Nursing care of patients with COPD Flashcards
COPD Stats
3rd leading cause of death in US, smoking is primary risk factor.
Bronchitis presentation
Bluish red skin tone, cyanosis, red from polycythemia, tendency for obesity, frequent cough, foul sputum, pulmonary infections. high risk for DVT due to H&H increase.
Emphysema presentation
pursed lip breathing, use of accessory muscles, barrel chest, underweight, progressive DOE, diminished breath sounds, PERSISTENT TACHYCARDIA d/t inadequate oxygenation.
What is COPD
Chronic airway obstruction, airway collapse or inflamation, bronchospasm, swelling, and excess mucus. Air get’s in but is trapped inside.
Risk factors
Repeated lung damage from infections, pollution. Genetics (alpha 1 trypsin deficiency), Cystic Fibrosis. DIRECT AND SECOND HAND SMOKE are 80% of the problem.
Smoking
leading preventable cause of death in the US, if quit 2-5 year risk of stroke falls to that of non smoker, ten years after risk of lung cancer drops by half.
second hand smoke
50,000 deaths from heart disease, 750,000 middle ear infections in children, increases asthma
Nicotine Addiction
smoking allows rapid nicotine addiction, peaks and dissipates quickly. increases levels of dopamine, long term brain change.
Quitting strategies
counseling, medications
smoking interventions
biofeedback, emotional support, counseling
COPD symptom triad
Increased sputum production, cough (bronchitis), Dyspnea on exertion (Emphysema).
Bronchitis Diagnostics
X-ray showing enlarged heart, congested lungs, normal or flattened diaphragm. Pulmonary function test showing an increase in residual volume, a decrease in vital capacity, and a decreased FEV1/FVC ration - less than 70%. Lower circulating O2, and elevated H&H in later stages.
Emphysema Diagnostics
Chest x ray showing hyper inflated lungs, flattened diaphragm, Pulmonary Function test will show an increase in residual volume, a decrease in vital capacity and a decrease in FEV1/FEV ratio. 6 minute test walk on level surface for 6 minutes and measure the distance traveled.
Complications COPD
chronic low )2 levels, pneumonia and other infections, pneumothorax, atelactisis, pulmonary HTN, lung cancer, peptic ulcer disease, Right sided HF, Respiratory failure, increased risk of DVT, fatique, altered mobility, depression, social isolation, shortened lifespan, mechanical ventilator.
COPD medical treatment General Goals
early diagnosis, prevent further deterioration, alleviate symptoms, improve ability to do ADL’s.
COPD general Strategies
medication as needed, regular O2 PRN, early intervention for infections, Chest PT, adequate fluid intake, vaccinations, pulmonary rehab.
COPD nursing care - GOALS
Smoking cessation, managing symptoms, maintain patient airway, promote adequate ventilation, remain free of infections. Maximize functions and maintain performance of daily living, decrease anxiety. Decrease knowledge deficit: Disease, Treatment, Medications.
Nursing Assessments COPD - Respiratory Status
Lung sounds, symmetry, airway clearance, Respiratory effort, use of accessory muscles, pursed lip breathing. Confusion and signs of hypoxemia.
Nursing Interventions COPD - Respiratory Status
Vitals, Labs, O2 as ordered, positioning. Education: avoid pulmonary irritants. Run humidifiers at night, encourage cessation, encourage pursed lip breathing.
Nursing Assessments Nutrition
Weight, I&O
Nursing Interventions Nutrition
Encourage well balanced diet, fluids unless contraindicated, O2 use during meals, adequate time for meals, position properly for meals. EDU: easily prepared meals, lightweight cookware.
Human response SOB
Impaired gas exchange, impaired airway clearance, ineffective breathing pattern.
Human response: Depression
Ineffective Coping
Human Response: Weight loss
Imbalanced nutrition: less than body requirements
Human Response: Anxiety
Knowledge Deficit
Pursed Lip breathing
Reduced hyperventilation, increase CO2 level in alveoli which dilates smooth muscle, keeps airways open longer.
Pursed Lip breathing Results
decreases work of breathing, conserves oxygen, releases trapped air.
Nursing Assessments activity level
self care, activity tolerance
Nursing Assessments Skin
redness, sponginess
Nursing Interventions activity level
pulmonary rehab, maintain a level of physical activity, encourage self care, allow for adequate rest
Nursing Interventions skin
moisturize, reposition, monitor for breakdown - around cannula.
Nursing Assessments coping
behavior changes, mood swings
Nursing Interventions coping
provide emotional support, allow/encourage autonomy, encourage verbalization of feelings, perceptions and fears, encourage identifications of strengths and weaknesses. Provide education about disease.
Early signs of respiratory distress
increased dyspnea, increased fatigue, chest tightness, increased sputum.
Energy saving strategies
tripod sitting, adequate rest periods.
S&S of CO2 narcosis
drowsiness, confusion, increase in respirations and pulse, diaphoresis
length of inhale for inhaler
5-6 seconds, at least one minute between puffs.
spacers
should be used with corticosteroids.
Bronchodialators
albuterol, effects of adrenaline without side effects. short acting -erol. onset in minutes last 4-6 hours.
long acting bronchodilators
salmeterol - hrs
anti-cholinergic
atrovent, spiriva, blocks aceteylcholine, prevents airways from narrowing.
Corticosterioids
advair, flovent, interferes with inflammatory process.
MRC breathlessness scale
1-5 five being too breathless to leave the house.
