Nursing 211

N211: Health Differences Across the Lifespan I decreased vital capacity and forced expiratory volumes, with normal static compliance and diffusion capacity. Nursing Interventions Include the lowest FiO2 to prevent CO2 retention. Monitor for signs and symptoms of fluid overload. Maintain PaO2 between 55 and 60, and perform baseline ABGs. Teach the client pursed lip breathing and diaphragmatic breathing. Teach client the tripod position. Increase fluid intake to 3000 ml/day. Diet is increased protein and vitamin C, calories and nitrogen. Intubate and ventilate if respiratory status deteriorates. Administer low FiO2 because COPD patients use their hypoxic drive to breathe and increased FiO2 shuts that drive system down, they will stop breathing and become hypercapnic, somnolent and obtunded. Medications Include yearly immunizations against pneumonia (one time every 5 years) and influenzae (yearly), antibiotics, bronchodilators such as ipratropium (Atrovent), long acting theophylline and corticosteroids. Emphysema is when recurrent pulmonary inflammation damages and eventually destroys the alveolar wall, creating large air spaces and reducing the area available to exchange oxygen and carbon dioxide. The lungs are less able to recoil after expanding, there is air trapping, a decreased capillary network. The increased work causes increased oxygen consumption. The precipitating factors are cigarette smoking, genetics and environmental and occupational exposure. Nursing Assessment Includes barrel chest, dyspnea, pursed-lip breathing, and increased use of accessory muscles for breathing. These clients have distant, quiet breath sounds, wheezes and are “pink puffers”. Diagnostics Will show pulmonary blebs on x-ray. Chest x-ray reveals a flattened diaphragm, reduced vascular markings, enlarged antero-posterior chest diameter and a vertical heart. Pulmonary function tests show increased residual volume, total lung capacity and compliance and decreased vital capacity, diffusing capacity and expiratory volumes. Nursing Interventions Are the lowest FiO2 possible to prevent CO2 retention; monitor for signs and symptoms of fluid overload. Maintain PaO2 between 55 and 60, baseline ABGs. Medications include bronchodilators, steroids (hydrocortisone, solu-medrol), aerosolized steroids. Teach the client diaphragmatic and pursed-lip breathing to strengthen respiratory muscles, high-fowler’s position to improve

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