Mr. D has a hx of emphysema and Chronic bronchitis. He is 73 years old & a retired farmer. Recently...
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Transcript of Mr. D has a hx of emphysema and Chronic bronchitis. He is 73 years old & a retired farmer. Recently...
COPDCydnee Patterson, Ali Lubbers,
Nicole Newinger, Heidi Proudfoot & Kaitlin Oudshoorn
SenarioMr. D has a hx of emphysema andChronic bronchitis. He is 73 years
old & aretired farmer. Recently he has
foundthat he can no longer walk around
hisfarm without extreme SOB. He is
treatedat the outpatient clinic today forincreasing SOB, occuring even at
rest
Subjective Data Reports sputum production
increased over past week & color has changed to greenish/yellow
Has more sputum in morning & it gradually reduces throughout the day
Taking Salbutamol (Ventolin) inhaler & Fluticasone (Flovent) inhaler 2 puffs q6hrs
On no other meds @ this time
Objective Data Appears frail & older than stated age Labored breathing & visible use of
accessory muscles during respiration Sitting in orthopneic position & using
pursed-lip breathing VS: BP normal; P 96; R 28; T 38.8c AG: pH 7.36; PaO2 55 mm Hg; PaCo2
65 mm Hg Upon chest assessment: crackles in
lower lt. lobe; diffuse expiratory wheezing t/o chest; lower lt. lobe dull to percussion.
http://video.about.com/copd/COPD.htm
Chronic obstructive pulmonary disease (COPD) is a long term lung disease that usually includes emphysema and chronic bronchitis. It slowly damages the airways & air sacs making it difficult for the patient to breath. The disease includes symptoms such as shortness of breath, increased mucus and coughing. COPD cannot be cured, but it can be treated.
Triggers of COPD
Viral Infection Bronchiolitis Deviation from diet Discontinuation of Meds Inhalation of environmental
inhalants Small airway mucosa hyperemia
PneumoniaCould Mr. D. have pneumonia?
Pneumonia is an inflammation of the lung tissue caused by a microbial agent. Conditions such as COPD, and especially bronchitis, put individuals at an increased risk for developing such infections as their defense mechanisms are weakened. This inflammation causes the accumulation of fluid in the lungs, and can cause symptoms such as:
Greenish- yellow sputum production Labored breathing with use of accessory muscles Shortness of breath Crackles on auscultation and dullness on percussion of
affected lobe Increased respiratory rate Increased temperature
And Mr. D. has all of these symptoms! So could it be???
As the nurse… Smoking cessation Medication education Oxygen therapy Positioning Vaccinations Diet Exercise Breathing techniques
Now… lets try something…
ABG’sArterial Blood Gases Normal Ranges Critical Ranges
Partial Pressure of oxygen (Pa02)
75-100mm Hg (9.9-13.2 kPa)
<40 mm Hg
Partial Pressure of carbon dioxide (PaC02)
35-45 mm Hg 94.6-5.9 kPa)
<20 mm Hg
Ph 7.35-7.45 <7.2 or >7.6
Bicarbonate (HCO3) 20-29 mEq/L (20-29 mmol/L)
<10 mmol/L or 40 mmol/L
Oxygen Content (O2CT)
15-22 mL per 100 mL of blood (6.6-9.7 mmol/L)
Oxygen Saturation (O2Sat)
95%-100% (0.95-1.00) <60%
Common Nursing Dx
Ineffective Airway Clearance r/t bronchoconstriction, increased mucous, ineffectie cought, infection
Auscultate breath sounds q1-4 hrs; Monitor resp patterns, depth, effort; Monitor ABG’s & O2Sats; Positioning; Deep breathing & coughing; Observe sputum
Impared Gas Exchange r/t ventilation-perfusion inequality
Monitor resp patterns, depth, rate, effort; O2Sats; Auscultate breath sounds q1-2 hrs; Monitor for cyanosis; Positioning; Deep breathing & coughing
Risk for Infection: due to status of respiratory secretions
Monitor for s/s of infection; Note & report lab values; Use hand hygiene; Use standard precautions; Encourage fluid intake
COPD TRIGGERS & PATHOLOGY
NURSING CARE
PNEUMONIA
100 100 100
200 200 200
300 300 300
JEPOARDY
Can you tell me how I got, how I got COPD?
