Multimedia

Bronchitis

Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from
your lungs. People who have bronchitis often cough up thickened mucus, which can be
discolored. Bronchitis may be either acute or chronic.
Often developing from a cold or other respiratory infection, acute bronchitis is very common.
Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining
of the bronchial tubes, often due to smoking.
Acute bronchitis usually improves within a few days without lasting effects, although you may
continue to cough for weeks. However, if you have repeated bouts of bronchitis, you may have
chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions
included in chronic obstructive pulmonary disease (COPD).
or either acute bronchitis or chronic bronchitis, signs and symptoms may include:
Cough
Production of mucus (sputum), which can be clear, white, yellowish-gray or green in
color rarely, it may be streaked with blood
Fatigue
Shortness of breath
Slight fever and chills
Chest discomfort
If you have acute bronchitis, you may have a nagging cough that lingers for several weeks after
the inflammation resolves. Chronic bronchitis is defined as a productive cough that lasts at least
three months, with recurring bouts occurring for at least two consecutive years.
If you have chronic bronchitis, you're likely to have periods when your signs and symptoms
worsen. At those times, you may have acute bronchitis on top of your chronic bronchitis.
When to see a doctor
See your doctor if your cough:
Lasts more than three weeks
Prevents you from sleeping
Is accompanied by fever higher than 100.4 F (38 C)
Produces discolored mucus
Produces blood
Is associated with wheezing or shortness of breath
Causes
By Mayo Clinic Staff
Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds
and flu (influenza). Antibiotics don't kill viruses, so this type of medication isn't useful in
most cases of bronchitis.
The most common cause of chronic bronchitis is smoking cigarettes. Air pollution and
dust or toxic gases in the environment or workplace also can contribute to the condition.
Complications
By Mayo Clinic Staff
Although a single episode of bronchitis usually isn't cause for concern, it can lead to
pneumonia in some people. Repeated bouts of bronchitis may indicate that you're
developing chronic obstructive pulmonary disease (COPD).
Tests and diagnosis
By Mayo Clinic Staff
Multimedia

Spirometer

During the first few days of illness, it can be difficult to distinguish the signs and symptoms of
bronchitis from those of a common cold. During the physical exam, your doctor will use a
stethoscope to listen closely to your lungs as you breathe.
In some cases, your doctor may suggest:
Chest X-ray. A chest X-ray can help determine if you have pneumonia or another
condition that may explain your cough. This is especially important if you ever were or
currently are a smoker.
Sputum tests. Sputum is the mucus that you cough up from your lungs. It can be tested
to see if you have whooping cough (pertussis) or other illnesses that could be helped by
antibiotics. Sputum can also be tested for signs of allergies.
Pulmonary function test. During a pulmonary function test, you blow into a device
called a spirometer, which measures how much air your lungs can hold and how quickly
you can get air out of your lungs. This test checks for signs of asthma or emphysema.
Treatments and drugs
By Mayo Clinic Staff
Most cases of acute bronchitis resolve without medical treatment in two weeks.
Medications
In some circumstances, your doctor may prescribe medications, including:
Antibiotics. Bronchitis usually results from a viral infection, so antibiotics aren't
effective. However, your doctor might prescribe an antibiotic if he or she suspects that
you have a bacterial infection.
Cough medicine. It's best not to suppress a cough that brings up mucus, because
coughing helps remove irritants from your lungs and air passages. If your cough keeps
you from sleeping, you might try cough suppressants at bedtime.
Other medications. If you have allergies, asthma or chronic obstructive pulmonary
disease (COPD), your doctor may recommend an inhaler and other medications to reduce
inflammation and open narrowed passages in your lungs.
Therapies
If you have chronic bronchitis, you may benefit from pulmonary rehabilitation a breathing
exercise program in which a respiratory therapist teaches you how to breathe more easily and
increase your ability to exercise.
1. Basics
2.
3. In-Depth
4. Expert Answers
5. Multimedia
6. Resources
7. News From Mayo Clinic
1. Definition
2. Symptoms
3. Causes
4. Risk factors
5. Complications
6. Preparing for your appointment
7. Tests and diagnosis
8. Treatments and drugs
9. Lifestyle and home remedies
10. Prevention
Products and services


