The assignment details the nursing care provided to a patient with COPD, including oxygen therapy, medication administration, and non-invasive ventilation. It also explores the patho-physiology of COPD and its impact on the patient's condition.
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Signs and symptoms Difficulty in breathing, Sputum producing cough, Confusion and distress, Drowsy, but rousable,SpeakinginshortsentencesandProlongedexpiratoryrate,chestpain, sweating, wheezing with auscultations, peripheral oedema, crackles in lungs, bluish nails and lips. This suggests tha the patient is the Blue-Bloater variant of COPD. Patho-physiology The patients Glasgow coma score was 13/15 which signified that the patient was mildly disoriented and his eyes reacted to light. The patient was able to be woken up when necessary but was more or less unconscious. The airway passage pf the patient was blocked and caused sputum generation along with inflammation. The inflammation is the cause of bronchitic condition. The patient shows lowering of ventilation quotient and compensation which elevates the level of CO2. The poor ventilation in the pulmonary arteries causes hypoxic conditions. The arterial blood gas reports showed that the respiratory cavity contains excess base and partial CO2 pressure is also observed to be high. The x-ray reports show that the patient is undergoing wheezing breath with crackles in his lower right lungs. The acidosis of the pulmonary cavity leads to the vasoconstriction of the respiratory vessels and the right ventricle is more pressurized. The patients are called blue-bloaters due to the fact that the imbalance of the V/Q produces inadequate oxygenation in the cavity which makes the nails and lips bluish. The acidosis also causes the pH of the pulmonary cavity to lower. COPD(CHRONIC OBSTRUCTIVE PULMONARY DISORDER) Nursing Interventions Oxygen Therapy was commenced to the patientwith 8L/minusingnebulizermaskstolowerthehypoxic conditioninthepulmonaryartery.Medicationwas administeredwithsalbutanol5mgandisopratroprium 2.5mg. This helped the arterial blood pressure to lower and the oxygen saturation was elevated to 89%. The patient’s Glasgow coma score was found to be 10/15, which did not improveandstillshowedsymptomsofmoderate disorientation.Afterthis,non-invasiveventilationwas commenced by the method of bi-level airway pressure (BiPAP). Rational Moderate amounts of supplemental oxygen can reduce the risk factors of COPD, which helps to overcome the hypoxic conditions. In this case, the oxygen was exceeding the arterial volume, which leads to the facilitation of the hypercapnia in Arnold. This is the reason why the patient’s coma score was increased and caused neurological effects. Excess oxygenation also cause the curve of the partial pressure of the CO2 to shift on the right, which means that the oxygenated hemoglobin induce the affinity for CO2. The process is called Haldane effect. The administration of Salbutamol and Ipratropium is commonly administered drugs for COPD treatment. The Salbutamol is a “short actingβagonist” or SABA, which stimulates theβ adregenic receptors. It relaxes the bronchial smooth myocytes by elevating the cAMP production which in turn activates adenylyl cyclase enzyme. The denylyl cyclase phosphorylates protein kinase and inhibits myosin phosphorylation as well as intracellular calcium ion concentration. This causes relaxation of muscle cells and bronchodilation. Ipratropium, which blocks the action of cholinergic receptors and results in the cGMP, to decrease the intracellular calcium ions and smooth muscle relaxation. BiPAP is a form of non invasive therapy that delivers pressurized air though the airway which helps patients breathe through an airway. The machine will recognize the patient’s condition and regulate the diaphragm, which is relaxed or contracts with respect to the breathing. The machine will force the air into the alveoli sacs and help in breathing. This lowers the pulmonary pressure and relaxes the patient’s condition.