慢性阻塞性肺疾病体征的解释，得了慢性阻塞性肺疾病

慢性阻塞性肺疾病体征的解释，得了慢性阻塞性肺疾病2.2 Emphysema with loss of interstitial membranes and airway support tissue resulting in airway collapse and loss of alveolar surface area for gas exchange. 肺气肿伴有间质膜和气道粘膜组织丢失，导致气道塌陷和影响肺泡表面积的气体交换。2.1 Chronic bronchitis with persistent airway oedema excessive mucus production and impaired airway clearance. 慢性支气管伴有持续性气道水肿，粘膜分泌物过多，和气道清理受损。慢阻肺又称为慢性阻塞肺疾病和慢性气流受限疾病，是由于慢性气管炎和/或者肺气肿引起的。慢阻肺多见于中老年人群。该病是一种周期

Chronic obstructive pulmonary disease (COPD)慢性阻塞性肺疾病

1. What is COPD? 什么是慢性阻塞性肺疾病（慢阻肺）呢？

健康和COPD的肺组织

Chronic obstructive pulmonary disease (COPD) is also known as chronic obstructive lung disease and chronic airflow limitation due to chronic bronchitis and/or emphysema. Moreover COPD typically affects middle-aged and older adults. The disease is one of periodic exacerbations often related to respiratory infection with increased symptoms of dyspnea and sputum production. COPD can cause pulmonary insufficiency pulmonary hypertension and cor pulmonale.

慢阻肺又称为慢性阻塞肺疾病和慢性气流受限疾病，是由于慢性气管炎和/或者肺气肿引起的。慢阻肺多见于中老年人群。该病是一种周期性进行性加重疾病，通常与呼吸道感染有关，伴有呼吸困难和痰液增多的现象。慢阻肺可引起肺功能不全，肺动脉高压，和肺心病。

2. Pathophysiology of COPD 慢阻肺的病理生理学

COPD is a progressive nonreversible process of airway narrowing and loss of supporting tissue. Three separate processes typically are following as: 慢阻肺是一种进行性的，不可逆的气道狭窄和粘膜组织的丢失。 三个典型的独立的过程如下：

2.1 Chronic bronchitis with persistent airway oedema excessive mucus production and impaired airway clearance. 慢性支气管伴有持续性气道水肿，粘膜分泌物过多，和气道清理受损。

2.2 Emphysema with loss of interstitial membranes and airway support tissue resulting in airway collapse and loss of alveolar surface area for gas exchange. 肺气肿伴有间质膜和气道粘膜组织丢失，导致气道塌陷和影响肺泡表面积的气体交换。

2.3 Small airways disease with bronchoconstriction. 支气管狭窄的小气道疾病

The result of these processed and their combined effects is increased work of breathing impaired expiration with air trapping and impaired gas exchange. 这些过程和结合的效果导致呼吸费力，呼出气体受限和气体交换受损。

正常肺叶和肺气肿肺叶

3. Clinical features and manifestations of COPD 慢阻肺的临床特征和临床症状

临床表现和症状

正常人胸廓和慢阻肺患者胸廓

4. Nursing interventions and education 护理措施和健康教育

4.1 Assessment: vital signs (temperature pulse blood pressure respiratory) oxygen saturation particular with respiratory status (rate pattern) cough and secretions (color amount consistency and odor) and breath sound both normal and adventitious. Monitor ABG results. 评估：生命体征（体温，脉搏，血压，呼吸），氧饱和度，尤其是呼吸性状（频率，样式），咳嗽和分泌物（颜色，量，持续性，和味道），呼吸音包括正常和异常的。监测动脉血气分析结果。

4.2 oxygen therapy: Administer a concentration of oxygen is based on arterial blood gas values and oxygen saturation by pulse oximetry as ordered. Long-term oxygen therapy is used for severe and progressive hypoxemia. Oxygen therapy improves exercise tolerance mental functioning and quality of life in advanced COPD. It also reduces the avoidance of hospitalization and increases length of survival. 氧气疗法:给氧气需要遵医嘱，并根据动脉血气分析结果和指脉氧饱和度。长期氧疗适用于严重进行性低氧血症患者。氧疗可以改善晚期慢阻肺患者的活动耐受力，精神状态和提高他们的生活质量。也可以避免住院和延长寿命。

4.3 Place in Fowler's high-Fowler's or orthopneic position; encourage movement and activity to tolerance. Upright positions improve ventilation and reduce the work of breathing. 半卧位，高卧位或者端坐位；鼓励可耐受的活动和运动。直立体位可以改善通气和利于减轻呼吸。

4.4 Administer expectorant and bronchodilator medications as prescribed. 遵医嘱给予祛痰药和支气管扩张药。

4.5 Deep and coughing breathing exercise at least every 2 hours while awake. Position seated upright leaning forward during coughing. The upright position promotes chest expansion increasing the effectiveness of coughing and reducing the work involved. 患者清醒时，至少每两小时进行深呼吸及咳嗽锻炼。坐直，当咳嗽时向前倾。直立的姿势可以促进胸部扩张，增加咳嗽有

深呼吸咳嗽锻炼

效性。

Encourage the client in diaphragmatic or abdominal breathing techniques and pursed-lip breathing techniques which increase airway pressure and keep air passages open promoting maximal carbon dioxide expiration.

鼓励患者采用膈式或者腹式呼吸法和俯唇呼吸法，这些方法可增加气道压力，保持气道通畅，促进最大程度呼出二氧化碳。

腹部呼吸锻炼

俯唇呼吸法

4.6 Encourage fluid intake of at least 2000-2500ml daily unless contraindicated. Adequate fluid intake helps keep mucus secretions thin. Provide high-calorie high-protein diet with supplement. Avoid eating gas-producing food spicy food and extremely hot or cold food. 鼓励每天至少摄入2000-2500毫升液体，禁忌情况例外。充足的液体摄入可帮助稀释粘稠分泌物。提供高热量，高蛋白饮食和营养物值。避免进食产气，辛辣，极热或极冷的食物。

4.7 Weight daily monitor intake and output and assess mucous membranes and skin turgor. 每天监测体重，监测出入量，评估分泌物和皮肤充盈情况。

4.8 Avoid fireplace pets feather pillows and other environmental allergens. Flu immunization every year recommended. Stop smoking. 避免接触壁炉，宠物，羽毛枕头，和其他环境过敏原。建议每年接种流感疫苗。戒烟。

References:

Lemone P. Burke K.M. Levet-Jones T. Dwyer T. Moxham L. Reid-Searl K. Berry K. Carville K. Hales M. Knox N. Luxford Y. & Raymond D. 2014 Medical-Surgical Nursing: Critical Thinking for Person-Centred Care 2nd Australian Edition. Person Australia.

Silvestri L.A. 2017 Saunders Comprehensive Review for the NCLEX-RN Examination 7th edn Elsevier Missouri.

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