COPD Case Study: Diagnosis, Treatment and Patient Response Analysis

This case study focuses on a patient diagnosed with COPD, detailing their symptoms, including difficulty breathing, cough, confusion, and bluish discoloration. The patient's condition was assessed, revealing a Glasgow Coma Score of 10/15. Treatment involved oxygen therapy, the administration of Salbutamol and Ipratropium, and the use of BiPAP. The assignment explains the pathophysiology of the disease, including the role of hypoxemia and the Haldane effect. It also elucidates the mechanisms of action for the medications used, such as Salbutamol’s effect on bronchial smooth muscles and Ipratropium’s role in blocking cholinergic receptors. Furthermore, it describes the function of BiPAP in assisting the patient's breathing and reducing pulmonary pressure. The case study highlights the importance of understanding both the patient's condition and the rationale behind the interventions applied.

Signs and symptoms
Difficulty in breathing, Sputum producing cough, Confusion and distress, Drowsy, but
rousable, Speaking in short sentences and Prolonged expiratory rate, chest pain,
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 patient with
8L/min using nebulizer masks to lower the hypoxic
condition in the pulmonary artery. Medication was
administered with salbutanol 5mg and isopratroprium
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
improve and still showed symptoms of moderate
disorientation. After this, non-invasive ventilation was
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 acting β agonist” or SABA, which stimulates the β
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.