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Unformatted text preview: d of disease Dyspnea at rest u Barrel Chest u Accessory & intercostal muscle use u Chest tightness u Wheezing u Weight loss/ anorexia­more with advanced COPD u Fatigue u Tripod Position u Pursed­lip Breathing (see table 29­14 p. 607) u Bluish­red color of skin (late) Complications of COPD u Cor pulmonale – S/S: u Hypoxia, hypoxemia u Enlarged & tender liver u Distended neck veins u Dependent edema u Weight gain – Treatment: u Continuous low flow O2 u COPD Exacerbations – Change in patient’s typical COPD symptoms u Causes: viral, bacterial, environmental factors u Respiratory Failure Diagnostic Studies COPD u PFT u Chest X­rays u H & P u Check serum Alpha 1 Antitrypsin level for deficiency u ABGs (for acidosis) Nursing Care for Pt with COPD u PNA and flu vaccine u Smoking cessation education u Position to maximize ventilation u Drug therapy­stepwise fashion u Airway Clearing Techniques – – Effective coughing (Table 29­23 p. 623) Chest physiotherapy Nursing Care for Pt with COPD Humidified O2 as ordered u Breathing Techniques u – Pursed­lip breathing Provide periods of rest for patient u Nutrition u – – u Eat 5­6 small meals ↑calorie & ↑ protein if underweight Chest Physiotherapy – Percussion, Vibration and Postural Drainage Promote Sleep u Exercise 15­20 min/day three times/week u Cystic Fibrosis Cystic Fibrosis (CF) u Autosomal recessive u Exocrine glands (found in lungs, pancreas, and sweat glands) aren’t working properly due to altered CFTR u Chromosome 7 produces protein CFTR – – CFTR regulates sodium & chloride channels In CF, CFTR is altered & channels are blocked → thick, sticky _______________→ obstructs ________________& glands→ organs to atrophy and then fail CF u Multisystem disease – Altered function of exocrine glands mainly involving: – _____________________ u Lots of thick secretions from mucus glands → chronic obstructive pulmonary disorders →lung tissue destruction – ________________________ u Mucus plugging in pancreas → fibrosis, so amylase, lipase & proteases don’t reach intestine to digest nutrients→ malabsorption of fat, protein & Vit A, D, E, K – ________________________ glands u Produce and excrete excessive amounts of sodium and chloride Cystic Fibrosis Clinical Manifestations u u u u u u u u u Steatorrhea __________________________malabsorption → failure to grow and gain weight Recurrent lung infections Difficulty breathing Productive cough, often viscous green colored sputum GI pain Distal Intestinal Obstruction Syndrome (DIOS) Reproductive Problems Pneumothorax Diagnosis of CF u _____________________Chloride Test – Pilocarpine put on skin to stimulate sweat & carried by small electric current – Collect sweat on filter paper and then analyzed – > 60 mEq/L for sweat chloride = CF – If positive, then perform again to confirm unless genetic testing has been shown 2 CF mutations Nursing Implications u Set reasonable Goals: – Promote clearance of secretions u Chest physiotherapy – – Control lung infections Nutrition u _________________________enzyme replacement of lipase, protease and amylase given before each meal and snack u Supplement with Vit A, D, E, K u Adequate intake of fat, calories, proteins & vitamins u When sweating, ↑ _______________intake Referen...
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This document was uploaded on 03/05/2014 for the course NURS 301 at Liberty University Duplicate.

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