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JM Emphysema
Emphysema pgs 30 ppt
| Question | Answer |
|---|---|
| Emphysema pgs 31-32 ppts | |
| Give a definition for emphysema. | Progressive; enlarged airspaces distal to the terminal bronchioles & destruction of alveolar walls/support structures. |
| Discuss etiology of emphysema. | Direct effect of cig smoking; <1% d/t genetic defect. |
| What are the s/s of emphysema? | cough (late;afterdyspnea)scant, mucoid sputum(BRONCHITES: copious, purulent);wt loss is marked(absent /slight in bronchitis);CXRlow,flat diaphragmlongnarrowcardiacsilhouetted/tairetention;co2retention (uncommon early;commonlater)may be hypercapniec early; |
| What is the i:e ratio norm and w/ emphysema? | 1-2.5 seconds is norm: with emphysema 1: 4 or more |
| Describe pink puffer: | typically thin, barrel chest |
| Describe changes in lungs d/t emphysema. | Lung parenchyma changes result in loss of elasticity;elastic surrounding alveoli dissolves=stiff lung& decreased compliance=expiration decreased by loss of recoil=airtrapped;barrel chest! |
| What is parenchyma? | functional unit of any organ |
| What drives a pt with emphysema to breathe? | Hypoxia!! Their body has adapted to the hypercapnia!! |
| What is normal drive for respiration? | Increased CO2 followed by increase in H+ ions. |
| What are the two main types of emphysema? | centrilobular andn panlobula |
| Describe centrilobular emphysema. | Respiratory bronchiole destroyed; males, assoc w/ chronic bronchitis, smokers. May occur with panlobular. |
| Describe panlobular emphysema. | Destruction/dilation of bronchioles & alveoli. May occur with centrilobular. |
| What type of onset is commonly seen with emphysema? What age is usual for dx? | Insidious onset(if unaccompanied by chronic bronchitis,bronchiectasis or other);dx age 50-75; |
| What are clinical manifestations of emphysema? | dyspnea inc over time;progress to dyspnea @rest;pursed lip breathing: prolonged expiration: use/access musc;airtrapping;anorexic, wt loss;musc wast:including resp; hypercapnia leading to Co2 narcosis |
| What is co2 narcosis? | Unconsciousness induced by too much co2 |
| S/S Co2 narcosis? | PCO2>75 occipital HA; changes in LOC; difficulty concentrating, ULTIMATELY OBTUNDED, COMA |
| What is obtunded? | difficult to arouse |
| What is normal PCo2? | 35-45 mm Hg |
| Normal pO2? | 80-100 mm Hg |
| Normal O2 Sat? | 95-100% |
| What is the hallmark symptom of emphysema? | dyspnea worsening over time;from progressive dyspnea to dyspnea @ rest |
| What affect does airtrapping have on auscultating lungs/heart? | hyperresonant chest to percussion; distant, absent or dull breath/heart sounds and increased AP diameter of chest |
| Why might pt w/ emphysema be anorexic? | wt loss d/t takes too much energy to eat;muscle wasting include rep musc : futher impairs ability to assist w/expiration |
| What history would might pt with emphysema have? | Smoking, dyspnea, chronic cough (COPIOUS SPUTUM WITH CHRONIC BRONCHITIS) wheezing, frequent repiratory infections. |
| What might be heard when auscultating lungs with emphysema pt? | Coarse, inspiratory crackles @ bases. |
| How is diagnosis for emphysema made? | PFT, CXR, ABGs |
| What does PFT show in emphysema pt? | Decreases FEV, prolonged expiration, decreased FVC, increased total lung capacity & residual volumes d/t rapped air. |
| What is FEV? | force expiratory volume: vol of air that is forcefull exhaled in one second |
| FVC? | Forced vital capacity-the volume of air that can be MAXIMALLY FORCEFULLY EXHALED |
| What is normal PCO2? | 35-45 mm Hg |
| Normal HCO3? | 21-28 |
| What would CXR of emphysema pt likely show? | Enlarged thoracic cage, flattened diaphragm, elongated,narrow cardiac silhouette, widened itnercostal spaces, blebs/bullae in apices/ bases, dilated bronchioles. |
| What is a bleb/bullae? | alveolar wall blister when they lose elasticity; a bunch of blebs or weak areas and put them together make bullae. |
| What may result d/t lost elasticity in alveoli? | they are ready to pop out! Could lead to pneumothorax. |
| What might md do in case of many blebs/bullae? | may do chest tube in anticipation of lung blowing out |
