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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:oSpirometry test-go into resp. therapy BREATHE OUT CO2determine level of airflow obstruction oChest XRAY – will see a FLAT diaphragm & hyperinflated lungs = in COPD pt’s
oIf genetic – may suspect Antitrypsin* levelsoBaseline of Artierial blood Gas (ABG)o6 minute WALK TEST– determine how oxygen levels do when they do activity (with a continuous pulse oxygen) walk the pt with a continuous pulse oxygenwhere it starts to decrease like 85% notehow 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 oxygenoCOPD assessment testoBODE INDEX for COPD Survival Predictionhow you monitor process of the disease based on the score – the higher the score the worse the COPD isBody mass index (obesity b/c hard to breath= duh), airflow Obstruction, Dyspnea and Exercise capacity how you monitor the process of the diseaseCARE?-Tell them to STOP SMOKING!-Meds to reduce symptoms – BronchodilatorLong acting beta agonistINHALED corticosteroids** (decrease inflammation)OLDER ADULTS need to be in higher doses of INHALE corticosteroidsoside effects: increase chances of glaucoma and decreases bone densityinhaler – ALWAYS START ON LOWERDOSE 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-NUTRITIONIS IMPORTANT HIGH protein dietconserve energy 30 minutes before meals (b/c it takes a lot of effort to eat)increase fluid intake to 3L per day BEFORE mealuse Bronchodilator BEFORE meal (open airway, make it easier to breathe)if underweight may need additional protein and calories-SURGICAL THERAPY FOR COPDLung volume reduction surgeryNURSING 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 geneticsINTERVENTIONS:Medication teachingEducate indoor/outdoor pollutionAmbulatory – refer them to PULMONARY REHAB (for lungs--Exercising and also get education
AMBULATORY CARE & HOME CARECOMPLICATIONS OF COPD?-Respiratory failure -Pneumothorax-Atelectasis-Pneumonia-Pulmonary HTN COR PULMONALECOPD-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 failurewhat are early signs?