COPD is treated by
administering ipratropium bromide through oral or intranasal inhalation (Smith, Brown and Chan
2014, pp 231-245). I have also discovered that an individual who has COPD is required to keep
away from salt since a high salt diet can cause the body to retain water, minimize milk
consumption to decrease mucus production, eat cruciferous vegetables to decrease bloating and
lastly avoid carbonated drinks which will bloat the stomach with gas leading to breathing
discomfort.
The other thing learned in the management of COPD include nicotine replacement therapy for
clients who cannot give up smoking, eating right and exercise, getting enough rest, asking
medication correctly, use of oxygen appropriately, retraining your breathing, avoiding infections,
learning techniques to bring up mucus, and lastly making and use an action plan (Chabra, Gupta
and Rajpal 2016, pp 19-26).
From the knowledge acquired about COPD am now able to answer questions clients ask like,
how is it like to live with COPD. Most of individuals plan their daily activities knowing that they
will cause shortness of breath such as going upstairs or walking long distances. From the
experienced, I gained I can now advise them on techniques to prevent shortness of breath such as
alternating activities with rest. The other question I get from my clients is what they can do to
help themselves get better. The usual advice I give them is quit smoking and also refer them to
the rehabilitation group where they are educated on how to stop smoking. For clients who cannot
stop smoking after going through rehabilitation, I usually give them nicotine patches to decrease
the urge of smoking.

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References
Buist, M., Moore, G. and Anderson, J. (2013). Australian Commission on Safety and Quality in
Health Care. Best Practice Guidelines for Australian Hospitals, [online] 62, pp.137-141.

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Available at: http://www.surgeons.org/racs/fellows/ resources-for-surgeons#WHO [Accessed 22
Mar. 2019].
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chronic respiratory morbidity among cigarette smokers. Indian J Chest Dis Allied Sci, [online]
43, pp.19-26. Available at: https://www.dovepress.com/efficacy-and-safety-of-ipratropium-
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Endacot, R., Kidd, T. and Chaboyer, W. (2013). Recognition and communication of patient
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