Lifestyle and home remedies
By Mayo Clinic Staff
To help you feel better, you may want to try the following self-care measures:
Avoid lung irritants. Don't smoke. Wear a mask when the air is polluted or if you're
exposed to irritants, such as paint or household cleaners with strong fumes.
Use a humidifier. Warm, moist air helps relieve coughs and loosens mucus in your
airways. But be sure to clean the humidifier according to the manufacturer's
recommendations to avoid the growth of bacteria and fungi in the water container.
Consider a face mask outside. If cold air aggravates your cough and causes shortness of
breath, put on a cold-air face mask before you go outside.\

****Bronchitis is an inflammation of the air passages within the lungs. It occurs when the
trachea (windpipe) and the large and small bronchi (airways) within the lungs become inflamed
because of infection or other causes.
Bronchitis is one of the disease condition (together with asthma) that defines chronic
obstructive pulmonary disease. They are also known as blue bloaters since lack of oxygen can
cause cyanosis in patients with bronchitis.

Emphysema is an abnormal, irreversible enlargement of air spaces distal to terminal bronchioles
due to destruction of alveolar walls, resulting in decreased elastic recoil properties of lungs.
Contents
1 Causes of Emphysema
2 Pathophysiology of Emphysema
3 Schematic Diagram
4 Nursing Care Plans
Causes of Emphysema
Cigarette smoking and congenital deficiency of alpha-antitrypsin
Recurrent inflammation associated with release of proteolytic enzymes from cells in
lungs causes bronchiolar and alveolar wall damage and ultimately destruction.
Pathophysiology of Emphysema
Emphysema is a pathological diagnosis defined by permanent enlargement of airspaces distal to
the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available
for gas exchange. Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms. First,
loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation.
Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits
airflow.
Emphysema commonly presents with chronic bronchitis. Chronic bronchitis leads to obstruction
by causing narrowing of both the large and small (< 2 mm) airways. In the large airways, an
increase in Goblet cells, squamous metaplasia of ciliary epithelial cells, and loss of serous acini
can be seen. In the small airways, Goblet cell metaplasia, smooth muscle hyperplasia, and
subepithelial fibrosis can be seen. In healthy individuals, small airways contribute little to airway
resistance; however, in COPD patients, these become the main site of airflow limitation.
(PubMed.gov)
efinition
Chronic Obstructive Bronchitis is an inflammation of the bronchi (chronic obstructive
bronchitis) causes increase mucus production and chronic cough. The clinical manifestations of
Chronic Bronchitis continue for at least 3 months of the year for 2 consecutive years. Chronic
bronchitis is also known the blue bloater. It is characterized by the following:
An increase in the size and number of submucosal glands in the large bronchi which causes
increase mucus production
An increased number of goblet cells, which also secrete mucus
Impaired ciliary function, which reduces mucus clearance
Nursing Care Plans
Ineffective Airway Clearance
COPD is an inflammatory response to the offending microorganism. The defense mechanisms of
the lungs lose effectiveness and allow organisms to penetrate the sterile respiratory tract, as a
result inflammation develops. The inflammation and increased secretions make it difficult to
maintain a patent airway.
Assessment Planning Nursing Interventions Rationale
Expected
Outcome
S:O: The may patient
manifest the ffg.:
with
wheezes/cra
ckles upon
auscultation
Short
term:After 4-5
hours of
nursing
interventions
the patient will
1. Establish rapport
to the pt. and SO
2. Assess the
patient
condition
3. Monitor and
record V/S
1. To gain
trust and
active
participat
ion
2. To know
the
Short
term:The
patient shall
have
demonstrated
effective
on the BLF
with
subcostal
retraction
with nasal
flaring
presence of
non-
productive
cough
increase RR
above
normal range
demonstrate
effective
clearing of
secretions.Long
term:After 2
days of nursing
interventions,
the patient will
maintain
effective
airway
clearance.
4. Position head
midline with
flexion on
appropriate for
age/condition
5. Elevate HOB
6. Observe S/Sx of
infections
7. Auscultate
breath sounds &
assess air movt
8. Instruct the
patient to
increase fluid
intake
9. Demonstrate
effective
coughing and
deep-breathing
techniques.
10. Keep back dry
11. Turn the patient
q 2 hours
12. Demonstrate
chest
physiotherapy,
such as
bronchial
tapping when in
cough, proper
postural
drainage.
13. Administer
bronchodilators i
f prescribed.
condition
of the pt
3. To have a
baseline
data.
4. To gain
or
maintain
open
airway
5. To
decrease
pressure
on the
diaphrag
m and
enhancin
g
drainage
6. To
identify
infectious
process
7. To
ascertain
status &
