Respiratory: ASTHMA

ABG – measures the amount of oxygen and co2 in blood.

Peak flow meter – measures how fast air comes out of your lungs when you exhale forcefully.
2. Treatments

 Medications.

 Long term control—inhaled steroids, bronchodilators.

 Quick relieve—ventolin inhalers or nebulizer, oral prednisolone.

 Modifications.

 Lifestyle and occupational.

 Environmental Control.

 “Asthma Action Plan”.

https://www.asthma.ca/adults/control/pdf/AsthmaActionPlan_ENG.pdf

https://www.nhlbi.nih.gov/files/docs/public/lung/asthma_actplan.pdf
Think-Pair-Share!

1. Discuss the education plan for a client who is being discharged with asthma.

Asthma is a chronic respiratory disease that affects the airways in the lungs, causing
inflammation and narrowing of the airways. It can lead to symptoms such as coughing,
wheezing, shortness of breath, and chest tightness. While there is no cure for asthma, it
can be managed effectively with appropriate treatment and self-care.

Education plans for clients with asthma typically include the following components:

1. Understanding asthma: Clients should be educated about what asthma is, what
causes it, and how it affects the body. This includes information about triggers,
such as allergens, irritants, exercise, and infections, and the importance of
avoiding them.
2. Medications: Clients should be informed about their asthma medications,
including how to use them properly, what to do if they experience side effects,
and how to manage their symptoms.
3. Asthma action plan: Clients should be given an individualized asthma action plan
that outlines what to do in case of an asthma attack or worsening of symptoms.
This plan should include steps for using medication, seeking medical attention,
and managing triggers.
4. Self-care: Clients should be educated about self-care measures to manage their
asthma, such as avoiding triggers, maintaining a healthy lifestyle, and monitoring
their symptoms.
 5. Follow-up care: Clients should be informed about the importance of regular
follow-up care with their healthcare provider to monitor their asthma and adjust
their treatment plan as needed.

In addition to the above components, it is important to provide clients with the

opportunity to ask questions and address any concerns they may have. Asthma can be a
complex and challenging condition to manage, so it is important to provide clients with
the resources and support they need to successfully manage their asthma and maintain
their overall health and well-being.

2. Explore and identify the importance of “Asthma Action Plan”.

An asthma action plan is a written document that outlines the steps a person with
asthma should take to manage their symptoms and prevent asthma attacks. The plan is
typically developed in collaboration with a healthcare provider and tailored to the
individual's specific needs and circumstances. The following are some reasons why an
asthma action plan is important:

1. Improved asthma control: An asthma action plan can help people with asthma to
better control their symptoms and prevent asthma attacks. The plan provides
clear instructions for taking medication, managing triggers, and seeking medical
attention when necessary. By following the plan, people with asthma can reduce
the frequency and severity of their symptoms, leading to improved overall health
and quality of life.
2. Personalization: An asthma action plan is personalized to the individual's needs
and circumstances. The plan takes into account factors such as the person's
asthma triggers, symptoms, and medication regimen. By tailoring the plan to the
individual, it is more likely to be effective in managing their asthma.
3. Empowerment: An asthma action plan empowers people with asthma to take an
active role in managing their condition. By providing clear instructions and
guidelines, the plan gives people with asthma a sense of control over their
symptoms and helps them to feel more confident in managing their condition.
4. Communication: An asthma action plan promotes communication between
people with asthma, their healthcare providers, and other caregivers. The plan
provides a clear and consistent framework for managing the person's asthma,
which can help to avoid confusion and misunderstandings. This can lead to more
effective and coordinated care.
5. Emergency preparedness: An asthma action plan includes instructions for what to
do in case of an asthma attack or emergency. By having a plan in place, people
 with asthma and their caregivers are better prepared to respond quickly and
effectively in the event of an emergency.

