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

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

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

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

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 Clearnace

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 More Bronchopneumonia Nursing Care Plans Original source at: Nurseslabs

]]> http://nurseslabs.com/more-bronchopneumonia-nursing-care-plans/feed/ 2 http://nurseslabs.com/legionnaires-disease/ http://nurseslabs.com/legionnaires-disease/#comments Sat, 21 Jan 2012 09:16:17 +0000 NursesLabs http://nurseslabs.com/?p=1001 Legionnaire’s Disease is an acute bronchopneumonia produced by gram-negative bacillus, Legionella pneumophila. Legionnaire's Pneumonia case study.

Legionnaire’s Disease Nursing Management Original source at: Nurseslabs

]]>

Legionnaire’s Disease is an acute bronchopneumonia produced by gram-negative bacillus, Legionella pneumophila. It derives its name and notoriety from the peculiar and highly publicized disease that struck 182 (29 of whom died) at an American Legion convention in Philadelphia in July 1976.

Etiology

It is caused by Legionella pneumophilla, which is an aerobic, gram-negative bacillus which flourishes on soils and transmitted airborne through cooling towers and air-conditioning systems.

At Risk

• Middle-age and elderly people
• Immunocompromised patients or those with lymphoma or other disorders associated with delayed hypersensitivity.
• Patients with chronic underlying diseases, such as diabetes, chronic renal failure, or chronic obstructive pulmonary disease.
• Those with alcoholism
• Cigarette smokers
• Those on a ventilator for extended periods

Incubation Period

It has an incubation period around 2 to 10 days.

Manifestations

• diarrhea,
• anorexia,
• malaise,
• diffuse myalgias,
• and generalized weakness,
• headache,
• and recurrent chills.
• blood-tinged sputum

Diagnostics

• White Blood Count would show leukocytosis
• Chest Xray would show consolidations
• Auscultation would show fine crackles
• Definitive tests include direct immunofluorescence of respiratory tract secretions and tissue, culture of L. pneumophilia, and indirect fluorescent antibody testing of serum comparing acute samples with convalescent samples drawn at least 3 weeks later. A convalescent serum showing a fourfold or greater rise in antibody titer for Legionella confirms the diagnosis.

Treatment

• Quinolones (ciprofloxacin)
• Macrolides (erythromycin)

Nursing Management

• Closely monitor the patient’s respiratory status
• Continually monitor the patient’s vital signs
• Replace fluid and electrolytes
• Provide mechanical ventilation and other respiratory therapy
• Give antibiotic therapy as indicated

Legionnaire’s Disease Nursing Management Original source at: Nurseslabs

]]> http://nurseslabs.com/legionnaires-disease/feed/ 0 http://nurseslabs.com/thoracentesis-procedure-nursing-management/ http://nurseslabs.com/thoracentesis-procedure-nursing-management/#comments Mon, 16 Jan 2012 10:46:29 +0000 NursesLabs http://nurseslabs.com/?p=1036 Thoracentesis is pleural fluid analysis. Learn about the Nursing care plans, nursing management and drugs used for thoracentesis. Responsibilities of a nurse during thoracentesis.

Thoracentesis Procedure, Nursing Care Plans & Management Original source at: Nurseslabs

]]> Thoracentesis is also known as pleural fluid analysis.  Thoracentesis is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the interior chest wall) to remove fluid or air. Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.

Thoracentesis may be performed for diagnostic and/or therapeutic reasons. The diagnostic use of a thoracentesis involves pleural fluid analysis to distinguish between exudate, which may result from inflammatory or malignant conditions, and transudate, which may result from failure of organ systems that affect fluid balance in the body. This analysis aids in determining the cause of the abnormality.

