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Respiratory medicine copd nursing rounds

Updated: 2019-09-12

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Respiratory Medicine Nursing Care for Patients with Chronic Obstructive Pulmonary Disease (COPD) on December 14, 2015 Secondary Condition • 34 beds X Female 64 years old • Diagnosis: COPD Type Ⅱ Respiratory Failure Chronic Pulmonary Cardiopathy • Patient Cause "Frequent cough, sputum, shortness of breath for 40 years, plus one week's rest" was admitted to the hospital on November 15, 2015. The patient has frequently presented with cough and white foam-like sputum since more than 40 years ago, which is more frequent sooner or later, more frequently in winter and spring, and lasts for more than 3 months. He has planned 6 times of "acutely exacerbated COPD period" in our hospital for anti-infection and elimination Phlegm, cough, antispasmodic and asthma were all relieved by medical treatment. In 2010, the lung function examination was heavily blocked, moderate, and impaired general energy. This time, one week ago, the patient developed symptoms of cough and sputum after the cold, accompanied by fever, shortness of breath, and drowsiness. He was taking anti-inflammatory and antiasthmatic medication at home. . • Patient's past history: deny epidemics such as hepatitis, negate diabetes and hypertension history. Minor conditions • Admission examination: T: 38.1 < C; P: 110 times / minute; R: 25 times / minute; BP: 145 / 90mmhg. The patient was cold, with a chronic face, slightly shortness of breath, mild cyanosis on the lips, and mild edema in both lower extremities. Assistant check B-ultrasound: liver, gallbladder, pancreas, spleen and kidney were not seen very often, a small amount of pleural effusion. ECG: sinus rhythm. The chest radiograph showed that the slow branches of both lungs and emphysema were accompanied by infection. A blood test routine for a recent test (2015-12-3): white blood cells 10.1 〜 109 / L, red blood cells 3.35 〜 1012 / L, white egg white 37g / L, B-type natriuretic peptide 8754 pg / ml, blood gas analysis shows partial pressure of carbon dioxide 55mmHg, oxygen partial pressure 75.75mmHg. Recently, the patient's appetite is still acceptable, and the symptoms of shortness of breath are reduced compared with admission, but the symptoms of shortness of breath and subsidence still appear after minor details, and the cough and sputum are improved. Decreased physical strength, poor sleep, normal stools, and reduced urine output. • Healing: symptomatic treatment with anti-inflammatory, asthma, diuretic, nutrient support, oxygen therapy • Specific medications: isopamicin, colamin, dexamethasone, doxofylline, lansoprazole, speed Pee. Oral: Gai Sanchun, spironolactone, digoxin, compound methenamin, Kedalong, Miya tablets. COPD Global 2011 (GOLD) • Chronic obstructive pulmonary diseases (COPD) is a common disease that can be prevented and treated, and is characterized by persistent airflow limitation. Restriction of airflow often develops progressively, with the addition of airways and lungs to chronic inflammation caused by harmless particles or gases. • Symptoms of COPD include: breathing difficulty, chronic cough, and chronic sputum. • Clinical diagnosis requires lung function check. FEV1 / FCV 0.70 after bronchodilator inhalation indicates persistent airflow limitation, which can diagnose COPD. Health evaluation • Nursing evaluation: • The patient has no recent poor living affairs, medical insurance charges, general psychological response, patient understanding of the disease department, family members, no special private needs; no pain or sorrow; 2 points for nutrient assessment. The patient's daily subsistence department took care of himself; the self-care ability score was 55 points; the high-risk score was 6 points for the evaluation of pressure ulcer elements, 4 points for the fall assessment of the bed, and 1 point for the catheter evaluation. Health assessment • Nursing examinations • Patients with chronic illness and weight loss. Clear, bilateral pupils and other large circles, active light reflection; sclera without yellow staining, normal eye movements; skin pigmentation around the eyes; no redness and swelling in the ears, free access to the external auditory canal, and average hearing; no nasal tenderness and nasal septum No curvature, smooth nasal cavity; pale lips, oral mucosa intact, most teeth are scattered. The neck is soft and uncompromising, the jugular veins are slightly full, the carotid arteries are beating in general, the thyroid is normal, no tremor is touched, and no mass is seen. Xinjing: The shape of the anterior region of the heart is symmetrical on the left side without any bulging or collapse. Auscultation of the heart rhythm is 70 beats / min. The rhythm is uniform. No murmur of each valve is heard and the pulsation under the xiphoid process is strengthened. Abdominal examination: flat inspection, abdominal wall veins are not obvious, no bowel shape and crawling waves are seen; auscultation bowel sounds are average; palpation of the abdomen is soft, no tenderness, no touch of the liver