copd教学查房演练-ppt课件共77页

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目录一、定义三、流行病学二、病案介绍四、病因与发病机制五、临床表现六、实验室检查七、诊断要点八、治疗要点九、护理诊断及措施十、健康教育CONTENTS1.Definition3.Epidemiology2.ClinicalCase4.Etiology&Pathogenesis5.ClinicalManifestation6.LaboratoryTests7.Diagnosis8.Treatment9.NursingDiagnosis&Implementations10.HealthEducation关键词(KeyWords)咳嗽cough咳痰sputumproduction呼吸困难dyspnea桶状胸“barrel-shaped”chest气流受限airflowlimitation急性加重期acuteexacerbations气体交换受损impairedgasexchange清理呼吸道无效ineffectiveairwayclearanceAECOPD1、什么是慢性阻塞性肺疾病(COPD)?2、哪些人群更容易患COPD?3、作为医护人员,我们应该如何诊断、治疗?4、作为21世纪的新护士,我们应该如何提供护理?思考一、COPD定义慢性阻塞性肺疾病简称慢阻肺,是一种以气流受限为特征的可以预防和治疗的疾病,气流受限不完全可逆、呈进行性发展。Chronicobstructivepulmonarydisease:COPD,isapreventableandtreatabledisease.Itischaracterizedbyairflowlimitation.Theairflowlimitationisnotfullyreversibleandusuallyprogressive.Definition二、COPD病案介绍姓名:郭其文性别:男年龄:83岁简要病史:患者二十余年来反复出现咳嗽、咳痰,无咯血及胸痛,无低热、盗汗。两天前受凉后咳嗽、咳痰加重,痰量多,为黄色粘痰,畏寒,感咽痛声嘶。查体:T:36.4℃,P:80次/分,R:19次/分,BP:126/72mmHg(卧位),可见桶状胸,横膈下移,肢端发绀。X线:双肺纹理增多、肋间隙增宽增粗,确诊为“慢性阻塞性肺疾病”,为进一步诊治于2019年8月14日收住我院。ClinicalCaseName:QiwenGuoGender:maleAge:83Casehistory:Thepatientcomplainedofcoughandsputumproductionover20years.Inthepasttwodays,hehasbeenhavingacold,anexacerbatedcoughproductiveofyellowmucoussputum.PE:T:36.4℃,P:80/min,R:19/min,BP:126/72mmHg(supine).“Barrel-shaped”chest,downwarddisplacementofdiaphragm,acrocyanosisareexisted.Chestfluoroscopy:increasedbilaterallungsmarkings,widenedintercostalspaces.HewasdiagnosedasCOPDandadmittedonAugust14th,2019.体格检查三、流行病学03-04年,我国通过对七个地区的40岁以上人群抽样调查发现,COPD总患病率为8.2%,患病率存在性别、地区等差异。1.吸烟;Smoking2.职业性粉尘及化学物质;Occupationaldustsandchemicals3.空气污染;Airpollution4.呼吸道感染;Respiratorytractinfection5.其他Others四、病因与发病机制四、病因与发病机制有害颗粒或气体COPD病理学改变蛋白酶氧化应激②粘液分泌增加①肺实质破坏③肺血管壁增厚④气道壁结构重塑气流受限炎症反应五、临床表现:症状☻1.慢性咳嗽晨间明显,白天较轻,睡眠时有阵咳或排痰。☻ChroniccoughItisobviousinthemorningandrelievedinthedaytime.Thereisaparoxysmalcoughorsputumproductionwhensleeping.☻2.咳痰为白色粘液或浆液性泡沫痰,偶可带血丝。急性发作伴细菌感染时,痰量增多,可有脓性痰。☻SputumproductionThereisawhitemucusorserousfrothysputum,withbloodoccasionally.Thesputumwouldbetoomuchandpurulentwithbacterialinfection.五、临床表现:症状☻3.气短或呼吸困难仅在体力劳动或上楼等活动时出现,病情重时日常活动也能感到气促,是COPD的标志症状。☻ShortnessofbreathordyspneaItonlyappearswhenlaboring,goingupstairsordoingotheractivities.Patientmayfeelunwellevenindailyactivitieswhenitisworse,whichisthesignalsymptomsofCOPD.五、临床表现:症状☻4.喘息和胸闷重度病人或急性加重时出现喘息和胸闷.☻AsthmaandchestdistressCriticallyseriouspatientsmayshowasthmaandchestdistressinacuteexacerbations.五、临床表现:症状五、临床表现:症状☻5.其他晚期病人有体重下降,食欲减退等全身症状。☻OthersTerminallyillpatientshavesystemicsymptomssuchasweightloss,lossofappetite.