Discontinuation of medicationOr a viral infectionCan you tell me how I got, how I got COPD?
Bronchiolitis or from switching your dietThis may have worsened your diseaseCan you tell me how I got, how I got COPD?
Being in a dusty placeTo much mucus in your airwaysThis can make it harder to breathSo this is how I got, how I got COPD… how I got COPD!!
ReferencesBarnett, M. (2008a). Management of end-stage chronic
obstructive pulmonary disease. British Journal of Nursing 17 (22). p. 1390-1394. Retrieved February 07, 2009 from Health Source: Nursing and Academic Edition Database.
Barnett, M. (2008). Nursing management of chronic obstructive pulmonary disease. British Journal of Nursing 17 (21). p.1314-1318. Retrieved February 07, 2009 from Health Source: Nursing and Academic Edition Database.
Causes and types of chronic obstructive pulmonary disorder (2009). Retrieved February 8, 2009, from http://video.about.com/copd/COPD.htm
Celona, A.F. (20. 02). Diagnosing and treating community-acquired pneumonia. Physician Assistant, 26(1), 38-50
Celona, 2002; Mayo Foundation, 2007; Smeltzer & Bare, 2004COPD (2009, January 8). Retrieved February 9, 2009, from
http://www.lung.ca/diseases-maladies/copd-mpoc_e.php
ReferencesCOPD-ALERT 2000. (2008). It’s a matter of breath and death!
Retrieved February 3, 2009, from http://www.copd-alert.com/COPD.html
Day, R., Paul, P., Williams, B., Smeltzer, S., & Bare, B. (2007). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 1st Canadian ed. Philadelphia, PA: Lippincott Williams & Wilkins.
Essig, M. G. (2008). Seniors health: COPD's effect on the lungs. Retrieved February 8, 2009, from https://www.blueshieldca.com/hw/articles/hw_article.jsp?articleId=HWUG1539ABC&fromCategoryId=8&_requestid=1602421
Healthwise (2008, June 17). Arterial Blood Gases. Retrieved February 9, 2009, from http://www.webmd.com/a-to-z-guides/arterial-blood-gases
Smeltzer, S.C. & Bare, B.G. (2004). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Tuder, R., Voelkel, N. (2000). COPD Exacerbation. Chest, 14, 376-379. Retrieved from www.chestjournal.org on Feb. 2, 2009.
Name 3 causes of COPD exacerbation.
Any of the following may exacerbate COPD: - Viral Infection- Brochiolitis- Deviation from diet- Discontinuation of Meds- Inhalation of environmental inhalants- Small airway mucosa - Hyperemia
What 3 conditions or diseases(HINT: One we discussed…) are commonly associated with COPD exacerbation.
Emphysema, Bronchiolitis, and Pneumonia.Asthma may also trigger COPD.
True or False:Morphine should never be given to patients with COPD because it dangerously slows their respirations.
False – True in that it does slow their respiration rates but in doing so, allows the breathing to be more efficient and reduces the feeling of breathlessness.
What two common vaccinations are always suggested to COPD patients?
S. Pneumonia & Influenza.
What are two types of breathing that are useful to teach to patients with COPD?
Pursed Lip and Abdominal breathing techniques.
What are other causes of pneumonia besides viral & bacterial infection?
Aspiration & Fungal.
Name three health risks that increase likely hood of getting pneumonia?
Pulmonary diseases, Smoking, Surgery, Trauma, Decrease immune system, Alcohol use, Hospitalization.
How does the respiratory system of a healthy individual differ from that of an individual with COPD?
In COPD the bronchial tubes become inflamed, narrowed and filled with mucous, lungs then loose elasticity and the alveoli burst creating large spaces.
Name three non-specific symptoms of pneumonia.
Headache, Dypsnea, Fatigue, Sweating, Chest pains, Chills, Cough, Decreased temperature in elderly.