note
progress
8. To help
to liquefy
secretion
s.
9. To
maximize
effort
10. To
prevent
further
complicat
ions
11. To
prevent
possible
aspiratio
ns
12. These
techniqu
es will
clearing of
secretions.
Long term:
The patient
shall have
maintained
effective
airway
clearance.
prevent
possible
aspiratio
ns and
prevent
any
untoward
complicat
ions
13. More
aggressiv
e
measures
to
maintain
airway
patency.
Ineffective Breathing Pattern
NDx: Ineffective Breathing Pattern RT Retained Secretions
The presence of microorganisms in the lungs causes body to increase the secretory activity of
goblet cells to get rid of the invading organism but the mechanism is not enough which allows
the stasis of mucus secretion leading to ineffective breathing pattern.
Assessment Planning Nursing Interventions Rationale
Expected
Outcome
S:
Reports of
dyspnea
O: The patient
may manifest the
manifest the ffg.:
with
wheezes
/crackles
upon
auscultation
on BLF
increase RR
above
Short
term:After 4-
5 hours of
nursing
interventions
the patient
will improve
breathing
pattern.Long
term:After 2
days of
nursing
interventions
the patient
will maintain
1. Establish
rapport to the
pt. and SO
2. Assess the
patient
condition
3. Monitor and
record V/S
especially RR
4. Provide rest
periods
5. Place pt in
semi-fowlers
position
6. Increase fluid
intake
7. Keep patient
1. To gain
trust
and
active
participa
tion
2. To know
the
conditio
n of the
pt
3. To have
a
baseline
data.
4. To
reduce
Short
term:The
patient shall
have
improved
breathing
pattern.Long
term:The
patient shall
have
maintained
a respiratory
rate within
normal
normal
range
presence of
productive
cough
use of
accessory
muscle
when
breathing
presence of
nasal flaring
and
retractions
a respiratory
rate within
normal
limits.
back dry
8. Change
position every
2 hours
9. Perform CPT
10. Place a pillow
when the
client is
sleeping
11. Instruct how
to splint the
chest wall with
a pillow for
comfort
during
coughing and
elevation of
head over
body as
appropriate
12. Maintain a
patent airway,
suctioning of
secretions
may be done
as ordered
13. Provide
respiratory
support.
Oxygen
inhalation is
provided per
doctors order
14. Administer
prescribed
cough
suppressants
and analgesics
and be
cautious,
however,
because
opioids may
depress
respirations
more than
fatigue
and
obtain
rest
5. To have
a
maximu
m lung
expansio
n
6. To
liquefy
secretio
ns
7. To avoid
stasis of
secretio
ns and
avoid
further
complic
ation
8. To
facilitate
secretio
n movt
and
drainage
9. To
loosen
secretio
n
10. To
provide
adequat
e lung
expansio
n while
sleeping
.
11. To
promote
physiolo
gical
ease of
maximal
inspirati
on
limits.
desired. 12. To
remove
secretio
ns that
obstruct
s the
airway
13. To aid in
relieving
patient
from
dyspnea
14. To
promote
deeper
respirati
ons and
cough
Impaired Gas Exchange
NDx: Impaired Gas Exchange RT Altered Oxygen Balance
The disruption of the mechanical defenses of cough and ciliary motility leads to colonization of the lungs
and subsequent infection leading to inflammation and accumulation of secretions. Inflamed and fluid-
filled alveolar sacs cannot exchange oxygen and carbon dioxide effectively.
Assessment Planning
NursingInter-
ventions
Rationale
Expected
Outcome
S:O: The patient may
manifest the ffg.:
Appearance
of bluish
extremities
when in
cough
(cyanosis),
lips
Lethargy
Restlessness
Hypercapnea
Hypoxemia
Abnormal
rate, rhythm,
Short
term:After
4-5 hours of
nursing
interventio
ns the
patient will
improve
ventilation
and
adequate
oxygenatio
n of tissues
1. Establish
rapport to
the pt. and
SO
2. Assess the
patient
condition
3. Monitor
and record
V/S
4. Monitor
level of
consciousn
ess or
mental
status
1. To gain trustand active
participation
2. To know the condition of the
pt
3. To have a baseline data.
4. Restlessness,anxiety, confusio
n, somnolence are common
manifestation of hypoxia and
hypoxemia.
5. The upright position allows
full lung excursion and
enhances air exchange
6. To help liquefy secretions
7. To eliminate thick, tenacious,
copious secretions which
contribute for the impairment
Short
term:The
patient
shall have
improved
ventilatio
n and
adequate
oxygenati
on of
tissues
Long
depth of
breathing
Diaphoresis
Long term:
After 2
days of
nursing
interventio
ns the
patient will
minimize
or totally
be free of
symptoms
of
respiratory
distress.
5. Assist the
client into
the High-
Fowlers
position
6. Increase
patients
fluid intake
7. Encourage
expectorati
on
8. Encourage
frequent
position
changes
9. Encourage
adequate
rest & limit
activities to
within
client
tolerance
10. Promote
calm/restfu
l
environme
nts
11. Administer
supplement
al oxygen
judiciously
as indicated
12. Administer
meds as
indicated
such as
bronchodila
tors
of gas exchange.
8. To promote drainage of
secretions
9. Helps limit
oxygen needs/consumption
10. To correct/improve existing
deficiencies
11. May correct or prevent
worsening of hypoxia.
12. To treat the underlying
condition
term:
The
patient
shall
have
minimize
d or
