• Asthma is a chronic inflammatory disease of the airways characterized by hyper-responsiveness, mucosal edema, and mucus production.
• This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea.
• Patients with asthma may experience symptom-free periods alternating with acute exacerbations that last from minutes to hours or days.
• Asthma, the most common chronic disease of childhood, can begin at any age.

Risk Factors

Risk factors for asthma include family history, allergy (strongest factor), and chronic exposure to airway irritants or allergens (eg, grass, weed pollens, mold, dust, or animals). Common triggers for asthma symptoms and exacerbations include airway irritants (eg, pollutants, cold, heat, strong odors, smoke, perfumes), exercise, stress or emotional upset, rhinosinusitis with postnasal drip, medications, viral respiratory tract infections, and gastroesophageal reflux.

Clinical Manifestations

• Most common symptoms of asthma are cough (with or without mucus production), dyspnea, and wheezing (first on expiration, then possibly during inspiration as well).
• Asthma attacks frequently occur at night or in the early morning.
• An asthma exacerbation is frequently preceded by increasing symptoms over days, but it may begin abruptly.
• Chest tightness and dyspnea occur.
• Expiration requires effort and becomes prolonged.
• As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur.
• Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure, may occur.
• Exercise-induced asthma: maximal symptoms during exercise, absence of nocturnal symptoms, and sometimes only a description of a “choking” sensation during exercise.
• A severe, continuous reaction, status asthmaticus, may occur. It is life-threatening.
• Eczema, rashes, and temporary edema are allergic reactions that may be noted with asthma.

Assessment and Diagnostic Methods

• Family, environment, and occupational history is essential.
• During acute episodes, sputum and blood test, pulse oximetry, ABGs, hypocapnia and respiratory alkalosis, and pulmonary function (forced expiratory volume [FEV] and forced vital capacity [FVC] decreased) tests are performed.

Medical Management

Pharmacologic Therapy

There are two classes of medications—long-acting control and quick-relief medications—as well as combination products.

• Short-acting beta2-adrenergic agonists
• Anticholinergics
• Corticosteroids: metered-dose inhaler (MDI)
• Leukotriene modifiers inhibitors/antileukotrienes
• Methylxanthines

Nursing Management

The immediate nursing care of patients with asthma depends on the severity of symptoms. The patient and family are often frightened and anxious because of the patient’s dyspnea. Therefore, a calm approach is an important aspect of care.

• Assess the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
• Obtain a history of allergic reactions to medications before administering medications.
• Identify medications the patient is currently taking.
• Administer medications as prescribed and monitor the patient’s responses to those medications; medications may include an antibiotic if the patient has an underlying respiratory infection.
• Administer fluids if the patient is dehydrated.
• Assist with intubation procedure, if required.

Teaching Points

• Teach patient and family about asthma (chronic inflammatory), purpose and action of medications, triggers to avoid and how to do so, and proper inhalation technique.
• Instruct patient and family about peak-flow monitoring.
• Teach patient how to implement an action plan and how and when to seek assistance.
• Obtain current educational materials for the patient based on the patient’s diagnosis, causative factors, educational level, and cultural background.

Continuing Care

• Emphasize adherence to prescribed therapy, preventive measures, and need for followup appointments.
• Refer for home health nurse as indicated.
• Home visit to assess for allergens may be indicated (with recurrent exacerbations).
• Refer patient to community support groups.
• Remind patients and families about the importance of health promotion strategies and recommended health screening.

Asthma Nursing Management Original source at: Nurseslabs

• Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition. It is a form of breathing failure that can occur in very ill or severely injured people.
• It is not a specific disease.
• It starts with swelling of tissue in the lungs and build up of fluid in the tiny air sacs that transfer oxygen to the bloodstream. This leads tlow blood oxygen levels.
• ARDS is similar tinfant respiratory distress syndrome, but the causes and treatments are different. ARDS can develop in anyone over the age of one year old.
• Also known as Adult Respiratory Distress Syndrome, Respiratory Distress Syndrome,

Causes

Direct injury to the lungs: 

• Chest trauma, such as a heavy blow
• Breathing vomit
• Breathing smoke, chemicals, or salt water
• Burns

Indirect injury to the lungs: 

• Severe infection
• Massive blood transfusion
• Pneumonia
• Severe inflammation of the pancreas (pancreatitis)
• Overdoses of alcohol or certain drugs (eg, aspirin, cocaine, opioids, phenothiazines, and tricyclic antidepressants)
• Lung and bone marrow transplantation–within few days of a lung transplant, the recipient is prone tdevelopment of ARDS.

