4. Medical-surgical nursing: Assessment and management of clinical problems. Monitor the effectiveness of O2 therapy (e.g., pulse oximetry, ABGs). Explain, as indicated, that mechanical ventilation may be necessary and this would necessitate intensive care support. Long-term oxygenation for chronic hypoxemia has been shown to reduce mortality. Option A: Asthma may be one of the chronic pulmonary diseases but atelectasis is not. B. Parenchyma. ROM exercises help build stamina and prevent complications of decreased mobility. 3. We invite you to navigate through our informative and complete website to fully prepare for your next appointment by referral. C. Pulmonary vasculature. Current medical diagnosis & treatment 2020. The small pulmonary arteries vasoconstriction due to hypoxia. The BODE index will result in a score of zero to ten dependent upon FEV1, body-mass index, the distance walked in six minutes, and the modified MRC dyspnea scale. Once you are finished, click the button below. Collect, analyze, report, and disseminate COPD-related public health data . An effective nursing care plan will help the client with COPD to achieve the goals and the patient. Bullectomy. Patients with COPD expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass. Mosby, Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Nursing management of patients suffering from this disease is aimed at helping to control individual patient's symptoms and improve their quality of life. Two diseases common to the etiology of COPD are: A. Sputum evaluation and sputum culture: An increase in the quantity of sputum production and the presence of neutrophils is often a sign of an acute exacerbation. Assist with active range-of-motion (ROM) exercises. Bullae and blebs are not effective in gas exchange, as they do not contain the capillary bed that normally surrounds each alveolus. D. Fifth. By Daral Chapman, sRN Last updated Feb 2, 2020. Document assessment findings including respiratory rate, character of breath sounds; frequency, amount and appearance of secretions laboratory findings and mentation level. COPD heterogeneity: Gender differences in the multidimensional BODE index. Third. 3 . Patients with chronic CO2 retention may have chronically compensated respiratory acidosis with a low normal pH (7.35-7.38) and a Paco2 greater than 50 mm Hg. Mortality from COPD among women has increased, and in 2005, more women than men died of COPD. At McLaren Greater Lansing, we are committed to delivering quality care to our patients and providing excellence in the treatment of lung conditions such as asthma and bronchitis to more serious conditions such as chronic obstructive pulmonary disorder (COPD), lung disease, and emphysema. Document attainment or progress towardsgoals. Adapted from Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2013). Smoking depresses the activity of scavenger cells and affects the respiratory tract’s ciliary cleansing mechanism. 2. Airway Clearance Techniques: ACTs include effective coughing, chest physiotherapy, airway clearance devices, and high frequency chest ventilation. Volume of air present in the lungs at the end of passive expiration. To monitor and manage potential complications: During evaluation, the effectiveness of the care plan would be measured if goals were achieved in the end and the patient: It is important for the nurse to assess the knowledge of patient and family members about self-care and the therapeutic regimen. The chronic inflammatory process affects the pulmonary vasculature and causes thickening of the vessel lining and hypertrophy of smooth muscle. Be sure to grab a pen and paper to write down your answers. High-protein, high-calorie nutritional supplements can be offered between meals. Option C: Alveolar wall destruction leads to loss of alveolar attachments and a decrease in elastic recoil. SABA + anticholinergic, e.g. The abnormal inflammatory response in the lungs occurs primarily in the: The airways, parenchyma, and pulmonary vasculature undergo inflammation in COPD. Chapter 29 Nursing Management Obstructive Pulmonary Diseases Jane Steinman Kaufman There's so much pollution in the air now that if it weren't for our lungs there' d be no place to put it all. These two types of COPD can be sometimes confusing because there are patients who have overlapping signs and symptoms of these two distinct disease processes. Describe the nursing management … The objectives of effective COPD management are to: Prevent disease progression. Option D: Tuberculosis and pleural effusion are not chronic pulmonary diseases. Nursing management of COPD. Pulmonary Emphysema is a pathologic term that describes an. AAT deficiency is a genetic risk factor for COPD. SpO2 at 87% or less can indicate need for O2 therapy. If loading fails, click here to try again. Global Initiative for Chronic Obstructive Lung Disease (GOLD). McGraw-Hill Education. Obtain a clear history of the disease process and assess for exposure to risk factors. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Provide information about disease process/prognosis and treatment regimen. Management of COPD consists of reduction of risk factor exposure (for example, smoking cessation), influenza vaccination, pharmacotherapy, and pulmonary rehabilitation. Six-Minute Walking Distance: The distance walked in 6 minutes (6MWD) is a good predictor of mortality in patients with moderate COPD. Allergens. To evaluate patient response to therapy. As the disease condition progresses, hypoxemia worsens and hypercapnia may develop. Option A: The airways are inflamed in COPD. C. Fourth. D. Areas identified in all of the above. Breathlessness: is the most significant symptom. People with emphysema are also called “pink puffers”. Assessment of the respiratory system should be done rapidly yet accurately. Peripheral airway obstruction also results in V/Q imbalance and, combined with respiratory muscle impairment, can lead to CO2 retention, particularly in severe disease. Chronic Obstructive Pulmonary Disease (COPD) Nursing Management. Now on his late fifties, he started to notice that his cough has been going on for more than three months. Inflammation of central airways: Chronic exposure to cigarette smoke, noxious particles and gases causes abnormal inflammatory response throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature. Option A: The airways are inflamed in COPD. Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Chest Radiography: Chest radiographs of emphysematous patients reveal signs of hyperinflation, including flattening of the diaphragm, increased retrosternal air space, and a long, narrow heart shadow. Inflammation, hypersecretion of mucus, and alveolar wall destruction are included in the pathophysiology of COPD. The index uses the four factors to predict risk of death from the disease – Body-mass index, airflow Obstruction, Dyspnea, and Exercise capacity. No time limit for this exam. Desired Outcome: Following treatment/intervention, the patient’s breathing pattern improves as evidenced by reduction in or absence of reported dyspnea and related symptoms. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. Nurses have a central role in the care and management of people with chronic obstructive pulmonary disease. Peripheral airway remodeling: The hallmark feature of COPD is airflow limitation during forced exhalation. Severe AAT deficiency leads to destruction of lung tissues by proteases and can cause premature bullous emphysema. Other common systemic diseases include cachexia (skeletal muscle wasting), osteoporosis, diabetes, and metabolic syndrome. MEDICAL MANAGEMENT The treatment goal for the client with COPD are: To improve ventilation To facilitate the removal of bronchial secretions To promote health maintenance To reduce complications, and To slow progression of the disease 37. (GOLD – Global Initiative for Chronic Obstructive Lung Disease). BODE index: The BODE index is a multidimensional scoring system used to test patients who have been diagnosed with COPD and to predict mortality. D. Characterized by variations in all of the above. A comprehensive program includes exercise training, nutrition counseling, and education and provides benefits to patients with all stages of COPD. Be mindful of the weather (very cold weather can aggravate the bronchi) Allergens like dust or pollen. Pulmonary hypertension may progress and lead to hypertrophy of the right ventricle of the heart (cor pulmonale) and may eventually lead to right-sided heart failure. The predominant inflammatory cells are neutrophils, macrophages, and lymphocytes. Treatment of infection (antimicrobial therapy at the first sign of respiratory infection) Oxygenation in low concentrations for severe hypoxemia. New York: The McGraw-Hill Companies. Pulmonary & Critical Care Consultants is a specialty practice concentrating on pulmonary (lung) disease, critical care medicine and sleep disorders.Our physicians and staff strive to provide you with the best care and clinical expertise. These include cough, worsening dyspnea, progressive exercise intolerance, sputum production, and alteration in mental status. There are two main types of emphysema: panlobular and centrilobular. Please visit using a browser with javascript enabled. Serum Chemistries: Monitor serum sodium and potassium levels. 1. Etiology: viral /bacterial infections, air pollution, ICU admission and mechanical ventilation for life-threatening exacerbations, Nursing assessment should include the following. Patients with advanced disease may experience tachypnea and respiratory distress with simple activities. Patient who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease. Individuals with COPD may become hypoxic during increased activity and require oxygen therapy to prevent hypoxemia, which increases the risk for exacerbations of the COPD. Elevate head of the bed and provide an over bed table for the patient to lean on. As an outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent study guide writer for student nurses. SpO2 at 93% or more can indicate need for decreasing O2 therapy. Patients may have a predominance of chronic bronchitis or emphysema, and it is often difficult to determine because the conditions usually coexist. This disease … Option B: Hypersecretion occurs due to the increase in the number of goblet cells. Nursing care for COPD patients focuses on managing symptoms, maximizing function, and teaching skills to enhance self-care. 22, In Papadakis, M. A., In McPhee, S. J., & In Rabow, M. W. (2020). 