THERAPEUTIC NURSING

CARE
 Care of Patient with …
Respiratory problems/dyspnea
Altered body temperature
Fluid & electrolyte imbalance
Unconscious patient
Bedridden (traction, fractures)
Pain
Body elimination deviation
 
Shortness of breath, also known as dyspnea, is a feeling like one
cannot breath well enough.

Dyspnea means difficulty in breathing or as it is most usually called
breathlessness.

The underlying
Respiratory cause in
problems/dyspnea most cases Is a deficiency of oxygen.
Causes of dyspnea
1. Obstruction of air passages
Eg ;mucus, vomit, blood & other foreign
body.
2.Pressure from outside like abdominal
distension.
3.Respiratory disease such as asthma,
pneumonia, TB.
 Clinical signs of dyspnea

Exaggerated respiratory effort, use of

accessory muscles of respiration .
Nasal flaring
Increased rate & depth of respirations.
Nursing history taking in dyspnea
Orthopnoea
Sputum production
Haemoptysis
Wheezing
Strider
Chest pain
Environmental exposure
Respiratory infection
Allergies
Health risk
Medication
 Nursing management for dyspnea

Treatment modalities need to be

individualized for each client
Cause or worsens dyspnea must be
treated & stabilized initially.
 Pharmacological agents may include
 Branco dilators, steroids, mucolytics,
and low dose antianxiety medications.
 oxygen therapy can reduce dyspnea
that is associated with exercise:
 physical technique such as cardio
pulmonary reconditioning breathing
technique a cough control can help to
dyspnea.
 Relaxation technique, bio feed back, and
medication are psychological measures
that can lessen the sensation of dyspnea.
 Difficulty in breathing is a distressing
symptom: it always require immediate
attention by the health care personal .
 Cont….
Four additional therapies
1. Pharmacological measures
2. Oxygen therapy
3. Physical technique
4. Psychological technique
Nursing measure during treatment
 Maintenance of clear airway patency.
 Mobilization of pulmonary secretion .
 Increasing ventilatory efficiency.
 Ensuring adequate supply of oxygen
 Nebulization
 Coughing technique
 Decreasing demand of oxygen
 Minimize the patients anxiety
NEBULIZATION
 DEFINITION
• Process of dispersing a liquid (medication)
into microscopic particles and delivering into
lungs as patient inhales through the
nebulizer.

• It is used to liquefy and remove

retained secretions from the respiratory
tract.
Most aerosol medication have broncho
dilating effects and are administered by
respiratory therapy personnel.
 PURPOSES
• To relieve respiratory insufficiency due to
broncho spasm.
• To correct the underlying respiratory disorders
responsible for broncho spasm.
• To liquefy and remove retained thick
secretions.
• To reduce inflammatory and allergic responses
of the upper respiratory tract.
• To correct humidify deficit resulting from
inspired air by passing the airway during the
use of mechanical ventilation in critically
and post surgical patents.
• When a person has a acute asthma attack.
• When a person is in respiratory distress.
• If a person is unable to use a inhaler.
• If a person has stridor.
• Respiratory congestions
• Pneumonia
• Atelectasis
• Asthma
 HISTORY
• The first "powered" or pressurized inhaler
was invented in France by Sales-Girons in
1858. This device used pressure to atomize
the
liquid medication. The pump handle is
operated like a bicycle pump. When the pump
is pulled up, it draws liquid from the reservoir,
and upon the force of the user's hand, the
liquid is pressurized through an atomizer, to be
sprayed out for inhalation near the user's
mouth.
• In 1864, the first steam-driven nebulizer
was invented in Germany. This inhaler,
known as "Siegle’s steam spray inhaler”.

• The first electrical nebulizer was invented

in the 1930s and called a Pneumostat.
 BERNOULIIS PRINCIPLE:

• By the mid 19th century the search was on for a device that
would turn a solution into a spray. It was believed that
such a device would break down the solution into atoms,
and in this way the solution could be inhaled. This
breakdown was thus referred to as atomization, pulverizing
or nebulizing, and the devices created were often referred to
as atomizers, pulverizers or nebulizers.

• Yet no such machine would have been invented if not for

the discovery of the Bernoulli Principle. Daniel Bernoulli
observed that when water hits a rock it creates a mist that
can be inhaled. He published a book in 1738 where he
described that a similar effect could be created by forcing
water through a narrow tube.
• His concept was based on the fact that the faster water flows
through a tube, the less the lateral pressure will be. A
decreased lateral pressure is also referred to as a negative
side stream pressure. If
there is a hole in the side of the tube, the negative pressure
will force water into the stream.

• This same concept was used in creating the first nebulizers,

only using air. Air is forced through a tube, and a hole in
the tube is connected to a container with a solution in it that
contains the medication. The fluid is basically sucked in
due to the negative sidewall pressure, and turned into a
spray or mist.
 TYPES OF NEBULIZER:
• Inhaler or meterd-dose
nebulizer
• Jet nebulizer
• Ultrasonic nebulizer
 FUNCTION:
• A nebulizer is a device that uses a small
compressor to convert liquid medication
into tiny droplets of mist that can be inhaled
directly into the lungs.
• Since the medication goes straight to the
lungs, onset of the medication’s action often
takes place rapidly.
• This promotes quick symptom relief in the
case of illnesses such as asthma, where
fast relief is desirable.

