resp د. وفاء

‫ وفاء محمد عطوف‬.
‫د‬ 3 ‫نظري‬/ 1‫تمريض البالغين‬ ‫جامعة البيان‬/ ‫كلية التمريض‬
Nursing Care for patients with Respiratory Disorders
Outlines:
1.1. Sign and symptoms.
1.2 Diagnostic tests.
1.3 Nursing care and rehabilitation for patient with:
1.4 Bronchitis.
1.5 Pneumonia.
1.6 COPD.
The respiratory system: is basically a tract divided into upper and lower respiratory
portions
1. upper respiratory tract: is the above the thoracic cavity . it consists of nose,
nasal cavity ,phrynx and larynx.
2. lower respiratory tract: is within the thoracic cavity it consist of
Lungs:
• Left lung consists 2 lops, upper lope and lower lope and there is one oblique
fissure.
• Right lung consists 3 lops, upper lope, middle lope and lower lope and there are
2 fissure, upper and lower horizontal fissure.
1
‫ وفاء محمد عطوف‬.‫د‬ 3 ‫نظري‬/ 1‫تمريض البالغين‬ ‫جامعة البيان‬/ ‫كلية التمريض‬
Trachea; lying just in front of the esophagus, the trachea is a rigid tube about 4,5
inches(11cm) long and 1 inch (2.5 cm)wide. C- shaped rings of cartilage encircle
the trachea to reinforce it and keep it from collapsing during inhalation. The
open part of the “C” faces posterior, giving the esophagus room to expand
during swallowing. The trachea extends from the larynx to a cartilaginous ridge
called the carina.
Bronchial tree: at the carina the trachea branches into two primary bronchi.
Like the trachea, the primary bronchi are supported by C-shaped rings of
cartilage. ( All of the divisions of the bronchial tree also consist of elastic
connective tissue). The right bronchus is slightly wider and more vertical than
the left, making this the most likely location for aspirated (inhaled) food
particles and small objects to lodge. It divided in the lung to secondary bronchi
and smaller branch to tertiary bronchi and bronchioles. Less than 1 mm wide
2
and lacking any supportive cartilage, bronchioles divide further to form thin-
walled passages called alveolar ducts.
• Alveolar sacs, alveolar ducts throughout the lungs terminate in clusters of

alveoli it is primary structures for gas exchange
The alveoli of the lungs are the site of gas exchange between the air and the
blood of pulmonary circulation. The rest of the system moves air into and out
of the lungs.
Together with the cardiovascular system, the respiratory system supplies the
body with oxygen and eliminates carbon dioxide.
• Inhalation: also called inspiration is active process.
• Exhalation: normal exhalation is a passive process.
The medulla responds by increasing respiration during hypoxemia,

hypercapnia.
3
‫د‪ .‬وفاء محمد عطوف‬ ‫تمريض البالغين‪/ 1‬نظري ‪3‬‬ ‫كلية التمريض ‪/‬جامعة البيان‬
‫‪4‬‬
‫د‪ .‬وفاء محمد عطوف‬ ‫تمريض البالغين‪/ 1‬نظري ‪3‬‬ ‫كلية التمريض ‪/‬جامعة البيان‬
‫‪5‬‬
ne othorax Acc la on o air in the le ral s ace

ca sin a ress re i alance that revents
Terms the l n s ro ll ex an in or can ca se it
to colla se
e othorax An acc la on o loo in the l ral cavit
othorax he resence o s in the l ral cavit

et een the la ers o the l ral e rane
iro eter A recor in evice that eas re the a o nt

o air inhale or exhale vol e an the
len th o e re ire or each reath
6
Signs & symptoms