and spleen and ribs; no percussion of the percussion. The muscles of the limbs are average, the joints are free, and the knee reflexes and Achilles tendon reflexes are present. The skin is flawless, the skin is elastic, and the lower limbs are slightly edema. There is one oxygen pipe, the label is clear, the double fixation is in place, and the ineffective oxygen inhalation; the automatic position, the physical examination is done together, the words are clear, and the answer questions are posted. Health assessment • Nursing examinations • Pulmonary examinations: inspect the patient's barrel chest, widened intercostal space, shallow breathing, symmetrical breathing on both sides; palpation centered, speech tremor weakened in both lungs, and no costal friction Percussion was overreacted, with over-voiced sounds, lower lung lowering, and mobility decreased; auscultation revealed that the breathing sounds of both lungs were weakened, the expiratory phase was delayed, the alveolar breathing sounds were weakened, and the left lower lung was audible and scattered with wet rales. Existing Nursing Problems I. Clearing the respiratory tract is ineffective: thin sputum is taken and cough is weak. • Nursing policy: The patient's breathing connection is unobstructed, and sputum can be effectively discharged. • Nursing methods: 1. Promote expectoration: the significance of expectoration to patients, (automatically) motivating patients to take deep breaths and ineffective coughing, (passive) in accordance with the doctor's advice and giving aerosolized inhalation to dilute sputum, and help to turn over and pat back. Oral care after expectoration. 2. Check the cough and sputum environment for the color, nature and amount of sputum. 3. Insufficient water intake can connect the wet airway mucosa. In view of the patient's indecent body fluids, excessive fluid intake should be avoided, and fluid intake should be controlled. 4. Treatment: Use phlegm and cough medicines as prescribed by your doctor, and use bronchodilators to relieve bronchospasm. • Shen evaluation: changes in the amount, nature, breath, color of sputum, breathing patterns and breathing sounds. Existing Nursing Problems 2. Impaired gas exchange: Resilience of lung tissue is reduced, and ventilation and ventilation are impeded. • Nursing policy: The arterial blood gas analysis value of the patient is in the fundamental category. The patient eased from complaining of asthma symptoms. • Nursing methods: 1. Encourage patients to ineffectively cough and sputum, and connect the airways; 2. Connect the indoor air of the patient is novel, its room temperature and humidity are suitable, temperature control is 20-22 ℃, humidity 50% -70%, sooner or later Ventilation once, 15-30min each time; 3. Rest in bed to reduce oxygen consumption, instruct the patient to use the body to lean forward in a semi-recumbent position, so that the auxiliary breathing muscles take part in breathing; 1-2L / min; Non-invasive mechanical ventilation is given to assist treatment when needed; 5. Instruct the patient's ineffective breathing techniques, such as abdominal breathing and constricted breathing; 6. Look closely for changes in the condition, if there is any headache, dizziness, Symptoms of pulmonary encephalopathy such as restlessness, change; 7. Use respiratory stimulants and bronchodilators as required by your doctor, and closely observe the side effects of the drug. Instruct patients to use MDI. • Shen evaluation: changes in heart rate and breathing frequency, rhythm and cyanosis. Changes in arterial blood gas interpretation values. Existing Nursing Problems III. Intolerance of the program: Hypoxia, asthma, and impaired lung function are related. • Nursing policy: the endurance of the program is gradually increased without symptoms of wheezing; the program is weak, and the feeling of frustration is reduced or disappeared. • Nursing methods: 1. Evaluate the relevant elements of the program's endurance, and try to eliminate and reduce the relevant factors; 2. Continuous low-flow oxygen inhalation of 1 to 3 L / min, increase the partial pressure of arterial blood oxygen, and prevent myocardial and cerebral hypoxia. Rest in bed after bedtime, add program volume slowly; 3. Patiently explain to patients, eliminate serious and disturbed emotions, and make them treat together; 4. Patients rest and sleep adequately, reduce unnecessary physical programs; 5. Strengthen inspections and check Whether the patient's program tolerance can be added, and the daily needs of the patient can be handled at any time for the patient; 6. The patient cooperates with the plan to formulate the program plan, place the program and rest time reasonably, first let the patient show the limbs on the bed, and then the bedside program Step by step, it is advisable for patients to tolerate; when they go out to check, they will be accompanied by a special person when they go to the latrine. • Shen evaluation: the patient's tolerance of the program and an indication of endurance of the program; changes in breathing, heart rate, and rhythm during the program.

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