Problem # 1: Productive cough

Assessment:

Cues:

Subjective: Patient¶s statement:³inuubo ako simula pa noong

Mayo´ ³ang tigas ng plema ko, nahihirapan akong ilabas ito´
Objective: (+)wheezes and (+)crackles upon auscultation
;RR:22(NV:12-20);PR 98(NV:60-100);(+) green, thick sputum with
scanty blood ; chest PA shows primary Koch¶s infection.
Nursing Diagnosis: Ineffective airway clearance r/t accumulation
of thick copious secretions
Rationale:
Goal: After 2hrs. of nursing intervention, the patient will
expectorate or clear secretions readily.
The patient will maintain airway patency within the shift.

Intervention:

Independent:

1. Assessed respirations and breath sounds, noting rate and

sounds. Indicative of respiratory distress and/or accumulation

of secretions.(Doenges, 2008:78)
2. Assess mental status during periods when airway is
obstructed. Lack of oxygen for even short periods can affect
cerebral oxygenation, resulting in changes in mental status and
LOC. (Rodgers, 2007:243)
3. Encouraged deep-breathing and coughing exercises. To maximize
effort.(Doenges, 2008:79)
4. Increased fluid intake to at least 2000ml/day within cardiac
tolerance. Hydration can help liquefy viscous secretions and
improve secretion clearance.(Doenges, 2008:79)

5. Placed patient in semi- or high-Fowler¶s position.

Positioning helps maximize lung expansion and decreases
respiratory effort.(Doenges, 2002:184)
6. Established intravenous access. Ensures a route for rapid-
acting medications.(Rodgers, 2007:243)
7. Monitor the patient for signs of aspiration into lungs:
abnormal breath sounds, fever, and increased secretions.
Frequently foreign objects are in the airway, some particles may

be aspirated in the lungs and may cause aspiration pneumonia; monitoring the patient allows detection of early symptoms

that may require further treatment. (Rodgers, 2007:243)

Dependent:

1. Administered Combivent neb.every 8hrs.as ordered

2. Give levofloxacin 500mg 1tab ODx7days as ordered.

Evaluation: Goal met. The patient was able to expectorate/clear

secretions readily after 2hrs.of NI.

The patient was able to maintain airway patency within the

shift.
Problem 5 : dsturbed sleeping pattern

Assessment:
Cues:
Subjective: patient stated: ³hindi nga ako makatulog ng maayos

dahil dito sa pag ihi ko, sa tuwing naiihi ako, nagigising

talaga ako, bumabangon at umiihi.´
³pagising gising talaga ako kasi hindi ko mapigilan yung pag ihi
ko, matutulog ako, tapos maya maya gigising nanaman para lng
umihi, hindi ko na alam ang gagawin ko´
³hindi ako makatulog kagabi kasi mainit´

Objective: restlessness, irritability, slowed reaction

Nursing Diagnosis: Sleep deprivation r/t prolonged discomfort

Rationale:

Goal: The patient will report improvement in sleep/rest pattern

within the shift.

Intervention:

Independent:
1. Determined presence of physical or psychological
stressors.(Doenges, 2008:631)
2. Noted Medical diagnosis that affect sleep. (Doenges,

2008:632)

3. Noted environmental factors that affect sleep. (Doenges,

2008:632)

4. Determined client¶s usual sleep pattern. (Doenges, 2008:632)

5. Observed physical signs of fatigue. (Doenges, 2008:632)

6. Recommended quiet activities such as, listening to soothing

music. (Doenges, 2008:632)
7. Provided calm, quiet environment and manage controllable
sleep-disrupting factors

Coughing is the body’s way of removing foreign material or mucous from the lungs
and throat. The two general classifications of cough are productive coughs
(producing phlegm or mucous from the lungs) and nonproductive coughs (dry and
not producing any mucous or phlegm). Coughs are also divided into acute (less than
3 weeks’ duration) and chronic (more than three weeks’ duration). Acute cough is
most often caused by the common viral upper respiratory tract infection. Chronic
cough may be caused by a variety of underlying diseases including asthma, cystic
fibrosis, allergies, GERD and chronic post

Acute bronchitis is caused in most cases by a viral infection and may begin after you develop a cold or
sore throat. Bronchitis usually begins with a dry cough. After a few days it progresses to a productive
cough, which may be accompanied by fever, fatigue, and headache. The cough may last up to several
weeks.

