老年copd病人的護理課件

1、老年慢性阻塞性肺疾病病人的護理（二）湘雅二醫(yī)院 蘇晶老年慢性阻塞性肺疾病病人的護理（二）一 老年COPD病人的主要護理問題二 老年COPD病人的護理措施 湘雅二醫(yī)院老年?？谱o士培訓一 老年COPD病人的主要護理問題1.氣體交換受損：與呼吸道阻塞，炎癥，痰液過 多有關。2.活動無耐力：與疲乏、呼吸困難、氧氣供給與消耗失衡有關。3.焦慮：與病情反復、自理能力下降、經(jīng)濟狀況緊張有關。4.潛在并發(fā)癥：肺性腦病、休克、肺源性心臟病、DIC。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施一般護理 增加呼吸功能 用藥指導 心理護理 4123湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施

2、（一）一般護理飲食 休息與活動 皮膚二 老年COPD病人的護理措施（一）一般護理1、飲食攝取充足的蛋白質、熱量、維生素和微量元素時刻注意“八分飽”應盡量少吃或不吃容易產(chǎn)氣的食物多喝水 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（一）一般護理2、休息與活動病人采取舒適的體位安排適量的活動養(yǎng)成良好的睡眠習慣合理使用安眠藥室內溫濕度適宜 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（一）一般護理3、皮膚-預防壓瘡的發(fā)生 定時變換體位 必要時使用氣墊床 保持大小便失禁病人皮膚干燥 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能 有效排痰 氧療呼吸功

3、能訓練二 老年COPD病人的護理措施（二）增加呼吸功能1.呼吸功能訓練（1）縮唇呼吸（2）腹式呼吸（3）呼吸訓練器 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能1.呼吸功能訓練-縮唇呼吸 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能1.呼吸功能訓練-腹式呼吸 湘雅二醫(yī)院老年專科護士培訓二 老年COPD病人的護理措施（二）增加呼吸功能1.呼吸功能訓練-呼吸訓練器 湘雅二醫(yī)院老年專科護士培訓二 老年COPD病人的護理措施（二）增加呼吸功能 2.有效排痰 多飲水 霧化 指導病人有效咳痰 叩擊排痰 體位引流 湘雅二醫(yī)院老年專科護士培訓二 老年

4、COPD病人的護理措施（二）增加呼吸功能2.有效排痰-指導病人有效咳痰咳痰前，先輕輕咳嗽幾次，使痰松動，再用口深吸一口氣 摒氣 稍停片刻 短絀用力地咳嗽一兩次，排出痰液。 湘雅二醫(yī)院老年專科護士培訓二 老年COPD病人的護理措施（二）增加呼吸功能2.有效排痰-叩擊排痰體位選擇：根據(jù)患者病情及耐受情況選擇合適的體位 如肺尖 部炎癥采取坐位 肺底和肺中段炎癥采取側臥位 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能2.有效排痰-叩擊排痰方法： 兩手手指并攏，手背隆起手指關節(jié)微屈頻率： 頻率要快，100-200次/min。幅度： 手掌根部離開胸壁3-5cm，手指尖部離開胸

5、部10- 15cm為宜。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能2.有效排痰注意：病重或體弱的老年人應禁用體位引流的方法，并且要密切觀察咳嗽咳痰的情況，包括痰液的顏色、量及性狀，以及咳痰是否順暢。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（二）增加呼吸功能3.氧療長期家庭氧療的指征：PaO255mmHg或SaO288%，有或沒有高碳酸血癥；PaO25560mmHg或SaO288%，并有肺動脈高壓、心力衰竭所 致的水腫或紅細胞增多癥。氧流量12L/min，每天15小時以上。 湘雅二醫(yī)院老年專科護士培訓二 老年COPD病人的護理措施支氣管舒張劑

6、糖皮質激素 止咳藥 祛痰藥 4123（三）用藥指導湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施2受體激動劑和抗膽堿藥聯(lián)合用藥（三）用藥指導支氣管舒張劑 2受體激動劑抗膽堿藥茶堿類藥物湘雅二醫(yī)院老年專科護士培訓二 老年COPD病人的護理措施（三）用藥指導-支氣管舒張劑2受體激動劑-以吸入性作為首選，如沙丁胺醇氣霧劑劑量： 每次100200ug（12噴）副作用：大劑量使用可引起心動過速、心律失常，長期使用可 發(fā)生肌肉震顫； 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（三）用藥指導-支氣管舒張劑抗膽堿藥物-如異丙托溴銨 噻托溴銨氣霧劑劑量： 4080ug（24噴） 每天34

7、次副作用：口干、口苦等注意： 青光眼或因前列腺增生而尿道梗阻者應慎用 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（三）用藥指導-支氣管舒張劑茶堿類-如茶堿緩釋片劑量： 0.2g，每天2次副作用：惡心、嘔吐注意： 茶堿類使用過程中要監(jiān)測血藥濃度，當大于 15mg/L時，等副作用明顯增加 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（三）用藥指導-糖皮質激素注意：其使用可引起老年人高血壓、白內障、糖尿病、骨質疏松及繼發(fā)感染等，故對COPD病人不推薦長期口服糖皮質激素，長期吸入僅適用于有癥狀且治療后肺功能有改善者。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（

8、三）用藥指導-止咳藥可待因-有麻醉性中樞鎮(zhèn)咳作用，可因抑制咳嗽而 加重呼吸道阻塞，不良反應有惡心、嘔吐、 便秘等；噴托維林-是非麻醉性中樞鎮(zhèn)咳藥，不良反應有口 干、惡心、腹脹、頭痛等。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（三）用藥指導-祛痰藥對痰不易咳出者可選用鹽酸氨溴索鹽酸氨溴索-為潤滑性祛痰藥，不良反應輕； 劑量：30mg，每天3次。溴已新-偶見惡心、轉氨酶增高，胃潰瘍者慎用。 湘雅二醫(yī)院老年?？谱o士培訓二 老年COPD病人的護理措施（四）心理護理了解病人及家庭成員對疾病的態(tài)度與病人和家屬共同制定和實施康復計劃合理用藥舒緩治療 湘雅二醫(yī)院老年專科護士培訓謝謝聆聽！ 湘

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