copd教學(xué)查房演練 ppt課件

1、慢性阻塞性肺疾病CHRONIC OBSTRUCTIVE PULMONARY DISEASE目錄一、定義三、流行病學(xué)二、病案介紹四、病因與發(fā)病機制五、臨床表現(xiàn)六、實驗室檢查七、診斷要點八、治療要點九、護理診斷及措施十、健康教育 CONTENTS1. Definition3. Epidemiology2. Clinical Case4.Etiology & Pathogenesis5. Clinical Manifestation 6. Laboratory Tests7. Diagnosis8. Treatment9. Nursing Diagnosis & Implementa

2、tions10. Health Education關(guān)鍵詞 (Key Words)咳嗽 cough咳痰 sputum production呼吸困難 dyspnea桶狀胸 “barrel-shaped” chest氣流受限 airflow limitation急性加重期 acute exacerbations氣體交換受損 impaired gas exchange清理呼吸道無效 ineffective airway clearanceAE、什么是慢性阻塞性肺疾病(COPD)？、哪些人群更容易患COPD？、作為醫(yī)護人員，我們應(yīng)該如何診斷、治療？、作為21世紀的新護士，我們應(yīng)該如何提供護理？考慮一、C

3、OPD定義慢性阻塞性肺疾病簡稱慢阻肺，是一種以慢性阻塞性肺疾病簡稱慢阻肺，是一種以氣流受限為特征的可以預(yù)防和治療的疾病，氣氣流受限為特征的可以預(yù)防和治療的疾病，氣流受限不完全可逆、呈進行性發(fā)展。流受限不完全可逆、呈進行性發(fā)展。Chronic obstructive pulmonary disease: COPD, is a preventable and treatable disease. It is characterized by airflow limitation. The airflow limitation is not fully reversible and usually

4、progressive.Definition二、COPD病案介紹姓名：郭其文 性別：男 年齡：83歲簡要病史： 患者二十余年來反復(fù)出現(xiàn)咳嗽、咳痰，無咯血及胸痛，無低熱、盜汗。兩天前受涼后咳嗽、咳痰加重，痰量多，為黃色粘痰，畏寒，感咽痛聲嘶。查體：T：36.4，P：80次/分，R：19次/分，BP：126/72mmHg臥位）,可見桶狀胸，橫膈下移，肢端發(fā)紺。X線：雙肺紋理增多、肋間隙增寬增粗，確診為“慢性阻塞性肺疾病”，為進一步診治于2019年8月14日收住我院。Clinical CaseName: Qiwen Guo Gender: male Age: 83Case history： The

5、patient complained of cough and sputum production over 20 years. In the past two days, he has been having a cold, an exacerbated cough productive of yellow mucous sputum. PE: T: 36.4, P: 80/min, R: 19/min, BP: 126/72mmHg (supine).“Barrel-shaped” chest, downward displacement of diaphragm, acrocyanosi

6、s are existed. Chest fluoroscopy: increased bilateral lungs markings, widened intercostal spaces. He was diagnosed as COPD and admitted on August 14th, 2019.體格檢查三、流行病學(xué) 03-04年，我國通過對七個地區(qū)的40歲以上人群抽樣調(diào)查發(fā)現(xiàn)，COPD總患病率為8.2%，患病率存在性別、地區(qū)等差異。1. 吸煙 ； Smoking2. 職業(yè)性粉塵及化學(xué)物質(zhì)； Occupational dusts and chemicals3. 空氣污染； Ai

7、r pollution4. 呼吸道感染； Respiratory tract infection5. 其他 Others四、病因與發(fā)病機制四、病因與發(fā)病機制有害顆?；驓怏wCOPD病理學(xué)改變蛋白酶氧化應(yīng)激抗氧化物抗蛋白酶粘液分泌增加肺實質(zhì)破壞肺血管壁增厚氣道壁結(jié)構(gòu)重塑氣流受限炎癥反應(yīng)五、臨床表現(xiàn)：病癥 1. 慢性咳嗽 晨間明顯，白天較輕，睡眠時有陣咳或排痰。 Chronic cough It is obvious in the morning and relieved in the daytime. There is a paroxysmal cough or sputum production

8、 when sleeping. 2. 咳痰 為白色粘液或漿液性泡沫痰，偶可帶血絲。急性發(fā)作伴細菌感染時，痰量增多，可有膿性痰。 Sputum production There is a white mucus or serous frothy sputum, with blood occasionally. The sputum would be too much and purulent with bacterial infection.五、臨床表現(xiàn)：病癥 3. 氣短或呼吸困難 僅在體力勞動或上樓等活動時出現(xiàn)，病情重時日?；顒右材芨械綒獯?，是的標志癥狀。 Shortness of breat