Usually bronchitis occurs after the person was infected with cold or infection. The
virus that causes the common cold can also be the virus that can cause bronchitis.
Acute bronchitis can also happen by inhaling irritants that can damage and inflame
the bronchial tubes. Cigarette smoke and other chemical fumes inhaled can
significantly damage your bronchial tubes. The inflamation causes the airways to
constrict and therefore cause you to have difficvulty of breathing. If left untreated
or if you continue inhailing irritants such as cigarette smoke, the acute bronchitis
will eventually develop into its chronic form where it can permanently damage your
bronchial tubes and tissue surrounding it.

Acute
Bronchitis
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Acute bronchitis is inflammation of the upper airways, commonly following a URI. The cause is usually a viral infection, though

it is sometimes a bacterial infection; the pathogen is rarely identified. The most common symptom is cough, with or without

fever, and possibly sputum production. In patients with COPD, hemoptysis, burning chest pain, and hypoxemia may also

occur. Diagnosis is based on clinical findings. Treatment is supportive; antibiotics are necessary only for selected patients with

chronic lung disease. Prognosis is excellent in patients without lung disease, but in patients with COPD, acute respiratory

failure may result.

Acute bronchitis is frequently a component of a URI caused by rhinovirus, parainfluenza, influenza A or B, respiratory syncytial

virus, coronavirus, or human metapneumovirus. Less common causes may be Mycoplasma pneumoniae, Bordetella pertussis,

and Chlamydia pneumoniae. Patients at risk include those who smoke and those with COPD or other diseases that impair

bronchial clearance mechanisms, such as cystic fibrosis or conditions leading to bronchiectasis (see Bronchiectasis).

Symptoms and Signs

Symptoms are a nonproductive or minimally productive cough accompanied or preceded by URI symptoms. Subjective

dyspnea results from chest pain or tightness with breathing, not from hypoxia, except in patients with underlying lung disease.

Signs are often absent but may include scattered rhonchi and wheezing. Sputum may be clear, purulent, or, occasionally,

bloody. Sputum characteristics do not correspond with a particular etiology (ie, viral vs bacterial). Mild fever may be present,

but high or prolonged fever is unusual and suggests influenza or pneumonia.

 On resolution, cough is the last symptom to subside and often takes several weeks or even longer to do so.

http://www.merck.com/mmpe/sec05/ch051/ch051a.html?qt=acute
%20bronchitis&alt=sh

Nursing Diagnosis: Ineffective airway clearance

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

• Respiratory Status: Airway Patency

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

• Cough Enhancement

• Airway Management

• Airway Suctioning
NANDA Definition: Inability to clear secretions or obstructions from the respiratory tract to
maintain airway patency
Maintaining a patent airway is vital to life. Coughing is the main mechanism for clearing the
airway. However, the cough may be ineffective in both normal and disease states secondary to
factors such as pain from surgical incisions/ trauma, respiratory muscle fatigue, or
neuromuscular weakness. Other mechanisms that exist in the lower bronchioles and alveoli to
maintain the airway include the mucociliary system, macrophages, and the lymphatics. Factors
such as anesthesia and dehydration can affect function of the mucociliary system. Likewise,
conditions that cause increased production of secretions (e.g., pneumonia, bronchitis, and
chemical irritants) can overtax these mechanisms. Ineffective airway clearance can be an acute
(e.g., postoperative recovery) or chronic (e.g., from cerebrovascular accident [CVA] or spinal
cord injury) problem. Elderly patients, who have an increased incidence of emphysema and a
higher prevalence of chronic cough or sputum production, are at high risk.
Defining Characteristics:
• Abnormal breath sounds (crackles, rhonchi, wheezes)
• Changes in respiratory rate or depth
• Cough
• Hypoxemia/cyanosis
• Dyspnea
• Chest wheezing
• Fever
 • Tachycardia
Related Factors:
• Decreased energy and fatigue
• Ineffective cough
• Tracheobronchial infection
• Tracheobronchial obstruction (including foreign body aspiration)
• Copious tracheobronchial secretions
• Perceptual/cognitive impairment
• Impaired respiratory muscle function
• Trauma
Expected Outcomes
• Patient's secretions are mobilized and airway is maintained free of secretions, as
evidenced by clear lung sounds, eupnea, and ability to effectively cough up secretions
after treatments and deep breaths.

Ongoing Assessment

• Assess airway for patency. Maintaining the airway is always the first priority,
especially in cases of trauma, acute neurological decompensation, or cardiac arrest.