Overall, an asthma action plan is an important tool for managing asthma and promoting
better health outcomes. By providing clear instructions, personalization, empowerment,
communication, and emergency preparedness, an asthma action plan can help people
with asthma to take control of their symptoms and lead healthier, more active lives.

3. List 2 nursing diagnoses and appropriate nursing interventions for asthma.

Here are two nursing diagnoses and appropriate nursing interventions for asthma:

1. Impaired gas exchange related to airway obstruction and inflammation as

evidenced by dyspnea, wheezing, and decreased oxygen saturation.

Nursing interventions:

 Administer oxygen therapy as prescribed to improve oxygenation.

 Assist the patient in adopting a position of comfort that facilitates breathing.
 Administer bronchodilators and other respiratory medications as prescribed to
improve airway patency and reduce inflammation.
 Monitor respiratory status frequently, including respiratory rate, depth, and
pattern, and auscultate lung sounds to assess for changes.
 Encourage and assist with effective coughing and deep breathing techniques to
promote airway clearance.
2. Anxiety related to the unpredictable and distressing nature of asthma symptoms
as evidenced by restlessness, increased heart rate, and difficulty sleeping.

Nursing interventions:

 Provide a calm and supportive environment to help reduce anxiety.

 Encourage the patient to express their concerns and feelings about their asthma,
and provide education and reassurance as needed.
 Teach the patient relaxation techniques, such as deep breathing, meditation, or
guided imagery, to help manage anxiety symptoms.
 Encourage the patient to engage in activities that promote relaxation and stress
reduction, such as listening to music or reading a book.
 Consider referring the patient to a mental health professional or support group
to help address their anxiety and promote coping strategies.
PART 2!!!!

1. COPD

Disease characterized by airflow limitation that is not fully reversible.

2. Chronic Bronchitis.

Chronic inflammation of the lower respiratory tract with excessive mucus secretion, cough and
dyspnea.

3. Emphysema.

Complex lung disease which involves destruction of the lungs over time.
Nursing Interventions

 Lifestyle changes.

 Quit smoking, avoid second-hand smoke.

 Medical treatments.

 Inhaled bronchodilators, corticosteroids.

 Vaccinations.

 Oxygen therapy.

 Pulmonary rehabilitation.

 Surgery.

 Watch video: https://www.youtube.com/watch?v=9-ErVE--vjM

Nursing Interventions

 Oxygen therapy.

 Administering the right amount of oxygen in COPD clients.

 Watch video: https://www.youtube.com/watch?v=6h0Ea4Tc-Qk

https://www.youtube.com/watch?v=ooJ-_e22LYE
 Part 2: Think-Pair-Share!

1. Emphysema is reversible provided the client stops smoking. True or false?

False. Emphysema is a chronic and progressive lung disease characterized by the

destruction of the alveoli, which are the tiny air sacs in the lungs responsible for
exchanging oxygen and carbon dioxide. The damage to the alveoli is irreversible,
meaning that the lung tissue cannot be regenerated or repaired. While stopping
smoking is an important step in preventing further damage to the lungs, it cannot
reverse the damage that has already occurred in emphysema. Treatment for emphysema
is focused on managing symptoms, preventing complications, and slowing the
progression of the disease. This may involve the use of medications, oxygen therapy,
pulmonary rehabilitation, and lifestyle modifications such as avoiding respiratory irritants
and getting regular exercise.

2. What are some of the warning signs and symptoms of a COPD flare-up?

COPD, or chronic obstructive pulmonary disease, is a chronic and progressive lung

disease that can cause flare-ups or exacerbations. Some warning signs and symptoms of
a COPD flare-up may include:

1. Increased shortness of breath, even at rest

2. Wheezing, coughing, or chest tightness
3. Increased sputum production or a change in sputum color or thickness
4. Fatigue or weakness
5. Increased heart rate or breathing rate
6. Swelling in the ankles, feet, or legs
7. Confusion or decreased mental alertness
8. Bluish tint to the lips or fingernail beds (cyanosis)

It's important to recognize the warning signs of a COPD flare-up and seek prompt
medical attention if they occur. Early intervention can help to prevent further lung
damage and improve outcomes. People with COPD can also benefit from developing a
COPD action plan with their healthcare provider, which outlines steps to take in case of
a flare-up, such as adjusting medication dosages, using rescue inhalers, and seeking
emergency care if necessary.
 1. Pneumonia

 An inflammatory process involving the terminal airways and alveoli of the lung.

