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We would like to thank the following persons that made this case study possible.
First of all, to our case advisor Mr. John Eric Salvador for giving us more courage and
advices. To Ms. CJ Tonog, for her patience and willingness in helping us finished this
case. To our panels; though we know it is not easy to finish a case study, still you have
given us much time to do more research. To our group mates, thank you for your
cooperation and perseverance to know this case study, without this, it will be impossible
for us to defend it today. For some, who thought that this is not a serious matter, thank
you; because you inspired us a lot to study more. To the family of our group mates,
Almario, Pantig, Morales, Martin and the Castro family, thank you. To Mr. X and family,
thank you for the cooperation and sharing us the information we need to finished this
case study. To our family; for their financial and spiritual support, thank you. And most of
all, to God our Father, for the knowledge and for keeping on motivating us for the times
that we feel we can’t finish this case presentation. Thank you so much.

Emphysema (pink puffers) is a lung disease that involves damage to the air
sacs (alveoli) in the lungs. The air sacs are unable to completely deflate, and are
therefore unable to fill with fresh air to ensure adequate oxygen supply to the body.
Emphysema is among a group of lung disorders classified as chronic obstructive
pulmonary disease (COPD). The most common cause of emphysema is cigarette
smoking, but other risk factors, air pollution or work-related exposure, may also play a
part in the development of emphysema. A naturally occurring substance in the lungs
called alpha-1 antitrypsin may protect against this damage. People with alpha-1
antitrypsin deficiency are at an increased risk for this disease. The type of emphysema
caused by A1AD is known as panacinar emphysema (involving the entire acinus) as
opposed to centrilobular emphysema, which is caused by smoking. Symptoms includes
dyspnea, chronic cough with tapioca like plug, wheezing, tachypnea, barrel chest,
decrease exercise tolerance and loss of appetite leading to weight loss.

Currently, there are no drug treatments available that have proven successful in
modifying the rate of decline in lung function for those who have emphysema. There are,
however, common medications used in the treatment of stable COPD include the
following Bronchodilators, Glucocorticoids (limited to specific indications), Antibiotics
(only during infectious exacerbations).

Influenza (flu) vaccines and Pneumovax (pneumonia vaccine) are

recommended for people with emphysema. These tests help confirm the diagnosis,
Pulmonary function tests, Chest x-ray, Arterial blood gases showing low levels of oxygen
in the blood (hypoxemia), and high levels of carbon. Low-flow oxygen can be used
during exertion, continuously, or at night. Pulmonary rehabilitation can improve exercise
tolerance and quality of life in the short-term. Lung transplantation is an option for
patients with severe disease. Carefully selected patients may be eligible for lung
reduction surgery. This procedure removes the damaged portions of the lung, which
allows the normal portions of the lung to expand more fully and take advantage of
increased aeration. And smoking cessation is the most important and effective

Nursing Responsibilities:

 Establish rapport.
 Monitor vital signs, ABG, laboratory and diagnostic result.
 Assist the patient to keep head, neck, and chest in body alignment.
 Perform bronchial hygiene (suction) open obstructed airways.
 Reduce or eliminate the pt. exposure to possible irritants.
 Teach coughing exercise (abdominal/ diaphragmatic breathing and
pursed lip breathing technique.
 Maintain side lying position with head elevated 30 degree angle.
 Administer low-flow oxygen 2-3 L/min.
 Instruct to increase fluid intake 2L of water.
 Encourage the pt. to quit smoking.

 Medication compliance on time.

General Data
Name: Mr. X
Age: 57years.old
Gender: Male
Status: Married
Height: 5’8’’
Weight: 170 lbs.
Address: San Nicolas Florida Blanca Pampanga
Number of Children: four siblings (3 boys and 1 girl)
Chief Complaint
(+) difficulty of breathing
(+) chest tightness 7/10 Pain Scale

“Nahihirapan akong huminga at sumisikip din minsan ang dibdib ko.” as

verbalized by the patient.


Received pt. on hi-fowler’s position on bed, conscious and coherent, with O2 via
nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts./min.
(KVO) @ 780 ml. level infusing well @ right metacarpal vein.