Dyspnea
◼ shortness of breath.
Movement of air between the alveoli and atmosphere
Subjective sensation that breathing is excessive, difficult, or uncomfortable
◼ Does the dyspnea occur when the patient is lying flat (as is seen more
commonly in heart failure)? Orthopnea
◼ Does the dyspnea awaken the patient at night (paroxysmal nocturnal
dyspnea)?
◼ Does the dyspnea occur only with exertion?
◼ Types of dyspnea
◼ Paroxysmal nocturnal dyspnea (PND) is a sensation of shortness of breath that
awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in
the upright position.
◼ . Trepopnea is dyspnea that occurs in one lateral decubitus position as opposed
to the other.
◼ Platypnea refers to breathlessness that occurs in the upright position and is
relieved with recumbency.
◼ Different classifications for breathing terms
◼ Tachypnea is an increase in the respiratory rate above normal;
◼ hyperventilation is increased minute ventilation relative to metabolic need. ‫فرط‬
‫التهوية هو زيادة التهوية الدقيقة مقارنة بالحاجة األيضية‬.
◼ hyperpnea is a disproportionate rise in minute ventilation relative to an
increase in metabolic level.
◼
7
Chest Pain
◼ Dyspnea that occurs with primary lung disease is associated with an anterior
chest discomfort,pleuritic, intercostal, generalized chest pain.
◼ PQRST
Sputum production
◼ Yellow, green, or brown sputum typically signifies bacterial infection.
◼ clear or white sputum may signify absence of bacterial infection.
◼ The color comes from white blood cells in the sputum.
◼ Rust-colored sputum (yellow sputum mixed with blood) may signify
tuberculosis.
◼ Mucoid, viscid, or blood-streaked sputum is often a sign of a viral infection.
◼ Persistent slightly blood-streaked sputum is present in patients with
carcinoma.
◼ Large amounts of clotted blood are present in the sputum of patients who
have suffered a pulmonary infarct.
◼ Profuse, frothy, pink material, often welling up into the throat, may indicate
pulmonary edema
Cough
◼ cough can be stimulated by external agents, by inflammation of the
respiratory mucosa, or by pressure on an airway caused by a tumor.
◼ caused by smoking, allergies, heartburn, asthma, and certain medications from
the patient about the cough should include onset, precipitating factors, timing,
frequency, and whether the cough is productive or non.
◼ The four main types of coughs are: wet, dry, paroxysmal and croup.
Time of coughing
• Coughing at night may indicate the onset of left-sided heart failure or
bronchial asthma.
• A cough in the morning with sputum production may indicate bronchitis.
• A cough that worsens when the patient is supine suggests postnasal drip
(rhinosinusitis).
• Coughing after food intake may indicate aspiration of material into the
tracheobronchial tree or reflux.
8
• A cough of recent onset is usually from an acute infection.

Wheezing
Is a high-pitched, musical sound which is continuous, meaning it is heard on either

expiration (asthma) or inspiration (bronchitis). It is often the major finding in a patient
with bronchoconstriction or airway narrowing
Hemoptysis
Is the expectoration of blood from the respiratory tract. It can
present as small to moderate blood-stained sputum to a large hemorrhage and always
warrants further investigation. The onset of hemoptysis is usually sudden, and it may be
intermittent or continuous. The most common causes are:
Pulmonary infection
Carcinoma of the lung
Abnormalities of the heart or blood vessels
Pulmonary artery or vein abnormalities
Pulmonary embolism or infarction
Clubbing of the Fingers
Clubbing of the fingers is a change in the normal nail bed. It appears as
sponginess of the nail bed and loss of the nail bed angle .It is a sign of lung disease
that is found in patients with chronic hypoxic conditions,
chronic lung infections, or malignancies of the lung. Clubbing can also be seen in
congenital heart disease and other chronic infections or inflammatory conditions,
such as endocarditis or inflammatory bowel disease.
Cyanosis
a bluish coloring of the skin, is a very late indicator of hypoxia. The
presence or absence of cyanosis is determined by the amount of unoxygenated
hemoglobin in the blood. Cyanosis appears when there is at least 5 g/dL of
unoxygenated hemoglobin.
Diagnostic Procedures of Respiratory Disorders
1. Pulmonary Function Tests
Pulmonary function tests (PFTs) are routinely used in patients with chronic respiratory
disorders. They are performed to assess respiratory function and to determine the
extent of dysfunction. Such tests include measurements of lung volumes, ventilatory
function, and the mechanics of breathing, diffusion, and gas exchange .
9
2.Arterial Blood Gases Studies