• Also, it minimizes the risk of side effects of

the medication, preventing the medication
from being metabolized into a less effective
form by the body.
 EQUIPMENTS:
• Nebulizer and nebulizer connecting
tube
• Mouthpiece/mask

• Respiratory medication to
be administered
• Normal saline solution
• Sterile water
• Cotton balls
• Face mask
• Sputum mug with disinfectant
• Disposable tissues
• Kidney tray
• Medication card
 Drugs

 Bronchodilators
 Decongestants
 Bronchodilators:
 promote relaxation of musculature in
the tracheobronchial tree.
The relaxed passage produce less
resistance to airflow & provide an
opened respiratory passage way.
 
Decongestants

Are local vasoconstrictors .

SNO. PROCEDURE RATIONALE

1. Identify patient and Ensures that the right procedure

check has
physician’s instructions. been done for the patent.
2. Monitor heart rate before and after Drugs may cause
the treatment for patients tachycardia
using bronchodilator drugs. palpitation, dizziness, nausea,
or nervousness
3. Explain the procedure to Proper explanation of the
the procedure
patient. This therapy depends helps to ensure patient’s
on the patient’s effort. cooperation and effectiveness of the
treatment.
4. Place the pt in a Diaphragmatic excursion and
comfortable lung
sitting or a semi fowlers position. compliance are greater in this position.
This ensures maximal distribution and
deposition of aerosolized particles tp the
base of lungs.
5. Add the prescribed amount Aerosol particles enable
of deep
medications to the medicine chamber of penetration into tracheobronchial
the tubing. Connect the tube to the tree.
compressor.
A fine mist from the device should be
visible.
6. Place the mask on patient’s face to cover This encourages
his mouth and nose and instruct him to optimal
inhale deeply and slowly through mouth, dispersion of the medication.
hold breath and then exhale several
times.

7. Observe expansion of chest to ascertain This will ensure that

that patient is taking deep breaths. the
medication is deposited below the
level in the oropharynx.
8. Instruct the pt to breath slowly Medication will usually
and be
deeply until all the medications nebulized within 15 mins.
is
9. On completion of the The medication may dilate airways
treatment facilitating expectoration
encourage the patient to cough of secretions.
after several deep breaths.
10. Observe the pt for any adverse reaction Patient may
to the treatments. develop
bronchospasms due to inhalation of
aerosol.
The fluid may also cause dried and
retained secretions in airways,
leading to narrowing of the airway.

11. Document the medication used and the Proper documentation is a proof of
description of the work done and observed.
secretions
expectorated.
12. Disassemble and clean nebulizer Proper cleaning, sterilization
after and
each use. Keep the equipment in pt’s storage of equipments
room. Tubing’s to be changed in every prevents organisms from entering
48hrs. the lungs.
13. Wash hands.
 PROCEDURE:

1.Position the patient appropriately, allowing

optimal ventilation. (semi fowlers
position)
2.Assess and record breath sounds,
respiratory status, pulse rate and other
significant respiratory functions.
3.Teach patient the proper way of inhalation.
4. Prepare equipments at hand
5. Check doctor’s orders for the medication, prepare
thereafter
6. Place the medication in the nebulizer (can add a
amount of saline solution if ordered)
7. Attach the nebulizer to the compressed gas
source

8. Attach the connecting tubes and mouthpiece to

the nebulizer
 Turn the machine on (notice the mist produced
by the nebulizer)
10. Offer the nebulizer to the patient, offer
assistance until he is able to perform proper
inhalation (if unable to hold the nebulizer
[pediatric/geriatric/special cases], replace
the mouthpiece with mask.
 AFTER CARE
• Each time it is used, wash the nebulizer
chamber in warm water or clean with a
spirit swab and then rinse thoroughly with
clean water. Do not use a brush to clean the
nebulizer chamber as it may damage it.

• Reconnect the nebulizer chamber to

the tubing and blow air from it.
• This will dry the nebulizer chamber and
tubing. Disconnect the nebulizer chamber
from the tubing and allow it to dry
completely. Disconnect the tubing from the
compressor unit.
 SIDE EFFECTS:
• Dry or irritated throat, temporary or
occasional cough

• Sneezing, stuffy or itchy nose, watery eyes.

• Burning or bleeding of your nose

• Nausea, heartburn, stomach pain.

• Urinating more or less than usual.

• Dizziness, drowsiness, headache.

• Unusual or unpleasant taste in your

mouth.
 CONTRAINDICATIONS:
• In some cases, nebulization is restricted or
avoided due to possible untoward results or rather
decreased effectiveness such as:
• Patients with unstable and increased blood
pressure
• Individuals with cardiac irritability (may result to
dysrhythmias)
• Persons with increased pulse
• Unconscious patients (inhalation may be done via
mask but the therapeutic effect may be
significantly low)