老年copd病人的护理

老年慢性阻塞性肺疾病病人的护理（二）湘雅二医院 苏晶,老年慢性阻塞性肺疾病病人的护理（二）,一 老年COPD病人的主要护理问题二 老年COPD病人的护理措施,湘雅二医院老年专科护士培训,一 老年COPD病人的主要护理问题,1.气体交换受损：与呼吸道阻塞，炎症，痰液过 多有关。2.活动无耐力：与疲乏、呼吸困难、氧气供给与消耗失衡有关。3.焦虑：与病情反复、自理能力下降、经济状况紧张有关。4.潜在并发症：肺性脑病、休克、肺源性心脏病、DIC。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,一般护理,增加呼吸功能,用药指导,心理护理,4,1,2,3,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（一）一般护理,饮食,休息与活动,皮肤,二 老年COPD病人的护理措施,（一）一般护理1、饮食摄取充足的蛋白质、热量、维生素和微量元素时刻注意“八分饱”应尽量少吃或不吃容易产气的食物多喝水,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（一）一般护理2、休息与活动病人采取舒适的体位安排适量的活动养成良好的睡眠习惯合理使用安眠药室内温湿度适宜,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（一）一般护理3、皮肤-预防压疮的发生 定时变换体位 必要时使用气垫床 保持大小便失禁病人皮肤干燥,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能,有效排痰,氧疗,呼吸功能训练,二 老年COPD病人的护理措施,（二）增加呼吸功能1.呼吸功能训练（1）缩唇呼吸（2）腹式呼吸（3）呼吸训练器,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能1.呼吸功能训练-缩唇呼吸,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能1.呼吸功能训练-腹式呼吸,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能1.呼吸功能训练-呼吸训练器,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能 2.有效排痰 多饮水 雾化 指导病人有效咳痰 叩击排痰 体位引流,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能2.有效排痰-指导病人有效咳痰咳痰前，先轻轻咳嗽几次，使痰松动，再用口深吸一口气 摒气 稍停片刻 短绌用力地咳嗽一两次，排出痰液。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能2.有效排痰-叩击排痰体位选择：根据患者病情及耐受情况选择合适的体位 如肺尖 部炎症采取坐位 肺底和肺中段炎症采取侧卧位,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能2.有效排痰-叩击排痰方法： 两手手指并拢，手背隆起手指关节微屈频率： 频率要快，100-200次/min。幅度： 手掌根部离开胸壁3-5cm，手指尖部离开胸部10- 15cm为宜。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能2.有效排痰注意：病重或体弱的老年人应禁用体位引流的方法，并且要密切观察咳嗽咳痰的情况，包括痰液的颜色、量及性状，以及咳痰是否顺畅。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（二）增加呼吸功能3.氧疗长期家庭氧疗的指征：PaO255mmHg或SaO288%，有或没有高碳酸血症；PaO25560mmHg或SaO288%，并有肺动脉高压、心力衰竭所 致的水肿或红细胞增多症。氧流量12L/min，每天15小时以上。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,支气管舒张剂,糖皮质激素,止咳药,祛痰药,4,1,2,3,（三）用药指导,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,2受体激动剂和抗胆碱药联合用药,（三）用药指导支气管舒张剂,2受体激动剂,抗胆碱药,茶碱类药物,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-支气管舒张剂2受体激动剂-以吸入性作为首选，如沙丁胺醇气雾剂剂量： 每次100200ug（12喷）副作用：大剂量使用可引起心动过速、心律失常，长期使用可 发生肌肉震颤；,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-支气管舒张剂抗胆碱药物-如异丙托溴铵 噻托溴铵气雾剂剂量： 4080ug（24喷） 每天34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应慎用,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-支气管舒张剂茶碱类-如茶碱缓释片剂量： 0.2g，每天2次副作用：恶心、呕吐注意： 茶碱类使用过程中要监测血药浓度，当大于 15mg/L时，等副作用明显增加,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-糖皮质激素注意：其使用可引起老年人高血压、白内障、糖尿病、骨质疏松及继发感染等，故对COPD病人不推荐长期口服糖皮质激素，长期吸入仅适用于有症状且治疗后肺功能有改善者。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-止咳药可待因-有麻醉性中枢镇咳作用，可因抑制咳嗽而 加重呼吸道阻塞，不良反应有恶心、呕吐、 便秘等；喷托维林-是非麻醉性中枢镇咳药，不良反应有口 干、恶心、腹胀、头痛等。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（三）用药指导-祛痰药对痰不易咳出者可选用盐酸氨溴索盐酸氨溴索-为润滑性祛痰药，不良反应轻； 剂量：30mg，每天3次。溴已新-偶见恶心、转氨酶增高，胃溃疡者慎用。,湘雅二医院老年专科护士培训,二 老年COPD病人的护理措施,（四）心理护理了解病人及家庭成员对疾病的态度与病人和家属共同制定和实施康复计划合理用药舒缓治疗,湘雅二医院老年专科护士培训,谢谢聆听！,湘雅二医院老年专科护士培训,Contents,Click to add title in here,Click to add title in here,Click to add title in here,Click to add title in here,4,1,2,3,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,Hot Tip,How do I incorporate my logo to a slide that will apply to all the other slides? 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