Risk Factors

• ARDS usually develops in people whare already in the hospital and are being treated for an injury listed above.
• However, only a small number of people whhave these injuries actually develop ARDS.
• While none can predict whwill get ARDS, cigarette smokers, those with chronic lung disease, or those whare over age 65 are more at risk of developing ARDS.

Symptoms

• Shortness of breath
• Fast, labored breathing
• Bluish skin or fingernail color
• Rapid pulse

Diagnosis

• A person suffering from severe infection or injury develops breathing problems
• A chest x-ray shows fluid in the air sacs of both lungs
• Blood tests show a low level of oxygen in the blood
• Other conditions that could cause breathing problems have been ruled out
• Blood pressure check
• Blood tests for oxygen levels and signs of infection as well as levels of BNP (brain natriuretic peptide) a marker of heart failure
• Chest x-ray
• Analysis of coughed-up matter
• Occasionally, an echocardiogram (heart ultrasound), trule out congestive heart failure
• Pulmonary artery catheterization taid in diagnostic work-up
• Bronchoscopy tanalyze airways. A labolatory examination may indicate presence of certain viruses, cancer cells etc.
• Open lung biopsy is reserved for cases when diagnosis is difficult testablish

Nursing Diagnoses

Treatment

• Treating the underlying cause or injury
• Providing support until the lungs heal:
• Mechanical ventilation (a breathing machine) through a tube placed in the mouth or nose, or through an opening created in the neck
• Monitoring blood chemistry and fluid levels
• Often, ARDS patients are sedated to tolerate these treatments.

Acute Respiratory Distress Syndrome (ARDS) Nursing Management Original source at: Nurseslabs

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.

Bronchitis Pathophysiology & Schematic Diagram

Bronchitis Pathophysiology

Bronchitis Pathophysiology & Schematic Diagram Original source at: Nurseslabs

Predisposing and Precipitating Factors

Modifiable and Non-modifiable Factors

Poor Diet is a modifiable factor in which this is crucial in the strengthening of the immune system of the client. Without the sufficient intake of vitamins and minerals that are present in the diet, the defense mechanism of the body is weakened; making it susceptible to infection and invasion of possible microorganisms that are present in the environment. This can be attributed to the possibility that these microorganisms are dwelling in the environment itself.

Place of residence is underdeveloped is another modifiable factor since crowdedness of the people living in a particular geographical area would facilitate direct contact mode of transmission of possible microorganisms or through droplet infection, as well. This will make the client susceptible for acquiring a disease from someone proximal to him; therefore, a disease may or may not develop depending on the distance of the client from an infected person and the virulence of the disease.

Age is a non-modifiable factor in which the client’s immunity against possible diseases is not that developed in comparison to adults.

Sex is a non-modifiable factor in which the occurrence of the said disease in prevalent in males more it is in females.

Signs and Symptoms

Cough an important way to keep your throat and airways clear. However, excessive coughing may mean you have an underlying disease or disorder. Some coughs are dry, while others are considered productive; a reflex which is said to be a natural defense mechanism because of its action of expulsing bacteria out of the tracheobronchial tree.

Dyspnea is the difficult or labored breathing; shortness of breath. It is a sign of serious disease of the airway, lungs, or heart.

Chills refer to feeling cold after an exposure to a cold environment. The word can also refer to an episode of shivering, accompanied by paleness and feeling cold

Fever isn’t an illness itself, but it’s usually a sign that something out of the ordinary is going on in your body. Fevers aren’t necessarily bad. In fact, fevers seem to play a key role in helping your body fight off a number of infections.

Vomiting is seldom related to food intake, is usually the result of irritation of the vagal centers in the medulla

Chest pain or angina, uncomfortable pressure, squeezing or fullness in substernum, radiation to arms and hands is described as numbness, tingling, or aching

Cyanosis refers to a blue or purple hue to the skin. It is most easily observed on the lips, tongue and fingernails. Cyanosis indicates there may be decreased oxygen in the bloodstream. It may suggest a problem with the lungs, but most often is a result of mixing blue and red blood due to defects of the heart or great vessels. Cyanosis is a finding based on observation, not a laboratory test. Cyanosis is usually caused by either serious lung or heart disease, or circulation problems.