• Auscultate lungs for presence of normal or adventitious breath sounds, as in the

following:
○ Decreased or absent breath sounds These may indicate presence of mucus plug or
other major airway obstruction.
○ Wheezing These may indicate increasing airway resistance.
○ Coarse sounds These may indicate presence of fluid along larger airways.

• Assess respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnea on
exertion, evidence of splinting, use of accessory muscles, and position for breathing.
Abnormality indicates respiratory compromise.

• Assess changes in mental status. Increasing lethargy, confusion, restlessness, and/or

irritability can be early signs of cerebral hypoxia.

• Assess changes in vital signs and temperature. Tachycardia and hypertension may be
related to increased work of breathing. Fever may develop in response to retained
secretions/atelectasis.
 • Assess cough for effectiveness and productivity. Consider possible causes for
ineffective cough (e.g., respiratory muscle fatigue, severe bronchospasm, or thick
tenacious secretions).

• Note presence of sputum; assess quality, color, amount, odor, and consistency. This
may be a result of infection, bronchitis, chronic smoking, or other condition. A sign of
infection is discolored sputum (no longer clear or white); an odor may be present.

Send a sputum specimen for culture and sensitivity as appropriate. Respiratory infections
increase the work of breathing; antibiotic treatment is indicated.

• Monitor arterial blood gases (ABGs). Increasing PaCO2 and decreasing PaO2 are
signs of respiratory failure.

• Assess for pain. Postoperative pain can result in shallow breathing and an
ineffective cough.

• If patient is on mechanical ventilation, monitor for peak airway pressures and airway
resistance. Increases in these parameters signal accumulation of secretions/ fluid and
possibility for ineffective ventilation.

• Assess patient’s knowledge of disease process. Patient education will vary

depending on the acute or chronic disease state as well as the patient’s cognitive level.
Therapeutic Interventions

• Assist patient in performing coughing and breathing maneuvers. These improve

productivity of the cough.

• Instruct patient in the following:

○ Optimal positioning (sitting position)
○ Use of pillow or hand splints when coughing
○ Use of abdominal muscles for more forceful cough
○ Use of quad and huff techniques
○ Use of incentive spirometry
○ Importance of ambulation and frequent position changes
Directed coughing techniques help mobilize secretions from smaller airways to larger
airways because the coughing is done at varying times. The sitting position and splinting
the abdomen promote more effective coughing by increasing abdominal pressure and
upward diaphragmatic movement.
• Use positioning (if tolerated, head of bed at 45 degrees; sitting in chair, ambulation).
These promote better lung expansion and improved air exchange.

• If patient is bedridden, routinely check the patient’s position so he or she does not
slide down in bed. This may cause the abdomen to compress the diaphragm, which would
cause respiratory embarrassment.

• If cough is ineffective, use nasotracheal suctioning as needed:

○ Explain procedure to patient.
○ Use soft rubber catheters. This prevents trauma to mucous membranes.
○ Use curved-tip catheters and head positioning (if not contraindicated). These
facilitate secretion removal from a specific side (right versus left lung).
○ Instruct the patient to take several deep breaths before and after each nasotracheal
suctioning procedure and use supplemental oxygen as appropriate. This prevents
suction-related hypoxia.
○ Stop suctioning and provide supplemental oxygen (assisted breaths by Ambu bag
as needed) if the patient experiences bradycardia, an increase in ventricular
ectopy, and/or desaturation.
○ Use universal precautions: gloves, goggles, and mask as appropriate. If sputum is
purulent, precautions should be instituted before receiving the culture and
sensitivity report.
Suctioning is indicated when patients are unable to remove secretions from the airways
by coughing because of weakness, thick mucus plugs, or excessive mucus production.

• Institute appropriate isolation precautions for positive cultures (e.g., methicillin-

resistant Staphylococcus aureus [MRSA] or tuberculosis).

• Use humidity (humidified oxygen or humidifier at bedside). This loosens secretions.

• Encourage oral intake of fluids within the limits of cardiac reserve. Increased fluid
intake reduces the viscosity of mucus produced by the goblet cells in the airways. It is
easier for the patient to mobilize thinner secretions with coughing.

• Administer medications (e.g., antibiotics, mucolytic agents, bronchodilators,

expectorants) as ordered, noting effectiveness and side effects.