My Assessment to the pt. are as follows:

(+) difficulty of breathing
(+) chest tightness (7/10 pain scale)
(+) body weakness
(+) has fast and shallow breathing
(+) pallor
(+) wheezing upon auscultation
(+) tapioca like plug
(+) barrel chest
Vital Signs:
BP: 110/80 mmHg
PR: 102 bpm (tachycardia)
RR: 27 cpm (tachypnea)
Temp: 36.3 C

History of the Past Illness

Mr. X was been confined before due to asthma attack last September 2, 2009.
He told us that he feels difficulty of breathing with productive cough and minimal
excretion upon walking. Though Mr. X was taking his medicines like salbutamol syrup
and predisone regularly, still, he never follows his doctor’s advice to quit smoking. During
his confinement, Mr. X told us that he received oxygen via nasal cannula (2x daily) and
nebulizer like salbutamol sulfate (1 or 2 x daily) that ease his breathing. And upon his
confinement he told us that he sometimes feels body weakness whenever he was trying
to walk or go to comfort room. He was been confined for about 4 days (Sept. 2- Sept. 6,

History of the Present Illness

Three days prior to admission, he told us that while he was watching his grand
daughter playing, he was also smoking. He said that he consumed 2 packs or 40 pcs. of
cigarette sticks everyday (39 yrs. of smoking). He told us that he already feels difficulty
of breathing at that moment, but he never told his family about it because he don’t want
to be on the sick bed again. He told us that he always feels difficulty of breathing and
chest tightness whenever he was trying to do house chores. One day prior to admission,
he told us that while he was playing cards and smoking with his friends he feels sudden
difficulty of breathing and chest tightness that made his friends worried and call his
family and bring him into the hospital at Romana Pangan District Hospital last January 8,
2010 at around 6:00 P.M and discharged last January 14, 2010 (6 days of confinement).

Personal and Social History

Mr. X was a navy man working in a engine of a ship. He said he was working in
ship for more than 23 yrs. Though he doesn’t have much time for his family, he makes
sure that he communicates with them. His wife, Mrs. X was a teacher and they have four
siblings (1 girl and 3 boys working here and abroad). He said that he was been addicted
to cigarette smoking at the age of 18 yrs. old and also due to influence of his co-worker.
He admits that while they have a free time, they play cards and smoking just to get away
from stress and to get away from bored while on sea. Though he really smokes, Mr. X
was not fond of drinking alcohol, but he drink occasionally.

Complete Physical Assessment
Date Assessed: January 11, 2010
Time Assessed: 10:30 A.M
Initial Vital Signs:
Temperature: 36.3 C
Pulse Rate: 102 bpm (tachycardia)
Respiratory Rate: 27 cpm (tachypnea)
Blood Pressure: 110/80 mmHg

General Appearance:
The pt. is awake in hi-fowler’s position on bed, conscious and coherent,
with ongoing O2 via nasal cannula regulated @ 2 LPM, with ongoing IVF of D5W
regulated @ 10-15 gtts./min. (KVO) @ 780 ml. level infusing well @ right
metacarpal vein.

My Assessment to the pt. are as follow:

(+) difficulty of breathing
(+) chest tightness (7/ 10 pain scale)
(+) body weakness
(+) has fast and shallow breathing
(+) pallor (or hypoxia)
(+) wheezing upon auscultation
(+) tapioca like plug
(+) barrel chest

Area Assessed Technique Normal Actual Analysis

Used Findings Findings
Color Inspection Tan Pale Due to
oxygen supply.
Texture Palpation Smooth, soft Smooth, soft Normal
Turgor Palpation Skin snaps Skin does not Due to
back snap back decrease
immediately when pinched. oxygen supply.
when pinched
Hair Distribution Inspection Evenly Evenly Normal
distributed distributed
Temperature Palpation Warm to touch Warm to touch Normal
Moisture Palpation Dry, skin folds Dry, skin folds Normal
are normally are normally
moist moist
Color of Nail bed Inspection Pink and clear Slightly pink Due to
and clear decrease

oxygen supply.

