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1、慢性阻塞性肺疾病CHRONIC OBSTRUCTIVE PULMONARY DISEASE主讲：昆医主讲：昆医20082008级级 护理实习组护理实习组目录一、定义三、流行病学二、病案介绍四、病因与发病机制五、临床表现六、实验室检查七、诊断要点八、治疗要点九、护理诊断及措施十、健康教育 CONTENTS1.Definition3.Epidemiology2.Clinical Case4.Etiology&Pathogenesis5.Clinical Manifestation 6.Laboratory Tests7.Diagnosis8.Treatment9.Nursing Diagnosis
2、&Implementations10.Health Education关键词(KeyWords)咳嗽 cough咳痰 sputum production呼吸困难 dyspnea桶状胸 “barrel-shaped”chest气流受限 airflow limitation急性加重期 acute exacerbations气体交换受损 impaired gas exchange清理呼吸道无效 ineffective airway clearanceAECOPD、什么是慢性阻塞性肺疾病(COPD)？、哪些人群更容易患COPD？、作为医护人员，我们应该如何诊断、治疗？、作为21世纪的新护士，我们应该如
3、何提供护理？思考?一、COPD定义慢性阻塞性肺疾病简称慢阻肺，是一种以气流受限为特征的可以预防和治疗的疾病，气流受限不完全可逆、呈进行性发展。Chronicobstructivepulmonarydisease:COPD,is a preventable and treatable disease.It is characterized by airflow limitation.The airflow limitation is not fully reversible and usually progressive.Definition二、COPD病案介绍姓名：郭其文 性别：男 年龄：83
4、岁简要病史：患者二十余年来反复出现咳嗽、咳痰，无咯血及胸痛，无低热、盗汗。两天前受凉后咳嗽、咳痰加重，痰量多，为黄色粘痰，畏寒，感咽痛声嘶。查体：T：36.4，P：80次/分，R：19次/分，BP：126/72mmHg（卧位）,可见桶状胸，横膈下移，肢端发绀。X线：双肺纹理增多、肋间隙增宽增粗，确诊为“慢性阻塞性肺疾病”，为进一步诊治于2011年8月14日收住我院。ClinicalCaseName:Qiwen Guo Gender:male Age:83Casehistory：The patient complained of cough and sputum production over
5、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,acrocyanosis are existed.Chest fluoroscopy:increased bilateral lungs markings,wide
6、ned intercostal spaces.He was diagnosed as COPD and admitted on August 14th,2011.体格检查三、流行病学03-04年，我国通过对七个地区的40岁以上人群抽样调查发现，COPD总患病率为8.2%，患病率存在性别、地区等差异。1.吸烟；Smoking2.职业性粉尘及化学物质；Occupational dusts and chemicals3.空气污染；Air pollution4.呼吸道感染；Respiratory tract infection5.其他Others四、病因与发病机制四、病因与发病机制有害颗粒或气体COP
7、D病理学改变蛋白酶氧化应激抗氧化物抗蛋白酶粘液分泌增加肺实质破坏肺血管壁增厚气道壁结构重塑气流受限炎症反应五、临床表现：症状1.慢性咳嗽晨间明显，白天较轻，睡眠时有阵咳或排痰。Chroniccough It is obvious in the morning and relieved in the daytime.There is a paroxysmal cough or sputum production when sleeping.2.咳痰为白色粘液或浆液性泡沫痰，偶可带血丝。急性发作伴细菌感染时，痰量增多，可有脓性痰。Sputumproduction There is a white
8、mucus or serous frothy sputum,with blood occasionally.The sputum would be too much and purulent with bacterial infection.五、临床表现：症状3.气短或呼吸困难仅在体力劳动或上楼等活动时出现，病情重时日常活动也能感到气促，是的标志症状。Shortnessofbreathordyspnea It only appears when laboring,going upstairs or doing other activities.Patient may feel unwell e
9、ven in daily activities when it is worse,which is the signal symptoms of COPD.五、临床表现：症状4.喘息和胸闷重度病人或急性加重时出现喘息和胸闷.Asthmaandchestdistress Critically serious patients may show asthma and chest distress in acute exacerbations.五、临床表现：症状五、临床表现：症状5.其他 晚期病人有体重下降，食欲减退等全身症状。Others Terminally ill patients have