Loss of Appetite is a result of decrease in the brain impulses that stimulates the function of the taste buds. It is because of the vascular changes in the cephalic area. Since the alveoli where filled with fluids and exudates, gas exchange was not accomplished well; so what happened was, there was diminished Oxygen in the body, as it was manifested by the presence of cyanosis. Hypoxemia had erupted resulting to low oxygen in the brain and muscles which eventually lead to the vascular changes.

Abdominal pain: the patient experiences pain on his/hers stomach

Decreased activity: decrease in activity patter

Loss of appetite (in older children) or poor feeding (in infants)

In extreme cases, bluish or gray color of the lips and fingernails

Headache is the outcome when there is low oxygen in the brain. There are vascular changes in the cephalic area.

Body Malaise had resulted out of low oxygen content in the muscles. Since the cells in the body require sufficient amount in oxygen, it cannot work properly if its level is decrease resulting to malaise.

Preventive Measures

Get vaccinated. A vaccine known as pneumococcal conjugate vaccine can help protect young children against pneumonia. It’s recommended for all children younger than age 2 and for children 2 years and older who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.

Wash hands. Hands are in almost constant contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub the inside of your nose. Washing your hands thoroughly and often can help reduce your risk. When washing isn’t possible, use an alcohol-based hand sanitizer, which can be more effective than soap and water in destroying the bacteria and viruses that cause disease. What’s more, most hand sanitizers contain ingredients that keep your skin moist. Carry one in your purse or in your pocket.

Don’t smoke. Smoking damages your lungs’ natural defenses against respiratory infections.

Proper rest and a diet. Foods rich in fruits, vegetables and whole grains along with moderate exercise can help keep the immune system strong.

Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isn’t possible, help protect others by wearing a face mask and always coughing into a tissue.

Pneumonia Original source at: Nurseslabs

Tuberculosis

People living in crowded, poorly ventilated conditions and those who are immunocompromised are the most vulnerable in acquiring this diseases.

The Pulmonary Tuberculosis Pathophysiology & Schematic Diagram below will help you further understand the process of the disease.

Pulmonary Tuberculosis Pathophysiology & Schematic Diagram

Pulmonary Tuberculosis Pathophysiology & Schematic Diagram Original source at: Nurseslabs

Emphysema

Causes of Emphysema

• Cigarette smoking and congenital deficiency of alpha-antityrpsin
• 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)

COPD: Emphysema Pathophysiology & Schematic Diagram

COPD: Emphysema Pathophysiology & Schematic Diagram Original source at: Nurseslabs

Description

• Pneumothorax is the accumulation of atmospheric air in the pleural space, which results in a rise in intrathoracic pressure and reduced vital capacity.
• It is the loss of negative intrapleural pressure results in collapse of the lung.
• A spontaneous pneumothorax occurs with the rupture of a bleb.
• An open pneumothorax occurs when an opening through the chest wall allows the entrance of positive atmospheric pressure into the pleural space.
• Diagnosis of pneumothorax is made by chest x-ray film.

Causes

• The cause of a closed or primary spontaneous pneumothorax is the rupture of a bleb (vesicle) on the surface of the visceral pleura.
• Secondary spontaneous pneumothorax can result from chronic obstructive pulmonary disease (COPD), which is related to hyperinflation or air trapping, or from the effects of cancer, which can result in the weakening of lung tissue or erosion into the pleural space by the tumor.
• Blunt chest trauma and penetrating chest trauma are the primary causes of traumatic and tension pneumothorax.
• Other possible causes include therapeutic procedures such as thoracotomy, thoracentesis, and insertion of a central line.