9、h or dyspnea It only appears when laboring, going upstairs or doing other activities. Patient may feel unwell even in daily activities when it is worse, which is the signal symptoms of COPD.五、臨床表現(xiàn)：病癥 4. 喘息和胸悶 重度病人或急性加重時出現(xiàn)喘息和胸悶. Asthma and chest distress Critically serious patients may show asthma an

10、d chest distress in acute exacerbations.五、臨床表現(xiàn)：病癥五、臨床表現(xiàn)：病癥 5. 其他 晚期病人有體重下降，食欲減退等全身癥狀。 Others Terminally ill patients have systemic symptoms such as weight loss, loss of appetite.視診 桶狀胸，呼吸淺快，嚴重者可有縮唇呼吸。 Inspection Barrel-shaped chest, rapid and shallow breathing, severe cases may have pursed-lip breat

11、hing.五、臨床表現(xiàn)：體征 觸診 觸覺語顫減弱或消失。Palpation Tactile fremitus is weakened or disappeared.五、臨床表現(xiàn)：體征 叩診 呈過清音，心濁音界縮小，肺下界和肝濁音界下降。Percussion It sounds too voiceless, the border of cardiac dullness narrows, inferior boundary of lung and the border of hepatic dullness go down.五、臨床表現(xiàn)：體征 聽診 兩肺呼吸音減弱，呼氣延長，部分病人可聞及干性啰音

12、和或濕性啰音。Auscultation Breath sounds reduces, expiratory sound extends, some patients can be heard wheezes or moist crackles.五、臨床表現(xiàn)：體征 I 級：輕度級：中度級：重度IV級：極重度COPD嚴重程度分級FEV1/FVC0.7,FEV180%預(yù)計值FEV1/FVC0.7,50%FEV180%預(yù)計值FEV1/FVC0.7,30%FEV150%預(yù)計值FEV1/FVC0.7,FEV130%預(yù)計值或FEV150%預(yù)計值Stage I: MildStage II: ModerateS

13、tage III: SevereStage IV: Very Severe Severity ClassificationFEV1/FVC0.7, FEV180% predictedFEV1/FVC0.7, 50%FEV180% predictedFEV1/FVC0.7, 30%FEV150% predictedFEV1/FVC0.7, FEV130% predicted or FEV115 h/d). Nursing Implementations 5. 呼吸功能鍛煉呼吸功能鍛煉（1縮唇呼吸方法： 閉嘴經(jīng)鼻吸氣，縮唇緩慢呼氣，同時收縮腹部。（二護理措施 (1) Pursed-lip brea

14、thing Method : Close your mouth and use your nose to breathe in. Then purse lip and exhale slowly. At this time, you must contract the abdominal muscles.5. Respiratory function exerciseNursing Implementations（2腹式呼吸方法： 用鼻緩慢吸氣，膈肌最大限度下降，腹肌松弛。呼氣時用口呼出，腹肌收縮，膈肌松弛。 如下圖:（二護理措施 (2) Abdominal respiration Breat

15、he in with your nose, in order to put down your diaphragm muscles furthest and relax your abdominal muscles. Breathe out with your mouth, to contract your abdominal muscles and relax your diaphragm muscles.Method: Nursing Implementations 患者呼吸困難減輕、呼吸頻率減慢、發(fā)紺減輕、心率減慢、活動耐力增加、呼吸功能得到改善。 The symptoms of dys

16、pnea and cyanosis was lightened, breath rate and heart rate slowed down, activities endurance increased and respiratory function improved.（三護理評價九、護理診斷、措施及依據(jù)清理呼吸道無效Ineffective Airway ClearanceB相關(guān)因素 Related factors1.分泌物多而黏稠 Sticky mucus 2.氣道濕度減低 The low humidity of windpipe3.無效咳嗽 Ineffective coughing（

17、一護理依據(jù) 1. 病情觀察病情觀察 密切觀察咳嗽咳痰情況，包括密切觀察咳嗽咳痰情況，包括痰液的顏色、量及性狀，以及咳痰痰液的顏色、量及性狀，以及咳痰是否順暢。是否順暢。Patients condition observation: Observe closely about the state of coughing, including the sputum color, nature, odour and quantity.（二護理措施 2. 用藥護理注意觀察藥物療效和不良反應(yīng)。（1止咳藥（2祛痰藥（二護理措施 Medication nursing:Especially observe t