• For patients with chronic problems with bronchoconstriction, instruct in use of

metered-dose inhaler (MDI) or nebulizer as prescribed.
 • Consult respiratory therapist for chest physiotherapy and nebulizer treatments as
indicated (hospital and home care/rehabilitation environments). Chest physiotherapy
includes the techniques of postural drainage and chest percussion to mobilize secretions
in smaller airways that cannot be removed by coughing or suctioning.

Coordinate optimal time for postural drainage and percussion (i.e., at least 1 hour after
eating). This prevents aspiration.

• For patients with reduced energy, pace activities. Maintain planned rest periods.
Promote energy-conservation techniques. Fatigue is a contributing factor to ineffective
coughing.

• For acute problem, assist with bronchoscopy. This obtains lavage samples for culture
and sensitivity, and removes mucus plugs.

• If secretions cannot be cleared, anticipate the need for an artificial airway

(intubation). After intubation:
○ Institute suctioning of airway as determined by presence of adventitious sounds.
○ Use sterile saline instillations during suctioning. This helps facilitate removal of
tenacious sputum.

• For patients with complete airway obstruction, institute cardiopulmonary

resuscitation (CPR) maneuvers.
Education/Continuity of Care

• Demonstrate and teach coughing, deep breathing, and splinting techniques. Patient
will understand the rationale and appropriate techniques to keep the airway clear of
secretions.

• Instruct patient on indications for, frequency, and side effects of medications.

• Instruct patient how to use prescribed inhalers, as appropriate.

• In home setting, instruct caregivers regarding cough enhancement techniques and

need for humidification.

• Instruct caregivers in suctioning techniques. Provide opportunity for return

demonstration. Adapt technique for home setting.
• For patients with debilitating disease being cared for at home (CVA, neuromuscular
impairment, and others), instruct caregiver in chest physiotherapy as appropriate. This
may also be useful for the patient with bronchiectasis who is ambulatory but requires
chest physiotherapy because of the volume of secretions and the inability to adequately
clear them.

• Teach patient about environmental factors that can precipitate respiratory problems.

• Explain effects of smoking, including second-hand smoke. Smoking contributes to

bronchospasm and increased mucus production in the airways.

• Refer patient and/or significant others to smoking-cessation group, as appropriate,

and discuss potential use of smoking-cessation aids (e.g., Nicorette Gum, Nicoderm, or
Habitrol) to wean off the effects of nicotine.

• Instruct patient on warning signs of pending or recurring pulmonary problems.

• Refer to pulmonary clinical nurse specialist, home health nurse, or respiratory

therapist as indicated.
• Free Nursing Essay Samples

• Sample Nursing Care Plan

Nursing Care Plan

The patient is Norm Gallagher, a 72 year old man who has been admitted for dyspnea or shortness of breath. Norm

Gallagher reported that he has been coughing for the past week and his coughing has accompanied sputum discharge. His past

medical history includes emphysema and chronic bronchitis. He used to smoke but has stopped since a year ago for economical

reasons as well as it is also bad for his asthma. His bowel movements have also been irregular since his admission. He also reported

that he is feeling depressed and fearful about the future. Further examination revealed that he has crackles in his left lower lobe with

diffuse expiratory wheezing throughout his chest. Chest percussion also revealed his left lower lobe to be dull.

Goals Interventions Evaluation

Needs / Problems

Dyspnea or shortness of Use the visual analog Dyspnea is difficult to quantify Evaluation of how nursing interventions in

breath scale (VAS) to make an and to treat (Potter & Perry, dyspnea is usually done by evaluating the

objective assessment of 2004). Interventions need to underlying cause of dyspnea.

dyspnea. The VAS is a be individualized for each

100-mm vertical line patient, and more than one

with end points of 0 and therapy is usually

10. zero is equated with implemented.

no dyspnea and 10 is
 equated with the worst The underlying process that

brethlessness the client causes or worsens dyspnea

has experienced (Potter must be treated and stabilized

& Perry, 2004) initially. Three additional

therapies have to be

implemented: pharmacological

measures, physical

techniques, and psychosocial

techniques are then

implemented.

Coughing up green and The nurse should Interventions can be geared A cough is difficult to evaluate, and almost

yellow sputum determine if the cough is towards curing the underlying everyone has periods of coughing.

a manifestation of any cause such as chronic

underlying diseases. In bronchitis.

addition, other

diagnostic tests must be

performed.