totally be
free of
symptom
s of
respirator
y
distress.
Sleep Pattern Disturbance
NDx: Sleep Pattern Disturbance RT Difficulty of Breathing
COPD patients need a comfortable position such as the High-Fowlers position during sleeping
in order to promote lung expansion. Lying flat on bed promotes the occurrence of DOB and
makes the patient uncomfortable due to the impaired alveolar ventilation which the body
processes at night cant be controlled
Assessment Planning
Nursing
Interventions
Rationale
Expected
Outcome
S:
O:The patient may
manifest the ffg.:
irritability
restlessness
lethargy
changes in
posture
difficulty of
breathing
which worsens
at night
Short
term:After 4-5
hours of
nursing
interventions
the patient
will identify
individually
appropriate
interventions
to promote
sleep.Long
term:After 2
days of
nursing
interventions,
the patient
will be able to
report
improvement
s in sleep/rest
pattern.
1. Establish
rapport to the
pt. and SO
2. Assess the
patient
condition
3. Monitor and
record V/S
4. Monitor level of
consciousness
or mental status
5. Promote
comfort
measures such
as back rub and
change in
position as
necessary
6. Observe
provision of
emotional
support
7. Provide quiet
environment.
8. Increase
patients fluid
intake
9. Encourage
expectoration
10. Limit the fluid
intake in
evening if
nocturia is a
problem
11. Obtain feedback
from SO
regarding usual
bedtime,
rituals/routines
12. Provide safety
for patient sleep
1. To gain trust and
active
participation
2. To know the
condition of the
pt
3. To have a
baseline data
4. Restlessness,
anxiety,confusio
n, somnolence
are common
manifestation of
hypoxia and
hypoxemia.
5. To provide non
pharmacologic
management
6. Lack of
knowledge and
problems,
relationships
may create
tension.
Interfering with
sleep routines
based on adult
schedules may
not meet childs
needs.
7. To promote an
environment
conducive to
sleep.
8. To help liquefy
secretions
9. To eliminate
thick, tenacious,
copious
secretions which
contribute for
Short term:The
patient shall
have identified
individually
appropriate
interventions
to promote
sleepLong
term:
The patient
shall have
reported
improvement
s in pt.s
sleep/rest
time safety
13. Recommend
mid morning
nap if one
required
14. Administer pain
medication as
ordered.
the DOB
10. To reduce need
for nighttime
elimination
11. To determine
usual sleep
patterns &
provide
comparative
baseline
12. To promote
comfort/safety
13. Napping esp. in
the afternoon
can disrupt
normal sleep
pattern
14. To relieve
discomfort and
take maximum
advantage of
sedative effect
Risk for Spread of Infection
NDx: Risk for Spread of Infection RT Stasis of Secretions & Decreased Ciliary Action
Once the bacteria, virus, or fungus enter the lungs, they usually settle in the air sacs of the lung
where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus
as the body attempts to fight the infection. Disruption of the mechanical defenses of cough and
ciliary motility leads to colonization of the lungs and subsequent infection
Assessment Planning Nursing Interventions Rationale
Expected
Outcome
S:O:The patient may
manifest:
Body
temperature
above normal
range
dehydration
increase WBC
count
presence of
Short
term:After 4-
5 hours of
nursing
interventions
the patient
will identify
interventions
to prevent
1. Establish
rapport to the
pt. and SO
2. Assess the
patient
condition
3. Monitor &
record V/S
4. Review
importance of
breathing
1. To gain trust and
active
participation
2. To know the
condition of the
pt
3. To have a
baseline data
and fever may be
present because
of infection
Short
term:The
shall have
identified
interventions
to prevent
and/or
reduce the
risk of
increase mucus
production
and/or
reduce the
risk of
infectionLong
term:
After 2 days
of nursing
interventions
the patient
will have
minimize or
totally be
free from the
risk of
infection.
exercises,
effective cough,
frequent
position
changes, and
adequate fluid
intake
5. Turn the patient
q 2 hours
6. Encourage
increase fluid
intake
7. Stress the
importance of
handwashing to
SOs
8. Teach the SOs
how to care for
and clean
respiratory
equipment
9. Teach the SOs
the
manifestations
of pulmonary
infections
(change in color
of sputum,
fever, chills) ,
self-care and
when to call the
physician
10. Recommend
rinsing mouth
with water
11. Administer
antimicrobial
such as
cefuroxime as
indicated.
and/or
dehydration
4. These activities
promote
mobilization and
expectoration of
secretions to
reduce the risk of
developing
pulmonary
infection.
5. To facilitate
secretion movt
and drainage
6. To liquefy
secretions
7. Handwashing is
the primary
defense against
the spread of
infection
8. Water in
respiratory
equipment is a
common source
of bacterial
growth
9. Early recognition
of manifestations
can lead to a
rapid diagnosis.
10. To prevent risk
of oral
candidiasis.
11. Given
prophylactically
to reduce any
possible
complications
infectionLong
term:
The patient
shall have
minimized
or totally be
free from
the risk of
infection.