a. The arterial oxygen tension (PaO2) indicates the degree of oxygenation of the blood,
and b. the arterial carbon dioxide tension (PaCO2) indicates the adequacy of alveolar
ventilation. ABG studies aid in assessing the ability of the lungs to provide adequate
oxygen and remove carbon dioxide and the ability of the kidneys to reabsorb or excrete
bicarbonate ions to maintain normal body pH.
3.Pulse Oximetry
Pulse oximetry is a noninvasive method of continuously monitoring the oxygen
saturation of hemoglobin (SaO2). When oxygen saturation is measured with pulse
oximetry. it is an effective tool to monitor for subtle or sudden changes in oxygen
saturation. It is used in all settings where oxygen saturation monitoring is needed,
such as the home, clinics, ambulatory surgical settings, and hospitals.
4. End-Tidal Carbon Dioxide
End-tidal carbon dioxide (ETCO2) monitoring is a noninvasive method of monitoring
partial pressure of carbon dioxide (CO2) at end exhalation.
5. Cultures Throat cultures may be performed to identify organisms responsible for
respiratory infections
6 t t ies
Sputum is obtained for analysis to identify pathogenic organisms and to determine
whether malignant cells are present. It also may be used to assess for hypersensitivity
states (in which there is an increase in eosinophils). Periodic sputum examinations
may be necessary for patients receiving antibiotics, corticosteroids, and
immunosuppressive medications for prolonged periods, because these agents are
associated with opportunistic infections. In general, sputum cultures are used in
diagnosis, for drug sensitivity testing, and to guide treatment.
7.Imaging Studies
Imaging studies, including x-rays, computed tomography (CT), magnetic
resonance imaging (MRI), contrast studies, and radioisotope diagnostic scans may be
part of any diagnostic workup, ranging from a determination of the extent of infection
in sinusitis to tumor growth in cancer.
8. Thoracoscopy
Thoracoscopy is a diagnostic procedure in which the pleural cavity is examined with an
endoscope.
10
9.Bronchoscopy
Bronchoscopy is the direct inspection and examination of the larynx, trachea, and
bronchi .
• he r oses o ia nostic ronchosco are to:
a. Examine tissues or collect secretions.
b. Determine the location and extent of the pathologic process and to
obtain a tissue sample for diagnosis .
c. Determine whether a tumor can be resected surgically, and
,Diagnose bleeding sites (source of hemoptysis
hera e tic ronchosco is se to :
a. Remove foreign bodies from the tracheobronchial tree.
b. Remove secretions obstructing the tracheobronchial tree when the patient cannot
clear them.
c. Treat postoperative atelectasis, and .
d. Destroy and excise lesions
Bronchitis
Bronchitis is a pulmonary disease caused by the onset of inflammation in the bronchial
tubes, which are the air passages into the lungs. It causes a cough that often brings up
mucus, as well as shortness of breath, wheezing, and chest tightness.
Types of bronchitis:
a. Acute bronchitis often occurs after a cold or the flu, as the result of
bacterial infection, or from constant irritation of the bronchi by polluted air or
chemical fumes in the environment.
It is characterized by :
• slight fever that may last for a few days to weeks, and is often accompanied by a
cough that may persist for several weeks.
• Acute bronchitis, symptoms usually resolve within 7 to 10 days, however, a dry,
hacking cough can linger for several weeks.
• b. Chronic bronchitis, also known as chronic obstructive pulmonary disease or
COPD. As the condition gets worse, the affected person becomes:
• increasingly short of breath.
• has difficulty with physical exertion.
• and may require supplemental oxygen.
11
• It may include fever, nasal congestion, and a hacking cough that can linger for
months at a time.
Symptoms
Symptoms of acute bronchitis usually begin 3 to 4 days after an upper respiratory
infection, such as a cold or influenza (flu). Symptoms usually include:
1. A cough, which is the main symptom of acute bronchitis. It may be dry at first (does
not produce mucus) and after a few days may bring up mucus from the lungs
(productive cough). The mucus may be clear, yellow, or green. Sometimes, small
streaks of blood may be present.
2. A mild fever, usually less than 101F (38.3C) .
3. A higher fever may indicate pneumonia.
4. A general feeling of tiredness..
5. A sensation of tightness, burning, or dull pain in the chest under the
breastbone that usually is worse when breathing deeply or coughing.
6. Whistling noises (wheezing) when breathing, especially during physical exertion.
7. Hoarseness.
Diagnoses
1. Chest X-ray. The result of a chest X-ray of people who have acute bronchitis
is usually normal.
2. Gram stain and culture and sensitivity of the mucus from the lungs. These
tests may help doctor to find out if bacteria are causing the infection and
12
which antibiotic will be effective.