Thoracentesis Procedure

1. Position patient in the sitting position with arms and head resting supported on a bedside adjustable table. If unable to sit, the patient should lie at the edge of the bed on the affected side with the ipsilateral arm over the head and the midaxillary line accessible for the insertion of the needle. Elevating the head of the bed to 30 degrees may help.
2. The usual site for insertion of the thoracentesis needle is the posteriolateral aspect of the back over the diaphragm, but under the fluid level. Confirm site by counting the ribs based on chest x-ray and percussing out the fluid level. Mark the top of the dullness by washable ink mark or indenting the skin.
3. Select the thoracentesis site in an interspace below the point of dullness to percussion in the midposterior line (posterior insertion) or midaxillary line (lateral insertion).
4. Sterile technique should be used including gloves, betadine prep and drapes.
5. Anesthetize the skin over the insertion site with 1% lidocaine using the 5 cc syringe with 25 or 27-gauge needle. Next anesthetize the superior surface of the rib and the pleura. The needle is inserted over the top of rib (superior margin) to avoid the intercostals nerves and blood vessels that run on the underside of the rib (the intercostals nerve and the blood supply are located near the inferior margin). As the needle is inserted, aspirate back on the syringe to check for pleural fluid. Once fluid returns, note the depth of the needle and mark it with a hemostat. This gives an approximate depth for insertion of the angiocatheter or thoracentesis needle. Remove the anesthetizing needle.
6. Use a hemostat to measure the same depth on the thoracentesis needle or angiocath as the first needle. While exerting steady pressure on the patient’s back with the nondominant hand, use a hemostat to measure the 15- to 18- gauge thoracentesis needle to the same depth as the first needle. While exerting steady pressure on the patient’s back with the nondominant hand, insert the needle through the anesthetized area with the thoracentesis needle. Advance the needle until it encounters the superior aspect of the rib. Continue advancing the needle over the top of the rib and through the pleura, maintaining constant gentle suction on the syringe. Make sure you march over the top of the rib to avoid the neurovascular bundle that runs below the rib.
7. Attach the three way stopcock and tubing, and aspirate the amount needed. Turn the stopcock and evacuate the fluid through the tubing.
8. Remove the necessary amount of pleural fluid (usually 100 mL for diagnostic studies), but generally not remove more than 1500 mL of fluid at any one time because of increased risk of pleural edema or hypotension. A pneumothorax from needle laceration of the visceral pleura is more likely to occur if an effusion is completely drained.
9. When draining of fluid is completed, have the patient take a deep breath and hum, and gently remove the needle. This maneuver increases intrathoracic pressure and decreases the chance of pneumothorax. Cover the insertion site with a sterile occlusive dressing.

Thoracentesis Nursing Considerations

Before the Procedure

• Check the doctor’s order.
• Identify the client.
• Asked patient to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
• Explain and emphasize the importance of the procedure.
• Inform that she will be experiencing mild pain on the site where the needle was pricked
• Inform the client that the procedure takes only few minutes, depending primarily on the time it takes for fluid to drain from the pleural cavity.
• Inform the client not to cough while the needle is inserted in order to avoid puncturing the lung
• Explain when and where the procedure will occur and who will be present.
• Explain the procedure to the patient and SO, reinforcing what the physician has previously explained to the patient/SO

• The patient may have a diagnostic procedure, such as a chest x-ray, chest fluoroscopy, ultrasound, or CT scan, performed prior to the procedure to assist the physician in identifying the specific location of the fluid in the chest that is to be removed.
• The patient may receive a sedative prior to the procedure to help the patient relax.
• Asked the patient to remove any clothing, jewelry, or other objects that may interfere with the procedure.
• The area around the puncture site may be shaved.
• Vital signs (heart rate, blood pressure, breathing rate, and oxygen level) are to be monitored before the procedure.

During the Procedure

• Support the client verbally and describe the steps of the procedure as needed.
• Vital signs (heart rate, blood pressure, breathing rate, and oxygen level) are to be monitored during the procedure.
• The patient may receive supplemental oxygen as needed, through a face mask or nasal cannula (tube).
• Observe the client for signs of distress, such as dyspnea, pallor, and coughing
• Place the patient in a sitting position with arms raised and resting on an overbed table. This position aids in spreading out the spaces between the ribs for needle insertion. If the patient is unable to sit, the patient may be placed in a side-lying position on the edge of the bed on unaffected side.
• The skin at the puncture site will be cleansed with an antiseptic solution.
• The patient will receive a local anesthetic at the site where the thoracentesis is to be performed.
• Don’t remove more than 1000 ml of fluid from the pleural cavity within first 30 minutes.
• Place a small sterile dressing over the site of the puncture.

After the Procedure

• Observe changes in the client’s cough, sputum, respiratory depth, and breath sounds, and note complaints of chest pain.
• Position the client appropriately
• Some agency protocols recommend that the  client lie on the unaffected side with the head of the bed elevated 30 degrees for at least 30 minutes because this position facilitates expansion of the affected lung and eases respirations
• Position the patient in a side-lying position with the unaffected side down for an hour or longer.
• Include date and time performed; the primary care provider’s name; the amount, color, and clarity of fluid drained; and nursing assessments and interventions provided.
• Transport the specimens to the laboratory.
• The dressing over the puncture site will be monitored for bleeding or other drainage.
• Monitor patient’s blood pressure, pulse, and breathing until are stable.
• Document all relevant information.

