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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Activity Intolerance related to - COPD

Nursing Diagnosisi Activity intolerance related to imbalance between oxygen supply with demand.

Goal : Shows the progress at a higher level of activity possible.

Nursing Interventions Activity intolerance - COPD:

• Assess the individual response to the activity; pulse, blood pressure, respiration.
• Measure vital signs immediately after the activity, the client rest for 3 minutes then measuring the vital signs again.
• Support the patient in establishing a regular exercise using a treadmill and exercycle, walking or other exercise appropriate, such as walking slowly.
• Assess the patient's level of function of the last and develop training plans based on the status of basic functions.
• Recommend consultation with a physical therapist to determine the specific training program on the ability of the patient.
• Provide oxygen as represented is required before and during the run of activity just in case.
• Increase activity gradually; clients currently or long bed rest started doing range of motion at least 2 times a day.
• Increase tolerance to the activity by encouraging clients to do the activity more slowly, or a shorter time, with more rest or with a lot of help.
• Gradually increase exercise tolerance by increasing the time out of bed until 15 minutes per day 3 times a day.

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Ineffective Airway Clearance related to - COPD

Nursing Diagnosis Ineffective airway clearance related to :

•  bronchoconstriction,
• increased mucus formation, 
• ineffective cough, 
• bronchopulmonary infection.

Goal: Achievement of client airway clearance

Nursing Interventions Ineffective airway clearance:

• Give the patient 6 to 8 glasses of fluid / day unless there is a cor pulmonale.
• Teach and give encouragement use of diaphragmatic breathing and coughing techniques.
• Assist in the provision of action nebulizer, metered dose inhalers.
• Perform postural drainage with percussion and vibration in the morning and evening according to the required.
• Instruct patient to avoid irritants such as cigarette smoke, aerosols, temperature extremes, and smoke.
• Teach about the early signs of infection should be reported to your doctor immediately: increased sputum, change in sputum color, viscosity of sputum, increased shortness of breath, chest tightness, fatigue.
• Give antibiotics as required.
• Give encouragement to patients to immunize against influenzae and Streptococcus pneumoniae.

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Physical Assessment for COPD

Physical Assessment for COPD

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

1. How long the patient has trouble breathing?
2. Does the activity increase of dyspnea?
3. How far the patient's tolerance limit activity?
4. When patients complain of fatigue and shortness of breath most?
5. Are eating and sleeping habits affected?
6. History of smoking?
7. The drugs used every day?
8. The drugs used in acute attacks?
9. What is known about the condition of the patient and his disease?

Additional data collected through observation and examination as follows:

1. Patient's pulse rate and breathing?
2. Is breathing the same regardless of effort?
3. Is there a contraction of abdominal muscles during inspiration?
4. Is there any use of accessory respiratory muscles during breathing?
5. Barrel chest?
6. Does seem cyanosis?
7. Is there a cough?
8. Are there any peripheral edema?
9. Are the neck veins look bigger?
10. What is the 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. The results of diagnostic tests such as:

Physical Assessment for COPD

Palpation:

1. Palpation reduction in chest development?
2. Is there decreased tactile fremitus?

Percussion:

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

Auscultation:

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

Read More..