3. Other tests, including tests to measure blood oxygen levels and tests that can
help identify bacteria and viruses. The test results can help doctor know
whether acute bronchitis is seriously harming lung function.
Nursing Diagnosis For Bronchitis.
• Ineffective airway clearance related to: increased production of secretions.
• Acute pain related to: the inflammation of the pleura.
• Impaired gas exchange related to: airway obstruction by secretions, spasm of
the bronchus.
• Ineffective breathing pattern related to: bronchoconstriction, mucus.
• Imbalanced Nutrition, Less Than Body Requirements related to: dyspnea,
anorexia, nausea, vomiting.
• Risk for infection related to: the settlement of secretions, chronic disease
processes.
• Activity intolerance related to: insufficiency of ventilation and oxygenation.
• Anxiety related to: changes in health status.
• Knowledge Deficit related to: the lack of information about the disease
process and treatment at home.
Nursing interventions
• Answer the patients questions and encourage him and his family to express their
concerns about the illness.
• As needed, perform chest physiotherapy, including postural drainage and chest
percussion and vibration for involved lobes several times daily.
• Make sure the patient receives adequate fluids (at least 3 liters per day) to loosen
secretions.
• Schedule respiratory therapy for the patient at least 1 hour before or after meals.
• Provide mouth care after bronchodilator inhalation therapy.
• Encourage daily activity and provide diversional activities as appropriate.
• To conserve the patient’s energy and prevent fatigue, help him to alternate periods
of rest and activity.
• Administer medications as ordered and note the patient’s response to them.
• Assess the patient for changes in baseline respiratory function.
• Evaluate sputum quality and quantity, restlessness, increased tachypnea, and altered
breath sounds. Report changes immediately.
13
• Monitor the patient’s weight by weighing him three times weekly. Assess for edema.
• Evaluate the patient’s nutritional status regularly.
• Watch the patient for signs and symptoms of respiratory infection, such as fever,
increased cough and sputum production, and purulent sputum.
• Advise the patient to avoid crowds and people with known infections and obtain
influenza and pneumococcus immunizations.
Pneumonia
Pneumonia is an inflammation of the lung parenchyma caused by various
microorganisms, including bacteria,mycobacteria, chlamydia, mycoplasma, fungi,
parasites, and viruses. ―Pneumonitis‖ is a more general term that describes an
inflammatory process in the lung tissue that may predispose or place the patient at
risk for microbial invasion.
Pneumonia Classification
1. Community-Acquired Pneumonia‫االلتهاب الرئوي المكتسب‬- ‫المجتمع‬
• CAP occurs either in the community setting or within the first 48 hours
after hospitalization or institutionalization.
• The need for hospitalization for CAP depends on the severity of the
pneumonia.
• The causative agents for CAP that requires hospitalization are most
frequently S. pneumoniae, H. influenzae, Legionella, Pseudomonas
aeruginosa, and other gram-negative rods
2. Hospital-Acquired Pneumonia
• HAP, also known as nosocomial pneumonia, is defined as the onset of
pneumonia symptoms more than 48 hours after admission in patients with
no evidence of infection at the time of admission.
• Ventilator-associated pneumonia can be considered a type of nosocomial
pneumonia that is associated with endotracheal intubation and mechanical
ventilation.
3. Health care–associated pneumonia (HCAP): Pneumonia occurring in a
nonhospitalized patient with extensive health care contact with one or more of
the following:
- Hospitalization for ≥2 days in an acute care facility within 90 days of infection
14
- Residence in a nursing home or long-term care facility