Texture Palpation Smooth Smooth Normal

Shape Inspection Convex Convex Normal
curvature curvature
Nail base Inspection Firm Firm Normal
Capillary refill Blanch test 2-3 seconds 4 sec. (delayed Due to
time capillary decrease
refilled) oxygen supply.
HAIR Normal
Color Inspection Black (varies) Black (varies)
Distribution Inspection Evenly Evenly Normal
distributed distributed
Moisture Inspection Neither Neither Normal
excessively dry excessively dry
nor oily nor oily
Texture Inspection Silky, resilient Silky, resilient Normal

Scalp symmetry Inspection Symmetrical Symmetrical Normal

Skull size Inspection Normocephalic Normocephalic Normal

Shape Inspection Round Round Normal
and Palpation
Nodules/ masses Palpation Absence of Absence of Normal
nodules and nodules and
masses masses
Symmetry Inspection Symmetrical Symmetrical Normal

Facial movement Inspection Symmetrical Symmetrical Normal

Skin color Inspection Tan Pale Due to

oxygen supply.
EYES Symmetrically Symmetrically Normal
Eyebrows Inspection aligned, equal aligned, equal
movement movement
Eyelashes Inspection Slightly curved Slightly curved Normal
upward upward
Eyelids Inspection Smooth, tan, do Smooth, tan, do Normal
not cover pupil not cover pupil
as sclera, close as sclera, close
symmetrically symmetrically
Ability to blink Inspection Blinks Blinks Normal
voluntarily and voluntarily and
bilaterally bilaterally.
Frequency of Inspection 20 blinks per 20 blinks per Normal
blinking min. min.
Ocular movement Inspection Eye moves Eye moves Normal

freely freely
Position Inspection Drawn from Drawn from Normal
lateral angel lateral angel
Size Inspection Medium Medium Normal
Texture Palpation Mobile, firm and Mobile, firm and Normal
non-tender non-tender
Color Inspection Transparent Transparent Normal
with light color with light color
Texture Inspection Shiny and Shiny and Normal
smooth smooth
Presence of Inspection No lesions No lesions Normal

Color Inspection Black Black Normal
Texture Inspection Shiny and Shiny and Normal
smooth smooth
Color Inspection Black Black Normal
Reaction to light Inspection Pupils Equally Pupils Equally Normal
Round and Round and
React to Light React to Light
Accommodatio Accommodatio
Size Inspection Equal Equal Normal
Shape Inspection Round and Round and Normal
constrict briskly constrict briskly
Symmetry Inspection Equal in size Equal in size Normal
Visual Acuity Inspection Able to real new Able to real new Normal
print. print.
Visual Fields Inspection When looking When looking Normal
straight ahead, straight ahead,
client can see client can see
objects in objects in
periphery periphery
Ocular Inspection Eyes move Eyes move Normal
freely freely
Symmetry, shape, Inspection Symmetrical, Symmetrical, Normal
size and color smooth and tan smooth and tan
Mucosa color Inspection Reddish to Reddish to Normal
pinkish pinkish
Inspection Oval, Oval, Normal
symmetrical symmetrical
Nasal discharge Inspection No discharge No discharge Normal

Sinuses Inspection Not tender Not tender Normal
Secretion Inspection (Neutral in With mucus Due to loss of
color) without production. elasticity of the
mucus alveoli
Color Inspection Clear Tapioca like Due to
plug. destruction of
the alveoli.
Lips Inspection Pinkish to Dark and brown Due to
Color slightly brown and cracking decrease
lips oxygen level
Symmetry Palpation Symmetrical Symmetrical Normal
Texture Palpation Soft, moist, Dry Due to
oxygen supply.
Moisture Palpation Soft and moist Dry Due to
Color Inspection Pinkish Pale Due to
oxygen level.
Moisture Palpation Moist Moist Normal
Color Inspection Glistening pink Slightly pale Due to
oxygen level.
Texture Palpation Soft Soft Normal
Moisture Palpation Moist Moist Normal
Color Inspection Pinkish Slightly pinkish Due to
oxygen level.
Size Inspection Medium Medium Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Mobility Inspection Moves freely Moves freely Normal
Location Inspection At the midline At the midline Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Color Inspection Pinkish Pinkish Normal
Discharges Inspection No discharges No discharges Normal
Color Inspection Ivory/yellowish Yellowish Normal
Number of teeth Inspection 32 28 Due to tooth
decay (teeth

