This paper expounds the contents of health guidance for patients with chronic obstructive pulmonar
This paper expounds the contents of health guidance for patients with chronic obstructive pulmonary disease during hospitalization, including prevention of upper respiratory tract infection, nutrition conditioning, respiratory function exercise in remission period, oxygen therapy, etc., which can effectively help patients prevent complications, promote self-care and improve quality of life.
Chronic obstructive pulmonary disease; During hospitalization; health guidance
Chronic obstructive pulmonary disease (COPD) is a common and frequently-occurring disease among middle-aged and elderly people in China. According to the survey [1], 90% of patients with chronic obstructive pulmonary disease lack disease-related knowledge, some patients may develop cor pulmonale after 5 ~ 10 years, and 10% patients are complicated with peptic ulcer. Therefore, health guidance for patients with chronic obstructive pulmonary disease is particularly important. In this paper, health guidance for patients with chronic obstructive pulmonary disease during hospitalization can effectively help patients prevent complications, promote self-care and improve their quality of life.
Clinical data of 1
Thirty patients with chronic obstructive pulmonary disease diagnosed in undergraduate hospitals from June 5438+ 10 to June 2065438+065438+February were selected, belonging to the local public medical care, and were observed and followed up. The respondents ranged in age from 53 to 58, including 27 males and 3 females. From June 2005 to February 2005, 1 1, 65438, among 30 patients, 22 were hospitalized for 6 times and 8 were hospitalized for 9 times, with an average of 2.27 hospitalizations per person per year. From June to 10, 2007, the inpatients were given health guidance and followed up regularly after discharge, and a * * * clinic was established. In 2007, 65438+1October-20165438+February, the same 30 patients were hospitalized twice on 18 and three times on 12, with an average of only 0.8 hospitalizations per person per year. Of the 30 patients, 1 had no complications, and 2 patients died of * * *.
2 Health guidance
2. 1 Keep respiratory tract unobstructed and prevent upper respiratory tract infection.
2. 1. 1 Clear airway obstruction
There are many sputum and endotracheal secretions in elderly patients, which are easy to cause respiratory obstruction, increase ventilation resistance and aggravate infection and dyspnea. Therefore, it is very important to instruct patients to drink enough water * * *1000 ~1500ml * * every day and cough and expectorate effectively. Methods * *1* * * Take a deep breath, then hold your breath, and then cough suddenly, so that the sputum in the large trachea can be discharged. ***2*** instructs the patient to take a deep abdominal breath first, inhale through the nose first, and then shrink his mouth into a whistle to leave air. Blow quickly and inhale through your nose after blowing. When the patient has mastered this breathing method, he can start coughing by inhaling. Take the above deep breaths for 4-5 times, then open your mouth and stick out your tongue to cough at least twice. After coughing up phlegm, you can relax your physical strength, take a short rest, then do deep breathing exercises, cough after practice, and try to expel phlegm.
2. 1.2 Appropriate physical exercise
Patients with chronic obstructive pulmonary disease feel worse during exercise, and most patients are afraid of exercise. Instruct patients to decide the amount of exercise and exercise according to cardiopulmonary function during remission. The form of exercise should be combined with daily activities, such as walking, jogging, climbing stairs, pedaling bicycles and doing housework. The initial stage of exercise generally lasts for 5 ~ 10 min, and the number of exercises increases gradually with light exercise load, 4 ~ 5 times a day, and then the time is extended for 20 ~ 30 min after gradual adaptation.
2. 1.3 cold-resistant exercise
Cold-resistant exercise should start in summer, first wipe the head and face with cold water towels, and gradually expand the kit to the limbs. For those with good physique, strong endurance and respiratory function below level 3, they can persist until winter. Cold water rubbing the face and limbs can enhance the adaptability of the panel to cold, improve the cold resistance of the body, reduce the number of diseases in winter, and achieve the purpose of preventing diseases.
2. 1.4 Prevention of colds
Pay attention to the changes of environment and temperature, and avoid going to crowded places; Change clothes, change sweaty clothes in time when the temperature changes; Pay attention to indoor air circulation and fumigate with vinegar to prevent colds. The amount of vinegar is 5 ~ 10 ml/m3, and then it is heated and evaporated with warm water. If you have symptoms of upper respiratory tract infection such as runny nose and cough, you should seek medical treatment and medication in time to prevent the infection from spreading downwards. Bronchodilators such as β2 stimulant and theophylline should be used in remission period to reduce acute attack.
