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Saint Marys University

Bayombong, Nueva Vizcaya

Graduate School

In Partial Fulfillment of the Requirements in
Master of Science in Nursing- Adult Health Nursing 201


Submitted to:
Mrs. Hazel M. Valmores, RN, MSN, USRN

Submitted by:
Mark Anthony T. Tabago, RN

1. Explain the pathophysiology of emphysema.

(See separate page for pathophysiology)

2. Are D.Z.s VS and Sa0
appropriate? If not, explain why?

Yes D.Z.s vital signs and oxygen saturation are appropriate to the
situation because he is in acute exacerbation meaning his condition gets worse;
thus, he will manifest tachypnea and tachycardia as compensatory mechanism;
and the oxygen saturation will be low. In the data, D.Z.s respiratory rate is 36
cpm, pulse rate is 124 bpm and oxygen saturation of 88%.

3. Identify three (3) nursing measures you could try to improve oxygenation.

The following are nursing interventions to improve oxygenation:
Place patient in Orthopneic position or high Fowlers position to maximize
lung expansion and to reduce respiratory effort
Teach effective breathing patterns such as pursed-lip breathing and
diaphragmatic breathing to improve ventilation in the alveoli by maintaining
intrathoracic pressure at the end of exhalation
Encourage patient to cough or huff every 1 to 2 hours, drink 10 glasses of
fluid a day if not contraindicated, and humidify inspired air to improve airway
clearance and remove mucus from airways allowing better ventilation
Administer supplementary oxygen at 2 Lpm to improve oxygenation/ tissue

4. Explain the main purpose of the following classes of drugs: antibiotics,
bronchodilators, and corticosteroids.

Antibiotics are given to treat infections as most exacerbations are triggered by
bacterial infections; Antibiotics may be used to help fight respiratory infections
common in people with emphysema, such as acute bronchitis, pneumonia
and the flu
Bronchodilators are given to improve airflow; Bronchodilator medications may
help to relieve symptoms of emphysema by relaxing and opening the air
passages in the lungs
Corticosteroids are given to decrease inflammation if bronchodilators are not
sufficient; Corticosteroids can help relieve symptoms of emphysema
associated with asthma and bronchitis

5. What are the two most common side effects of bronchodilators?

Patients who have COPD are often prescribed medications called
bronchodilators. Bronchodilators work by relaxing and expanding the smooth
muscle of the airways making it easier to breath. Three types of bronchodilators
are commonly used for the treatment of emphysema: beta adrenergic agonists,
anticholinergics, and methylxanthines.

Common side effects of beta adrenergic agonists includes
Premature ventricular contractions

Common side effects of anticholinergics are
Dry mouth
Metallic taste

Common side effects of methylxanthines includes
Heart dysrhythmias

6. You deliver D.Z.s dietary tray, and he commends how hungry he is. As you
leave the room, he is rapidly consuming the mashed potatoes. When you
pick up the tray, you noticed that he hasnt touched anything else. When
you question him, he states, I dont understand it. I can be so hungry but
when I start to eat, I have trouble breathing and I have to stop. Explain this
phenomenon based on your knowledge of breakdown of carbohydrates

Carbohydrates tend to produce more carbon dioxide when broken down
which forces the lungs to work harder to expel the gas from our bodies. This
explains why D.Z. experience difficulty breathing when eating.

An important nutritional objective is to reduce the amount of carbon
dioxide being produced by the body. Carbohydrate is the macronutrient that
increases RQ (respiratory quotient) which is a measure of the ratio of the volume
of CO2 expired to the volume of oxygen consumed. By decreasing carbohydrate
in the diet, we are effectively decreasing the amount of CO2 produced, thereby
decreasing the burden of expiration on the patient. This also helps to decrease
respiratory infections and acidosis associated with emphysema. Therefore, the
prescribed diet is high in fat (as much as 55%) and protein and low in

7. Identify four (4) strategies that might improve his caloric intake

The following are strategies that improve caloric intake:
Eat meals when energy levels are at their highest, which is usually in the morning
Eat several small, nutrient-rich meals to avoid becoming breathless while eating
Eat slowly and chew foods thoroughly to avoid swallowing air while eating
Choose foods that are easy to chew. Modify food consistency if mastication
seems to increase fatigue while eating
Choose foods that are easy to prepare to conserve energy for eating
Limit salt. Consuming too much can cause the body to retain water and can
make breathing more difficult
Eat calcium- and vitamin D-rich foods to support bone health
Prepare meals that appear palatable and well presented
Avoid foods that cause gas or bloating. A full abdomen can make breathing
Eat while sitting up to ease lung pressure
Drink liquids at the end of the meal to avoid feeling full while eating
Wear a cannula while eating if continuous oxygen is prescribed. Eating and
digestion require oxygen, so the body will need the extra oxygen
Limit caffeinated beverages, as caffeine can interfere with some medications and
cause nervousness or restlessness
Make the meal more enjoyable by engaging in social interaction while dining
Avoid aspiration by breathing carefully, swallowing, and sitting properly and with
good posture while eating
Rest before meals

