SMahalakshmi SCENARIO Here is a 76 yrs old elderly male patient hospitalized for 9 days with complaints of breathlessness and cough with expectoration since 3 days ID: 920595
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Slide1
PARKINSONISM WITH EXACERBATION OF COPD
-
S.Mahalakshmi
Slide2SCENARIO-
Here is a 76 yrs old elderly male patient hospitalized for 9 days with complaints of breathlessness and cough with expectoration since 3 days.
PATIENT DEMOGRAPHICS-
Name- mavappa Age- 76 yrs
Gender- male I.P. No- 0963
CHIEF COMPLAINTS-
c/o, breathlessness and cough with expectoration since 3 days.
Breathlessness insidious in onset and progressive. Sputum was thick and white in
colour
.
Slide3PAST MEDICAL HISTORY-
k/c/o , COPD since 2 yrs and parkinsonism since 1 yr.
PAST MEDICATION HISTORY-
Tab.
Deriphylline
1-0-1
Tab.
Syndopa
100mg 1-1-1
Tab. Amantadine 100mg 1-1-1
SOCIAL /PERSONAL HISTORY-
Patient is a smoker since 25yrs
Alcoholic since 25yrs.
Systemic examination-
rhonchi
heard.
Slide4LABORATORY VALUES-
CHEST X RAY-
Right mild pleural effusion is present.
TEST
VALUES
TLC cumm
12800 ( increased )
ESR
mm/hr
30 (increased )
NEUTROPHILS
82 (increased )
Slide5SOAP ANALYSIS
SUBJECTIVE DATA-
Here is a 76 yrs old male patient hospitalized for 9 days with complaints of breathlessness and cough with expectoration since 3 days.
OBJECTIVE DATA-
The
T
otal
L
eukocyte
Count (12,800)
is increased- which indicates infection/ inflammation.
The
ESR (30)
values are increased - which indicates infection.
The
Neutrophil
(82)
values are increased- Neutrophil values are increased in COPD conditions.
Chest X- Ray indicates presence of mild pleural effusion in the right lung
Slide6ASSESSMENT-
1.
Breathlessness
- it occurs due to excessive mucous production and mucous plugging in the airways. (in COPD there will be hypertrophy of the mucous glands and goblet cells causing excessive production of mucous, there would also be impairment in the mucociliary function hence the mucous is not expelled out causing airway obstruction of airways).
2.
Cough with Expectoration
- cough is the protective reflux of the body to expel out sputum, through the activation of mechano and chemoreceptor present in the airways.
3.
COPD
- it is a progressive, irreversible chronic obstructive airway disorder characterized by airway obstruction.
Slide7Here the patient is a chronic smoker since 25 yrs. So smoking could be the possible etiology involved in the causation of COPD. Smoking generates release of oxidants. These oxidants react with various proteins and lipids in the cell leading to the cell and tissue damage. Oxidants also promote inflammation by release of various chemical mediators like TNF-
α
and IL-8, through the activation of neutrophils. Oxidants due to smoking also causes the imbalance of protease and antiprotease.
4.
PARKINSONISM
-
It occurs due to lack of dopaminergic neurons in the substantia nigra. Thereby deficiency of dopamine occurs due to which there will be a loss of control of muscle tone and coordination of movements.
Imbalance between neurotransmitters like dopamine and acetyl choline .
Slide8Slide9S.No
BRAND NAME
GENERIC NAME
DOSE
&
REGIMEN
9/1
10/1
11/1
12/1
13/1
14/1
15/1
16/1
17/1
1.
I. LEVOFLOX
levofloxacin
100ml
1-0-0
y
y
y
y
y
y
2.
I.
GRAMOCEF
Ceftriaxone
1gm
1-0-1
y
y
y
y
y
y
3.
I. RANTAC
ranitidine
150mg
1-0-1
y
y
y
y
y
y
y
y
y
4.
I.
DERIPHYLLINE
Theophylline
1amp
1-0-1
y
y
y
y
y
y
y
y
y
5.
TAB.
SYNDOPA
levodopa
+
carbidopa
100mg
1-1-1
y
y
y
y
y
y
y
y
y
6.
T.
AMANTADINE
amantadine
100mg
1-1-1
y
y
y
y
y
y
y
y
y
7.
DUOLIN.
NEB
Salbutamol+ ipratropium
1-1-1-1
y
y
y
y
y
y
y
y
y
8.
MUCOMIX.
NEB
Acetyl cystein
1-1-1-1
Y
y
y
y
y
9.
TAB.
D3
Calcium + vitamin D
1-0-0
y
y
y
Slide10DISCHARGE DRUGS-
1. tab.
Rantac
150mg 1-0-0
2. tab. Syndopa 100mg 1-1-13. tab. Deriphylline
1-1-1
4. tab. Amantadine 100mg 1-1-1
5.
duolin
nebulizer 1-1-1-1
6. tab. D3 1-0-0
INTERVENTION
-
Note- corticosteroid is usually given in the treatment of COPD, but the drug was not given during the patient hospitalization.
PATIENT COUNSELLING-
Medication
-
Take
rantac
daily after breakfast.
Take
syndopa
thrice daily after food. This drug can cause drowsiness in the daytime hence driving vehicle or running any machinery should be avoided.
Slide11Take
theophylline
on empty stomach.
Take 2 to 3 puffs of
duolin nebulizer for every 6 hours.Take tablet D3 daily morning after breakfast.Use caution while rising from sitting position.
Disease
-
Avoid stress
Avoid smoking/ abstain from smoking
Avoid exposure to allergens/ smoke
Strict adherence to medications is encouraged.
Help the patient improve perception of the disease through education.
Adherence to medications is encouraged.
Avoid tea/ diary products.
Avoid alcohol.
Slide12Exercise can prevent complications of Parkinson's disease like bent posture.
If the speech is slurred, then consult a speech therapist.
Slide13THANK YOU