18、he therapeutic effects and the side effects.(1) Antitussive (2) Expectorant3. 對癥護理 患者胸痛時，常隨呼吸、咳嗽而加重，可采取側(cè)臥位。Symptomatic nursing: When the patient is suffering the chest pain, the pain usually increases following breathing and coughing. Lateral position can be adopted.（二護理措施 1. 患者能有效地將痰咳出，保持呼吸道暢通。 The

19、 patient is able to expectorate the sputum effectively and keep the respiratory tract open.2. 患者掌握了有效的排痰技巧。 The patient masters effective skills of expectoration.（三護理評價九、護理診斷、措施及依據(jù)焦慮 AnxietyC 相關(guān)因素 Related factors 1.健康狀況的改變 Health condition changed 2.病情危重 Severity 3.經(jīng)濟負擔 Economic burden （一護理依據(jù)1.了解患者的

20、心理狀態(tài)及其原因 TO understand the patients psychological state and reasons.（二護理措施 2.與家屬和患者進行溝通 Communicate with family members and the patients3.制定康復(fù)計劃和協(xié)助康復(fù)活動 Make rehabilitation programs and help rehabilitation activities.4. 教給患者緩解焦慮的方法 Teach patients the ways to relieve anxiety.（二護理措施 患者焦慮情緒緩解，積極配合治療與康復(fù)活

21、動。 The patient relieves anxiety, and cooperate with treatment and rehabilitation activities . （三護理評價十、COPD健康教育飲食指導(dǎo) 12有效排痰指導(dǎo) 3 用藥指導(dǎo) 4長期家庭氧療指導(dǎo)5 疾病知識指導(dǎo)1. Food Nutrition Guidance2. Long- term Domiciliary Oxygen Therapy3. Effective Expectoration Guidance 4. Medication Guidance5. Disease Knowledge Guidanc

22、e Health Education1. 進食高熱量、高蛋白、高維生素的食物； Keep in the high-protein, high-calorie, multi-vitamins digestible diet.2. 避免進食產(chǎn)氣和引起便秘的食物； Avoid the foods which can cause gas and constipation .（一飲食指導(dǎo) Food Guidance Limit the salt intake less than 3. 限制食鹽的攝入：每日食鹽量小于6克。6 grams every day.（一飲食指導(dǎo) Food Guidance4. 少

23、量多餐，餐后避免 平臥，利于消化；（一飲食指導(dǎo) Food Guidance 可穩(wěn)定或阻斷肺動脈高壓的發(fā)展,增加動脈血氧飽和度,改善缺氧癥狀，提高生活質(zhì)量和生存率。（二長期家庭氧療 Long- term Domiciliary Oxygen Therapy1. 家庭氧療注意事項: 供氧裝置“四防”：防火、防震、防熱、防油 To use oxygen apparatus safely, we should do as the following tips:fireproofing,shockproofing, heatproofing， greaseproofing. （二長期家庭氧療 Long-

24、 term Domiciliary Oxygen Therapy2. 定期清潔、消毒供氧裝置，預(yù)防感染。 In order to prevent the infection, we shoud clean and disinfect the oxygen apparatus regularly.（二長期家庭氧療 Long- term Domiciliary Oxygen Therapy 鼓勵病人有效咳嗽，清除呼吸道分泌物。對痰液粘稠不易咳出者和年老體弱者，可給予翻身、拍背、霧化吸入、祛痰劑等協(xié)助排痰。（三有效排痰指導(dǎo) Effective Expectoration Guidance Encou

25、rage the patients to cough effectively which can help to clear the respiratory secretions. For the people who are difficult to expectorate due to viscosity and the elderly, some measures can be given such as turning over, clapping back, aerosol inhalation,expectorant,etc.to assist the expectoration.（三有效排痰指導(dǎo) Effective Expectoration Guidance （三有效排痰指導(dǎo) Effective Expectoration Guidance COPD患者在疾病穩(wěn)定期,應(yīng)遵醫(yī)囑使用支氣管舒張藥,如2受體激動劑和抗膽堿藥，教會病人正確的吸入方法和注意事項，囑患者切勿自行停藥、減藥，指導(dǎo)患者在用藥過程中注意觀察藥物療效和不良反應(yīng)，定期復(fù)診，如有不適，及時就診。 （四用藥指導(dǎo) Medication Guidance Instruct the patients to use drugs with doctors advice and tell them the prop