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Transcript of Nursing
By: Jordann W., Becky K., and Bailey L. Learning Needs In Closing. . . Future Implications Time For a Post Test!! Summary and Questions Pulmonary Rehab Effective Breathing
Techniques Immunization and
When to Seek Help Lifestyle Changes Meet Barbara Why Was She Hospitalized?
What's her Progress? Introductions Barbara is a retired 65 year old female diagnosed with COPD. She currently lives with her husband in Lethbridge. Barbara does all of the household work, cooking and cleaning. She has trouble moving around her house and feels like she needs assistance sometimes. There are six steps in her home and has trouble walking up them. Barbara came to the hospital with a lot of anxiety and was hospitalized for acute exacerbation of COPD, with severe SOB, SOBOE and ineffective airway clearance. Her oxygen saturation upon arrival at the hospital was 74%.
During her hospitalization, Barbara continued to be short of breath on exertion although she was able to breathe more effectively while at rest. On 3L of oxygen therapy, her O2 sats were maintained at 92%. With encouragement, Barbara increased her calorie intake and gained 3 pounds during her hospital stay. -Avoid airborne toxins
-Drink plenty of fluids
-planning to conserve energy
-use shower seats or baths
(Lung Disorders, 2007) Pursed Lip Breathing. . . - In our future nursing practice we will be using the knowledge for patient teaching as well as helping them manage and adjust to their condition.
-We will utilize the knowledge on COPD and have a greater understanding of the treatment methods our patients will be undergoing.
- We will focus on the learning needs of the patient and understand how they learn and what they need to learn and base our teaching on that. Barbara has a smoking history of 50 pack years (which means she has smoked a pack of cigarettes a day for the past 50 years) but has recently cut back to 3 cigarettes a day. Barbara has anxiety about her condition and is afraid that she might not be able to breathe at all one day. Prior to admission to the ER, Barbara had not seen a doctor in about 10 years. Barbara currently has a BMI of 15. Barbara's Overall Goals 1) Prevention of disease progression
2) Client being able to perform ADL’s
3) Relief of breathlessness and other respiratory symptoms
4) Improved exercise tolerance
5) Prevention and treatment of exacerbation's
6) Improved quality of life
7) Reduction in premature mortality
(Lewis et al., 2010) What the Patient and Family Should Know and Learn -Common medication routes for COPD
-Reason for changes in lifestyle
-Promote a healthy lifestyle of working out, eating well and receiving vaccinations
-Oxygen therapy and how to use effectively
-When to seek help for COPD flare-ups - avoid humidity, aerosols, and heavy scented sprays
-simplify any routines like dressing or grooming
-exercise Inhale through your nose, then exhale
with your lips pursed in a whistling or kissing position. Each inhalation should take about two seconds, and each exhalation should last about four to six seconds.
(Lung Disorders, 2007) Diaphragmatic Breathing. . . To practice using the diaphragm, lie on your back, place your hand or a small book on your abdomen, and breathe. Your hand or the book should rise on inhalation and fall on exhalation. Practice for 20 minutes twice daily. Once you have mastered this skill while lying down, try to do it while sitting up (without the book, of course). Forward-bending Posture. . . Breathing while bending slightly
forward from the waist relieves symptoms for some people with severe COPD, possibly because the diaphragm has more room to expand. Huff Coughing Main goals of effective coughing are: conservation of energy, reduction of fatigue and removal of secretions
1. Pt assumes sitting position with head slightly flexed, shoulders relaxed, knees flexed, forearms supported by pillow and feet on the floor.
2. Pt drops head and bends while using slow, pursed lip breathing to exhale.
3. Sitting up again, pt used diaphragmatic breathing to inhale slowly and deeply.
4. Client repeats steps 2 and 3, 3 or 4 more times to facilitate mobilizations of secretions
5. Before initiating a cough, pt should take a deep abdominal breath, bend slightly forward, and then huff cough (3-4 times on exhalation) People with COPD should get annual flu and pneumonia vaccines. This will help to reduce the risk of life threatening infections. If you have COPD and you experience any of the following symptoms, you should call your doctor immediately -Shortness of Breath (SOB)
-Change in color of mucus
-Cough up blood
-Edema of the legs and abdomen (Swelling)
-Fever over 100F
-Severe Chest Pain
-Flu like symptoms
-Medication seems to not be working
(Lung Disorders, 2007) Things to watch out for. 1) Flare Up and infections: SOB, increase in mucus, different coloured sputum. "Flare ups often result from a bronchial infection which may be treatable with antibiotics” (Lung Disorders, 2007, pg. 32)
2)Hear Failure: Edema of lower limbs. In COPD, these people are more likely to develop cor pulmonale. COPD can also cause decreased right ventricular contraction. 3) Pneumothorax:-“a hole that develops in the lung allowing air to escape into the space between the lung and chest wall” (Lung Disorders, 2007, pg. 32). Will show as: SOB, Pain while breathing, Sharp chest pain (usually on one side), Tightness in the chest, Dry cough, Increased heart rate. Treatment involves usage of chest tubes. (Lung Disorders, 2007) 4.Polycythemia (Increase RBC)
-Signs and symptoms include:
-These symptoms result from there being not enough oxygen in the blood due to the increase in red blood cells
-To treat this, generally oxygen is applied.