视诊—桶状胸,呼吸浅快,严重者可有缩唇呼吸。InspectionBarrel-shapedchest,rapidandshallowbreathing,severecasesmayhavepursed-lipbreathing.五、临床表现:体征触诊—触觉语颤减弱或消失。PalpationTactilefremitusisweakenedordisappeared.五、临床表现:体征叩诊—呈过清音,心浊音界缩小,肺下界和肝浊音界下降。PercussionItsoundstoovoiceless,theborderofcardiacdullnessnarrows,inferiorboundaryoflungandtheborderofhepaticdullnessgodown.五、临床表现:体征听诊—两肺呼吸音减弱,呼气延长,部分病人可闻及干性啰音和(或)湿性啰音。AuscultationBreathsoundsreduces,expiratorysoundextends,somepatientscanbeheardwheezesormoistcrackles.五、临床表现:体征I级:轻度Ⅱ级:中度Ⅲ级:重度IV级:极重度COPD严重程度分级FEV1/FVC0.7,FEV1≥80%预计值FEV1/FVC0.7,50%≤FEV180%预计值FEV1/FVC0.7,30%≤FEV150%预计值FEV1/FVC0.7,FEV130%预计值或FEV150%预计值StageI:MildStageII:ModerateStageIII:SevereStageIV:VerySevereSeverityClassificationFEV1/FVC0.7,FEV1≥80%predictedFEV1/FVC0.7,50%≤FEV180%predictedFEV1/FVC0.7,30%≤FEV150%predictedFEV1/FVC0.7,FEV130%predictedorFEV150%predicted六、COPD实验室检查1.肺功能检查:判断气流受限的主要客观指标。PulmonaryfunctiontestsItisthemainobjectiveindicatorsofairflowlimitations.2.动脉血气分析:用于判断呼吸衰竭的类型。ArterialbloodgasanalysisItisusedtoestimatethetypeofrespiratoryfailure.3.X线检查:慢阻肺早期X线胸片可无明显变化,以后出现肺纹理增多、紊乱等非特征性改变。X-raycheckChestx-raymaybenochangeatitsearlystage,latershowsincreasedlungmarkings,disordersandothernon-characteristicchanges.六、COPD实验室检查4.其他:并发感染时痰涂片可见大量中性粒细胞,痰培养可检出各种病原菌。OthersSputumsmearrevealsnumerousneutrophils,lotsofpathogenscanbefoundinsputumcultureininfections.六、COPD实验室检查临床表现+体征+实验室检查七、诊断要点异常正常1.哮喘Asthma2.充血性心力衰竭Congestiveheartfailure3.支气管扩张Bronchiectasis4.结核病Tuberculosis5.闭塞性细支气管炎Bronchiolitisobliterans6.弥漫性细支气管炎等Diffusebronchiolitis与COPD鉴别的疾病COPD稳定期治疗八、COPD的治疗1.支气管舒张药①β2受体激动剂(如沙丁胺醇气雾剂)②氨茶碱③抗胆碱药(如溴化异丙托)2.祛痰药(如盐酸氨溴索)TreatmentofStableCOPDTreatment1.Bronchodilatordrugs①β-receptoragonists(eg.salbutamolaerosol)②Aminophylline③Anticholinergicdrugs(eg.ipratropiumbromide)2.Expectorants(eg.ambroxol)急性加重期治疗1.支气管舒张药使用同稳定期。2.糖皮质激素治疗3.积极抗感染治疗八、COPD的治疗AcuteExacerbationsofCOPDTreatment1.Bronchodilatormedicine(thesameusagewithstableperiod)2.Glucocorticoidtreatment3.Antibiotictreatment九、护理诊断、措施及依据气体交换受损ImpairedGasExchangeA相关因素Relatedfactors1.气道阻塞airwayobstruction2.通气不足hypoventilation3.呼吸肌疲劳respiratorymusclefatigue4.分泌物过多excessivesecretions5.肺泡呼吸面积减少abatementofalveolarsurfacearea(一)护理依据1.休息与活动体位活动量环境2.病情观察观察症状监测体征(二)护理措施NursingImplementations1.RestandmovementpositionActivityamountenvironment2.Observationobservingsymptomsmonitoringvitalsigns应用3.用药护理效果反应4.氧疗护理(1)鼻导管吸氧(2)长期家庭氧疗(LTOT)持续低流量吸氧,氧流量1~2L/min,每日15h以上。(二)护理措施Application3.MedicationnursingEffectivenessReaction4.Oxygen

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