Case Study On Chronic Obstructive Pulmonary Disease (COPD)

By Mrittika Ganguly

PHYSICAL PARAMETERS OF PATIENT

Patient Name – Xyz Sex-f Age=77 Yrs Height = 5ft Weight=45kg Bmi(kg/M2)= 19.48 Life Style= Sedentary Date Of Admission=24.02.12 Duration Of Stay=24.02.12-04.03.12

CASE HISTORY

CHIEF COMPLAIN - SOB since 21.02.12 SOB become very serious in 22.02.12 and she was admitted in

SNPG where given nibulisation Patient improving symptomatically. Alert on 23.02.12 evening. Since morning 24.02.12 patient was drowsy , responding 1-2

words on repeated asking. Patient is admitted in this condition.

PAST ILLNESS -

Known case of COPD since 2 yrs

DM2 since 8 yrs

HTN since 15 yrs.

DIAGNOSIS

COPDCO2 NARCOSISDM2 (DIABETES MELLITUS TYPE 2)HTN (HYPERTENSION)

COPD(CHRONIC OBSTRUCTIVE PULMONARY DESEASE)

COPD is the co occurrence of chronic bronchitis and emphysema, a pair of commonly coexisting disease in which the airways become narrow.

COPD is the preventable and treatable lung disease with some significant pulmonary and systematic features.

PULMONARY AND SYSTEMATIC FEATURES OF COPD

Signs and symptoms of COPD

a) Cough and sputum production.b) Shortness of breath.c) In advace stage presence of oedema.d) Wheezing.e) Anorexia .f) Chest tightness.

CO2 NARCOSIS

carbon dioxide (CO2) narcosis, a condition of confusion, tremors, convulsions, and possible coma that may occur if blood levels of carbon dioxide increase to 70 mm Hg or higher. Individuals with chronic obstructive pulmonary disease can have CO2 narcosis without these symptoms because they develop a tolerance to elevated CO2.

The partial pressure of carbon dioxide is generally near 40 mm Hg.

Hypetension (HTN)

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the artery is elevated.

Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole).

Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

DIABETES MELLITUS

DM is the metabolic disorder characterized by decreased ability or total inability of tissue to utilize carbohydrates(glucose)as a result glucose level in blood is increased.

Several form of diabetes have been identified. They are-

Type 1-Insulin Dependent DM(IDDM) Type 2-Non Insulin Dependent

DM(NIDDM) Gestational diabetes Impaired Glucose Tolerance.(IGT)

BIOCHEMICAL REPORTS

BIOCHEMICAL TESTS

TIME OF ADMISSION

DURING STAY

TIME OF DISCHARGE

NORMAL RANGE

HbRBCNeutrophilBasophilEeosiphilMonocyte

9.74.2286000201

9.7

89000400

11.9

0042

12-15

002-8%2-4%

Na 123 133 137 135-138mEq

K 2.9 2.2 3.1 3.5-5.5

Creatinine(mg/dl)

1.2 1 1 0.6-1.1mm/Eq

Urea(mg/dl)

50 18 23 10-30mgldl

BIOCHEMICAL REPORTS

BIOCHEMICAL TESTS

TIME OF ADMISSION

DURING STAY

TIME OF DISCHARGE

NORMAL VALUE

Pa co2 100.6 90.3 41.8 35-45mm/Hg

Pa o2 119.3 104.9 90 75-100mm/Hg

HCo3 35 30 26 22-26mm/Hg

HbA1C 7.5% 4-7%

CBG REPORT

DATE TIME READING

24.02.12 9pm1am4am

298mg/dl457 mg/dl350mg/dl

25.02.12 6 am12 noon4 pm8 pm

210mg/dl74 mg/dl125 mg/dl180 mg/dl

26.02.12 7 am12 noon12 mid night

92 mg/dl182 mg/dl198 mg/dl

27.02.12 8 am12 noon9 pm

108 mg/dl219 mg/dl175 mg/dl

CBG REPORT

Date Time Reading

28.02.12 6 am12 am12pm

124 mg/dl210 mg/dl195 mg/dl

29.02.12 8 am2 pm9 pm

310 mg/dl195 mg/dl170 mg/dl

01.03.12 6 am2 pm10 pm

247 mg/dl160 mg/dl140 mg/dl

02.03.12 7 am12 pm8 pm

210 mg/dl160 mg/dl130 mg/dl

03.03.12 9 am7 pm

201 mg/dl175 mg/dl

04.03.12(D/C) 7 am 200 mg/dl

Normal value of blood glucose- Fasting :90-110 mg/dl PP - :up to180 mg/dl Random :up to 140 mg/dlDoses of Insulin H/A-(Human Atrapid)- <70 = specialist concern 70-200 = no insulin 200-250 = 2 unit 251-350= 4 unit 301- 350 = 6 unit 351-400 = 8 unit >400 = 10 unit

DIETARY MODIFICATION

When patient was admitted in hospital she was unable to take food through mouth. Hence ryles tube was initiated.

After 4 days when she was improving. her diet was changed to soft diet.

On 04.02.12 patient was discharged.Salt restricted soft diabetic diet was

prescribed to her.