 Bacteria, viruses, fungi or parasites.

 Common in 65 years or older.

 Types.

 Community acquired (streptococcus pneumonia)

 hospital acquired

 immunocompromised.
 Think-Pair-Share!

1. What would your teaching plan be for pneumonia clients?

The teaching plan for pneumonia clients may include the following:

1. Understanding pneumonia: Educate the client about the causes, signs, and
symptoms of pneumonia, including the importance of seeking medical attention
if they suspect they have pneumonia.
2. Medication management: Teach the client about the prescribed medications,
their dosages, and how to take them correctly, as well as the potential side effects
and the importance of completing the full course of treatment.
3. Hydration and rest: Encourage the client to drink plenty of fluids and get
adequate rest to help support the immune system and promote healing.
4. Oxygen therapy: Explain to the client about the need for supplemental oxygen
therapy, if necessary, and how to use it properly.
5. Follow-up care: Teach the client about the importance of follow-up
appointments, including the need for repeat chest x-rays, blood tests, and other
monitoring to ensure complete recovery.
6. Prevention strategies: Educate the client about how to reduce the risk of
developing pneumonia, such as quitting smoking, getting vaccinated for
pneumococcal and influenza viruses, washing hands frequently, and avoiding
close contact with people who are sick.
7. Signs of worsening: Explain to the client the signs and symptoms of worsening
pneumonia, including shortness of breath, chest pain, high fever, and confusion,
and instruct them to seek immediate medical attention if these symptoms occur.

Overall, the teaching plan for pneumonia clients should be tailored to their individual
needs and circumstances, and healthcare providers should provide clear and accurate
information to help clients manage their condition effectively and promote recovery.

2. How is body temperature related to fluid balance?

Body temperature and fluid balance are closely related. The body's internal temperature
is regulated by the hypothalamus in the brain, which receives signals from temperature
sensors throughout the body. When body temperature rises, the hypothalamus triggers
mechanisms to dissipate heat, such as sweating and vasodilation of blood vessels in the
skin, which helps to lower body temperature.

Fluid balance in the body is also important for regulating body temperature. The body
loses fluids through sweating and other means, and if fluid intake is not sufficient to
replace these losses, dehydration can occur. When the body is dehydrated, it may be
less able to dissipate heat effectively, which can lead to an increase in body
temperature. In addition, dehydration can make it more difficult for the body to
maintain a stable internal temperature, which can lead to complications such as heat
exhaustion or heatstroke.

Maintaining adequate fluid balance is therefore essential for regulating body

temperature and preventing complications related to overheating. It's important to
drink enough fluids, especially during times of increased activity or exposure to high
temperatures, and to be aware of the signs and symptoms of dehydration, such as dry
mouth, dark urine, fatigue, and dizziness. If dehydration is suspected, it's important to
replace fluids and electrolytes promptly to avoid complications.