Position Inspection Head-centered Head-centered Normal
Movement Inspection Moves freely Moves freely Normal
Range of motion Inspection Full range Full range Normal
Consistency Inspection No enlargement No enlargement Normal
HEART Due to
Heart rate Auscultation 60-100bpm 102 bpm increase
contraction of
the heart.
Heart sounds Auscultation Clear, without Clear, without Normal
crackles crackles
Lung field Auscultation Resonant Wheezing Due to
Symmetry Inspection Symmetrical Barrel chest To
the decreased
surface area,
thoracic cage
Respiratory rate Inspection 12-21cpm 27 cpm Due to
ability for gas
Spinal Alignment Inspection Spine vertically Spine vertically Normal
align align
Skin integrity Inspection Skin intact Skin intact Normal
Breathing pattern Auscultation Breathing is Feeling of Due to
automatic and dyspnea with blockage in
effortless, effort in the airways.
regular and breathing.
even and
produces no
Lung/ breath Auscultation Bronchia- Wheezing Due to
sounds vesicular retained
Contour Inspection Flat Flat Normal
Texture Palpation Smooth Smooth Normal
Frequency and Auscultation Audible; soft Audible; soft Normal
character gurgling sound gurgling sound
occur irregularly occur irregularly
and rages from and rages from

5-30 mins 5-30 mins
Skin color Inspection Tan Pale Due to
oxygen level.

Movement Inspection With ROM With no ROM Due to body

Size (arms) Inspection Equal Equal Normal

Symmetry Inspection Symmetrical Symmetrical Normal

Hair distribution Inspection Evenly Evenly Normal
distributed distributed

Skin color Inspection Tan Pale Due to

oxygen level.

Movement Inspection With ROM With no ROM Due to body

Size (legs) Inspection Equal Equal Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Hair distribution Inspection Evenly Evenly Normal
distributed distributed
Level of Interview Can follow Can follow
consciousness instructions and instructions and
commands commands
Behavioral and Interview Makes eye Makes eye Normal
appearance contact with the contact with the
examiner examiner
Mood Interview Expresses Expresses Normal
feelings which feelings which
corresponds to corresponds to
the examiner the examiner
Voice inflection Interview Clear and Weak Due to
strong presence of
secretions on
the respiratory
Tone Interview Fluent and Fluent and Normal
articulated articulated

Manner and Interview Can give Can give Normal
speech appropriate appropriate
answer to answer to
questions questions
Orientation Interview Oriented with Oriented with Normal
time time
Recall recent and Interview Recall events Recall events Normal
remote memory readily, readily,
immediate immediate
recall of remote recall of remote
information information
Judgments and Interview Can make Can make Normal
thoughts logical logical
decisions decisions

Cranial Nerve Date Done Normal Actual Result Interpretation


Olfactory Nerve January 11, Can smell on Can smell on Normal
2010 both nostrils. both nostrils.
Optic Nerve With 20/20 With 20/20 Normal
vision vision.

Occulomotor PERRLA PERRLA Normal

Abducens Nerve Lateral Lateral Normal
movement. movement.

Trochlear Nerve Up and down Up and down Normal

movement. movement.

Trigeminal Nerve For touch and For touch and Normal

pain. pain sensation.

Facial Nerve Can smile, Can smile, Normal

frown, puff the frown, puff the
cheek and can cheek and can
feel the cotton. feel the cotton.
Acoustic Nerve Can hear on Can hear on Normal
both ears. both ears.

Glossopharengeal Can swallow. Can swallow. Normal

Vagus Nerve Check for gag With gag reflex. Normal


Accessory Nerve With strength on With no muscle Due to body

both shoulder. strength. weakness.
Hypoglossal Sense of taste. With sense of Normal
Nerve taste.