| What would ABGs of emphysema pt show? | usually normal until later stages. |
| What are complications of emphysema? | Resp infections, acute resp failure, spontaneous pneumothorax; V/P or V/Q mismatch; hypoxemia (corpulmonale in later stages)=edema;polycythemia: increased blood viscosity, inc cardiac workload, inc risk of emboli. |
| What are the objectives in mgt of emphysema? | Reverse airway narrowing, reduce mucous production, control symptoms, maintain general health. |
| What are the principle treatments for COPD? B2 agonists, anticholinergics, theophylline, and a combo of one or more of these drugs. | Beta2AGONISTS;anticholinergics;theophylline( a methylxanthine) |
| When is treatment with corticosteroids appropriate w/copd? | symptomatic copd w/an FEV1<50% predicted & repeated exacerbations. CHRONIC TX WITH CORTICOSTEROIDS SHOULD BE AVOIDED |
| What benefits are possible with drug therapy for copd? | meds can reduce or abolish sx; increase the capacity to exercise, improve overall health, reduce the |
| What do bronchodilators do for the copd pt? | relaxes smooth musc in airway and improves ventilation=reducing dyspnea and increase FEV1. BRONCHODILATORS ALSO VASODILATE!! |
| What route of meds is preferred w/ copd meds? | inhaled route prn or regular basis;only side effect is usually dry mouth. |
| Name a long acting broncholdilator used for copd. | Salmeterol (Serevent) is widely used long-acting B1-adrenergic agonist,unlike w/ asthma, can be used in copd as monotherapy, formoterol (Foradil) another one. |
| What is a trick to remember beta-2 agonists? | Generic names end in “-ol” (1/2 of Beta blockers “-olol. |
| Name three bronchodilators and their families. | Beta-2 agonist: salmeterol pirbuterol; another family is methylxanthine: aminophylline, theophylline |
| What bronchodilator meds are commonly used for copd? | b2-adrenergic agonists, anticholinergic agents, and methylxanthines. |
| What do anti-cholinergics do? How do we remember what they do? Name two. | dries resp/gi secretions; increases heart rate in cardiac emergencies: can’t see,can’t pee, can’t spit, can’t poop!! Atropine; Ipatropium (used to relieve bronchospams in copd. |
| Side effects of anticholinergics? | dry mouth, blurred vision, urinary retention, constipation, absence of sweating, tachycardia. |
| Name a short-acting bronchodilator? | albuterol or ipratropium (Atrovent) may be used singly or combo;improves effect and decreases risk of adverse effects, compared w/ use of a single agent. |
| Name a single agent used for copd. | ipratropium (Atrovent) |
| What anti-cholinergic is used for copd pt? What does it do? | Ipatropium: relieves bronchospasms |
| What meds may be used for emphysema and why? | Bronchodilators : usually B-adrenergic;Theophyllines, anticholenergics (Atrovent);corticosteroids . |
| Discuss use of corticosteroids with emphysema. | (3-4 weeks)Gradually decrease dose to lowest effective maintenance level; eventually place on inhaled steroid (less systemic S.E.) |
| Theophylline? | Bronchodilator: xanthines: pg cat C: long-term control of reversible airway obstruction caused by asthma or COPD.Increases diaphragmatic contractility (aminophylline-is converted to theophylline) |
| What are possible adverse reactions of bronchodilatros? | cardiac arrhythmias, angina, HA, tremors |
| What is action of theophylline? | inhibit phosphodiesterase, producing increased tissue conc/cyclic adenosine monophophae (cAMP). increased cAMP:bronchodilation, CNS stimulation, positive inotropic and chronotropic effects. diuresis, gastric acid secrection |
| Therapeutic Effects: Bronchodilation | |
| What does inotropic mean? | Inotropic: Affecting the force of muscle contraction. An inotropic heart drug is one that affects the force with which the heart muscle contracts. |
| What does chronotropic mean? | Affecting the rate of rhythmic movements, such as the heartbeat |
| What is the therapeutic level of theophylline? 10-20 mg/l few SE if blood level <20 mg/ml | 10-20 mg/ml few SE if blood level <20 |
| If theophylline levels 20-35 mg what are SE? | n/v, diarrhea, insomnia, restlessness |
| Theophylline levels >30, SE? | severe dysrhythmias, convulsions, CV collapse, death. |
| What does theophylline do? | improves contractility of diaphragm. |