- Antibiotic therapy, chemotherapy, or wound care within 30 days of current
infection
- Hemodialysis treatment at a hospital or clinic
- Home infusion therapy or home wound care
- Family member with infection due to multidrug-resistant bacteria
4. Pneumonia in the Immunocompromised Host‫االلتهاب الرئوي في المضيف المناعي‬
includes:
• Pneumocystis pneumonia (PCP).
• fungal pneumonias, and ,
• Mycobacterium tuberculosis.
5. Aspiration Pneumonia‫االلتهاب الرئوي التنفسي‬
• Aspiration pneumonia refers to the pulmonary consequences resulting from
entry of endogenous or exogenous substances into the lower airway.
• The most common form of aspiration pneumonia is bacterial infection from
aspiration of bacteria that normally reside in the upper airways.
• Aspiration pneumonia may occur in the community or hospital setting.
Common pathogens are Streptococcus pneumoniae, Staphylococcus
aureus and Haemophilus influenzae
Risk Factors
Pneumonia Based upon Pathogen Type
- Risk Factors for Infection with Penicillin-Resistant and Drug-Resistant
Pneumococci
-Age >65 years
-Alcoholism
-Beta-lactam therapy (e.g., cephalosporins) in past 3 months
-Immunosuppressive disorders
-Multiple medical comorbidities
-Exposure to a child in a day care facility
- Risk Factors for Infection with Enteric Gram-Negative Bacteria
-Residency in a long-term care facility
-Underlying cardiopulmonary disease
-Multiple medical comorbidities
-Recent antibiotic therapy
- Risk Factors for Infection with Pseudomonas aeruginosa
-Structural lung disease (e.g., bronchiectasis)
15
-Corticosteroid therapy
-Broad-spectrum antibiotic therapy (>7 days in the past month)
-Malnutrition
Clinical Manifestations
1. sudden onset of chills,
2. rapidly rising fever (38.5° to 40.5°C [101° to 105°F]), and,
3. pleuritic chest pain that is aggravated by deep breathing and coughing.
4. The patient is severely ill, with marked tachypnea (25 to 45 breaths/min),
accompanied by other signs of respiratory distress (eg, shortness of breath, use of
accessory muscles in respiration).
5. The pulse is rapid and bounding, and it usually increases about 10 bpm for every
degree (Celsius) of temperature elevation.
6. A relative bradycardia for the amount of fever may suggest viral infection,
mycoplasma infection
7. The patient may exhibit orthopnea (shortness of breath when reclining)
Assessment and Diagnostic Findings
1.Physical examination.
2. Chest x-ray,
3. Blood culture (bloodstream invasion, called bacteremia, occurs frequently), and
sputum examination. The sputum sample is obtained by having patients do the
following:
a. rinse the mouth with water to minimize contamination by normal oral flora,
b. breathe deeply several times.
c. cough deeply, and,
d. expectorate the raised sputum into a sterile container.
Medical Management
The treatment of pneumonia includes:
1. administration of the appropriate antibiotic as determined by the results of a Gram
stain.
2. Antibiotics are indicated with a viral respiratory infection only if a
secondary bacterial pneumonia, bronchitis, or sinusitis is present.
3. Hydration is a necessary part of therapy, because fever and tachypnea may result in
insensible fluid losses.
4. Antipyretics may be used to treat headache and fever;
16
5. antitussive medications may be used for the associated cough.

6. Warm, moist inhalations are helpful in relieving bronchial irritation
Nursing Process for patient with Pneumonia
A: Assessment
The nurse monitors the patient for the following:
• Changes in temperature and pulse
• Amount, odor, and color of secretions
• Frequency and severity of cough
• Degree of tachypnea or shortness of breath
• Changes in physical assessment findings (primarily assessed by inspecting
and auscultating the chest)
• Changes in the chest x-ray findings
B: Diagnosis
• Ineffective airway clearance related to copious tracheobronchial secretions
• Activity intolerance related to impaired respiratory function
• Risk for deficient fluid volume related to fever and a rapid respiratory rate
• Imbalanced nutrition: less than body requirements
• Deficient knowledge about the treatment regimen and preventive health measures
Ineffective airway clearance related to copious tracheobronchial secretions
• Activity intolerance related to impaired respiratory function
• Risk for deficient fluid volume related to fever and a rapid respiratory rate
• Imbalanced nutrition: less than body requirements
• Deficient knowledge about the treatment regimen and preventive health
measures
C: Planning and Goals
1. improved airway patency,
2. rest to conserve energy,
3. maintenance of proper fluid volume,
4. maintenance of adequate nutrition,
5. an understanding of the treatment protocol and preventive measures, and,
6. absence of complications.
17
Chronic Obstructive Pulmonary Disease