Possible Nursing Diagnoses:

Here are some possible nursing diagnoses for a patient post-thoracentesis (you may also check on the nursing care plans for Pleural Effusion)

• Ineffective Breathing Pattern RT Decreased Lung Volume Capacity
• Impaired Gas Exchange RT Alveolar Capillary Membrane Changes
• Impaired Skin Integrity RT Mechanical Factors Secondary to Thoracentesis and CTT Insertion
• Acute Pain rt surgical incision, chest tube sites, and immobility
• Impaired physical mobility
• Activity Intolerance

References:

• http://www.ucsfmedicalcenter.org/medstaffoffice/Standardized_Procedures/Thoracentesis.pdf
• http://www.nhlbi.nih.gov/health/dci/images/thoracentesis.jpg

Thoracentesis Procedure, Nursing Care Plans & Management Original source at: Nurseslabs

]]> http://nurseslabs.com/thoracentesis-procedure-nursing-management/feed/ 1 http://nurseslabs.com/pneumonia-nursing-care-plans/ http://nurseslabs.com/pneumonia-nursing-care-plans/#comments Thu, 12 Jan 2012 14:49:32 +0000 NursesLabs http://nurseslabs.com/?p=237 Pneumonia is an inflammatory illness of the lung. It is often described as lung parenchyma or alveolar inflammation leading to abnormal alveolar filling with fluid. Pneumonia can result from a variety of causes, including infection with microorganisms like bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs.

5 Pneumonia Nursing Care Plans Original source at: Nurseslabs

]]> Pneumonia is an inflammatory illness of the lung. It is often described as lung parenchyma or alveolar inflammation leading to abnormal alveolar filling with fluid. Pneumonia can result from a variety of causes, including infection with microorganisms like bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs.

INCIDENCES

Pneumonia is a common illness in all parts of the world in all age groups. Majority of deaths occur in the newborn period in children, with over two million deaths a year worldwide.

• The World Health Organization estimates that one out of three newborn infant deaths is due to pneumonia.
• It kills more children than any other illness, accounting for 19% of all under-five deaths.
• According to the National Statistical Coordination Board of the Philippines, there are 776,562 of pneumonia in the country in 2004 alone. This could be an implication that pneumonia is one of the leading causes of morbidity and mortality in the country.
• World Health Organization notes Invasive Pneumococcal Disease deaths at 1.6 million people each year.
• Of these, 700,000 to one million are children under five years old and over 90 percent of these deaths occur in developing countries.
• Pneumonia is a top killer in India,China,Nigeria,Pakistan,Bangladesh,Indonesia, and Brazil.

 

“]

Signs and Symptoms of Pneumonia [From Wikipedia

1 Ineffective Airway Clearance

The inflammation and increased secretions make it difficult to maintain a patent airway, which is cause by decrease ability to expel the excessive mucus produced that will lead to extensive obstruction of the airway.

ASSESSMENT	NURSING DIAGNOSIS	OBJECTIVES	NURSING INTERVENTIONS	RATIONALE	EXPECTED OUTCOMES
S> Ø   O> Patient manifested the ff:   - with unproductive cough -with wheezes and crackles auscultated on left lower lungfield. - presence of clear watery discharge from her nose   > Patient may manifest the ff: - restlessness - irritability	Ineffective airway clearance related to presence of secretions secondary to pneumonia.	Short Term:   After 3-4 hours of nursing interventions, the patient’s respiration will improve and difficulty of breathing will be relieved.   Long Term:   After 3 – 4 days of nursing interventions, the patient will maintain a patent airway.	>Establish rapport to patient and SO     >Assess patient’s condition     >Monitor and record V/S   >Auscultate lung fields, noting areas of decreased/absent airflow and adventitious breath sounds   >Assist patient to change position every 30 minutes   >Elevate head of bed and align head in the middle   >Provide health teachings regarding effective coughing and deep breathing exercise.   >Encourage to increase fluid intake.   >Encourage steam inhalation       >Administer meds as ordered	>To gain the trust and cooperation   >To know and determine patient’s needs   >To establish base line data   >To identify areas of consolidation and determine possible bronchospasm or obstruction.   >To mobilize secretions     >To facilitate breathing       >To expel the mucous             >To liquefy secretions     >To moisten secretions and alleviate congestion   >To reduce bronchospasm and mobilize secretion	Short Term:   After 3-4 hours of nursing interventions, the patient’s respiration shall have improved and difficulty of breathing shall have been relieved.     Long Term:   After 3 – 4 days of nursing interventions, the patient will have been able to maintain a patent airway.