10、systemic symptoms such as weight loss,loss of appetite.视诊 桶状胸，呼吸浅快，严重者可有缩唇呼吸。Inspection Barrel-shaped chest,rapid and shallow breathing,severe cases may have pursed-lip breathing.五、临床表现：体征触诊 触觉语颤减弱或消失。Palpation Tactile fremitus is weakened or disappeared.五、临床表现：体征叩诊 呈过清音，心浊音界缩小，肺下界和肝浊音界下降。Percussion
11、 It sounds too voiceless,the border of cardiac dullness narrows,inferior boundary of lung and the border of hepatic dullness go down.五、临床表现：体征听诊两肺呼吸音减弱，呼气延长，部分病人可闻及干性啰音和（或）湿性啰音。Auscultation Breath sounds reduces,expiratory sound extends,some patients can be heard wheezes or moist crackles.五、临床表现：体征I
12、级：轻度级：中度级：重度IV级：极重度COPD严重程度分级FEV1/FVC0.7,FEV180%预计值FEV1/FVC0.7,50%FEV180%预计值FEV1/FVC0.7,30%FEV150%预计值FEV1/FVC0.7,FEV130%预计值或FEV150%预计值Stage I:MildStage II:ModerateStage III:SevereStage IV:Very Severe SeverityClassificationFEV1/FVC0.7,FEV180%predictedFEV1/FVC0.7,50%FEV180%predictedFEV1/FVC0.7,30%FEV1
13、50%predictedFEV1/FVC0.7,FEV130%predicted or FEV115 h/d).NursingImplementations 5.呼吸功能锻炼（1）缩唇呼吸方法：闭嘴经鼻吸气，缩唇缓慢呼气，同时收缩腹部。（二）护理措施(1)Pursed-lip breathing 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.Respira
14、tory function exerciseNursingImplementations（2）腹式呼吸方法：用鼻缓慢吸气，膈肌最大限度下降，腹肌松弛。呼气时用口呼出，腹肌收缩，膈肌松弛。如图所示如图所示:（二）护理措施 (2)Abdominal respiration Breathe 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 abdomina
15、l muscles and relax your diaphragm muscles.Method:NursingImplementations 患者呼吸困难减轻、呼吸频率减慢、发绀减轻、心率减慢、活动耐力增加、呼吸功能得到改善。The symptoms of dyspnea and cyanosis was lightened,breath rate and heart rate slowed down,activities endurance increased and respiratory function improved.（三）护理评价九、护理诊断、措施及依据清理呼吸道无效Inef
16、fective Airway ClearanceB相关因素 Related factors1.分泌物多而黏稠 Sticky mucus 2.气道湿度减低 The low humidity of windpipe3.无效咳嗽 Ineffective coughing（一）护理依据 1.病情观察 密切观察咳嗽咳痰情况，包括痰液的颜色、量及性状，以及咳痰是否顺畅。Patients condition observation:Observe closely about the state of coughing,including the sputum color,nature,odour and q
17、uantity.（二）护理措施2.用药护理注意观察药物疗效和不良反应。（1）止咳药（2）祛痰药（二）护理措施Medication nursing:Especially observe the therapeutic effects and the side effects.(1)Antitussive(2)Expectorant3.对症护理 患者胸痛时，常随呼吸、咳嗽而加重，可采取侧卧位。Symptomatic nursing:When the patient is suffering the chest pain,the pain usually increases following br
18、eathing and coughing.Lateral position can be adopted.（二）护理措施1.患者能有效地将痰咳出，保持呼吸道畅通。The 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）护理评价九、护理诊断、措施及依据焦虑AnxietyC相关因素Related factors 1.健康状况的
19、改变 Health condition changed 2.病情危重 Severity 3.经济负担 Economic burden（一）护理依据1.了解患者的心理状态及其原因 TO understand the patients psychological state and reasons.（二）护理措施2.与家属和患者进行沟通 Communicate with family members and the patients3.制定康复计划和协助康复活动 Make rehabilitation programs and help rehabilitation activities.4.教给