| What are side effect of theophylline and wht level do they normally appear? | tremors, nausea (normal therapeutic range: 20-30mg/l); 20-25:N/V, diarrhea, insomnia, restlessness;levels>30 severe dysrhythmias, convulsions, CV collapse, death! |
| What O2 therapy is likely with emphysema? | Maintain PO2 @ least 60 mmHg; low-flow O2 @ 1-3 L/min relieves pulmonary HTN, polycythemia, increases exercise tolerance & improves mental function. |
| What initial action would be taken with ARF? | Intubation & mechanical ventilation. |
| What are nutrition needs for emphysema? | High fat/protein low CHO d/t break down into CO2 & H2O. |
| Why should copd pts be on low carb diet? | carbs breakdown into co2 and h2o making situation worse. |
| What surgical intervention may be done for emphysema pt? | Lung volume reduction surgery(removal of up to 30%);allows for chest & diaphragm to resume a more normal position, improves mechanics of breathing. Remaining lung performs better.see pg 644 |
| Rational for lung vol reduction surgery? | reduceing the size of the hyperinflated emphysematous lungs, decreased airway obstrtuction and increased room for the remaining normal alveoli to expand and function., improves lung vol/lung&chest wall mechanics SEE pgs644 |
| Discuss preventative measures that may help prevent irritation/infections associated with emphysema. | AVOID: smoke,dust,aerosol sprays,pollen(stay in when high& when tem/humidityhigh)exposure to colds,resp infections, crowds,get flu/pneumococcal pneumonia vac. |
| What should should pt be taught to report to MD? | Any change in sputum; if ordered antibiotics do not relieve symptoms in 24 hrs. |
| Describe nursing process for COPD. | Assessment: h&P;sleeping positions(flat to increase TLC or orthopnic;review Dx/labs (ABGs, CXR, PFT..). |
| What physical evidence may be assessed with COPD? | Digital clubbing, distended neck veins (expiration), increased Anterior/posterior diameter, sinking of tissues around neck & supraclavicular spaces, observe breathing pattern (use of accessory musc, pursed-lip breathing). |
| What might be heard upon auscultation with bronchitis and emphysema? | Wheezes w/ chronic bronchitis, distant/dull breath/heart sounds w/ emphysema.. |
| Discuss nursing diagnoses for emphysema r/t breathing/gas exchange etc... | Ineffective airway clearance (goal:coughs productively);impaired gas exchange ( goal: PCO2 between 40-55mmHg sats>92%..); ineffective breathing patterns(goal: demonstrates methods to relieve breathlessness) |
| Discuss nursing diagnoses associated with emphysema other than gas exchange/breathingpattern/ineffective airway clearance. | Activity intolerance r/t musc fatigue(goal: describes 4 basic techniques for enrgy conservation);risk ineffective individual coping (goal: verbalizes anxieties/fears); risk altered health maintenance (goal: lists symptoms to be reported) |
| What are interventions for ineffective airway clearance? | Secretion removal(pulmonary hygiene);fluids 2-3 L/d unless contraindicated (corpulmonale); bronchodilators, nebulizer tx (before meals);oral hygiene, monitor therapeutic effects of meds. |
| Discuss interventions for impaired gas exchange. | Low dose O2 as ordered pt education regarding O2;teach s/s hypoxia, hypercapnia; monitor O2 sats; air-driven nebulizers rxs |
| Discuss interventions for ineffective breathing patterns . | teach breathing techniques to promote ventilation, ease work of breathing, assist in control of dyspena: I:E ratio;diaphragmatic breathing; pursed-lip breathing |
| Explain I:E ratio to teach pt. | control severe dyspnea if pt can control I:E ratio. Have pt practice timing expiration so that it is 3-4 times longer than inspiration;diaphragmatic breathing: pursed-lip breathing |
| Discuss intervention for activity intolerance r/t muscular fatigue. | gradual increase in aerobic exercise;review purpose of exercise program, emphasis on benefits;stress-mgt, physical/mental relaxation, I.D work-simplification strategies, measures to promote restful sleep; encourage pt to adopt slower pace of living |
| Discuss interventions for risk ineffective individual coping. | |
