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Diagnostics for COPD
H&P, Pulmonary Function Test, ABGs, CBC, CXR, EKG & Echocardiogram, AAT deficiency
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Pulmonary Function Tests
- Decreased: Forced Expiatory Volume, Vital Capacity, FEV1/FVC ratio
- Increased: Residual Volume, Total Lung Capacity, Functional Residual Capacity
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Normal ABG Values
- pH: 7.35-7.45
- pCO2: 35-45 mm Hg
- HCO3: 22-26 mmol/liter
- pO2: 80-100 mm Hg
- SaO2: 95-100%
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Collaborative Care for COPD
Control/Avoid environment/occupational irritants; smoking cessation; avoid exposure to large crowds in peak cold/flu season; yearly flu vaccines, once/every 5 years pnuemococcal vaccines; treat resp infections
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Medications for COPD
- Bronchodilators: Beta adrenergic agonists & anticholinergics
- Steroids (exacerbation & infection control)
- Non-prescription drugs
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Oxygen Therapy in COPD
- Short Term: <30 Days, following exacerbation & hospitalization
- Long Term: >30 Days, disease stable w/ paO2 60 mg or less, may need only during sleep/excersize
- Goal: paO2 >/= 60 mm Hg
- O2 Sat >/= 90%
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Oxygen Therapy Complications
Combustion, CO2 Narcosis, Oxygen Toxicity, Infection
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Oxygen Toxicity
- Risk when O2 supplied at levels above 50% over 24 hrs
- Inactive pulmonary surfactant, reduce VC = pulmonary fibrosis
S/S = cough, chest pain, N/V, paresthesia, nasal stuffiness, sore throat, malaise, copious secretions
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Pulmonary Rehabilitation
- Physical Therapy: Bronchial hygiene, exercise conditioning, breathing retraining, energy conservation
- Nutrition, Smoking cessation, control of environmental factors, psychological counseling, vocational rehabilitation
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Respiratory/Physical Therapy
- Breathing Retraining - Most Important
- -Pursed Lip breathing (8-10x; 3-4x/day) - to prevent bronchial collapse/air trapping
- Effective Coughing = "huffing" - to get secretions out
- Chest physiotherapy
- -percussion
- -vibration
- -postural drainage (using gravity)
- Aerosol-Nebulization Therapy & Flutter mucus clearance device
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When should respiratory rate return to normal after exercise in COPD?
5 minutes. Longer than that indicated over excretion.
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Other Considerations
- Sleep - can't due to medications/inability to breath
- Psychosocial - variety of emotions, avoid higher elevations
- Sexual activity - not after meals/exercise, don't prolong foreplay
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Nursing Diagnoses
Impaired Gas Exchange; Ineffective Airway Clearance; Ineffective Breathing Patterns; Activity Intolerance, Imbalanced Nutrition (Less than Needed); Disturbed Sleep Patterns
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Surgery Therapy for COPD
- Lung Volume Reduction Surgery - Decreased airway obstruction = better gas exchange, reduce size of hyper-inflated lung
- Lung Transplant - single or bilateral
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