They might appear to be resting comfortably but

They might appear to be resting comfortably, but actually aren’t.
-
Abdominal surgery can lead to ineffective ventilation and respiratory failure due to the inability to take
deep breaths.
CONFIRM DX:
o Spirometry test -go into resp. therapy  BREATHE OUT CO2  determine level of airflow
obstruction
o Chest XRAY – will see a FLAT diaphragm & hyperinflated lungs = in COPD pt’s

o If genetic – may suspect Antitrypsin* levels
o Baseline of Artierial blood Gas (ABG)
o 6 minute WALK TEST – determine how oxygen levels do when they do activity (with a continuous
pulse oxygen) walk the pt with a continuous pulse oxygen  where it starts to decrease like 85%  note
how much DISTANCE they were at when they started to drop oxygen!
 Short distance  BAD(difficult breathing)
 Determines how severe the disease is & if they need home oxygen
o COPD assessment test
o BODE INDEX for COPD Survival Prediction 
how you monitor process of the disease based on the score –
the higher the score  the worse the COPD is
 B ody mass index (obesity b/c hard to breath= duh), airflow O bstruction,
 D yspnea and E xercise capacity  how you monitor the process of the disease
CARE?
-
Tell them to STOP SMOKING!
-
Meds to reduce symptoms –
 Bronchodilator
 Long acting beta agonist
 INHALED corticosteroids** (decrease inflammation)
 OLDER ADULTS need to be in higher doses of INHALE corticosteroids 
o side effects: increase chances of glaucoma and decreases bone density
 inhaler – ALWAYS START ON LOWER DOSE
 Long acting bronchodilators – act on long period of time
-
Maintain O2 sat -- 90%>
-
Always start with LOW LITER FLOW
-
Teach to Breathe better 
 Diaphragmatic breathing (DECREASES RR= helps control the SOB)
 Purse lip breathing (pucker up lips for expiration/prolong exhalation-slows
expiration/EXTENDING EXPIRATORY PHASE CO2),
 effective COUGHING (get secretions out to Chronic Bronchitis pt)
 Postural drainage
-
NUTRITION IS IMPORTANT 
 HIGH protein diet
 conserve energy 30 minutes before meals (b/c it takes a lot of effort to eat)
 increase fluid intake to 3L per day BEFORE meal
 use Bronchodilator BEFORE meal (open airway, make it easier to breathe)
 if underweight  may need additional protein and calories
-
SURGICAL THERAPY FOR COPD
 Lung volume reduction surgery
NURSING Management – focus on HEALTH PROMOTION:
-
Smoking cessation/education
-
Identify diagnosis early  decrease progression of the disease
-
Make sure family is aware of hx of COPD, especially genetics
INTERVENTIONS:
Medication teaching
Educate indoor/outdoor pollution
Ambulatory – refer them to PULMONARY REHAB (for lungs--Exercising and also get education

AMBULATORY CARE & HOME CARE
COMPLICATIONS OF COPD?
-
Respiratory failure
-
Pneumothorax
-
Atelectasis
-
Pneumonia
-
Pulmonary HTN  COR PULMONALE
COPD
-
Tripod position
-
Clubbing
-
Loss of body mass/tone
-
Orthopnea
-
Fatigue
-
Wheezing
-
Pursed Lip Breathing
-
Chronic Cough
-
Dyspnea
-
Bronchitis- Increased Sputum
-
LATE STAGE -- Cor Pulmonale (right side heart failure), clubbing, barrel chest
Respiratory failure
what are early signs?