Chronic Obstructive Pulmonary Disease (COPD) PDF
Added on 2021-04-17
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Question 1. Presenting Condition and name of the patientPresenting condition- COPD. Patient’s name- Jack StrawPrescription of the medication here: Write the Medication name-Medication-Ipratropium BromideDose and How often it is to be administered- 3mL vial Ipratropium nebulized every 6 hours as neededQuestion 2 Case study scenarioJack Straw came to the health facility with his wife as he complained of shortness of breath and fever. He is a 72 years old man who recently moved in the area and these symptoms began shortly. His wife brought his previous medical records.Jack’s past medical and surgical history- He suffered from heart failure after myocardial infarction at age of 64 years. His other conditions include COPD (on 2 L home oxygen), hypertension and appendectomy.His current symptoms included inability to speak in full sentences for past 3 hours as reportedby his wife, productive cough, audible wheezing for the last couple of hours, moderate tightness in chest and dyspnea. He was alert and oriented.Vital Signs: Blood Pressure- 126/72 mmHgPulse- 67
RR- 31 Ht- 5ft 7 inWt- 118 lbs Temperature- 101.4 °F oralRelated positives: •General: audible wheezing without use of any accessory muscle •Chest: Anteroposterior diameter increased; diffuse wheezing to auscultationInvestigation results:Pulse oximetry- 87%Chest x-ray revealed hyperinflation and left lower lobe pneumonia.Considering the subjective and objective data from Jack’s examination, certain clinical factors were identified which could increase the risk of a severe COPD exacerbation and therefore Ipratropium Bromide was administered. Those factors were noticeable surge in symptoms, alteration in the vital signs such as low oxygen saturation and new co-morbidity of pneumonia. These factors will combine with his severe baseline COPD [CITATION Anj15 \l1033].Question 3Ipratropium bromide will be given via a nebulizer as it is easier to use in a condition where the patient is presenting with acute symptoms. Ipratropium bromide is an anticholinergic which is given to treat bronchospasm that is airway narrowing which occurs during exacerbations of COPD in adult patients[CITATION Ana15 \l 1033].
There are certain safety requirements regarding its administration which must be kept in mind. The Ipratropium Bromide solution must be administered through the jet nebulizer which is attached with an air compressor with sufficient air flow. The nurse first evacuate the complete content of the single-use 3 ml vial into the reservoir and then she should connect thereservoir to the mouthpiece and to the compressor. The nurse should be cautious if a face mask instead of mouth piece is used so that leakage can be avoided to prevent adverse effectson eyes in case the drug enters Jack’s eyes. The mouthpiece of the nebulizer must be placed in the mouth and Jack must be asked to breathe calmly and evenly until the nebulizer finishesgenerating mist. Excessive use or dosage of the drug can lead to severe adverse consequences, so proper care regarding the dosage and frequency must be maintained[CITATION App18 \l 1033].Jack must be instructed to call for medical help if his conditions deteriorates. He must be educated to avoid exposure of his eyes to the drug as it may lead to various complications such as temporary pupillary dilation, blurring of vision, pain in the eyes, or precipitation or worsening of narrow-angle glaucoma.The drug has certain contraindications. It is contraindicated in patients who have history of hypersensitivity to atropine and related substances, with narrow-angle glaucoma, prostatic hypertrophy, obstruction in the GI tract or bladder-neck obstruction [CITATION Hel18 \l 1033].The drug can have various side-effects potentially. One of the reported side-effect is the deterioration of the narrowing in the airways which includes worsened breathing issues like wheezing, tightness of chest, shortness of breath or shock.The side effects in the ENT regions inlcude sore throat nasal, epistaxis, nasal dryness or irritation. In the cardiovascular system the drug may cause hypotension and palpitations
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