Chronic obstructive lung disease ( including chronic bronchitis, emphysema and
asthma) are the most common chronic lung disease for which pulmonary
rehabilitation is needed. Chronic obstructive lung disease is the disease of
respiratory tract that produce an obstruction to airflow and ultimately can affect
both the mechanical function of the lung and gas exchange capability of the lung .
18
Risk Factors for Chronic Obstructive Pulmonary Disease (COPD)

• Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases
• Passive smoking
• Occupational exposure
• Ambient air pollution
• Genetic abnormalities, including a deficiency of alpha1-antitrypsin, an enzyme
inhibitor that normally counteracts the destruction of lung tissue by certain other
enzymes
Pathophysiology
In the bronchi, there is enlargement of the mucous glands. Goblet cells proliferate,
producing excessive secretions that obstruct the airway.
The smooth muscles encircling the airways become hypertrophied, an increase in
connective tissue can be observed, and the bronchioles show inflammation.
mucous plugging, and fibrosis weakened bronchial walls, air trapping, and alveolar
hyperinflation and destruction
Causes of COPD
• Cigarette smoking: has been shown to be contributing factor in the early
development and severity of COPD.
• Air pollution and occupational exposures play a role in the
symptomatology and the progression of the COPD
• Modern medicine has created an even increasing geriatric population. As
people live longer and feel better, the problem of COPD become more and
more a sociologic problem as well as medical problem.
Spectrum of Obstructive Disease
• Asthmatic Bronchitis:
Narrowing due to hyper reactivity, eosinophilic inflammation
• Chronic Bronchitis:
Chronic productive cough for  3 month/year , for 2 successive year.
• Chronic Obstructive Bronchitis
above with obstruction of small airways.
• Emphysema
abnormal permanent enlargement of airspaces distal to the terminal bronchioles,
accompanied by destruction of the alveolar walls without signs of fibrosis.
19
Clinical Manifestations
COPD is characterized by three primary symptoms:
• Chronic cough.
• Sputum production, and,
• Dyspnea on exertion, dyspnea occurs even at rest
The major obstructive lung disorders are usually divided into many categories
which are due to:
1.Reversible factor ,e.g. inflammation, bronchospasm, mucus plugging
2. Irreversible factors ,e.g. thickened fibrotic airway wall, damaged alveoli
leading to loss of radial traction and unsupported airways.
3. Localized lesion. e.g. tumor, foreign body.
In addition , the differing location of the major sites of obstruction should be
understood. for the purpose of classifying the location of obstruction disease, the
anatomic generation of the airways are divided into:
1. Bronchi, or airways with cartilage in their wall (usually > 2mm in diameter)
2. Bronchioles, or airways without cartilage in their walls ( usually <2 mm in
diameter )
3. Lung parenchyma, or alveolar units, the gas exchanging part of the lung
Pharmacologic Therapy
1.Bronchodilators(Albuterol (Proventil, Ventolin, Volmax).
Bronchodilators relieve bronchospasm and reduce airway obstruction by allowing
increased oxygen distribution throughout the lungs and improving alveolar
ventilation.
2.Corticosteroids
Inhaled and systemic corticosteroids (oral or intravenous) may also be used in
COPD but are used more frequently in asthma. They may improve symptoms, but
it has been shown that they do not slow the decline in lung function.
3.Oxygen Therapy
Oxygen therapy can be administered as long-term continuous therapy, during
exercise, or to prevent acute dyspnea. Supplemental oxygen is effective in
prolonging survival of patients with COPD who have a resting partial arterial
pressure of oxygen (PaO2) of less than 60 mm Hg at sea level.
Assessing Health History of Patients with COPD:
1. Exposure to risk factors—types, intensity, duration.
20
2. Past medical history—respiratory diseases/problems, including asthma,