Assessment

• Absent breath sounds on affected side
• Cyanosis
• Decreased chest expansion unilaterally
• Dyspnea
• Hypotension
• Sharp chest pain
• Subcutaneous emphysema as evidenced by crepitus on palpation
• Sucking sound with open chest wound
• Tachycardia
• Tachypnea
• Tracheal deviation to the unaffected side with tension pneumothorax

Complications

• Another collapsed lung in the future
• Shock

Nursing Diagnoses

• Impaired gas exchange related to decreased oxygen diffusion capacity
• Anxiety related to breathlessness and fear of suffocation
• Activity Intolerance related to insufficient oxygen for activites and fatigue
• Impaired Verbal Communication related to dyspnea

Nursing Care Plan

View this post for Pneumothorax Nursing Care Plans

Diagnostic Evaluation

• Chest x-ray reveals lung collapse with air between chest wall and visceral pleura. Lungs are not filled with air but rather are collapsed.
• Other Tests: Complete blood count, plasma alcohol level, arterial blood gases, rib x-rays, computed tomography (CT) scan.

Medical Management

• The priority is to maintain airway, breathing, and circulation. The most important interventions focus on reinflating the lung by evacuating the pleural air. Patients with a primary spontaneous pneumothorax that is small with minimal symptoms may have spontaneous sealing and lung re-expansion.
• For patients with jeopardized gas exchange, chest tube insertion may be necessary to achieve lung re-expansion.
• Maintain a closed chest drainage system; be sure to tape all connections, and secure the tube carefully at the insertion site with adhesive bandages. Regulate suction according to the chest tube system directions; generally, suction does not exceed 20 to 25 cm H2O negative pressure.
• Monitor a chest tube unit for any kinks or bubbling, which could indicate an air leak, but do not clamp a chest tube without a physician’s order because clamping may lead to tension pneumothorax.
• Stabilize the chest tube so that it does not drag or pull against the patient or against the drainage system. Maintain aseptic technique, changing the chest tube insertion site dressing and monitoring the site for signs and symptoms of infection such as redness, swelling, warmth, and drainage.
• Oxygen therapy and mechanical ventilation are prescribed as needed. Surgical interventions include removing the penetrating object, exploratory thoracotomy if necessary, thoracentesis, and thoracotomy for patients with two or more episodes of spontaneous pneumothorax or patients with pneumothorax that does not resolve within 1 week.

Thoracentesis

View this post to read about thoracentesis. 

Pharmacologic Highlights

• No routine pharmacologic measures will treat pneumothorax, but the patient may need antibiotics, local anesthesia agents for procedures, and analgesics, depending on the extent and nature of the injury. Analgesia is administered for pain once the patient’s pulmonary status has stabilized.

Nursing Interventions

• Apply a dressing over an open chest wound.
• Administer oxygen as prescribed.
• Position the client in high fowler’s position.
• Prepare for chest tube placement until the lung has expanded fully.
• Monitor chest tube drainage system.
• Monitor for subcutaneous emphysema.

Documentation Guidelines

• Physical findings: Breath sounds, vital signs, level of consciousness, urinary output, skin temperature, amount and color of chest tube drainage, dyspnea, cyanosis, nasal flaring, altered chest expansion, tracheal deviation, absence of breath sounds
• Response to pain: Location, description, duration, response to interventions
• Response to treatment: Chest tube insertion—type and amount of drainage, presence of air leak, presence or absence of crepitus, amount of suction, presence of clots, response to fluid resuscitation; response to surgical management
• Complications: Infection (fever, wound drainage); inadequate gas exchange (restlessness, dropping SaO2); tension pneumothorax

Discharge and Home Healthcare Guidelines

• Review all follow-up appointments, which often involve chest x-rays, arterial blood gas analysis, and a physical exam. If the injury was alcohol-related, explore the patient’s drinking pattern.
• Refer for counseling, if necessary. Teach the patient when to notify the physician of complications (infection, an unhealed wound, and anxiety) and to report any sudden chest pain or difficulty breathing.

Further Reading

• NLM Pneumothorax. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001151/
• Wikipedia Pneumothorax.http://en.wikipedia.org/wiki/Pneumothorax

Pneumothorax Original source at: Nurseslabs

• An increase in the size and number of submucous glands in the large bronchi which causes increase mucus production
• An increased number of globlet cells, which also secrete mucus
• Impaired ciliary function, which reduces mucus clearance

1. 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.

2 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.

3. 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.