Irregular bowel The client has only Fluid intake has to be The client should be asked for any increased

movement defecated once since encouraged, and this should activity. The client has to state that his activity
 being admitted for four include appropriate fluids, fruit pattern has changed therefore there is an

days. The client has to juice, and water. achievement of outcome.

resume his regular

Activity within the limits of
bowel movements which
client's mobility should also be
is every two days.
encouraged. Laxative and
The client's subsequent stool should be observed
for characteristics such as consistency and color.
Bowel movement should now be every 24 to 48

stool softeners can be hours. Abdomen should be soft and

provided as ordered. Privacy is nondistended.

also important.

Crackles in the left lower The nurse has to identify Since the generation of Evaluation of nursing interventions on crackles

lobe of the lung with what is the underlying crackles depends more on and wheezes should be related to the evaluation

diffuse expiratory cause of the crackles lung volume changes than on of the underlying cause of such clinical

wheezing and wheezing that is airflow, patients should be manifestations.

revealed in the patient's advised to take slow and deep

exams. breaths in order to minimize

flow turbulence and thus

reduce the intensity of normal

breath sounds (Pasterkamp,

2001).
 Wheezing in Norm Gallagher

could just be normal response

of his asthma and therefore

interventions have to be

geared towards his asthma.

Consolidation in left The healthcare team Nursing interventions should Conventional evaluation of the lungs is based on

lower lung responsible for the care be geared towards treatment tests of lung volume, capacities and breathing of

of Norm Gallagher of the underlying cause, like the patient, among others.

should examine the pneumonia.

underlying cause of the

The participation of other
consolidated lung.
healthcare professionals is

usually needed, like the

diagnosis of a doctor.

Dyspnea means mental anguish associated with an inability to ventilate enough to satisfy the demand for air (Guyton & Hall,

2000). It is a clinical sign of hypoxia and manifests as breathlessness or shortness of breath. It is the subjective sensation of difficult

or uncomfortable breathing. A common synonym for it is air hunger. Dyspnea is shortness of breath associated with exercise or

excitement, but in some clients dyspnea may be present without any relation to activity or exercise. Dyspnea is associated with many
conditions, such as pulmonary diseases, cardiovascular diseases, neuromuscular conditions, and anemia (Potter & Perry, 2004).

Environmental factors such as pollution, cold air, and smoking, may also cause or worsen dyspnea. In the case of Norm Gallagher,

his dyspnea is probably related to his problem of the lung.

The rationale behind performing VAS for the patient is that dyspnea is subjective and performing VAS could objectively

confirm if the patient is indeed experiencing dyspnea or not. Studies have validated the use of VAS to evaluate a client's dyspnea in

the clinical setting (Potter & Perry, 2004). The nurse can evaluate the effectiveness of nursing interventions by monitoring the client's

assessment of their dyspnea.

In the interventions for dyspnea, pharmacological agents may include bronchodilators, steroids, mucolytics, and low-dose

antianxiety medications. Physical techniques, such as cardiopulmonary reconditioning through exercise, breathing techniques, and

cough control, can help to reduce dyspnea. Relaxation techniques, biofeedback, and meditation are psychosocial measures that can

lessen the sensation of dyspnea (Potter & Perry, 2004).

Cough is a sudden, audible expulsion of air from the lungs. Coughing is a protective reflex to clear the trachea, bronchi, and

lungs of irritants and secretions. A cough is difficult to evaluate, and almost everyone has periods of coughing. Once the nurse

determines that the client has a cough, it must be identified as productive or non-productive and its frequency must be assessed. In

Norm Gallagher's case, his cough is a productive one as it results in sputum production.

A productive cough results in sputum production, material coughed up from the lungs that may be swallowed or expectorated

(Potter & Perry, 2004). Sputum contains mucus, cellular debris, and microorganisms, and it may contain pus or blood. It is the duty of
the nurse to collect data about the type and quantity of sputum.

The rationale behind the nursing interventions in bowel elimination alterations of Norm Gallagher are pointed out in the

succeeding sentences. Adequate fluid intake is necessary to prevent hard and dry stool. Activity including minimal ones such as leg

lifts can increase peristalsis. The use of laxative and other medications can soften stool and prevent straining. Lastly, clients should

feel relaxed when moving their bowels (Potter & Perry, 2004).

Auscultation of lung sounds involves listening for movement of air throughout all lung fields: anterior, posterior, and lateral.