allergy, sinusitis, nasal polyps, history of respiratory infections.
3. Family history of COPD or other chronic respiratory diseases
4. Pattern of symptom development.
5. History of exacerbations or previous hospitalizations for respiratory
problems.
6. Presence of comorbidities.
7. Appropriateness of current medical treatments.
8. Impact of the disease on quality of life.
9. Available social and family support for patient.
10.Potential for reducing risk factors (eg, smoking cessation).
B: Diagnosis
• Impaired gas exchange and airway clearance due to chronic inhalation of
toxins
• Impaired gas exchange related to ventilation–perfusion inequality
• Ineffective airway clearance related to bronchoconstriction, increased mucus
production, ineffective cough, bronchopulmonary infection, and other
complications
• Ineffective breathing pattern related to shortness of breath, mucus,
bronchoconstriction, and airway irritants
• Activity intolerance due to fatigue, ineffective breathing patterns, and
hypoxemia
• Deficient knowledge of self-care strategies to be performed at home
• Ineffective coping related to reduced socialization, anxiety, depression,
lower activity level, and the inability to work.
C: Planning and Goals
Major patient goals may include:
1. smoking cessation.
2. improved gas exchange, airway clearance, improved breathing pattern,
3. improved activity tolerance,
4. maximal self-management,
5. improved coping ability,
6. adherence to the therapeutic program and home care, and ,
7. absence of complications.
21
D: Nursing Interventions
1. Promoting Smoking Cessation
2. Administer bronchodilators as prescribed
3. Instruct and encourage patient in diaphragmatic breathing and effective
coughing.
4. Adequately hydrate the patient.
5. Teach patient diaphragmatic and pursed-lip breathing.
6. Monitor respiratory status, including rate and pattern of respirations, breath
sounds, and signs and symptoms of acute respiratory distress.
7. Monitor pulse oximetry and arterial blood gases.
8. Administer supplemental oxygen and initiate mechanisms for mechanical
ventilation, as prescribed.
9. Avoiding Temperature Extremes
10.Monitoring and Managing Potential Complications
E: Evaluation
1. Demonstrates knowledge of hazards of smoking.
2. Demonstrates improved gas exchange.
3. Achieves maximal airway clearance:
• Stops smoking.
• Avoids noxious substances and extremes of temperature.
• Maintains adequate hydration
4. Improves breathing pattern:
• Practices and uses pursed-lip and diaphragmatic breathing.
• Shows signs of decreased respiratory effort (decreased respiratory
rate, less dyspnea)
5. Demonstrates knowledge of strategies to improve activity tolerance and
maintain maximum level of self-care.
6. Avoids or reduces complications:
• Has no evidence of respiratory failure or insufficiency.
• Maintains adequate pulse oximetry and arterial blood gas
values.
• Shows no signs or symptoms of infection, pneumothorax, or
pulmonary hypertension.
22

resp د. وفاء

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‫ وفاء محمد عطوف‬.

‫د‬ 3 ‫نظري‬/ 1‫تمريض البالغين‬ ‫جامعة البيان‬/ ‫كلية التمريض‬

Nursing Care for patients with Respiratory Disorders

• Alveolar sacs, alveolar ducts throughout the lungs terminate in clusters of

The medulla responds by increasing respiration during hypoxemia,

ne othorax Acc la on o air in the le ral s ace

othorax he resence o s in the l ral cavit

iro eter A recor in evice that eas re the a o nt

Signs & symptoms

• A cough of recent onset is usually from an acute infection.

Is a high-pitched, musical sound which is continuous, meaning it is heard on either

2.Arterial Blood Gases Studies

which antibiotic will be effective.

- Residence in a nursing home or long-term care facility

5. antitussive medications may be used for the associated cough.

Chronic Obstructive Pulmonary Disease

Risk Factors for Chronic Obstructive Pulmonary Disease (COPD)

2. Past medical history—respiratory diseases/problems, including asthma,

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