Physical Examination and Nursing Assessment for COPD

The assessment includes information about the symptoms and manifestations of the disease earlier. Here are some guidelines to get the data questions health history of the disease process:

1. How long has the patient had difficulty breathing?
2. Does activity increase dyspnea?
3. How much limits the patient's activity tolerance?
4. When patients complain most tired and short of breath?
5. Is eating and sleeping habits affected?
6. History of smoking?
7. The drugs used every day?
8. The drugs used in the acute attack?
9. What is known about the patient's condition and disease?

Additional data were collected through observation and examination as follows:

1. Patient's pulse rate and breathing?
2. Do the same breathing, without effort?
3. Is there a contraction of the abdominal muscles during inspiration?
4. Is there any use of accessory respiratory muscles during breathing?
5. Barrel chest?
6. Does it seem cyanosis?
7. Is there a cough?
8. Are there peripheral edema?
9. Is the neck veins appear enlarged?
10. What color, amount and consistency of sputum of patients?
11. What is the status of patients sensorium?
12. Is there an increase in stupor? Anxiety?
13. Results of diagnostic tests such as:

Chest X-Ray:
May indicate pulmonary hiperinflation, flattened diaphragm, increased retrosternal air space, decrease vascular signs / bullae (emphysema), an increase in the form of bronchovaskular (bronchitis), normally found during periods of remission (asthma)

Examination of Lung Function: Guide to determine the cause of dyspnea, determine whether the function abnormalities due to obstruction or restriction, to estimate the level of dysfunction and to evaluate the effects of therapy, eg bronchodilator.

TLC: Increase in severe bronchitis and usually on asthma, decreased in emphysema.

Capacity Inspiration: Decrease in emphysema

FEV1/FVC: Ratio of pressure expiratory volume (FEV) against the pressure of the vital capacity (FVC) decreased in bronchitis and asthma.

ABGs: Indicates a chronic disease process, often decreased PaO2 and PaCO2 normal or increased (chronic bronchitis and emphysema) but often decreased in asthma, the normal pH or acidosis, respiratory alkalosis secondary to hyperventilation light (moderate emphysema or asthma).

Bronchogram: Can show dilatation of the bronchi during inspiration, kollaps bronchial expiratory pressure (emphysema), enlargement of mucous glands (bronchitis)

Complete Blood: Increased hemoglobin (severe emphysema), an increase in eosinophils (asthma).

Blood Chemistry: Alpha 1-antitrypsin is made to the possibility of less on primary emphysema.

Sputum culture: To determine the presence of infection, identify the pathogen, cytologic examination to determine malignancy or allergic disease.

ECG: right axis deviation, tall P wave (severe asthma), atrial dysrhythmias (bronchitis), gel. P in Leads II, III, AVF length, height (bronchitis, emphysema), QRS axis vertical (emphysema)

Exercise ECG, Stress Test: Helping assess the level of respiratory dysfunction, evaluate the effectiveness of bronchodilator drugs, plan / program evaluation ..

Palpation:

1. Reduction in the development of breast palpation?
2. Is there decreased tactile fremitus?

Percussion:

1. Is there hiperesonansi on percussion?
2. The diaphragm moves just a little bit?

Auscultation:

1. Is there a loud wheezing sound?
2. Is there ronkhi sound?
3. Nomal or decreased vocal fremitus?

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Theories of Aging Process

1. Biological Theory

a. Gene Mutation Theory
Aging occurs as a result of changes in biochemistry that is programmed by the molecule / DNA and every cell in turn will undergo mutation.

b. Usage and broken
Effort can lead to excess stress causes the body's cells exhausted (used up).

c. Auto Immune theory
There are certain body tissues that are not resistant to certain substances that the body tissues become weak and sick.

d. stress theory
Aging occurs due to loss of cells commonly used body . Regeneration of body tissue can not maintain a stable internal environment, excess effort and stress that causes fatigue unused cells.

e. Free radical theory
Unstable oxygen free radicals resulting in oxidation of organic matter which in turn causes the cells can not regenerate.

f. Cross-linking theory
Old cells that cause a chemical reaction of a strong bond, especially the collagen network which in turn lead to less elastic, chaos and loss of function.

g. Theory courses
Organism's ability to set the number of dividing cells after the cells are dead cells.


2. Social psychological theory

a. Activity (activity theory)
In the elderly who are successful and those who are actively involved in many social activities and maintain the relationship between the individual and the social system that is stable from middle age to old age.

b. Personality continues
It is a combination of the above theory in which the changes occur in the elderly seseroang greatly influenced by the type of personality he has.

c. Liberation theory
The breakdown in relationships or relationships with the community and setbacks individual to individual. With increasing age, a gradually began to break away from social life or withdrawn surroundings. This situation resulted in decreased social interaction elderly, both in quality and quantity so often happens double loss: loss of role, social contact barriers, reduced commitment.

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