Laboratory Procedures

Laboratory Date Normal Result Nursing Nursing
Procedure Done Values Interpretatio Responsibilities
Hematolog January Hemoglobin 119 g/l Abnormal due Pretest:
y 9, 2010 120-170g/l to decrease Explain the procedure to
hemoglobin in the patient.
Instruct the patient to
wear easily manipulated
clothing to get blood
samples easily.
Erythrocyte 5.3 x Abnormal Tell the pt. to relax
4.0-5.0 x 10 g/l due to because the procedure
g/l presence of is painless.
Hematocrit 0.46 g/l Normal Intra-test:
0.37-0.54 g/l Instruct the patient to
look away when the
needle is being inserted.
Leucocytes 21.1 x Abnormal Post-test:
5-10 x 10 g/l 10 g/l due to Put cotton balls on the
presence of puncture site to avoid
infection bleeding.
Platelets 252 x Normal Tell the patient to rest
150-450 x 10/l after the test.

Diagnostic Date Result Impression Nursing
Procedure Done Responsibilities
Chest X-ray January Hyper inflated Emphysema, Pretest:
4, 2010 lung densities in right upper Inform the client
the right upper lobe. prior to the exam
lobe. Hazy if you are
infiltrates in the pregnant, may
right lower lung be pregnant or
zones. The heart have an IUD
is in normal size. inserted.
Aorta is
unremarkable. Remove all
Enlarged antero- jewelry and wear
posterior chest hospital gown
diameter. because certain
metal or clothing
can obscure the
Provide privacy.
Provide time for
the client to
change his

Anatomy and Physiology of the Respiratory System


The lungs are the body's major organs of respiration. The two vital parts that
make up the lungs are located on each side of the chest within the rib cage. They are
separated by the heart and other contents of the mediastinum - the tissues and organs
of the middle chest (e.g., the heart and large vessels, windpipe, etc.). The lungs are
shaped rather like an upside-down butterfly. The top, or apex, of each lung extends into
the lowest part of the neck, just above the level of the first rib. The bottom, or base, of
each lung extends down to the diaphragm, which is the major breathing-associated
muscle that separates the chest from the abdominal cavity. Each lung is divided into
upper and lower lobes, although the upper lobe of the right lung contains another
triangular subdivision known as the middle lobe. The right lung is larger and heavier than
the left lung, which is somewhat smaller in size because of the position of the heart. At
birth, the lungs are pinkish-white in color; however, with age, the lungs darken to gray or
mottled black because of deposits of carbon and other particles that are inhaled over the


An alveolus (alveoli is plural) is a tiny air sac located within the lungs. The
exchange of oxygen and carbon dioxide takes place within this sacs.The basic structure
of the respiratory system can be envisioned as an upside-down tree. Air is breathed into
the trachea, which is the tree trunk, and thus the broadest part of the respiratory tree.
The trachea divides into two major tree limbs, the right and left bronchi, each of which
branches off into multiple smaller bronchi, which course through the tissue of the lung.
Just as a tree's limbs branch off into ever-smaller branches and twigs, so each bronchus
divides into tubes of smaller and smaller diameter, finally ending in the terminal
bronchioles. The air sacs of the lung, in which oxygen-carbon dioxide exchange actually
takes place, are clustered at the ends of the bronchioles like the leaves of a tree at the
ends of the smallest twig-like branches, and are called alveoli.

Explanation of Pathophysiology (Pt. Base)
Mr. X was 57 yrs. of age, with an occupation of engine man in ship for more than
20 yrs. and with a lifestyle of cigarette smoking who consumed more than 40 pcs. of
stick/ day. He was been diagnosed of emphysema last Jan. 5, 2010. Mr. X’s work was
exposed to gas and fumes like carbon monoxide and nitrogen oxides aside from the fact
that he also smoked. As this air pollutant enters the nose or mouth for a long period of
time, cilia in the respiratory unit will be destroyed. These are important along with the
goblet cell, which secretes mucin, to protect the lung from foreign air pollutant. If the
blood ph will be affected, there will be sympathetic response which will stimulate the
aortic and carotid bodies chemoreceptors primarily respond to changes in blood oxygen
levels. Changes in blood oxygen levels can become important when they decline to low
level called hypoxia. They send action potentials to the medullary chemoreceptor and
produce an increase in the rate and depth of respiration called tachypnea. One factor
recently implicated to the development of emphysema is the damage to the elastic fiber
network of the alveolar wall by the enzyme elastase. Normally the lung are protected
against such damage by a circulating antielastase. However, in cigarette smokers, there
is imbalance between elastase and antielastase activity, as a result of suppression of
antielastase activity, more neutrophils (which release elastase) in the lung and secretion
of elastase by macrophages (does of non-smoker do not secretes this enzyme.) the
likelihood of bronchiolar obstruction is increase in cigarette smokers because terminal
bronchioles narrowed by hyperplasia and secretions of mucus is increase. Plugging of
bronchioles with mucus often traps air in the alveoli, causing them to become
overextended (+) wheezing, and, if an individual happen to cough, the sudden rise in
pressure may rupture alveolar walls, especially those damage by the action of elastase.
The physiological effect of emphysema includes increase airway resistance, with
increase effort expended in breathing (+) DOB/ barrel chest due to continues diaphragm
contraction and greatly decrease diffusing capacity. As this happen, there will be positive
chest tightness stimulated by nociceptor by increase action of prostaglandin.