**** efore i go any further, you can also get information and examples on care planning on this
thread: http://allnurses.com/general-nursing...ns-286986.html- help with
care plans

basically, a care plan is a document that lists out the nursing problems that the patient has along
with your strategies on what you are going to do about them. to diagnose, or determine the
problems, you must first examine all the data. this is the same process that doctors, car
mechanics , plumbers and other professionals go through when problem solving. for us nurses
the data (information) that is important for us to examine and consider includes the following:
a health history (review of systems)
performing a physical exam
assessing their adls (at minimum: bathing, dressing, mobility, eating,
toileting, and grooming)
reviewing the pathophysiology, signs and symptoms and complications
of their medical condition
reviewing the signs, symptoms and side effects of the
medications/treatments that have been ordered and that the patient is
taking
the abnormal data (what interests us because they are symptoms of problems) you posted was:
medical diagnosis: acute exacerbation of chronic bronchitis (this is one of the copd's)
worsening sob
r-26
coughing up yellow sputum
sao2 88% on room air
wheezes and gurgles in chest
smoker
p-120
finger tips brown and clubbed - sign of chronic hypoxemia
wbc slightly elevated
rbc slightly elevated.
now, every nursing diagnosis has a set of symptoms. in order to diagnose a nursing problem, the
patient must have one or more of the symptoms. when you are first learning to diagnose it is
helpful to have a nursing diagnosis reference to help you out. care plan books have this
information. two online websites between them have about 80 of the most commonly used
nursing diagnoses and information about them:
http://www1.us.elsevierhealth.com/ev...e/constructor/
http://www1.us.elsevierhealth.com/me...ctor/index.cfm
and, the appendix of recent editions of taber's cyclopedic medical dictionary has the
nanda nursing diagnosis taxonomy in it.

from the data above you can diagnose:
impaired gas exchange r/t alveolar-capillary membrane changes secondary to acute
exacerbation of chronic bronchitis aeb sao2 of 88% on room air, respiratory rate of
26, pulse of 120 and worsening sob.
ineffective airway clearance r/t secretion in bronchus and smoking aeb wheezes and
gurgles in chest, productive cough of yellow sputum and worsening sob.
ineffective health maintenance r/t lack of judgment (?) aeb continued smoking
your goals and nursing interventions are then based upon the aeb items (or symptoms) for each
of the diagnoses. just as a doctor, mechanic or plumber treats the symptoms or the root cause of a
problem, we do the same. for example, for the sao2 of 88% on room air we will have nursing
interventions to help correct and bring that to as close to 100% as possible. some interventions
will require a physician's order; some will be independent nursing actions. there are four types
of nursing interventions (actions) that can be developed for each symptom:
assess/monitor/evaluate/observe (to evaluate the patient's condition)
care/perform/provide/assist (performing actual patient care)
teach/educate/instruct/supervise (educating patient or caregiver)
manage/refer/contact/notify (managing the care on behalf of the
patient or caregiver)