5 Pneumonia Nursing Care Plans Original source at: Nurseslabs

]]> http://nurseslabs.com/pneumonia-nursing-care-plans/feed/ 0 http://nurseslabs.com/bronchitis-pathophysiology/ http://nurseslabs.com/bronchitis-pathophysiology/#comments Thu, 12 Jan 2012 14:49:30 +0000 NursesLabs http://nurseslabs.com/?p=1338 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 COPD or chronic obstruct pulmonary disease. They are also known as blue bloaters since lack of oxygen can cause cyanosis in patients with bronchitis.

Bronchitis Pathophysiology & Schematic Diagram Original source at: Nurseslabs

]]> 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 COPD or chronic obstruct pulmonary disease. They are also known as blue bloaters since lack of oxygen can cause cyanosis in patients with bronchitis.

Download and read this free bronchitis pathophysiology!

Bronchitis Pathophysiology

Bronchitis Pathophysiology & Schematic Diagram Original source at: Nurseslabs

]]> http://nurseslabs.com/bronchitis-pathophysiology/feed/ 0 http://nurseslabs.com/bronchial-asthma-in-acute-exacerbation-baiae-pathophysiologyschematic-diagram/ http://nurseslabs.com/bronchial-asthma-in-acute-exacerbation-baiae-pathophysiologyschematic-diagram/#comments Sat, 07 Jan 2012 23:00:58 +0000 NursesLabs http://nurseslabs.com/?p=3159 Bronchial asthma is a reversible lung disease that is characterized by obstruction or narrowing of the airways, which are typically inflamed and hyperresponsive to various stimuli. It may resolve spontaneously or with treatment.

Bronchial Asthma in Acute Exacerbation (BAIAE) Pathophysiology/Schematic Diagram Original source at: Nurseslabs

]]> Bronchial asthma is a reversible lung disease that is characterized by obstruction or narrowing of the airways, which are typically inflamed and hyperresponsive to various stimuli. It may resolve spontaneously or with treatment.

This is a post with a downloadable pathophysiology and schematic diagram of bronchial asthma in acute exacerbation.

Pathophysiology for Bronchial Asthma in Acute Exacerbation

Bronchial Asthma in Acute Exacerbation (BAIAE) Pathophysiology/Schematic Diagram Original source at: Nurseslabs

]]> http://nurseslabs.com/bronchial-asthma-in-acute-exacerbation-baiae-pathophysiologyschematic-diagram/feed/ 0 http://nurseslabs.com/bronchial-asthma-nursing-care-plans/ http://nurseslabs.com/bronchial-asthma-nursing-care-plans/#comments Thu, 05 Jan 2012 02:00:44 +0000 NursesLabs http://nurseslabs.com/?p=232 Nursing Care Plans for Bronchial Asthma or BAIAE, nursing management, respiratory function tests, nursing responsibilities, and assessment

5 Bronchial Asthma Nursing Care Plans Original source at: Nurseslabs

]]> Bronchial asthma is a disease caused by increased responsiveness of the tracheobronchial tree to various stimuli. The result is paroxysmal constriction of the bronchial airways.
Bronchial asthma is the more correct name for the common form of asthma.

What do you think is the nursing goal for patient’s with bronchial asthma, and what is that one-most nursing diagnosis that pops to your head when you hear asthma?

 

This post contains 5 bronchial asthma nursing care plans. 

1 Ineffective Airway Clearance

The presence of a foreign microorganism triggers the B lymphocyte to produce antibodies that are specific to that antigen. These antibodies then attach to mast cells in the lungs. The mast cells with the antibody attaches to the antigen and begins to degranulate. This degranulation causes the release of certain chemical mediators, namely, histamine, bradykinin, prostaglandin, and leukotriene. These chemical mediators cause bronchospasm leading to bronchoconstriction, increased vascular permeability leading to fluid leakage from the lung vasculature and increased mucus production. These lead to swelling of the bronchi, mucus buildup that plugs the airway and decreased bronchial diameter. This causes an increased airway resistance and a constricted pathway for air. Air cannot pass effectively and this manifests as a whistling sound. Coughing is a way to expel the obstruction (mucus plug) while dyspnea is a manifestation of the increased airway resistance.

Asthma- Ineffective- Airway- Clearance

5 Bronchial Asthma Nursing Care Plans Original source at: Nurseslabs

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