老年copd病人的护理课件.ppt

1、老年慢性阻塞性肺疾病老年慢性阻塞性肺疾病病人的护理（二）病人的护理（二）湘雅二医院湘雅二医院 苏晶苏晶老年慢性阻塞性肺疾病病人的护理（二）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湘雅二医院老年专科护士培训一一 老年老年COPDCOPD病人的主要护理问题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

2、护士培训湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施一般护理一般护理 增加呼吸功能增加呼吸功能 用药指导用药指导 心理护理心理护理 4123湘雅二医院老年专科护士培训湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（一）一般护理（一）一般护理饮食饮食 休息与休息与活动活动 皮肤皮肤二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年

3、COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（二）增加呼吸功能（二）增加呼吸功能 有效排有效排痰痰 氧疗氧疗呼吸功呼吸功能训练能训练二二 老年老年COPDCOPD病人的护理

4、措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二

5、医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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

6、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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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

7、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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施支气管舒张剂支气管舒张剂 糖皮质激素糖皮质激素 止咳药止咳药 祛痰药祛痰药 4123（三）用药指导三）用药

8、指导湘雅二医院老年专科护士培训湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施2受体激动剂和抗受体激动剂和抗胆碱药联合用药胆碱药联合用药（三）用药指导三）用药指导支气管舒张剂支气管舒张剂 2受体激受体激动剂动剂抗胆碱药抗胆碱药茶碱类药茶碱类药物物湘雅二医院老年专科护士培湘雅二医院老年专科护士培训训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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

9、湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老

10、年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDC

11、OPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训二二 老年老年COPDCOPD病人的护理措施病人的护理措施（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湘雅二医院老年专科护士培训谢谢聆听！谢谢聆听！湘雅二医院老年专科护士培训湘雅二医院老年专科护士培训ContentsClick to add title in here Cl

12、ick to add title in here Click to add title in here Click to add title in here 4123ThemeGallery 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?On the View menu,point to Master,and then cl

13、ick Slide Master or Notes Master.Change images to the one you like,then it will apply to all the other slides.Image information in product Title Image -, Note to customers:This image has been licensed to be used within this PowerPoint template only.You may not extract the image for any other use.Cli

14、ck to edit title styleText in hereText in hereThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Description of the contents Description of the contents Description of the business

15、Description of the business Description of the businessThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Description of the contentsDescription of the contentsClick to edit title styleText in hereText in hereText in hereText in hereText in hereText in hereText in h

16、ereText in hereContentsContentsContentsContentsContentsThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Click to edit title styleText in hereText in hereText in hereThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Click to add T

17、extClick to edit title styleContents01Contents02Contents03Contents04Contents05Contents060%20%40%60%80%100%18.5%17.5%8.7%23.6%63.6%84.3%ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Click to edit title styleThemeGallery is a Design Digital Content&Contents mall

18、developed by Guild Design Inc.Title in hereTitle in hereTitle in hereTitle in hereABCDClick to edit title styleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a D

19、esign Digital Content&Contents mall developed by Guild Design Inc.Title in here Title in here Title in hereClick to edit title styleTitle in hereThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Description of the contentsDescription of the contentsDescription of t

20、he contentsDescription of the contentsTitle in hereTitle in hereTitle in hereClick to edit title styleDescribe a vision of company or strategic contents.Describe a vision of company or strategic contents.Describe a vision of company or strategic contents.Describe a vision of company or strategic con

21、tents.Description of the productsDescription of the contentsThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Description of the contentsDescription of the contentsDescription of the contentsM1M2M4M3Click to edit title styleClick to edit title styleCEOText in hereT

22、ext in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereText in hereClick to edit title style

23、Contents01Contents02Contents03Contents04Contents05Contents060%20%40%60%80%100%18.5%17.5%8.7%23.6%63.6%84.3%ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Click to edit title styleDescription of the contents Title in hereThemeGallery is a Design Digital Content&C

24、ontents mall developed by Guild Design Inc.Title in hereThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Title in hereThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Title in hereThemeGallery is a Design Digital Content&Content

25、s mall developed by Guild Design Inc.Click to edit title styleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ConceptConceptConceptConceptThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content

26、&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.

27、Click to edit title styleService 03Service 02Service 01Click to edit title style200820072006 200520042003 200220012000 Description of the contents Description of the contents Description of the contents Description of the contents Description of the contents Description of the contents Description o

28、f the contents Description of the contents Description of the contentsClick to edit title style2004200520062006 statistics title2006 statistics title(unit:%)(unit:%)*2006 Statistics agency statistics*2006 Statistics agency statistics50%20042005200690%15%96%35%70%Contents of the product,and please fill it out.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Thank You!