慢阻肺危重患者护理计划单

慢阻肺危重患者护理计划单
Care Plan for Critically Ill COPD Patients.
Assessment.
Respiratory status: Assess respiratory rate, depth,
and effort; oxygen saturation; breath sounds; chest wall expansion; sputum production and character; and use of accessory muscles.
Cardiovascular status: Monitor heart rate, rhythm, and blood pressure; assess for edema, jugular venous distension, and cyanosis.
Neurological status: Assess level of consciousness, orientation, and mental status; check for signs of confusion, agitation, or lethargy.
Renal status: Monitor urine output, creatinine levels, and blood urea nitrogen; assess for oliguria or anuria.
Nutritional status: Assess weight, body mass index, and dietary intake; check for signs of malnutrition or cachexia.
Medication use: Review current medication regimen, including bronchodilators, steroids, antibiotics, and oxygen therapy.
Diagnosis.
Acute exacerbation of chronic obstructive pulmonary disease (COPD)。

Respiratory failure.
Hypoxemia.
Hypercapnia.
Acidosis.
Multi-organ dysfunction syndrome (MODS)。

Goals.
Improve respiratory status.
Maintain oxygenation and ventilation.
Minimize airway inflammation and bronchospasm.
Support cardiovascular function.
Prevent complications.
Enhance comfort and well-being.
Interventions.
Respiratory Management.
Oxygen therapy: Administer oxygen via nasal cannula, face mask, or mechanical ventilation as needed to maintain
oxygen saturation levels above 90%.
Bronchodilators: Use inhaled bronchodilators, such as albuterol or salmeterol, to relax airway muscles and improve airflow.
Steroids: Administer systemic or inhaled steroids, such as prednisone or budesonide, to reduce airway inflammation and bronchospasm.
Mucolytics: Use mucolytics, such as N-acetylcysteine or dornase alfa, to thin and loosen sputum and improve expectoration.
Airway suctioning: Perform airway suctioning as needed to remove secretions and maintain airway patency.
Mechanical ventilation: Initiate mechanical
ventilation if necessary to support ventilation and oxygenation.
Cardiovascular Management.
Fluid management: Monitor fluid intake and output closely and adjust as needed to maintain euvolemia and prevent fluid overload.
Vasopressors: Administer vasopressors, such as dopamine or norepinephrine, as needed to maintain blood pressure and support organ perfusion.
Inotropic agents: Use inotropic agents, such as dobutamine or milrinone, to improve myocardial
contractility and cardiac output.
Renal Management.
Diuretics: Administer diuretics, such as furosemide or spironolactone, as needed to promote diuresis and reduce fluid overload.
Renal replacement therapy: Initiate renal replacement therapy, such as hemodialysis or peritoneal dialysis, if necessary to manage severe renal dysfunction.
Nutritional Management.
Enteral nutrition: Provide enteral nutrition via nasogastric or nasojejunal tube to meet nutritional needs and prevent malnutrition.
Parenteral nutrition: Initiate parenteral nutrition if enteral nutrition is not feasible or adequate.
Medication Management.
Antibiotics: Administer antibiotics, such as azithromycin or levofloxacin, to treat or prevent bacterial infections.
Sedatives: Use sedatives, such as benzodiazepines or propofol, as needed to manage agitation, anxiety, or delirium.
Comfort and Well-being.
Pain management: Administer pain medication, such as opioids or non-steroidal anti-inflammatory drugs, as needed to relieve pain and discomfort.
Skin care: Provide meticulous skin care to prevent pressure ulcers and other skin problems.
Positioning: Position the patient in a semi-Fowler's position to facilitate breathing and prevent aspiration.
Emotional support: Provide emotional support to the patient and family to help them cope with the stress of critical illness.
Monitoring and Evaluation.
Respiratory status: Monitor respiratory rate, depth, and effort; oxygen saturation; breath sounds; chest wall expansion; and sputum production and character.
Cardiovascular status: Monitor heart rate, rhythm, and blood pressure; assess for edema, jugular venous distension,
and cyanosis.
Neurological status: Assess level of consciousness, orientation, and mental status; check for signs of confusion, agitation, or lethargy.
Renal status: Monitor urine output, creatinine levels, and blood urea nitrogen; assess for oliguria or anuria.
Nutritional status: Monitor weight, body mass index, and dietary intake; check for signs of malnutrition or cachexia.
Medication use: Monitor patient response to medications and adjust dosages as needed.
Expected Outcomes.
Improved respiratory status, with decreased
respiratory rate and effort, increased oxygen saturation, and clear breath sounds.
Stable cardiovascular function, with normal heart rate and rhythm, adequate blood pressure, and no signs of edema or cyanosis.
Improved renal function, with increased urine output and normalized creatinine levels and blood urea nitrogen.
Adequate nutritional status, with stable weight and body mass index, and no signs of malnutrition or cachexia.
Reduced pain and discomfort.
Improved skin integrity.
Enhanced comfort and well-being.
Reduced risk of complications.
Improved quality of life.
中文回答：
危重慢性阻塞性肺病患者护理计划单。