| Discuss interventions for risk altered health maintenance. | instruct in prevention/Rx; quit smoking programs;meet w/other COPD pt;teah s/infection; monitor s/s Rt sided HF; daily wts : report >5.5 lbs gain/wk 2 lbs in 24 hr=fluid vol excessWhat pts is it seen localized in? |
| Emphysema pgs 31-32 ppts | |
| Give a definition for emphysema. | Progressive; enlarged airspaces distal to the terminal bronchioles & destruction of alveolar walls/support structures. |
| Discuss etiology of emphysema. | Direct effect of cig smoking; <1% d/t genetic defect. |
| What are the s/s of emphysema? | cough (late;after onset of dyspnea); scant, mucoid sputum(BRONCHITEScopious,purulent);wtlossmarked(absent/slightinbronchitis);CXR:low,flatdiaphragm,long, narrowcardiacsilhouetted/tair reten;co2 retention(uncommon early;commonlater)maybehypercapniecearly; |
| What is the i:e ratio norm and w/ emphysema? | 1-2.5 seconds is norm: with emphysema 1: 4 or more |
| Describe pink puffer: | typically thin, barrel chest |
| Describe changes in lungs d/t emphysema. | Lung parenchyma changes result in loss of elasticity;elastic surrounding alveoli dissolves=stiff lung& decreased compliance=expiration decreased by loss of recoil=airtrapped;barrel chest! |
| What is parenchyma? | functional unit of any organ |
| What drives a pt with emphysema to breathe? | Hypoxia!! Their body has adapted to the hypercapnia!! |
| What is normal drive for respiration? | Increased CO2 followed by increase in H+ ions. |
| What are the two main types of emphysema? | centrilobular and panlobular |
| Describe centrilobular emphysema. | Respiratory bronchiole destroyed; males, assoc w/ chronic bronchitis, smokers. May occur with panlobular. |
| Describe panlobular emphysema. | Destruction/dilation of bronchioles & alveoli. May occur with centrilobular. |
| What type of onset is commonly seen with emphysema? What age is usual for dx? | Insidious onset(if unaccompanied by chronic bronchitis,bronchiectasis or other);dx age 50-75; |
| What are clinical manifestations of emphysema? narcosis. | Dyspnea worsening over time =progress to dyspnea @rest;PURSED-LIP BREATHING;PROLONGED EXPIRATION;use/accessory muscles;airtrapping;anorexic,wt loss; MUSCLE WASTING INCLUDING RESP;LATER STAGE: HYPERCAPNIA leading to Co@ |
| What is co2 narcosis? | Unconsciousness induced by too much co2 |
| S/S Co2 narcosis? | PCO2>75 occipital HA; changes in LOC; difficulty concentrating, ULTIMATELY OBTUNDED, COMA |
| What is obtunded? | difficult to arouse |
| What is normal PCo2? | 35-45 mm Hg |
| Normal pO2? | 80-100 mm Hg |
| Normal O2 Sat? | 95-100% |
| What is the hallmark symptom of emphysema? | dyspnea worsening over time;from progressive dyspnea to dyspnea @ rest |
| What affect does airtrapping have on auscultating lungs/heart? | hyperresonant chest to percussion; distant, absent or dull breath/heart sounds and increased AP diameter of chest |
| Why might pt w/ emphysema be anorexic? | wt loss d/t takes too much energy to eat;muscle wasting include rep musc : futher impairs ability to assist w/expiration |
| What history would might pt with emphysema have? | Smoking, dyspnea, chronic cough (COPIOUS SPUTUM WITH CHRONIC BRONCHITIS) wheezing, frequent repiratory infections. |
| What might be heard when auscultating lungs with emphysema pt? | Coarse, inspiratory crackles @ bases. |
| How is diagnosis for emphysema made? | PFT, CXR, ABGs |
| What does PFT show in emphysema pt? | Decreases FEV, prolonged expiration, decreased FVC, increased total lung capacity & residual volumes d/t rapped air. |
| What is FEV? | force expiratory vol: vol of air that is forcefully exhaled in one second |
| FVC? | Forced vital capacity-the volume of air that can be MAXIMALLY FORCEFULLY EXHALED |
| What is normal PCO2? | 35-45 mm Hg |
| Normal HCO3? | 21-28 |
| What would CXR of emphysema pt likely show? | Enlarged thoracic cage, flattened diaphragm, elongated,narrow cardiac silhouette, widened itnercostal spaces, blebs/bullae in apices/ bases, dilated bronchioles. |
| What is a bleb/bullae? | alveolar wall blister when they lose elasticity; a bunch of blebs or weak areas and put them together make bullae. |
| What may result d/t lost elasticity in alveoli? | they are ready to pop out! Could lead to pneumothorax. |