3. List 2 nursing diagnoses and appropriate nursing interventions.

Here are two nursing diagnoses and appropriate nursing interventions for pneumonia
patients:

1. Ineffective Airway Clearance related to excessive secretions as evidenced by

dyspnea and productive cough:
 Assess respiratory status and monitor oxygen saturation levels.
 Encourage the patient to perform deep breathing and coughing exercises to help
mobilize secretions and clear the airways.
 Administer prescribed bronchodilators and expectorants as directed to help open
airways and loosen secretions.
 Encourage the patient to drink plenty of fluids to help thin secretions and
promote effective coughing.
 Monitor the patient's response to interventions and adjust the plan of care as
needed.
2. Risk for Impaired Gas Exchange related to alveolar damage and decreased lung
function as evidenced by decreased oxygen saturation levels:
 Monitor the patient's oxygen saturation levels and respiratory status.
 Administer supplemental oxygen as prescribed to help maintain adequate
oxygen levels.
 Encourage the patient to perform breathing exercises, such as pursed-lip
breathing, to help improve lung function.
 Encourage the patient to rest and avoid activities that may increase oxygen
demand.
 Monitor the patient's response to interventions and adjust the plan of care as
needed.
Case Study
Respiratory Conditions: COPD

Chief Complaint: Mr. Allan Park, a 40-year-old man with episodes of breathlessness, wheezing and dry
coughs.

History: Mr. Allan Park, a 40-year-old man, who started working in an auto body shop 18 months ago
presents to your clinic because of episodes of breathlessness, wheezing and dry coughs.

Subjective Data:
• He notes that his respiratory symptoms are often better over weekends and they disappeared
completely when he had 2 weeks off over the Christmas holidays.
• Has been smoking a pack of cigarettes for past 20 years.
• His wife smokes as well.

Objective Data:
• Vital signs: B/P 130/88.
• No medical problems noted.
• O2 Sat 90-91% on room-air.
• Mild bilateral pitting edema noted on extremities.
• Examination: decreased breath sounds and prolonged expiration on wheezing.

Critical Thinking Questions

1. What are Mr. Park’s risk factors for COPD?

Mr. Park has several risk factors for COPD, including:

1. Smoking: He has been smoking for the past 20 years, which is a

significant risk factor for COPD. His wife also smokes, which may
contribute to his exposure to secondhand smoke.
2. Occupational exposure: He works in an auto body shop, which may
expose him to dust, chemicals, and other airborne irritants that can
damage the lungs.
3. Symptoms: Mr. Park has episodes of breathlessness, wheezing, and dry
coughs, which are common symptoms of COPD.
 4. Examination findings: His physical examination reveals decreased breath
sounds and prolonged expiration on wheezing, which are consistent
with COPD.
5. O2 Saturation: His O2 Saturation is 90-91% on room-air which is lower
than the normal range (95-100%) and suggests poor oxygenation, which
is often seen in COPD patients.

Based on these risk factors and symptoms, Mr. Park is at high risk for
developing COPD.

2. Which of Mr. Park’s signs and symptoms suggest COPD?

Mr. Park's signs and symptoms suggest COPD. The symptoms of breathlessness,
wheezing, and dry coughs, are often seen in patients with COPD. The physical
examination findings of decreased breath sounds and prolonged expiration on wheezing
are also consistent with COPD. Additionally, his O2 saturation is 90-91% on room-air
which is lower than the normal range (95-100%) and suggests poor oxygenation, which
is often seen in COPD patients. Therefore, his symptoms and examination findings
suggest that he may have COPD.

3. What might be the appropriate treatments for Mr. Park?

The appropriate treatments for Mr. Park would depend on the diagnosis and severity of
his COPD. However, some general treatments that may be considered for COPD include:

1. Smoking cessation: The most important treatment for COPD is to quit smoking.
Mr. Park should be advised to quit smoking and offered smoking cessation
interventions to help him quit.
2. Bronchodilators: Bronchodilators, such as beta-agonists and anticholinergics, can
help to open up the airways and improve breathing. These medications can be
delivered via inhaler or nebulizer.
3. Inhaled corticosteroids: Inhaled corticosteroids can help to reduce airway
inflammation and may be used in combination with bronchodilators for patients
with more severe COPD.
4. Oxygen therapy: For patients with severe COPD and low oxygen levels, oxygen
therapy may be necessary to maintain adequate oxygenation.
5. Pulmonary rehabilitation: Pulmonary rehabilitation programs can help patients
with COPD improve their exercise capacity, reduce symptoms, and improve their
quality of life.
 6. Lifestyle changes: Lifestyle changes such as regular exercise, a healthy diet, and
avoiding triggers such as pollution and respiratory infections can also be helpful
in managing COPD.