DIETARY MODIFICATIONS

Ryles Tube • 24.02.12 – 29.92.12

Salt restricted Soft diabetic diet

• 01.02.12- 04.0312

Discharge diet (salt restricted soft diabetic diet)

• 04.03.12

Ryles tube(special form)(24.02.12-29.02.12)

Fluid allowances= 120mlx10feed x 2 hrly 6 am : Pulmocare(30gm)+water

8 am : bread (2pcs)+ milk(100ml)

10 am :D-protein(30gm)+water

12 noon: Rice(raw 25 gm)+milk(200ml)+ OV(50gm)+fish(50gm)

2 pm : do

4 pm : bread(2pcs)+milk(100ml)

6 pm : D-protein(30gm)+water

8 pm : Rice(raw)(25gm)+milk(200ml)

+one egg white(25gm)

10 pm : DO

12 midnight : pulmocare(30gm)+water

Hospital diet (01.03.12-03.03.12)

Diagnosis – COPD,CO2 Narcosis,DM2,HTN Diet code – S/R,S/D/D INV Menu planning- 6am : D-protein(20gm)+water. 8am : Suji(30gm)+papaya(200gm)+ milk(200ml). 10am : D-protein (20gm)+water. 12 noon : Rice raw(40gm)+dal(15gm)+

cucumber(30gm)/g.papaya(30gm)/ pumpkin(30gm)+Fish

stew(75gm).

MENU OF HOSPITAL DIET

2 pm : D-protein(20gm)+water 4 pm : Tomato soup 6 pm : D-protein(20gm)+water 8 pm : Roti(2pcs)+Dal(15gm)+ lauki(15gm)/ pumpkin(15gm)/ papaya(15gm)/ cucumber(15gm)+Egg(50gm) 10 pm : D-Protein(20gm)+water

NUTRITIONAL MANAGEMENT OF COPD

Good nutrition helps the body to fight infections. Chest infection is common on COPD pateints.So it is important to reduce risk of infection by following a healthy diet.

Diet Principle-Moderate fat, low carbohydrate moderate protein feeding in patient with hypercapnia.

DISCHARGE DIET PRESCRIPTION (04.02.12)

Energy –Energy intake should be increased.Energy intake can be estimated at 35kcal/kg body weight.I suggest to give her 1600 kcal diet.

Carbohydrate – Carbohydrate intake should be restrict because it increased CO2 production.55% carbohydrate of total kcal is suggested.As pateint have DM2 simple sugars are avoided.

Protein – 2gm/kg body weight protein is recommended.It helps to restore lung and muscle strength and promote immune function.

Fat –. Fat kilocalorie produce less co2 than carbohydrate,so high fat diet is prescribed. But patient also have DM2 so I suggest to give her 22% of fat.

Vitamins An adequate intake of vitamin A and C essential for prevent pulmonary infections. Foods with high vitamin A as milk, GLV,egg,some breakfast cereals should be included in diet. Vitamin C rich foods like citrus fruits should also be included.

Minerals- Water balance and phosphorus level should be monitored. Fluid restriction is needed in case of presence of edema. As my patient is suffering from HTN so sodium restriction is needed. So I suggest her salt restricted diet(S/R).

NOTE- Sources of vitamin A and C should be carefully choosen to ensure that they do not produce gas.

MENU PLANNING

6.30 am : D-protein(2 scoops)(30gm)+water.

9.00 am : suji(30gm)+cheena(25gm)/ milk(100ml)+ oats. 10.30am : ripe papaya(100gm) 12.30am : Rice raw(50gm)+ dal(15gm)+any soft

veg(lauki/papaya) Mix veg(100gm) (pumpkin,r,jhinga)

+Fish(75gm)jhol.

4.00pm : leaker tea 1 cup w/o sugar

6.00pm : D-Protein(2 scoops)(30gm)+water

9.30pm : Roti(2pcs)+dal(15gm) any soft veg(100gm)

+Fish(75gm)jhol. 10.30pm: D- protein(2 scoops)(30gm)

+water.

Carbohydrate = 213.22 gm = 852.88 Kcal Protein = 90.53 gm = 362.12 kcal Fat = 39.84 gm = 358.56 kcal Total kcal

=(852.88+362.12+358.56)kcal =1573.56 kcalTotal kcal given to the patient is

1573.36kcal.Total Protein given - 90.53gm

FOODS TO BE INCLUDED OR EXCLUDED

High fibre foods as vegetables,whole grain foods,cereals etc.

Add oranges, musambi,tomato to increase potassium level.

Plenty of fluids. (should drink 6 to 8, eight-ounce glasses of non-caffeinated beverages daily. )

Include complex sugar.

Gas producing foods like beans,brocoli,sprouts, cabbage,cauliflower, corn,raddish, soyabeans,onions etc.

Carbonated beverages.

Fried or spicy foods Salt(Na)in food. Simple sugars like

jam jelly etc.

INCLUDED EXCLUDED

CONCLUSION

Eat cornflakes Oatmeal with

milkDrink plenty of fluids

Use herbs.Better than salt

Protein Booster

Go for potassium

Avoid caffine

Drink milk

Avoid gas producing food Fresh

vegetables

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