| What might md do in case of many blebs/bullae? | may do chest tube in anticipation of lung blowing out |
| What would ABGs of emphysema pt show? | usually normal until later stages. |
| What are complications of emphysema? | Resp infections, acute resp failure, spontaneous pneumothorax; V/P or V/Q mismatch; hypoxemia (corpulmonale in later stages)=edema;polycythemia: increased blood viscosity, inc cardiac workload, inc risk of emboli. |
| What are the objectives in mgt of emphysema? | Reverse airway narrowing, reduce mucous production, control symptoms, maintain general health. |
| What are the principle treatments for COPD? | B2 agonists, anticholinergics, theophylline, and a combo of one or more of these |
| When is treatment with corticosteroids appropriate w/copd? | symptomatic copd with an FEV1<50% predicted and repeated exacerbations. CHRONIC TX WITH CORTICOSTEROIDS SHOULD BE AVOIDED |
| What benefits are possible with drug therapy for copd? | meds can reduce or abolish sx; increase the capacity to exercise, improve overall health, reduce the |
| What do bronchodilators do for the copd pt? | relaxes smooth musc in airway and improves ventilation=reducing dyspnea and increase FEV1. BRONCHODILATORS ALSO VASODILATE!! |
| What route of meds is preferred w/ copd meds? | inhaled route prn or regular basis;only side effect is usually dry mouth. |
| Name a long acting broncholdilator used for copd. | Salmeterol (Serevent) is widely used long-acting B1-adrenergic agonist,unlike w/ asthma, can be used in copd as monotherapy, formoterol (Foradil) another one. |
| What is a trick to remember beta-2 agonists? | Generic names end in “-ol” (1/2 of Beta blockers “-olol. |
| Name three bronchodilators and their families. | Beta-2 agonist: salmeterol pirbuterol; another family is methylxanthine: aminophylline, theophylline |
| What bronchodilator meds are commonly used for copd? | b2-adrenergic agonists, anticholinergic agents, and methylxanthines. |
| What do anti-cholinergics do? How do we remember what they do? Name two. | dries resp/gi secretions; increases heart rate in cardiac emergencies: can’t see,can’t pee, can’t spit, can’t poop!! Atropine; Ipatropium (used to relieve bronchospams in copd. |
| Side effects of anticholinergics? | dry mouth, blurred vision, urinary retention, constipation, absence of sweating, tachycardia. |
| Name a short-acting bronchodilator? | albuterol or ipratropium (Atrovent) may be used singly or combo;improves effect and decreases risk of adverse effects, compared w/ use of a single agent. |
| Name a single agent: | ipratropium (Atrovent) |
| What anti-cholinergic is used for copd pt? What does it do? | Ipatropium: relieves bronchospasms |
| What meds may be used for emphysema and why? | Bronchodilators : usually B-adrenergic;Theophyllines, anticholenergics (Atrovent);corticosteroids . |
| Discuss use of corticosteroids with emphysema. | (3-4 weeks)Gradually decrease dose to lowest effective maintenance level; eventually place on inhaled steroid (less systemic S.E.) |
| Theophylline? | Bronchodilator: xanthines: pg cat C: long-term control of reversible airway obstruction caused by asthma or COPD.Increases diaphragmatic contractility (aminophylline-is converted to theophylline) |
| What are possible adverse reactions of bronchodilatros? | cardiac arrhythmias, angina, HA, tremors |
| Therapeutic Effects? | BRONCHODILATION |
| What does inotropic mean? | Inotropic: Affecting the force of muscle contraction. An inotropic heart drug is one that affects the force with which the heart muscle contracts. |
| What does chronotropic mean? | Affecting the rate of rhythmic movements, such as the heartbeat |
| What is the therapeutic level of theophylline? | 10-20 mg/l few SE if blood level <20 mg/ml |
| If theophylline levels 20-35 mg what are SE? | n/v, diarrhea, insomnia, restlessness |
| Theophylline levels >30, SE? | severe dysrhythmias, convulsions, CV collapse, death. |
| What does theophylline do? | improves contractility of diaphragm. |
| What are side effect of theophylline and wht level do they normally appear? | tremors, nausea (normal therapeutic range: 20-30mg/l); 20-25:N/V, diarrhea, insomnia, restlessness;levels>30 severe dysrhythmias, convulsions, CV collapse, death! |