It is important to note that the treatment plan for COPD should be individualized based
on the patient's specific needs and goals of care. Mr. Park should be referred to a
healthcare provider who specializes in the treatment of COPD to determine the most
appropriate treatment plan for him.

4. If Mr. Park had quit smoking, can he still have COPD?

Yes, even if Mr. Park quit smoking, he could still have COPD. While smoking is the most
common cause of COPD, there are other risk factors for the disease, such as exposure to
air pollution, occupational dusts and chemicals, and genetic factors. In fact, up to 25% of
people with COPD have never smoked. Additionally, even if someone quits smoking, the
damage to their lungs may already have been done and could lead to the development
of COPD later in life. Therefore, it is important for individuals who have been exposed to
risk factors for COPD to be aware of the signs and symptoms of the disease and seek
medical attention if they are experiencing respiratory symptoms.

5. What is the teaching plan for Mr. Park?

The teaching plan for Mr. Park should focus on the following areas:

1. Smoking cessation: The most important thing Mr. Park can do to improve his
respiratory symptoms and reduce his risk of COPD progression is to quit
smoking. The healthcare provider should provide him with information about
smoking cessation interventions and refer him to a smoking cessation program if
necessary.
2. Medications: Mr. Park should be taught about the medications he is prescribed,
including how to use them properly, potential side effects, and the importance of
adhering to the treatment plan.
3. Inhaler technique: If Mr. Park is prescribed inhalers, he should be taught proper
inhaler technique to ensure that he is receiving the correct dose of medication.
4. Avoiding triggers: Mr. Park should be educated on common triggers that can
worsen his respiratory symptoms, such as air pollution and respiratory infections,
and how to avoid them.
5. Breathing techniques: Breathing techniques such as pursed-lip breathing and
diaphragmatic breathing can help Mr. Park to control his breathing and improve
his symptoms. The healthcare provider should demonstrate these techniques and
ensure that Mr. Park is able to perform them correctly.
 6. Pulmonary rehabilitation: If appropriate, Mr. Park should be referred to a
pulmonary rehabilitation program. This program can help him to improve his
exercise capacity, reduce symptoms, and improve his quality of life.
7. Regular follow-up: Mr. Park should be encouraged to attend regular follow-up
appointments with his healthcare provider to monitor his symptoms and adjust
his treatment plan as needed.

It is important to individualize the teaching plan based on Mr. Park's specific needs,
preferences, and goals of care. The healthcare provider should ensure that he
understands the information provided and has the necessary support to make and
sustain behavior changes.

6. List 2 nursing diagnoses and appropriate interventions for Mr. Park based on the case
study.
Two nursing diagnoses and appropriate interventions for Mr. Park based on the case
study could be:

1. Ineffective breathing pattern related to bronchospasm and airway obstruction as

evidenced by wheezing and decreased breath sounds.

Interventions:

 Administer bronchodilators and other respiratory medications as ordered to help

relieve bronchospasm and improve breathing pattern.
 Monitor oxygen saturation levels and administer supplemental oxygen as needed
to maintain an adequate oxygen level.
 Teach Mr. Park about pursed-lip breathing and diaphragmatic breathing
techniques to help improve breathing pattern and reduce respiratory distress.
2. Risk for infection related to decreased respiratory function and exposure to
environmental pollutants as evidenced by chronic cough and exposure to auto
body shop fumes.