评估。

呼吸状况，评估呼吸频率、深度和用力程度；氧饱和度；呼吸音；胸壁扩张；痰液产生量和性质；以及辅助肌肉的使用。

心血管状况，监测心率、心律和血压；评估水肿、颈静脉扩张
和紫绀。

神经系统状况，评估意识水平、定向力和精神状态；检查神志
不清、烦躁或嗜睡的迹象。

肾脏状况，监测尿量、肌酐水平和血尿素氮；评估少尿或无尿。

营养状况，评估体重、体重指数和饮食摄入量；检查营养不良
或恶病质的迹象。

药物使用，回顾目前的药物方案，包括支气管扩张剂、类固醇、抗生素和氧疗。

诊断。

慢性阻塞性肺疾病（COPD）急性发作。

呼吸衰竭。

低氧血症。

高碳酸血症。

酸中毒。

多器官功能障碍综合征（MODS）。

目标。

改善呼吸状况。

维持氧合和通气。

最大程度减少气道炎症和支气管痉挛。

支持心血管功能。

预防并发症。

增强舒适度和幸福感。

干预措施。

呼吸管理。

氧疗，根据需要通过鼻导管、面罩或机械通气提供氧气，以维持氧饱和度水平在 90% 以上。

支气管扩张剂，使用吸入性支气管扩张剂，如沙丁胺醇或沙美特罗，以放松气道肌肉并改善气流。

类固醇，给予全身性或吸入性类固醇，如泼尼松或布地奈德，以减少气道炎症和支气管痉挛。

粘液溶解剂，使用粘液溶解剂，如 N 乙酰半胱氨酸或多奈哌齐，以稀释和松解痰液并改善排痰。

气道抽吸，根据需要进行气道抽吸，以去除分泌物并保持气道
通畅。

机械通气，如果需要，启动机械通气以支持通气和氧合。

心血管管理。

液体管理，密切监测液体摄入和输出，并根据需要进行调整，以维持容量平衡并防止液体过载。

血管加压药，根据需要给予血管加压药，如多巴胺或去甲肾上腺素，以维持血压并支持器官灌注。

正性肌力药物，使用正性肌力药物，如多巴酚丁胺或米力农，以改善心肌收缩力和心输出量。

肾脏管理。

利尿剂，根据需要给予利尿剂，如呋塞米或螺内酯，以促进利尿并减少液体过载。

肾脏替代治疗，如果需要，启动肾脏替代治疗，如血液透析或腹膜透析，以控制严重的肾功能障碍。

营养管理。

肠内营养，通过鼻胃管或鼻空肠管提供肠内营养，以满足营养需求并预防营养不良。

肠外营养，如果肠内营养不可行或不充分，则启动肠外营养。

药物管理。

抗生素，给予抗生素，如阿奇霉素或左氧氟沙星，以治疗或预防细菌感染。

镇静剂，根据需要使用镇静剂，如苯二氮卓类药物或丙泊酚，以控制激越、焦虑或谵妄。

舒适度和幸福感。

疼痛管理，根据需要给予止痛药，如阿片类药物或非甾体抗炎药，以缓解疼痛。