COPD the condition is also know as chronic obstructive pulmonary disorder case study. This is winning case study presentation for Just for hearts case study competition. Refer to these slides to know more about this case.

1. Case Study On
Chronic Obstructive Pulmonary
Disease (COPD)
By Mrittika Ganguly

2. 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

3. 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.

4. DIAGNOSIS
COPD
CO2 NARCOSIS
DM2 (DIABETES MELLITUS TYPE 2)
HTN (HYPERTENSION)

5. 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.

6. PULMONARY AND SYSTEMATIC
FEATURES OF COPD

7. Signs and symptoms of COPD
a) Cough and sputum
production.
a) Shortness of breath.
b) In advace stage presence
of oedema.
a) Wheezing.
b) Anorexia .
c) Chest tightness.

8. 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.

9. 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.

10. 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)

11. BIOCHEMICAL REPORTS
BIOCHEMIC
AL TESTS
TIME OF
ADMISSION
DURING
STAY
TIME OF
DISCHARG
E
NORMAL
RANGE
Hb
RBC
Neutrophil
Basophil
Eeosiphil
Monocyte
9.7
4.22
86
00
02
01
9.7
89
00
04
00
11.9
00
4
2
12-15
00
2-8%
2-4%
Na 123 133 137 135-138mEq
K 2.9 2.2 3.1 3.5-5.5
Creatinine(m
g/dl)
1.2 1 1 0.6-
1.1mm/Eq
Urea(mg/dl) 50 18 23 10-30mgldl

12. BIOCHEMICAL REPORTS
BIOCHEMI
CAL
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%

13. CBG REPORT
DATE TIME READING
24.02.12 9pm
1am
4am
298mg/dl
457 mg/dl
350mg/dl
25.02.12 6 am
12 noon
4 pm
8 pm
210mg/dl
74 mg/dl
125 mg/dl
180 mg/dl
26.02.12 7 am
12 noon
12 mid night
92 mg/dl
182 mg/dl
198 mg/dl
27.02.12 8 am
12 noon
9 pm
108 mg/dl
219 mg/dl
175 mg/dl

14. CBG REPORT
Date Time Reading
28.02.12 6 am
12 am
12pm
124 mg/dl
210 mg/dl
195 mg/dl
29.02.12 8 am
2 pm
9 pm
310 mg/dl
195 mg/dl
170 mg/dl
01.03.12 6 am
2 pm
10 pm
247 mg/dl
160 mg/dl
140 mg/dl
02.03.12 7 am
12 pm
8 pm
210 mg/dl
160 mg/dl
130 mg/dl
03.03.12 9 am
7 pm
201 mg/dl
175 mg/dl
04.03.12(D/C) 7 am 200 mg/dl

15. Normal value of blood glucose-
 Fasting :90-110 mg/dl
 PP - :up to180 mg/dl
 Random :up to 140 mg/dl
Doses 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

16. 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.

17. 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

18. 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

19. 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).

20. 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

21. 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.

22. 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.

23.  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.

24. 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.

25. 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.

26.  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 kcal
Total kcal given to the patient is 1573.36kcal.
Total Protein given - 90.53gm

27. 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. )
 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

28. CONCLUSION
Eat cornflakes
Oatmeal with milk Drink 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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