20、患者缓解焦虑的方法 Teach patients the ways to relieve anxiety.（二）护理措施 患者焦虑情绪缓解，积极配合治疗与康复活动。The patient relieves anxiety,and cooperate with treatment and rehabilitation activities.（三）护理评价十、COPD健康教育饮食指导 12有效排痰指导 3 用药指导 4长期家庭氧疗指导5 疾病知识指导1.Food Nutrition Guidance2.Long-term Domiciliary Oxygen Therapy3.Effective
21、Expectoration Guidance 4.Medication Guidance5.Disease Knowledge Guidance HealthEducation1.进食高热量、高蛋白、高维生素的食物；Keep in the high-protein,high-calorie,multi-vitamins digestible diet.2.避免进食产气和引起便秘的食物；Avoid the foods which can cause gas and constipation.（一）饮食指导 Food Guidance Limit the salt intake less than
22、 3.限制食盐的摄入：每日食盐量小于6克。6 grams every day.（一）饮食指导 Food Guidance Eat smaller,more frequent meals and avoid the recumbent position which is helpful to your digestion.4.少量多餐，餐后避免 平卧，利于消化；（一）饮食指导 Food Guidance 可稳定或阻断肺动脉高压的发展,增加动脉血氧饱和度,改善缺氧症状，提高生活质量和生存率。（二）长期家庭氧疗 Long-term Domiciliary Oxygen Therapy1.家庭氧疗注意
23、事项:供氧装置“四防”：防火、防震、防热、防油 To use oxygen apparatus safely,we should do as the following tips:fireproofing,shockproofing,heatproofing，greaseproofing.（二）长期家庭氧疗 Long-term Domiciliary Oxygen Therapy2.定期清洁、消毒供氧装置，预防感染。In order to prevent the infection,we shoud clean and disinfect the oxygen apparatus regula
24、rly.（二）长期家庭氧疗 Long-term Domiciliary Oxygen Therapy 鼓励病人有效咳嗽，清除呼吸道分泌物。对痰液粘稠不易咳出者和年老体弱者，可给予翻身、拍背、雾化吸入、祛痰剂等协助排痰。（三）有效排痰指导 Effective Expectoration Guidance Encourage the patients to cough effectively which can help to clear the respiratory secretions.For the people who are difficult to expectorate due t
25、o viscosity and the elderly,some measures can be given such as turning over,clapping back,aerosol inhalation,expectorant,etc.to assist the expectoration.（三）有效排痰指导 Effective Expectoration Guidance（三）有效排痰指导 Effective Expectoration Guidance COPD患者在疾病稳定期,应遵医嘱使用支气管舒张药,如2受体激动剂和抗胆碱药，教会病人正确的吸入方法和注意事项，嘱患者切勿自
26、行停药、减药，指导患者在用药过程中注意观察药物疗效和不良反应，定期复诊，如有不适，及时就诊。（四）用药指导 Medication Guidance Instruct the patients to use drugs with doctors advice and tell them the proper inhalation ways and concerns.Ask them do not stop or reduce the drugs freely,and tell the patients watch the effects and side effects in the proce
27、ss of drug using。Such as are unwell,hospital promptly。（四）用药指导 Medication Guidance1.使病人了解COPD相关知识，识别使病情恶化的因素；Tell the relevant konwledge about COPD to the patients and let them know how to distinguish the dangerous factors.2.劝导病人戒烟；Try to persuade the patients to quit smoking.（五）疾病知识指导 Disease Knowle
28、dge Guidance 3.避免粉尘和刺激性气体的吸入；Avoid dust and stimulating gas sucked in.4.预防感染；Prevent infections.5.注意保暖，避免受凉。Keep warm.（五）疾病知识指导 Disease Knowledge Guidance World COPD DayRaising COPD Awareness WorldwideIt is an annual awareness-raising event,taken place each year on the second or third Wednesday in November.You can learn to control this disease instead of letting it control you!讨论(Discussion)总结(Summary)