Explanation Pathophysiology (Book Base)
In normal breathing, air is drawn in through the bronchi and into the alveoli, which
are tiny sacs surrounded by capillaries. Alveoli absorb oxygen and then transfer it into
the blood. When toxicants, such as cigarette smoke, are breathed into the lungs, the
harmful particles become trapped in the alveoli, causing a localized inflammatory
response. Chemicals released during the inflammatory response (e.g., elastase) can
eventually cause the alveolar septum to disintegrate. This condition, known as septal
rupture, leads to significant deformation of the lung architecture. These deformations
result in a large decrease of alveoli surface area used for gas exchange.To
accommodate the decreased surface area, thoracic cage expansion (barrel chest) and
diaphragm contraction (flattening) take place. Expiration increasingly depends on the
thoracic cage and abdominal muscle action, particularly in the end expiratory phase.
Due to decreased ventilation, the ability to exude carbon dioxide is significantly impaired.
In the more serious cases, oxygen uptake is also impaired. Patients with alpha 1-
antitrypsin deficiency (A1AD) are more likely to suffer from emphysema. A1AD allows
inflammatory enzymes (such as elastase) to destroy the alveolar tissue. Most A1AD
patients do not develop clinically significant emphysema, but smoking and severely
decreased A1AT levels (10-15%) can cause emphysema at a young age. The type of
emphysema caused by A1AD is known as panacinar emphysema (involving the entire
acinus) as opposed to centrilobular emphysema, which is caused by smoking. Panacinar
emphysema typically affects the lower lungs, while centrilobular emphysema affects the
upper lungs. A1AD causes about 2% of all emphysema. Smokers with A1AD are at the
greatest risk for emphysema. Mild emphysema can often develop into a severe case
over a short period of time (1–2 weeks).

Drug Study

Drugs Classification Indication Side Effect Nursing

Generic Name: Bronchodilator Combivent Can produce  Monitor blood
Combivent pressure.
Inhalation paradoxical
 Monitor
Aerosol is bronchospasm respiratory
Brand indicated for use that can be life- rate.
Name: in patients with threatening. If
chronic it occurs, the
obstructive preparation
pulmonary should be
disease (COPD) discontinued
on a regular immediately
aerosol and alternative
bronchodilator therapy
who continue to instituted. It
have evidence of should be
bronchospasm recognized that
and who require paradoxical
a second bronchospasm,
bronchodilator. when
associated with
occurs with the
first use of a
new canister.

Generic Name: Anti-inflammatory Treatment of Convulsions;  Monitor Bp.

primary or increased
Brand Name: secondary intracranial
Solu-cortef adrenal cortex pressure with
insufficiency, papilledema
rheumatic (pseudotumor
disorders, cerebri);
collagen vertigo;
diseases, headache;
dermatologic neuritis;

diseases, allergic paresthesias;
states, allergic psychosis.
and inflammatory
states (resulting
from nephrotic
syndrome), GI
(ulcerative colitis
and sprue),
multiple sclerosis,
trichinosis with
neurologic or