2. Ventilation-perfusion (V/Q) mismatch: Continued air trapping causes destruction of alveolar walls, and bullae (large air spaces in the parenchyma) and blebs (air spaces adjacent to pleurae) can form. Option C: Infectious agents are part of the risk factors for emphysema but it is not the main factor. Diagnosis and assessment of COPD must be done carefully since the three main symptoms are common among chronic pulmonary disorders. The natural balance of protease/antiprotease is thus altered and results in the destruction of the alveoli and loss of the lungs’ elastic recoil. Safety check Because many seniors have more than one chronic condition, drug interactions are more likely for them. Option A: Air pollution is a risk factor in the development of emphysema but it is not the primary factor. Mosby. MANAGEMENT MEDICAL MANAGEMENT SURGICAL MANAGEMENT NURSING MANAGEMENT 36. Chronic Obstructive Pulmonary Disease (COPD) Care Management Assessment. a disease of increasing public health importance around the world.COPD The underlying pathophysiology of COPD is: A. Inflamed airways that obstruct airflow. Option B: Allergens may contribute to the development of emphysema but it is not the main factor. salbutamol and ipratropium bromide via nebulizers × 3 back-to-back q15min, If allergic to penicillin, Fuoroquinolone or doxycycline. Assess the signs and symptoms of COPD and their severity. Cough: Productive cough is a common symptom (usually worse in the mornings and produces a small amount of colorless sputum). These are side effects of bronchodilator therapy. In this phase the effectiveness of nursing care to meet the set goals are evaluated. B. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective.To diagnose your condition, your doctor will review your signs and symptoms, discus… Thoracic examination reveals the following: Certain characteristics allow differentiation between a disease that is predominantly chronic bronchitis and that which is predominantly emphysema. Inflammation, hypersecretion of mucus, and alveolar wall destruction are included in the pathophysiology of COPD. Adequate hydration helps decrease sputum viscosity for patients with chronic increased sputum production. •Sørensen D, Frederiksen K, and Grøfte T, Lomborg K. Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses. Assess respiratory and oxygenation status as indicated by the patient’s condition. Option C: Infectious agents are part of the risk factors for emphysema but it is not the main factor. There is impaired carbon dioxide and oxygen exchange, and the exchange results from the destruction of the walls of overdistended alveoli. Assist with measures to facilitate gas exchange. Source: Lewis S. M, Dirksen S. R, & Heitkemper M. M.(2014). Such a consultation enables a comprehensive nutritional assessment and possible additional therapies, including nutritional counseling related to the disease process. This is a community of professional nurses gifted with literary skills who share theoretical and clinical knowledge, nursing tidbits, facts, statistics, healthcare information, news, disease data, care plans, drugs and anything under the umbrella of nursing. Nursing Interventions and Rationales. You have entered an incorrect email address! Option B: Hypersecretion occurs due to the increase in the number of goblet cells. Sustained (>48 h) episodes of increased dyspnea and cough and change in the amount and character of sputum. Oral bronchodilators may be used in patients who cannot use inhaled devices efficiently. Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): 1. A wide range of viral, bacterial, and mycoplasmal infections can produce acute episodes of bronchitis. Cochrane Database Syst Rev . Smoking cessation is the only measure known that slows the progression of COPD so it should be considered at all stages of the disease. This “overinflated” state causes dyspnea and limited exercise capacity. 151-5. Lung Transplantation. Management of patients ith COPD takes a more reactive approach than a curative approach. Also, this page requires javascript. Surgical Therapy for COPD: Three different surgical procedures have been used in severe COPD. NIPPV has been shown to increase blood pH, reduce Paco2, and reduce severity of dyspnea in the first 4 hr of treatment, possibly eliminating the need for mechanical ventilation in some patients. COPD: Learn More, Breathe Better ® Backed by the National Heart, Lung, and Blood Institute, this group helps increase awareness of COPD and offers education and insights to help you manage your symptoms. Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). 2. The key to avoiding a flare-up of … Wheezing (frequently heard on forced and unforced expiration). B. The pathogens cultured most frequently during exacerbations are Streptococcus pneumonia, Haemophilus influenzae and Pseudomonas aeruginosa. •Scullion JE, Holmes S. Palliative care in patients with chronic obstructive pulmonary disease. Effective COPD management plan includes four components: (1) assess and monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage exacerbations. Since we started in 2010, Nurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Attempting oral intake while using NIPPV may result in aspiration. If you continue to use this site we will assume that you are happy with it. If this activity does not load, try refreshing your browser. Option C: Pneumonia and pleurisy are not classified under the COPD.
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