Chronic obstruction pulmonary disorder copd egh-nsg.forum-palestine.com

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Chronic obstruction pulmonary disorder copd egh-nsg.forum-palestine.com

  1. 1. Is a term that to group of conditions characterized by continued increased resistance to expiratory airflow. C.O.P.D includes chronic
  2. 2. Is a chronic inflammation of lower respiration tract characterized by : Excessive mucous secretion. Cough. Dyspnea associated with recurring infection of the lower respiratory tract.
  3. 3. Is a complex lung disease characterized by: Destruction of the alveoli. Enlargement of distal airspace. Breakdown of alveolar wall.
  4. 4.  Excessive secretion of muocus and chronic infection within the airway “ infection, bronchitis, irritation, hypersensitivity” Lead to
  5. 5. Local hyperemia Hypertrophy of muocus gland Increase in sizn and number of mucous producing elements in bronchi “ mucous glands & goblet cells” Inflammation and edema Narrowing and obstruction of air Increase in size of airspace distal to the terminal bronchioles Loss of alveolar wall “ elastic recoil of the lung” Emphysema
  6. 6. Cigarette smoking. Air pollution, occupational exposure Allergy, Autoimmunity Infection Genetic predisposition & aging
  7. 7.  A- chronic bronchitis: Usually insidious developing over a period of years.  productive cough lasting at least 3 months a year for 2 successive years. Production of thick, gelatinous sputum which increased during superimposed Wheezing and dyspnea as
  8. 8.  B- Emphysema “ pulmonary emphysema” gradual onset and steadily progressive Dyspnea decrease exercise tolerance Cough may be minimal except with respiratory infection
  9. 9. 1. Respiration force technique “RFT” demonstrate airflow obstruction Reduce Force ExpirationVolume “FEV” to ForceVital capacity “FVC” 2. ABGs show : decreased PaO2, PH, and Increased PaCO2 3. Chest x-ray : hyperinflation, flattened diaphragm increased retrosternal space 4. Alpha antitrypsin “Genetically” deficiency in Genetic pulmonary emphysema.
  10. 10. Goal: Reverse airflow obstruction 1. Stopped of smoking 2. Bronchodilators drug 3. Antibiotics for respiratory infection 4. Corticosteroid used in acute exacerbation for anti-inflammatory effect 5. Chest physical therapy “ postural drainage, breathing retraining 6. Low flow oxygen therapy for patient with sever hypoxemic 7. Pulmonary rehabilitation to reduce symptoms that limit activity
  11. 11.  When pt with COPD need Mechanical Ventilation: Pt with COPD may need mechanical ventilation if he / she have of sign & symptoms: 1. Restlessness 2. Aggressiveness 3. Anxiety 4. Irritability 5. Confusion 6. Disoriented 7. Central cyanosis 8. Shortness of breathing at rest All of these sign & symptoms may signal for respiratory failure
  12. 12.  Decrease PaO2 more than 55%  Decrease PH more than 7.2  Increase PaCo2
  13. 13.  pneumonia Respiratory failure Right heart failure, dysrrhythaias Depression Mechanical ventilation depenancy
  14. 14.  Nursing assessment  Smoking  Exposure history to drug, occupational or air pollution.  Note amount, color & consistency of sputum.  Inspect for use of accessory muscle. chest muscle, neck muscle, abdominal muscle, “abdominal muscle used during expiration.  Note barrel chest.  Auscultation for decreased/ absent of breathing.  Decreased heart function.  Ask for heart disease.
  15. 15. 1- Improve airway clearance a) Removing all pulmonary irritant “stop smoking, pt’s room free from dust”. b) Administer bronchodilator. c) Use postural drainage. d) Keep secretion liquid by: - highly of fluid intake - inhalation of nebuliger intake - avoid irritant drug if these it increase sputum secretion
  16. 16. 2- improve breathing pattern a) Teach pt to make breathing retaining exercise to stregth diaphragm and muscle expiration. b) Teach pt to use: low costal, diaphragmatic muscle , abdominal breathing in slow way. “slow in relaxed breathing to reduce respiratory rate & decrease energy cost of breathing”. c) Teach pt for relaxation exercise to
  17. 17. 3- Control infection a) Recognized early manifestation of respiratory infection “ increased dyspnea, fatigue, change in color, amount & character of sputum, fever”. b) Obtain sputum culture and antibiotic as culture.
  18. 18. 4- Improve Gas exchange a) report restlessness, aggressive, anxiety, confusion, shortness of breathing a rest, central cyanosis which indicate to acute respiratory insufficiency &may signal respiratory failure. b) Review ABGs. c) Give low flow oxygen as prescribed. d) If CO2 retention occurseek forincubation Mechanical ventilation.
  19. 19. 5- Improving nutrition a) Ask about nutritional history &weight. b) Encourage to frequent small meals if pt is dyspnea, because heavy meal increase abdominal contents may press in diaphragm and impede breathing. c) Offerliquid nutritional supplements to improve caloric intake &counteract weight loss. d) Avoid foods producing abdominal discomfort. e) Encourage pursed-lip breathing between bites if pt is dyspnic
  20. 20. 6- Increase activity intolerance a) Arrange forexercise regimen &physical condition programs. b) Enhance delivery of oxygen to tissue. c) Allows a higherlevel of functioning with greatercomfort. 7- Improving sleep pattern a) Maintain a balanced schedule of activity and rest. b) Use oxygen therapy. c) Avoid the use of sedatives that may cause respiratory depression.
  21. 21. 8- Enhancing coping a) Understand that the shortness of breathing & fatigue make pt irritable, anxious, depress & feeling with helpless /hopelessness b) Demonstrate a positive and interested approach to pt. - Be good listener&show that you care. - Be sensitive to pt fears, anxiety, depression. c) Strength the pt self image d) Allow to the pt to express feeling. e) Support the family members.
  22. 22. A. General education : - Explain of disease forpt &family “ expect, treat & live” - Review with pt the goal of treatment. - Work with pt to set Goals. B. Avoid exposure to respiratory irritant. C. Prevent & treat respiratory infection - Avoid to exposure to person with respiratory infection. - Avoid crowds with poorventilation. - Advise pt how to recognize &report evidence of respiratory infection “ amount, color, consistency of sputum”.
  23. 23. D) Reduce bronchial secretions: - Maintain an adequate fluid intake. - Use bronchodilators - Teach about postural drainage exercise every position from 5 to 15 min.

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