RISK FACTORS:

Age Male gender Reduced lung function \ Air pollution Smoking to second hand smoke Exposure Familial allergies Poor nutrition Alcohol intake 2X higher in Men between 65-74. 3X higher in Men between 75-84.

TREATMENT: Smoking cessation Pharmacotherapy Limited occupational exposure to toxins Air pollution Regular exercise & weight control Pneumococcal & annual influenza vaccinations Lung volume reduction surgery Lung transplantation

NURSING DIAGNOSIS:
Ineffective airway clearance r/t retained secretions Impaired gas exchange r/t an altered oxygen supply Inadequate nutrition r/t an inability to digest or ingest food or to absorb nutrients Insomnia r/t anxiety, dyspnea, depression, hypoxemia and/ or hypercapnia, paroxysmal nocturnal dyspnea, and orthopnea Risk for infection r/t inadequate primary & secondary defenses & chronic disease

SIGNS/SYMPTOMS:
Chronic & Progressive Dyspnea Coughing Sputum Production Wheezing & Chest Tightness

NURSING INTERVENTIONS
Provide active and passive range of motion at your sizes to maintain mobility. Assess need for supplemental oxygen to enhance activity tolerance. Arrange for physical and occupational therapy consultants. Pace activities to provide rest and decrease episodes of breathlessness. Teach the client to reduce activities that exacerbate fatigue. Provide hydration to maintain fluid volume status and to decrease viscosity do secretions. Turn every two hours throughout ventilation and to help train pulmonary secretions. Monitor ABGs as ordered. Monitor pulse oximetry continuously. Provide mechanical ventilation during acute phase. Suction as needed basis as the findings; maintain patent airway. Monitor peak airway pressure every two hours. Monitor ventilator settings every two hours. Provide reassurance for the client and family. Provide oral care every two hours. Provide rest periods. Schedule care activities based on the client energy level. Provide an alternative method of communication such as a picture, talking board, or alphabets board. Speaking clear, short sentences, and ask questions that only require a short response. Provide the client and family with information about home oxygen therapy, liter flow, and equipment for home use. Provide instructions about oxygen safety. Instruct the client and family [Type and smoking cessation text] techniques and how this relates to oxygen safety. Provide information about local smoking cessation program

Pulmonary Signs: o Weight loss, anorexia, depression, & anxiety MEDICATIONS:

Chronic Obstructive Pulmonary Disease

Bronchodilators; short & long acting. o Beta2- agonists o Anticholinergics o Methylxanthines Inhaled anticholinergics; ipratropium bromide or oxitropium bromide Combine bronchodilators & inhaled steroids; Salmeterol & fluticasone (Advair) Phosphodiesterase-4 inhibitor; Roflumilast (Daliresp). Theophylline

Pathophysiology:
A progressive airflow limitation that is not fully reversible and, during the course of the disease, lung tissue that becomes abnormally inflamed. The changes manifested include peripheral airway inflammation, airway fibrosis, hypertrophy of smooth muscles, hyperplasia of goblet cells, and resultant mucus hypersecretion, and eventually, the destruction of the lung parenchyma.

DIAGNOSTICS: Spirometry testing [Type text]

Complications: * Respiratory infections *High blood p ressure *Heart disease *Lung cancer [Type t ext] *Depression

References Ackley, B. J., & Ladwig, L. B. (2011). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. 9th ed. St. Louis: Mosby. Ignatavicius, D. D., &Workman, L. M. (2013). Medical- Surgical Nursing: Patient-Centered Collaborative Care. 7th ed. St. Louis: Saunders. Meiner, S. E. (2011). Gerontologic Nursing (Fourth Edition ed.). Las Vegas: Elsevier. Lilley, L. L., Collins, S. R., Harrington, S., Snyder, J. (2011). Pharmacology and the Nursing Process. 6th ed. St. Louis: Mosby. Skidmore-Roth, L. (2012). Mosbys Drug Guide for Nurses, with 2012 Update. 9th ed. St. Louis: Mosby.

Jilian McGugan