4. Sleep Pattern Disturbance RT Difficulty of Breathing

COPD patients need a comfortable position such as the High-Fowler’s 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 can’t be controlled

5. Risk for Spread of Infection RT Stasis of Secrections & 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

Other nursing diagnoses:

• 6 High risk for suffocation
• 7 High risk for aspiration
• 8 Anxiety RT acute breathing difficulties
• 9 Activity Intolerance RT inadequate oxygenation
• 10 Imbalanced Nutrition: Less than body requirements RT reduced appetite and dyspnea (for empysema)

10 Chronic Obstructive Pulmonary Disease: Bronchitis Nursing Care Plans Original source at: Nurseslabs

Two types of bronchiectasis:

• Congenital bronchiectasis usually affects infants and children. It results from a problem in the development of the lungs in the fetus.
• Acquired bronchiectasis occurs in adults and older children. It is more common.

Bronchiectasis cannot be cured, but with proper care, most people who have it can enjoy a good quality of life.

Causes

Bronchiectasis is caused by injury to the lower airways. This injury may be caused by another disease, including:

• Cystic fibrosis, which leads to almost half of the cases of bronchiectasis in the United States.
• Severe pneumonia.
• Whooping cough (uncommon because most people are now vaccinated against it).
• Tuberculosis (TB) and other similar infections.
• Immunodeficiency disorders, such as HIV infection and AIDS.
• Allergic bronchopulmonary aspergillosis, an allergic reaction to a fungus called aspergillus that causes swelling in the airways.
• Kartagener’s Syndrome, a rare inherited disease that involves the cilia (sil’-ee-ah). These are small hair-like structures that line your airways and normally clear out mucus.
• Other disorders that affect the function of the cilia.

Other conditions that can injure the lower airways and lead to bronchiectasis include:

• Blockage of your airways by a growth or a noncancerous tumor
• Blockage of your airways by something you inhaled—for example, a piece of a toy or a peanut that you inhaled when you were a child
• Fungal infections.

Signs and Symptoms

The most common signs and symptoms are:

• Daily cough, over months or years
• Daily production of large amounts of mucus, or phlegm
• Repeated lung infections
• Shortness of breath
• Wheezing
• Chest pain

Over time, you may have more serious symptoms, including:

• Coughing up blood or bloody mucus
• Weight loss
• Fatigue
• Sinus drainage

Bronchiectasis can also lead to other serious health conditions, including:

• Collapsed lung
• Heart failure, if the disease advances to affect all parts of your airways
• Brain abscess

Diagnostic Test

There is no one specific test for bronchiectasis. Even in its later stages, the signs of the disease are similar to those of other conditions, so those conditions must be ruled out before a diagnosis can be made.

The most commonly used tests to diagnose bronchiectasis are:

• Chest X-Ray

A chest x ray takes a picture of your heart and lungs. It can show infection and scarring of your airway walls.

• Computed Tomography

This test provides a computer generated image of your airways and other tissue in your lungs. It has more detail than a regular chest x ray. A CT scan is the defining test for bronchiectasis. It can show how much damage has been done to the airways and where the damage is.

Other tests your doctor may conduct include:

• Blood tests.

These tests can show if you have a disease or condition that can lead to bronchiectasis. They can also show if you have an infection or low levels of certain infection-fighting blood cells.

• Sputum culture.

Sputum contains mucus and often pus, blood, or bacteria. Laboratory tests of a sample of your sputum can show if you have bacteria, fungi, or tuberculosis.

• Lung function tests.

These tests measure how well your lungs move air in and out. These tests show how much lung damage you have.

• Sweat test or other tests for cystic fibrosis.

This is a patch test on your arm that measures the amount of salt (sodium chloride) in your sweat.

Treatment

The goals of treatment are to:

• Treat any underlying conditions and respiratory infections
• Help remove mucus from your lungs
• Prevent complications

Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating any underlying conditions that may be causing the bronchiectasis, the better the chances of preventing further damage to your lungs.