- - - - - - - - - - - - - - -

im having difficulty with the 3 nursing dx and related to factors. i've never had to do a full
care plan on my own and am hitting a wall.
the related to factors have to do with the cause of the nursing problem (your nursing diagnosis).
it is the reason the problem exists and reasons can be many and varied. ask
yourself "why did this happen?" or "how did this problem come about?"
"what caused this to become a problem in the first place?" and dig deep.
consider the medical diagnosis, the medical treatments that were ordered
and the patient's ability to perform their adls. pathophysiologies need to be
examined to find these etiologies if they are of a physiologic origin. it is
considered unprofessional to list a medical diagnosis, so a medical condition
must be stated in generic physiological terms. you can sneak a medical
diagnosis in by listing a physiological cause and then stating "secondary to
(the medical disease)" if your instructors will allow this.
i've come up with ineffective airway clearance r/t bronchial secretion build up and
bronchial inflammation????
yes this is correct. i'd just word it differently.
could impaired gas exchange r/t hypoxemia be a dx???
yes, but hypoxemia is a more of a medical diagnosis. also, this nursing diagnosis specifically
refers to gas exchange in the alveoli of the lungs. ask yourself why or what has happened to the
alveoli so that gas exchange has gotten messed up. the alveoli are either:
clogged up with secretions, as in pneumonia
or, damaged as in copd so that gas exchange is severely affected
in smokers with chronic bronchitis the walls of the alveoli are inflamed and this affects the gas
exchange across the alveolar membranes. it's a pathophysiology thing you have to know and
understand in order to get the right related factor on the nursing diagnosis.
risk for infection r/t increased wbc ???
depends on how increased the wbcs are. this is a chronic condition so the wbcs would be
expected to be slightly elevated. i'm not saying this is a wrong diagnosis. you can use it. i would
rather see the guy stop smoking if possible because that is an actual problem. infection is only a
potential problem and low on the totem pole of problems.

0
Jan 4, '10 by yellowfluffball
Our school had us get Sparks and Taylor's Nursing Diagnosis Reference Manual, it's a great help
it gives you multiple nursing diagnoses, with interventions, expected outcomes, etc
some diagnoses include:
activity intolerance r/t oxygen supply and demand
fatigue
knowledge deficit r/t difficulty understanding disease process and its effects on self care

We always start careplan out with
(1) assessment data that shows why you choose nursing diagnosis
vital signs, objective data, subjective data (facial expressions, pain, etc)
(2)nursing diagnosis
(3)patient expected outcomes
Patient will have increased O2 above 92% by end of hospital stay
Patient will verbalize reasons why smoking is dangerous to health by end of hospital stay
(4)interventions/rationales
monitor patient's vital signs every hour
monitor patient's lab values (mainly WBC, RBC) every day
(5)evaluation of patient outcomes
Patient outcome was not met because patient's O2 were unchanged by end of hospital stay
Patient outcome was met because by third hospital stay O2 increased to 95%.

Hope this helps

0
Jan 7, '10 by weardemgloves
Impaired gas exchange r/t bronchial inflammation AEB lung crackles per auscultation (if it's an
exacerbation he should have them).

Ineffective airway clearance r/t chronic, persistant sputum exacerbated by and secondary to
disease process AEB presence of productive sputum

Risk for infection r/t continual bronchial secretions AEB continuous, productive cough

**Emphysema is the other cause of COPD and does not cause impaired gas exchange r/t
productive cough, but causes impaired gas exchange r/t entrapment of air r/t damaged/collapsed
alveoli and "air trapping" in the lungs r/t that alveolar collapse.

You can find all the interventions and alter them to these diagnoses in your med/surg book r/t
most diagnoses you find or information on the internet. It is not easy, but then again, I am not
going to give you any other advice or diagnoses proofreading unless you put forth a large amount
of effort on your part from now on. Good luck.