(Lung Disorders, 2007) Quick Facts about COPD - COPD is the 4th leading cause of death worldwide, yet 75% of those affected remain untreated.
- The WHO estimates 600 million people worldwide have COPD
- Higher prevalence rates for COPD are found in men than in woman globally reflecting historic gender differences in smoking behaviour
(Quick Facts About COPD, 2011)
- COPD is common diagnosis that patient's have in the hospital setting and as student nurses, there is a good chance we will encounter it, and it is important that we know how teach our patients about this condition. Learning Outcomes What do you know? -What is COPD?
- Have any of you had a patient with COPD or a breathing disorder of some sort?
- What types of patient teaching would do or would you have done? Incentive Spirometer and Inhalers http://www.superteachertools.com/jeopardy/usergames/Nov201247/game1353376394.php Bloom’s Taxonomy -Origins of “ASK”: Attitude, Skill and Knowledge (Affective, Psychomotor, Cognitive)
Bloom's focus' on the Cognitive approach to learning teaching. Knowledge Knowledge: Recall of data
Comprehension: Understands the meaning of instructions
Application: Applies what is learned to situations and contexts
Analysis: Separates material or concepts into component parts so that its organizational structure may be understood.
Synthesis: Builds a structure from diverse information
Evaluation: Makes judgments about the value of ideas and patterns
(Bilash, 2011) What will you learn?
- We will be teaching you what COPD is
-Things to look for if you have COPD
~signs and symptoms of infection
- How to teach a patient with COPD how to care for themselves
~smoking cessation, how to use an inhaler, an incentive spirometer and proper coughing techniques Smoking Cessation - Cigarette smoking causes the vast majority of COPD cases
- Avoiding cigarettes and cigarette smoke is the most effective way to prevent COPD
- Smoking cessation is the #1 lifestyle modification that should be made in COPD patients
- People with advanced COPD can increase their life expectancy if they stop smoking including 2nd hand smoke
-O2 should not be used while smoking!
(Lung Disorders, 2007) COPD - Encompasses chronic bronchitis and emphysema
- Develops slowly over several years
- Symptoms include wheezing, chronic cough that produces phlegm, and progressive SOB
- At advanced stages, patients often become thin and find it tiring to eat because of the amount of energy it takes to breathe
(Lung Disorders, 2007) Oxygen Therapy - Enhances sleep and mood, increases mental alertness and stamina, and allows people to carry out their ADL's more efficiently.
- It prevents the development of cor pulmonale by decreasing the blood pressure in the lungs and the work load of the right side of the heart.
(Lung Disorders, 2007)
- People with COPD have higher levels of CO2. Too much oxygen in the body could trick the brain into thinking the CO2 level is ok. This will cause the individual to stop breathing and potentially go into respiratory failure.
-This is why people with COPD need to maintain an O2 saturation between 88-92%.
(Lewis et al., 2010) SEE EXERCISE VIDEO SEE PURSED LIP BREATHING VIDEO (Lung Disorders, 2007) How to Use an Incentive Spirometer -Breathing exerciser used to help you take deep breaths and keep your lungs clear
-Deep breathing exercises will help open the air sacs in your lungs and may reduce the chance of developing breathing problems (pneumonia)
-It is important to use the incentive spirometer on your own to help with your recovery.
(James & Solove, 2012, pg. 1) SEE PULMONARY REHAB VIDEO In summary you have learned about COPD, learned ways of assessing patients and you have a greater understanding of how to care with COPD patients. REFERENCES
Quick facts about COPD. (2011) International COPD coalition. Retrieved from http://www.internationalcopd.org/materials/patients/learn/facts.aspx
Bilash, O. (2011, January). Blooms taxonomy. Retrieved from http://www2.education.ualberta.ca/staff/olenka.Bilash/best of bilash/bloomstaxonomy.html
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R., O'Brien, P. G., & Bucher, L. (2010). Medical-surgical nursing in Canada: Assessment and management of clinical problems. (2nd ed.). Toronto, ON: Mosby Elsevier
Lung Disorders. (2007). Chronic Obstructive Pulmonary Disease (COPD). Retrieved from www.hopkinslung.com