JESSIE FRANK F.

MAPULA

BSN IV-B

NCM-118 ACTIVITY 2

1.) What are the nursing managements for each respiratory disorders?

ASTHMA
Nursing managements:

 Evaluate respiratory rate/depth and breath sounds.

 Assist client to maintain a comfortable position.
 Encourage in deep-breathing and directed coughing exercise.
 Obtain history of recent medication use (theophylline, steroids and inhalers.)
 Obtain baseline data on respiratory function using a peak flow meter.

Following physician order to:

 Administer inhaled rapid acting bronchodilators to open up the airways.

 Administer corticosteroids such as prednisone to reduce inflammation in the airways.
 Administer low flow humidified oxygen to prevent hypoxemia.
 Administer intravenous fluids to prevent dehydration and oral intake losses secretions in the
airways.
 Assess vital signs every 15 to 30 minutes.
 Observe for changes in level of consciousness.
 Removing any potential allergen or trigger from environment like dust or perfumes.
 Maintaining a quite calm environment to reduce anxiety.
 Monitoring the side effects of administered medications.
 Monitoring the ABG as an indication of improve mentor deterioration.
 Prepare for mechanical ventilation if patient cannot breath.

COPD
Nursing Management:

IMPROVE VENTILATION:

 Monitor lung sounds every 4 to 8 hours.

 Perform chest physiotherapy
 Advice the client to drink at least 8 to 10 glasses of fluid per day unless contraindicated
 Teach the client in coughing technique
 Asses the condition of oral mucus membrane and perform oral care
 Monitor and graph serial ABGs, pulse oximetry, chest x-ray.
  Suction secretions as needed.
 Administer bronchodilators if prescribed.

ADEQUATE REST:

 Promote relaxation by providing a darkened, quiet environment, ensure adequate room

ventilation.
 Avoid use of sleeping pills
 Schedule care activities to allow periods of uninterrupted sleep.

IMPROVE PERFORM DAILY ACTIVITY:

 Monitor the severity of dyspnea

 Stop or slow any activity that leads to change in respiratory rate
 Advice the client to avoid conditions that increase oxygen demand

PNEUMONIA
Nursing management:

 Assess rate, depth of respirations and chest movement.

 Auscultate lung fields.
 Elevate head of bed.
 Instruct the client to perform frequent deep-breathing exercises, splinting the chest and
coughing.
 Suction the client as indicated.
 Force fluids to at least 2500 mL per day, unless contraindicated
 Assist with and monitor effects of nebulizer treatments and other respiratory physiotherapy,
such as incentive spirometer, percussion, and postural drainage.
 Administer medications, as indicated, (mucolytics, expectorants, bronchodilators, and
analgesics.)
 Provide supplemental fluids such as IV, humidified oxygen, and room humidification.
 Monitor serial chest x-rays, ABGs, and pulse oximetry readings.

CYSTIC FIBROSIS
Nursing management:

 Encourage regular exercise Exercise helps maintain physical wellness and supplements the
patients airways clearance strategies by helping to loosen pulmonary secretion.
 Monitor oxygen saturation.
 Assess the chest wall for even chest expansion.
 Administer oxygen therapy and receive digoxin or diuretics to decrease the lungs work.
 Encourage coughing, deep breathing exercise and frequent position changes Promote lungs
expansion, mobilization, and drainage of secretions.
  Assess sputum for color, amount, and consistency.
 Monitor respiratory rate, depth and work of breathing

PULMONARY TUBERCULOSIS
Nursing management:

 Promote airway clearance:

 correct positioning to facilitate drainage increase fluid intake to promote systemic hydration
 Adherence to the treatment regimen.
 Promoting activity and adequate nutrition.
 Preventing spreading of tuberculosis infection
 Instruct patient to hygienic measures (mouth care, covering the mouth and nose when coughing
and sneezing, proper disposal of tissues, and handwashing)
 Acid-fast bacillus isolation.
 Proper Disposal.

MEDICATION: monitor adverse effect

 Dexamethasone
 Rifampicin
 Isoniazid
 Pyrazinamide
 Ethambutol
 Streptomycin

PNEUMOTHORAX and HEMOTHORAX

Nursing management:

 Check out respiratory function, note for rapid or shallow respirations, dyspnea, cyanosis,
changes in vital signs (↑RR ↑ HR↓ O2 SAT↓ BP)
 Auscultate breath sounds.
 Note chest excursion and position of the trachea.
 Assess for fremitus.
 Assist patient with splinting painful area when coughing, deep breathing.
 Maintain a position of comfort with the head of bed elevated affected side.
 Evaluate the need for tube stripping
What is the nursing care management for chest tubes?

CHEST TUBE
PATIENT CARE:

 Nursing management:
 Ensure that the dressing on the chest around the tube is tight and intact.
 Assess for DOB
 Assess breathing effectiveness by pulse oximetry
 Listen to breath sound for each lung
 Check alignment of trachea
 Check tube insertion site for condition of the skin. Palpate area for puffiness or crackling that
may indicate subcutaneuous emphysema
 Observe site for signs of infection ( redness, prulent drainage or excessive bleeding.)
 Check to see if tube eyelets are visible.
 Assess for pain location, administer drugs for pain as prescribed
 Assist patient to deep breath cough performed maximal deep breath inhalations, and use
incentive spirometry.
 Reposition patient if reports burning pain in the chest.

DRAINAGE SYSTEM CARE:

 Do not strip the chest tube.

 Keep drainage system lower than the chest.
 Keep the chest tube as straight as possible, avoid kinks and dependent loops.
 Ensure the chest tube is securely taped to connector, and connector is taped to the tubing going
into the chamber.
 Assess bubbling in the water seal chamber; it should be gentle bubbling in patients exhalation,
foreceful cough, position changes.
 Assess for tidaling.
 Assess water level in the seal chamber, keep at the level as recommended.
 Check water level in the sunction control chamber, keep at the level as prescribed by the doctor.
 Clamp the chest tube only when looking for air leaks.
 Check and document for the amount, color and types of fluid or blood in the chamber.
 Empty collection chamber or change the system before the drainage makes contact with the
bottom of the tube.
 When sample is needed for lab test, obtain it from chest tube, after cleaning the chest tube, use
20 gauge for smaller needle and draw up specimen into a syringe.

NOTIFY PHYSICIAN IF:

 Tracheal deviation occurs .

 Sudden onset dyspnea.
 O2sat less than 90 percent.
 Drainage greater than 70ml/hr .
 Visible eyelets on chest tube ..
 Chest tube falls out of the patients chest .
 Chest tube disconnects from the drainage system .
 Drainage in the tube stops in 24hrs.