▣ COPD : chronic destruction, irreversible
▪ 가장큰 원인은 smoking
▪ hypoxia (PaO2<80)
▪ hypercapnic (pH<7.35, CO2>45)
▪ SPO2 88-93% : normal for COPD pt
▪ clubbing finger(곤봉형 손가락) d/t chronic hypoxia
▪ RBC 증가 d/t body attempts to copensate for the long term hypoxia
▪ ☆ anemia는 copd 증상 아님!!!
▶ COPD 환자 target SPO2 88-92%
▪ target 유지되며 discharge시 집에서 nasal prong 정도 유지
▪ venturi mask 적용할 경우 22-28%정도만 venturi로 주어야함. 그 이상 되지 않도록
| ▶ Emphysema(pink puffer) | ▶ chronic bronchitis(blue bloater) |
| 1) pursed-lip breathing 2) Barrel chest 3) no chronic cough 4) keep tripoding 5) hyperresonance when percussing the lungs |
1) cyanosis(hypoxia) : big&blue skin 2) chronic cough & sputum 3) crackles & wheezing 4) edema peripherally: Rt. HF, body with fluid -> edema, JVD & wt gain - Tx: hypoxia, hypercalnic -> BIPAP!!! * 약(albuterol, steroids, nebulizer)& O2주는 거 우선 아님 * hypercapnic sx monitor: M/S (restless, LOC저하, confusion) ▶ COPD exerbation - opioids(morphine, ~odone), Benzos(~lam, pam) -> breathing slow -> surpress breathing => 오더있으면 clarify |
▶ Diet, Nsg
1) oral hygiene before meals
2) eat small, frequent
3) high cal, protein
4) avoid high amounts of CHO
5) avoid exercise 1hr before & after meals
6) avoid gassy foods(*가스유발식품) (carbonated drinks, high fiber foods) -> gas forming -> bloating, more
pressure on the diaphragm
7) 2-3L/day oral fluid (but X during meal)
8) infection sign: sputum증가, fever, dyspnea 악화
9) Vaccine: 폐렴 5년마다, Flu 매년
10) meds: Albuterol -> airflow 높여줌
11) before bed- mobilize secretion 할 수 있는 약
12) cool mist humidifier
13) pursed lip breathing : Inhale 2secs & exhale 4secs with pursed lip-> airway collapse(air trapping) 방지위함임.
14) huff coughing-> secretion 많은 환자에게 좋은 기침법
- sit up in chair
- deep slow inhalation
- hold breath 2-3secs -> fully exhale
- 5~10sec normal breathing (normal coughing X)
- repeat 1~2 more
| COPD : irreversible 폐포 손상 | ||
| Cause | Sx | Complication |
| 1) smoking ★(1순위 원인) 2) air pollution(직업적 공기오염도 포함) 3) chronic respiratory infection genetic( ↓ alpha-antitrypsin) |
productive or non-productive cough dyspnea wheezing crackles rhonchi Wt loss barrel chest(AP diameters ↑) prolonged expiration orthopnea cardiac dysrhythmia hypoxia ※rusty sputum: pneumonia Sx ※diminished both lung sound : pneumothorax Sx |
pneumonia pulmonary hypertension corpulmonale - 심장에까지 문제가 생김 long term steroid use: Na ↑ => BP↑, K↓, osteoporosis, glucose intolerance(BST ↑), 위산분비 ↑ -> peptic ulcer disease, |
| Intervention | ||
| ▪ coffee - noon전에 마시는것은 괜찮음. afternoon X ▪ pneumonia 생기는지 monitor - record about sputum : color, amount, consistency ▪ expiration 등 breathing 힘들경우rest, pursed lip breathing, diaphragm breathing, inspirometer 도움됨 ▪ diet: high calorie, high fat, high protein, 3끼 챙겨 먹기 힘드므로 small, frequent ▪ stress, depression, anxiety care ▪ shower assistive device(ex. bench) 같은것 필요 ▪ hot/cold exposure 피하기 ▪ immunozation 할 것 있음 하기 ▪ 기침시 pillow를 abdomen에 지지 ▪ 집안 먼지 청소는 피하기 ▪ oral fluid intake ↑ ▪ air pollution 심할 때에는 stay indoor (밖에 잠깐 나갔다오는것도 X) ▪ regular exercise - 3times a week ▪ OTC 맘대로 약 X , 처방된 것은 괜찮음(ex. 수면제..) ▪ NSAIDs 계통 쓰지 X - asthma attack 위험 높아짐 ▪ 수면시 머리 살짝 높여서 - pillow *2 사용 ▪ milk - 자기전 금기!! => milk: mucous ↑ -> coughing, wheezing ▪ 갑자기 dyspnea 있을 경우 - accessary muscle 이용해서라도 breathing 할 수 있도록 벽에 기대 어 앞으로 구부려 숨쉬게끔 ▪ 다학제 의뢰: dietitian, respiration therapist, speech therapist - 숨쉬는것이 힘들어 말을 계속 끊기며 이야기 |
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