Nursing Care of Patients with Chronic Obstructive Pulmonary Disease with Acute Exacerbation: Two Case Comparative Studies.

Abstract

Chronic obstructive pulmonary disease (COPD) is an abnormality in the lungs’ response to stimulating substances or gasses. The patient with COPD did not gasp for breath in the remission period. When the patient had acute exacerbation, they had cough up phlegm and gasp for breath, abnormal heart function, right ventricular congestive heart failure, and may be death. The nurse who provided nursing care must be aware that the patient must receive adequate oxygen, provided the bronchodilator and anti-inflammatory drug to reduce airway swelling. Then the symptoms improved, the nurse must plan discharge to the patient about rehabilitate lungs, exercise, and to calm the disease.

Objective: To compare the nursing results of two patients with chronic obstructive pulmonary disease who were treated with acute exacerbations.

Methods: The methods were selecting case studies of the patients with COPD with Acute exacerbation, who were admitted for treatment in In-patient department, Nam Khun Hospital. The data were collected during April to June 2021. The data analysis accordance with the concept of nursing process and holistic care concept.

Result: Both patients were elderly men. They were underling COPD, the chief complaint were cough up phlegm and gasp for breath, and used an inhalation drug for 3 times at home but it didn’t improve. The first case, aged 62 years, additional symptoms were high fever, lung sound Crepitation + Wheezing, Chest x-ray found Infiltration both lungs, provided Ceftriaxone IV, Roxithromycin. He was a high blood pressure level and provided amlodipine. The second case was 79 years, additional underling diseases namely asthma and HT. Among treatment, he had AF with tachycardia, provided amiodarone IV, warfarin, amlodipine, enalapril, the chest x-ray found cardiomegaly with infiltration both lung, provided ceftriaxone IV, azithromycin. Both patients received O₂ cannula, Berodual NB and Bromhexine. Received treatment and nursing care according to the problem, the symptoms improved respectively. The doctor discharged them to home, 3 days for length of stay and were the same for both cases.

Conclusion: The patient with COPD with acute exacerbation must provided the bronchodilator and anti-inflammatory drug to clear their airway, oxygen for therapy, and used antibiotics to reduce the cause of recurrence. Including treatment for other complications to keep patients safe. And the important was preparing to discharge the patient to home, so that the patient can take steps to prevent acute exacerbation.