The main medicines used to treat bronchiectasis are:

• Antibiotics are the main treatment for the repeated respiratory infections that bronchiectasis causes. Doctors usually prescribe oral antibiotics to treat these infections. For hard-to-treat infections, you may be given antibiotics through a tube into a vein in your arm. Your doctor may be able to help you arrange for a home care provider to give you intravenous antibiotics at home.
• Bronchodilators open your airways by relaxing the muscles around them. Inhaled bronchodilators can be breathed in as a fine mist from a metered-dose inhaler (puffer) or a nebulizer (ne’-byu-lye”-zer). These medicines work quickly because the drug goes directly into your lungs. Doctors usually recommend that you use a bronchodilator right before you do your chest physical therapy.
• Corticosteroids help reduce inflammation in your lungs. They work best when you take them with an inhaler.
• Mucus thinners, such as acetylcysteine, loosen the mucus.
• Expectorants help loosen the mucus in your lungs. They often come in combination with decongestants, which may provide additional relief. You do not need a prescription for them.
• Saline nasal washes help control sinusitis.

Chest Physiotherapy (CPT)

CPT is also called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up. You should do CPT for bronchiectasis three or four times each day.

CPT is often called postural drainage. This means that you sit or lie on your stomach with your head down while you do CPT. This lets gravity and force help drain the mucus from your lungs.

Some people find CPT difficult or uncomfortable to do. Several devices have been developed that may help with CPT. The devices include:

• An electric chest clapper, known as a mechanical percussor.
• A removable inflatable therapy vest that uses high-frequency air waves to force the mucus that is deep in your lungs toward the upper airways so you can cough it up.
• A “flutter” device, a small handheld device that you breathe out through. It causes vibrations that dislodge the mucus.
• A positive expiratory pressure mask that creates vibrations that help break the mucus loose from the airway walls.

Several breathing techniques may also help loosen some of the mucus so you can cough it up. These techniques include:

• Forced expiration technique (FET)—forcing out a couple of breaths or huffs and then doing relaxed breathing
• Active cycle breathing (ACB)—FET with deep breathing exercises that can loosen the mucus in your lungs

Depending on how serious your condition is, your doctor may also recommend:

• Oxygen therapy.
• Surgery to remove a section of your lung. Doctors usually do this only if other treatments have not helped and only one part of your lung is affected. If you have major bleeding, your doctor may recommend either surgery to remove the bleeding part of your lung or a procedure to control the bleeding.

If you have bronchiectasis, you should work closely with your doctor to develop self-management skills that can improve your quality of life. This means that you need to learn as much as you can about bronchiectasis and any underlying conditions that you have.

Avoiding respiratory infections should be a top priority. To do this:

• Have annual flu vaccinations
• Have pneumonia vaccinations as directed by your doctor
• Get regular aerobic exercise (walking and swimming, for example) to help loosen the mucus so it can be coughed up
• Eat a healthy diet
• Drink lots of fluids
• Wash your hands often
• Maintain a healthy weight.

Other things you can do to improve your condition include:

• Do not smoke
• Avoid exposure to tobacco smoke
• Avoid fumes and dust that can irritate your lungs

Source: (1)

Bronchiectasis Nursing Management Original source at: Nurseslabs

Pneumonia is the inflammation of the lung caused by bacteria in which the air sacs become filled with inflammatory cells and the lung becomes solid. The symptoms include those of any infection (fever, malaise, headache, etc.,) together with cough and chest pain.

It is estimated that, worldwide, some 4 million children under five years of age, die each year from acute respiratory infection (ARI) with the most of these deaths caused by pneumonia in developing countries.

In 1989, when the program for Control Acute Respiratory Infections (CARI) of the Philippines was launched, the death toll from pneumonia among children under the age of five years was 25,000. The latest statistics (2006) disclosed that almost 60 out of 1000 children under five children suffer from pneumonia and five in every 11,000 die from the disease. The Department of Health believes that if health workers used a standard method of detecting and managing ARI’s specially pneumonia, infant deaths could be cut by half, saving 50,000 lives a year. Pneumonia can be categorized by type of infiltrate: lobar pneumonia and bronchopneumonia.

View our gallery of nursing care plans

1. Ineffective Airway Clearance

NDx: Ineffective airway clearance r/t accumulation of tracheobronchial secretions

Mucus is produced at all times by the membranes lining the air passages. When the membranes are irritated or inflamed, excess mucus is produced and it will retain in tracheobronchial tree. The inflammation and increased in secretions block the airways making it difficult for the person to maintain a patent airway. In order to expel excessive secretions, cough reflex will be stimulated. An increased in RR will also be expected as a compensatory mechanism of the body due to obstructed airways.

6 Bronchopneumonia Nursing Care Plans Original source at: Nurseslabs

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