RISK FACTORS:

Age Male gender Reduced lung function \ Air pollution Exposure to second hand smoke Familial allergies Poor nutrition Alcohol intake 2X higher in Men between 65-74. 3X higher in Men between 75-84.

TREAMTENT: Smoking cessation Pharmacotherapy Limited occupational exposure to toxins Air pollution Regular exercise & weight control Pneumococcal & annual influenza vaccinations

NURSING DIAGNOSIS
Risk for injury Chronic confusion Compromised family coping Fear related to loss of self Impaired memory Self-neglect Powerlessness Impaired physical mobility Social isolation Wandering Risk for relocation stress syndrome Ineffective health management Risk for other directed violence Insomnia

SIGNS/SYMPTOMS:
Chronic & Progressive Dyspnea Coughing Sputum Production Wheezing & Chest Tightness

NURSING INTERVENTIONS

Establish an effective communication system with the patient and his family to help them adjust to the patients altered cognitive abilities. Provide emotional support to the patient and his family. Administer ordered medications and note their effects. If the patient has trouble swallowing, crush tablets and open capsules and mix them with a semi soft food. Protect the patient from injury by providing a safe, structured environment. Provide rest periods between activities because the patient tires easily. Encourage the patient to exercise as ordered to help maintain mobility. Encourage patient independence and allow ample time for him to perform tasks. Encourage sufficient fluid intake and adequate nutrition. Take the patient to the bathroom at least every 2 hours and make sure he knows the location of the bathroom. Assist the patient with hygiene and dressing as necessary. Frequently check the the patients vital signs. Monitor the patients fluid and food intake to detect imbalances. Inspect the patients skin for evidence of trauma, such as bruises or skin breakdown. Encourage the family to allow the patient as much independence as possible while ensuring safety to the patient and others.

Pulmonary Signs: o Weight loss, anorexia, depression, & anxiety MEDICATIONS Tacrine (Cognex) Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Reminyl) Memantine (Namenda) Ginkgo biloba (nutritional supplement)

Chronic Obstructive Pulmonary Disease

Pathophysiology
A progressive airflow limitation that is not fully reversible and, during the course of the disease, lung tissue that becomes abnormally inflamed. The changes manifested include peripheral airway inflammation, airway fibrosis, hypertrophy of smooth muscles, hyperplasia of goblet cells, and resultant mucus hypersecretion, and eventually, the destruction of the lung parenchyma.

DIAGNOSTICS: Spirometry testing

*Risk for Falls *Aspiration *UTIs

Complications *Memory Loss *Impaired Judgment *Dysphagia *Pneumonia *Urinary Incontinence

References Ackley, B. J., & Ladwig, L. B. (2011). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. 9th ed. St. Louis: Mosby. Gahart, B. L., & Nazareno, A, R. (2012). Intravenous Medications: A Handbook for Nurses and Health Professionals. 28th ed. St. Louis: Mosby. Ignatavicius, D. D., &Workman, L. M. (2013). Medical- Surgical Nursing: Patient-Centered Collaborative Care. 7th ed. St. Louis: Saunders. Lilley, L. L., Collins, S. R., Harrington, S., Snyder, J. (2011). Pharmacology and the Nursing Process. 6th ed. St. Louis: Mosby. Marieb, E., & Katja, H. (2007). Human Anatomy and Physiology. 7th ed. San Francisco: Pearson. Pagana, K., & Pagana, T. J. (2011). Mosbys Diagnostic and Laboratory Test Reference. 10th ed. St. Louis: Mosby. Skidmore-Roth, L. (2012). Mosbys Drug Guide for Nurses, with 2012 Update. 9th ed. St. Louis: Mosby.

Jessica Wilson NU240