Adventitious or abnormal breath sounds occur with collapse of a lung segment, fluid in a lung segment, or narrowing or obstruction of

an airway. Auscultation also evaluates the client's response to interventions for improving Norm Gallagher's response to

interventions for improving his respiratory status (Potter & Perry, 2004).

Crackles are most commonly heard in dependent lobes: right and left lung bases. The cause is random, sudden reinflation of

groups of alveoli and disruptive passage of air. Crackles (rales) are useful indicators of cardiorespiratory disease. The timing, pitch,

and waveform of crackles reflect different pathophysiology in diseases, such as pneumonia, bronchiectasis, asbestosis, sarcoidosis,

fibrosing alveolitis, cystic fibrosis, and pulmonary congestion due to cardiac failure (Pasterkamp, 2001). Wheezes on the other hand

can be heard all over lung fields. The cause of this is high-velocity airflow through severely narrowed bronchus. They are high-

pitched, continuous musical sounds like a squeak heard continuously during inspiration or expiration. It is usually louder during

expiration (Potter & Perry, 2004). Wheezing is a common clinical finding in patients with asthma and chronic obstructive pulmonary

disease (COPD) during episodes of severe airway obstruction, and can also be heard in normal subjects during forced expiratory

maneuvers; however, the properties of wheezing are difficult to perceive and quantify during auscultation (Morera, 2002). Chest
percussion of Norm Gallagher revealed that his left lower lobe is dull. A dull or flat sound may suggest atelectasis, pleural effusion,

pneumothorax or asthma (Potter & Perry, 2004).

The nurse should also take into account that Norm Gallagher is already 72 years old. The chest is normally more resonant in

the child than in the adult. Breath sounds are also much louder in children because of the thinness of the chest wall. The normal

assessment finding in the pulmonary system of an aging individual is as follows: The pathophysiological changes include (1)

decreased chest wall compliance and loss of elastic recoil, (2) decreased respiratory muscle mass/strength, (3) increased

ventilation/perfusion mismatch, (4) decreased alveolar surface area, (5) decreased carbon dioxide diffusion capacity, (6) decreased

responsiveness of central and peripheral chemoreceptors to hypoxemia and hypercapnia, (7) decreased number of cilia, (8)

decreased IgA production and humoral and cellular immunity, (9) decreased respiratory drive, and (10) decreased tone of upper

airway muscles (Potter & Perry, 2004).

Key clinical findings in an aging pulmonary system includes (1) prolonged exhalation phase, (2) decreased vital capacity, (3)

decreased PaO2, (4) decreased cardiac output, (5) slightly increased PaCO2, (6) increased respiratory rate, (7) decreased tidal

volume, (8) decreased airway clearance, (9) diminished cough reflex, (10) increased risk of aspiration and infection, (11) increased

risk of arterial oxygen desaturation, and (12) snoring, obstructive sleep apnea (Potter & Perry, 2004).

Upon physical examination of Norm Gallagher, it revealed that his arterial blood gases are at pH 7.36, the PaO 2 is at 55

mmHg, and the PaCO2 is at 65 mmHg. PaCO2 is the partial pressure of carbon dioxide in the arterial blood and PaO 2 is the partial

pressure of oxygen in the arterial blood. Unlike liquids, gases expand to fill the volume available to them, and the volume occupied by

a given number of gas molecules at a given temperature is ideally the same regardless of the composition of gas. This is what is
called as the partial pressure. The normal values for PaCO2 and PaO2 are 40 mmHg and 100 mmHg respectively (Ganong, 2001).

The past medical history of Norm Gallagher showed that he has emphysema and chronic bronchitis. The term pulmonary

emphysema literally means excess air in the lungs. However, chronic pulmonary emphysema is a complex obstructive and

destructive process of the lungs that is in most instances a consequence of long-term smoking (Guyton & Hall, 2000). Chronic

bronchitis is the chronic inflammation of the bronchi which leads to thickening of mucosa and decreased bronchial diameter (Marieb,

2004). Clients with chronic bronchitis generally produce sputum all day (Kozier & Erb, 2004). This is a result of the dependent

accumulation of sputum in the airways and is associated with reduced mobility.

Consolidation of the lungs – whole lobes or even the whole lung – is usually a manifestation of pneumonia. Large areas of

lungs become consolidated which means that they are filled with fluid and cellular debris (Guyton and Hall, 2000). All interventions

and evaluation of treatments for Norm Gallagher has to take into account the underlying causes of his medical manifestations like

crackles and wheezing.