| What O2 therapy is likely with emphysema? | Maintain PO2 @ least 60 mmHg; low-flow O2 @ 1-3 L/min relieves pulmonary HTN, polycythemia, increases exercise tolerance & improves mental function. |
| What initial action would be taken with ARF? | Intubation & mechanical ventilation. |
| What are nutrition needs for emphysema? | High fat/protein low CHO d/t break down into CO2 & H2O. |
| Why should copd pts be on low carb diet? | carbs breakdown into co2 and h2o making situation worse. |
| What surgical intervention may be done for emphysema pt? | Lung volume reduction surgery(removal of up to 30%);allows for chest & diaphragm to resume a more normal position, improves mechanics of breathing. Remaining lung performs better.see pg 644 |
| Rational for lung vol reduction surgery? | reduceing the size of the hyperinflated emphysematous lungs, decreased airway obstrtuction and increased room for the remaining normal alveoli to expand and function., improves lung vol/lung&chest wall mechanics SEE pgs644 |
| Discuss preventative measures that may help prevent irritation/infections associated with emphysema. | AVOID: smoke,dust,aerosol sprays,pollen(stay in when high& when tem/humidityhigh)exposure to colds,resp infections, crowds,get flu/pneumococcal pneumonia vac. |
| What should should pt be taught to report to MD? | Any change in sputum; if ordered antibiotics do not relieve symptoms in 24 hrs. |
| Describe nursing process for COPD. | Assessment: h&P;sleeping positions(flat to increase TLC or orthopnic;review Dx/labs (ABGs, CXR, PFT..). |
| What physical evidence may be assessed with COPD? | Digital clubbing, distended neck veins (expiration), increased Anterior/posterior diameter, sinking of tissues around neck & supraclavicular spaces, observe breathing pattern (use of accessory musc, pursed-lip breathing). |
| What might be heard upon auscultation with bronchitis and emphysema? | Wheezes w/ chronic bronchitis, distant/dull breath/heart sounds w/ emphysema.. |
| Discuss nursing diagnoses for emphysema r/t breathing/gas exchange etc... | Ineffective airway clearance (goal:coughs productively);impaired gas exchange ( goal: PCO2 between 40-55mmHg sats>92%..); ineffective breathing patterns(goal: demonstrates methods to relieve breathlessness) |
| Discuss nursing diagnoses associated with emphysema other than gas exchange/breathingpattern/ineffective airway clearance. | Activity intolerance r/t musc fatigue(goal: describes 4 basic techniques for enrgy conservation);risk ineffective individual coping (goal: verbalizes anxieties/fears); risk altered health maintenance (goal: lists symptoms to be reported) |
| What are interventions for ineffective airway clearance? | Secretion removal(pulmonary hygiene);fluids 2-3 L/d unless contraindicated (corpulmonale); bronchodilators, nebulizer tx (before meals);oral hygiene, monitor therapeutic effects of meds. |
| Discuss interventions for impaired gas exchange. | Low dose O2 as ordered pt education regarding O2;teach s/s hypoxia, hypercapnia; monitor O2 sats; air-driven nebulizers rxs |
| Discuss interventions for ineffective breathing patterns . | teach breathing techniques to promote ventilation, ease work of breathing, assist in control of dyspena: I:E ratio;diaphragmatic breathing; pursed-lip breathing |
| Explain I:E ratio to teach pt. | control severe dyspnea if pt can control I:E ratio. Have pt practice timing expiration so that it is 3-4 times longer than inspiration;diaphragmatic breathing: pursed-lip breathing |
| Discuss intervention for activity intolerance r/t muscular fatigue. | gradual increase in aerobic exercise;review purpose of exercise program, emphasis on benefits;stress-mgt, physical/mental relaxation, I.D work-simplification strategies, measures to promote restful sleep; encourage pt to adopt slower pace of living |
| Discuss interventions for risk ineffective individual coping. | |
| Discuss interventions for risk altered health maintenance. | instruct in prevention/Rx; quit smoking programs;meet w/other COPD pt;teah s/infection; monitor s/s Rt sided HF; daily wts : report >5.5 lbs gain/wk 2 lbs in 24 hr=fluid vol excessWhat pts is it seen localized in? |
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