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Asthma Ineffective Airway Clearance

Asthma Ineffective Airway Clearance

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Published by Nurseslabs
Asthma Ineffective Airway Clearance
Asthma Ineffective Airway Clearance

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Categories:Types, School Work
Published by: Nurseslabs on Jul 03, 2013
Copyright:Attribution Non-commercial

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09/18/2014

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www.NursesLabs.com
 
Medical Diagnosis
: Bronchial Asthma
Problem:
Ineffective Airway Clearance RT Bronchial Constriction and Increased Mucus Production
Assessment Nursing Diagnosis ScientificExplanationPlanning Interventions Rationale EvaluationSubjective:
(none)
 Objective:
 
wheezing uponinspiration andexpiration
 
dyspnea
 
coughing,sputum is yellowand sticky
 
tachypnea,prolongedexpiration
 
tachycardia
 
chest tightness
 
suprasternalretraction
 
restlessness
 
anxiety
 
cyanosis
 
loss of consciousnessIneffective airwayclearance RTbronchoconstriction,increased mucusproduction, andrespiratory infectionAEB wheezing,dyspnea, and coughThe presence of aforeignmicroorganismtriggers the Blymphocyte toproduce antibodiesthat are specific tothat antigen. Theseantibodies thenattach to mast cells inthe lungs. The mastcells with theantibody attaches tothe antigen andbegins todegranulate. Thisdegranulation causesthe release of certainchemical mediators,namely, histamine,bradykinin,prostaglandin, andleukotriene. Thesechemical mediatorscause bronchospasmleading tobronchoconstriction,increased vascularpermeability leadingto fluid leakage fromthe lung vasculatureand increased mucus
Choose:
Patient willmaintain/improveairway clearance AEBabsence of signs of respiratory distressPatient will verbalizeunderstanding thatallergens like dust,fumes, animaldander, pollen, andextremes of temperature andhumidity are irritantsor factors that cancontribute toineffective airwayclearance and shouldbe avoided.Patient willdemonstratebehaviors that wouldprevent therecurrence of theproblem1.
 
Adequatelyhydrate the pt.2.
 
Teach andencourage theuse of diaphragmaticbreathing andcoughingexercises.3.
 
Instruct pt toavoid bronchialirritants such ascigarette smoke,aerosols,extremes of temperature, andfumes.4.
 
Teach early signsof infection thatare to bereported to theclinicianimmediately.
 
Increasessputumproduction
 
Change incolor of sputum
 
Increased1.
 
Systemichydration keepssecretion moistand easier toexpectorate.2.
 
Thesetechniques helpto improveventilation andmobilizesecretionswithout causingbreathlessnessand fatigue.3.
 
Bronchialirritants causebronchoconstriction andincreased mucusproduction,which theninterfere withairwayclearance.4.
 
Minorrespiratoryinfections thatare of noconsequence tothe person withnormal lungs canproduce fatal
Short Term
:The pt shall be freefrom any signs of respiratory distress
Long Term
:The patient shallhave demonstratedbehaviors andunderstood causativefactors to preventrecurrence of problem.

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