Interventions:

 Teach Mr. Park about proper hand hygiene and respiratory hygiene to reduce the
risk of infection.
 Encourage Mr. Park to get vaccinated against influenza and pneumonia to reduce
the risk of respiratory infections.
 Advise Mr. Park to avoid exposure to environmental pollutants and fumes, such
as those found in the auto body shop.
 Monitor for signs and symptoms of respiratory infection and report to the
healthcare provider if they occur.

PART 4: TB

1. TB

2. An infectious disease caused by bacteria.

3. Mycobacterium tuberculosis.
4. Transmission: airborne.
5. Infects the lungs but may spread to other
organs.
 Think-Pair-Share!
1. What is the course (length) of treatment for TB?

The course of treatment for tuberculosis (TB) depends on the type of TB and the severity
of the infection. Generally, TB treatment involves a combination of antibiotics taken for
several months. The most commonly used antibiotics for treating TB are isoniazid,
rifampin, ethambutol, and pyrazinamide.
For drug-susceptible TB, the standard treatment regimen is usually a six-month course
of antibiotics, which consists of two months of daily isoniazid, rifampin, pyrazinamide,
and ethambutol, followed by four months of daily isoniazid and rifampin.

However, for drug-resistant TB, the treatment course can be much longer and more
complicated, often involving multiple medications taken for up to 24 months or more.

It is important to note that the length of treatment for TB may vary depending on
individual factors, such as the patient's response to treatment and any co-existing
medical conditions. Therefore, it is essential to follow the healthcare provider's
instructions and complete the full course of treatment to ensure effective TB
management and prevent the development of drug resistance.

2. List some of the health teaching plans for a client with tuberculosis.

Health teaching plans for a client with tuberculosis may include the following:

1. Education on TB transmission: The client needs to understand how TB is

transmitted from person to person, how to prevent the spread of the disease, and
the importance of adhering to infection control measures.
2. Medication management: The client needs to understand the importance of
taking their medication as prescribed, the potential side effects of TB medication,
and the consequences of missing doses or stopping treatment early.
3. Nutrition: The client needs to know the importance of a well-balanced diet that
includes adequate protein and calories to support the body during treatment.
4. Rest and exercise: The client needs to understand the importance of balancing
rest and physical activity during treatment to reduce fatigue and maintain overall
health.
5. Follow-up care: The client needs to understand the importance of attending all
scheduled medical appointments, such as sputum tests, chest X-rays, and medical
exams to monitor their progress and ensure the effectiveness of treatment.
6. Importance of completing treatment: The client needs to know the importance of
completing the full course of treatment even if they start to feel better to prevent
the development of drug-resistant TB.
7. Support systems: The client needs to know the importance of having a supportive
network of family and friends during treatment and the availability of support
groups and counseling services.
Overall, the health teaching plans for a client with TB aim to improve the client's
understanding of the disease, promote adherence to treatment, and prevent the spread
of TB to others.

3. List 2 nursing diagnoses and appropriate interventions.

here are two examples of nursing diagnoses and appropriate interventions for TB:

1. Ineffective Airway Clearance related to bronchial obstruction, thick and tenacious

secretions, and inflammation of the airways as evidenced by coughing, sputum
production, and dyspnea.

Interventions:

 Encourage the client to cough effectively and expectorate sputum as needed.

 Administer bronchodilators and nebulizer treatments as prescribed to promote
airway clearance.
 Position the client in a semi-Fowler's position to promote lung expansion and
ease breathing.
 Encourage adequate hydration to help thin secretions and promote
expectoration.
2. Risk for Infection related to exposure to TB, immunosuppression, and non-
adherence to infection control measures as evidenced by positive TB skin test or
sputum culture.

Interventions:

 Educate the client on the transmission of TB, infection control measures, and the
importance of adhering to treatment and follow-up care.
 Provide a private room or isolation precautions as indicated to prevent the
spread of TB to others.
 Encourage hand hygiene and the use of personal protective equipment for
healthcare workers and visitors.
 Monitor vital signs, oxygen saturation, and respiratory status to detect signs of TB
disease progression or treatment complications.