8. Identify three (3) expected outcomes of D.Z.s treatment.

D.Z. will maintain patent airway as evidenced by decreased wheezes, decreased
tachypnea, decreased dyspnea, and arterial blood gas (ABG) within normal limit
D.Z.s breathing pattern will improve as evidenced by respiratory rate within
normal limit
D.Z. will demonstrate behavior/lifestyle changes to regain and/or maintain
appropriate weight as evidenced by increased in weight of 1 kg per week

9. You answer D.Z.s call light, and he asks for a carton of milk. You remind
him that milk causes an increased production of thick mucus. He replies
Yes, but you told me that I need lots of protein. How should you

If I were in that scenario, I would tell to D.Z. that there are other food
sources that are rich in protein aside from milk that he can take in because milk
increases mucus production thus, worsens his condition- provokes difficulty of
breathing due to increase mucus production. I would enumerate other sources of
protein like meat, egg, and the like.

10. You notice a box of dark chocolate on D.Z.s overbed table. He tells you
that he wakes at night and eats four or five pieces of chocolate. Several of
your COPD patients have identified craving for chocolates in the past. What
is the basis for this craving?

Breathing is very difficult for the COPD patient and tends to worsen as the
disease develops. Just breathing causes the person to consume approximately
1,000 calories more on a daily basis than people who dont have the disease.
Besides being delicious, chocolate provides more calories quicker than eating large
amounts of other foods. The caffeine in chocolate is a natural bronchodilator,
allowing the person to breathe easier after eating chocolate.

11. What would you do to address dietary and nutritional teaching needs with
D.Z. and his wife?

One of the best ways to address dietary and nutritional teaching needs with
D.Z. and his wife is to include them in the planning of care. Including the patient and
his significant others in planning of care will increase the patients compliance to
treatment regimen. How to do it? You should set an appointment with them and
have a lecture about proper diet and nutrition for patients with emphysema using
visual aids such as pamphlets or videos. Afterwards, allow them to ask clarificatory
questions with you; and if possible, ask them to state what they have learned.

12. List six educational topics that you need to explore with D.Z.

The following are educational topics to be explored with D.Z.:
Smoking Cessation Education (Ways on how to stop/quit smoking)
Exercise Regularly (Importance of exercise)
Influenza Vaccination (Avoiding respiratory infections)
Nutrition (Adequate and Proper Nutrition)
Medication Education (Compliance to Medical Treatment Regimen)
Lung Volume Reduction Surgery Education

13. What other health care professional would probably be involved in D.Z.s
treatments and how? What is the license/certification status of that
professions in the state in which you are practicing?

Physician- make the diagnosis
Assessing the patient
Administering medications
Patient education
Dietitian- prepares food for the patient
Nutritionist- computes caloric intake of the patient
Physical Therapist- assist patient to find ways of increasing their strength and
activity tolerance
Respiratory Therapist
Assess patients cardio-respiratory system
Administer and interpret diagnostic breathing and blood test
Administer medical gases and medicated aerosol therapy to manage and
control breathing related abnormalities
Provide continuous invasive and non-invasive mechanical ventilation
Insert and maintain a variety of artificial airways
Assist the physician during flexible fiberoptic bronchoscopy services

14. How would you respond to her?

First of all, I will let the wife express all her concerns for me to assess and
prioritize it accordingly. By listening to her concerns I will be able to identify the
root or the cause why the wife is acting that way; and for that I would be able to
limit possible effects/complications that may arise by attending directly to the root
or cause of the problem. Secondly, I will be assessing her coping mechanism;
and I will offer/suggest other coping mechanisms that she may utilize since her
coping mechanism is no longer working for her. Third, I would explain to her the
condition of his husband that the weight loss she noticed was really expected for
COPD patients; and I will encourage her to lengthen her patience and
understanding for her husband because support mechanism is one factor that
may hasten the recovery of the patient.

Lastly, about her financial concerns, I will refer her to a social worker and
make an arrangement for both of them to discuss concerns about hospital bills/
financial bills.