They might appear to be resting comfortably but actually arent Abdominal

They might appear to be resting comfortably but

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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: 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
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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
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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?
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  • Spring '17
  • Chronic obstructive pulmonary disease

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