2.2 Nutrition aftercare
The incidence of malnutrition in patients with chronic obstructive pulmonary disease is 27% ~ 7 1%. The reason is insufficient intake, and the blood oxygen saturation decreases 10% during meals, which can cause asthma, anorexia, diaphragm decrease and gastric capacity decrease; Hypoxia and hypercapnia cause gastrointestinal congestion; Effects of antibiotics and theophylline drugs on gastric mucosa. Malnutrition will also reduce the muscle strength and endurance of respiratory muscles, easily lead to respiratory muscle fatigue, and then * * *. Therefore, patients with chronic obstructive pulmonary disease should have a diet with low sugar, high protein and high fat. Such as: milk, beef, eggs, pork and so on. A small amount of meals, no abdominal distension and diarrhea. Generally, protein accounts for 65,438+05% ~ 65,438+08% of the total daily calories, with fat accounting for 22% ~ 25% and carbohydrate accounting for 55% ~ 58%. If necessary, intravenous nutrition should be supplemented.
2.3 Respiratory function exercise in remission stage
2.3. 1 Lip-contracting Abdominal Breathing
Patients with emphysema can improve their vital capacity by increasing diaphragm activity through abdominal breathing, while the system of lip-shrinking breathing can slow down exhalation and delay small airway obstruction to improve respiratory function, so lip-shrinking abdominal breathing can effectively improve respiratory function. The patient can take a standing position, or sit or lie down, with one hand on his chest and the other on his abdomen. First, shrink your lips, abdomen, chest forward, and exhale slowly through your mouth. Don't use force at this time, then inhale through his nose, try to straighten his abdomen and keep his chest still. The ratio of breathing time to breathing time is 2: 1 or 3: 1, 7 ~ 8 times/minute, and exercise twice a day, each time 10 ~ 20min.
2.3.2 Controlled deep breathing method
Take a sitting position, lying position or lateral position, eliminate distractions, take a natural posture, relax the muscles of the whole body, slowly and deeply inhale to the maximum vital capacity and then exhaust. 2 ~ 5s, gradually increase to 10s, then exhale slowly, and continue to do 10 ~ 20 times. This method can increase vital capacity, lung volume and alveolar ventilation, improve the uneven distribution of inhaled gas during hypoxia and improve the gas exchange function. The nurse teaches the patient first, and then lets the patient master this method. To make patients keep exercising, only perseverance can be effective.
2.4 oxygen therapy
The purpose is to correct tissue hypoxia, reduce pulmonary hypertension, delay the occurrence of right heart failure and enhance people's tolerance for life. PaO2 _ 2 _ 2 is decreased and PaCO2 _ 2 _ 2 is increased in patients with chronic obstructive pulmonary disease, which is caused by decreased ventilation and imbalance of ventilation/blood flow ratio. Therefore, ltot is the main therapeutic measure for the rehabilitation of patients with chronic obstructive pulmonary disease. However, most patients with chronic obstructive pulmonary disease have a strong tolerance to hypoxia and do not understand their own diseases and treatments. They think that the more oxygen they take, the better, or they don't take oxygen for a while, or they only take oxygen when they feel short of breath. These factors will lead to the failure of oxygen therapy and even aggravate the condition. Because patients with chronic obstructive pulmonary disease, especially patients with type II respiratory failure, inhale high concentration oxygen, the effect of hypoxia on chemoreceptors of aortic body and carotid body is weakened, which makes the respiratory center lose the driving role of peripheral hypoxia, makes breathing shallow and slow, reduces the amount of carbon dioxide discharged, leads to increased carbon dioxide retention, and finally leads to paralysis and death of the respiratory center. Therefore, patients with chronic obstructive pulmonary disease should continue to inhale oxygen at a low concentration of *** 15h/d*** 25% ~ 30% * *, and at a low flow rate of * *1~ 2ml/min * *. Precautions: do a good job in earthquake prevention and fire prevention; Replace the liquid in the humidification bottle twice a week; The oxygen device is disinfected every week 1 time, and the oxygen tube is replaced every day 1 time. Print disease-related knowledge and exercise methods into pamphlets, and explain and teach them to patients repeatedly during hospitalization until they understand and master them. When leaving the hospital, the pamphlet will be distributed to the patients, which really achieves the purpose of publicity.