(2) Symptoms and signs of obstructive emphysema Chronic bronchitis has repeated acute attacks, and the condition is getting worse and worse, forming obstructive emphysema. In addition to chronic bronchitis, the main symptom is gradually increasing dyspnea.
Second, the relevant inspection
(1) When the blood test is secondary to bacterial infection, the total number of white blood cells and the proportion of neutrophils increase. In the aggravating period of obstructive emphysema infection, paco2 may decrease and PaCO 2 may increase.
(2) X-ray examination showed that lung texture was increased and disordered. When emphysema occurs, the transparency of both lungs increases and the intercostal space widens.
(3) Early pulmonary function examination of chronic bronchitis can be normal. Small airway dysfunction may occur in the early stage of COPD, and then the ratio of forced expiratory volume to forced vital capacity in the first second may decrease. When chronic bronchitis complicated with obstructive emphysema, the residual volume increases, and the percentage of residual volume in the total lung volume increases.
Three. Nursing diagnosis/problems
1. Cleaning respiratory tract is ineffective-related to phlegm and bronchospasm.
2. Inefficient breathing patterns-related to bronchial obstruction and increased respiratory resistance.
3. Exercise intolerance-related to hypoxemia and malnutrition.
4. Impaired gas exchange-related to secondary infection of chronic obstructive pulmonary disease.
5. Anxiety and ineffective personal coping-related to long-term dyspnea, insufficient family support or lack of relevant information.
6. Potential complications: spontaneous pneumothorax and respiratory failure.
Fourth, nursing measures
(a) according to the doctor's advice to give anti-inflammatory treatment, effective control of respiratory infections.
(2) Improving respiratory condition: The treatment for patients with obstructive emphysema is mainly to improve respiratory function.
1. Rational use of oxygen
2. Breathing training: lip contraction, exhalation and abdominal breathing training.
(3) Diet
(4) Systematic exercise
(5) Psychological nursing
Verb (abbreviation of verb) health education
1. Quit smoking, let patients know the harm of smoking and improve their living environment.
2. Enhance physical fitness, prevent acute respiratory infection and carry out cold-resistant exercise. Pay attention to the nutritional intake in remission period and improve the nutritional status.
3. Insist on whole-body exercise and breathing training, carry out appropriate whole-body activities, and guide patients to make reasonable exercise plans.
4. Family oxygen therapy guidance. Ltot can improve the prognosis of copd patients, improve their quality of life, and provide suggestions and help for patients with home oxygen therapy on the basis of this doctor's advice.
5. Insist on abdominal breathing and lip-shrinking exhalation training.
6. Pay attention to patients' psychological problems. Patients at home often have obvious loneliness, and the incidence of depression is high. Therefore, in addition to providing physical care, family and friends should pay more attention and help psychologically.