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 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.