Generic Name: Bronchodilator Terbutaline Palpitation,  Monitor blood

Terbutaline hypertension, . pressure.
sulfate injection is
in the mother,  Monitor
Brand Name: indicated for the these include respiratory
Brethine prevention and increased and heart
reversal of heart rate, rate.
bronchospasm in
patients 12 years hypokalemia,
of age and older cardiac
with asthma and arrhythmias,
edema, and
bronchospasm myocardial

associated with ischemia.
Increased fetal
bronchitis and
heart rate and
emphysema. neonatal
may occur as a
result of
Generic Name: Anti-thrombosis Treatment of mild Nausea,  Take Aspirin
Aspirin to moderate pain; vomiting, by mouth with
fever; various tinnitus, or without
Brand Name: inflammatory dizziness, food. If
Zorprin conditions; respiratory stomach
reduction of risk alkalosis, upset occurs,
of death or MI in metabolic take with food
patients with acidosis, to reduce
previous hemorrhage, stomach
infarction or convulsions. irritation.
unstable angina
pectoris or  Swallow
recurrent Aspirin whole.
transient Do not break,
ischemia attacks crush, or
or stroke in men chew before
who have had swallowing.
transient brain
ischemia caused  Take Aspirin
by platelet with a full
emboli. glass of water
(8 oz/240

Generic Name: Antibiotic Upper and lower Nausea,  Perform Skin

respiratory tract Abdominal Test before
infections and pain and administering
otitis media due Diarrhea any brand of
to S. antibiotic.
Brand Name:
Biaxin Mycoplasmas

Generic Name: Bronchodilator For the Hypertension,  Monitor blood

Budesonide maintenance migraine,
treatment of palpitations,
 Monitor
asthma as syncope, respiratory

prophylactic tachycardia, and heart
Brand Name: therapy in adults dizziness,
Entocort EC and children and fatigue.
for patients
requiring oral
therapy for

Generic Name: Bronchodilator Relief of Palpitation,  Monitor blood

respiratory hypertension, pressure.
distress due to in mother,  Monitor
bronchospasm, these include respiratory
to provide rapid increased and heart
Brand Name:
relief of heart rate, rate.
Adrenaline hypersensitivity transient
reactions to drug hyperglycemia,
and other hypokalemia,
allergens. cardiac
edema, and
Increased fetal
heart rate and
may occur as a
result of

SOAPIE (actual)

“Nahihirapan akong huminga paminsan-minsan”, as the pt. verbalized.


Received pt. on hi-fowler’s position, conscious and coherent, with ongoing O2 via
nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts/min.
@ 780 ml. level infusing well @ right metacarpal vein.
 (+) DOB
 (+) chest pain (pain scale 7/10)
 (+) Body weakness
 (+) Wheezing upon auscultation
 (+) pale due to hypoxia
 (+) tapioca-like plug
 Barrel chest
Vital Signs:
RR: 27cpm (tachypnea)
PR: 102 bpm (tachycardia)

Impaired gas exchanged related to alveolar capillary membrane destruction.

After 4 hrs. of N.I, the pt. verbalized understanding of causative factors and
appropriate intervention.


 Established rapport.
 Monitored and recorded vital signs.
 Reduced or eliminated the pt. exposure to possible irritants.
 Thought coughing exercise (abdominal/ diaphragmatic breathing and
pursed lip breathing techniqued.
 Administered low-flow oxygen 2-3 L/min.
 Instructed to drink 2-3 L of water.
 Encouraged the pt. to quit smoking.
 Medication compliance on time.

Goal partially met AEB the client’s respiratory and heart rate are slightly beyond
 RR: 22 cpm
 PR: 97 bpm
 P/S 4/10

SOAPIE (potential)



Received pt. on hi-fowler’s position, conscious and coherent, with ongoing O2 via
nasal cannula regulated @ 2 LPM, with ongoing D5W 1L regulated @ 10-15 gtts/min.
@ 780 ml. level infusing well @ right metacarpal vein.

Risk for infection related to retained secretions in the lung.

After 2hrs. of N.I, the client verbalized understanding and techniques on how to
avoid or reduce infections.

 Established rapport.
 Monitored and recorded vital signs.
 Provided comfort and safety.
 Instructed the pt. to increase fluid intake.
 Educated the pt. about proper using and disposing of tissue.
 Thought the pt. and relative about proper hand washing.
 Instructed the pt. to avoid cigarette smoking.

Goal partially met AEB the client’s respiratory condition became slightly good.