Exam 20 - Acute and Chronic Resp. Disorders

• The following material discusses acute and chronic respiratory disorders/diseases, including pneumothorax, lung cancer, pulmonary edema, pulmonary embolus (PE), acute respiratory distress syndrome (ARDS), acute respiratory failure, chronic obstructive pulmonary disorder (COPD), emphysema, chronic bronchitis, bronchiectasis, asthma, and the nursing process for patients with respiratory disorders.

Pneumothorax

• It's caused by air or gas in the pleural space, leading to lung collapse by interrupting normal negative pressure.
• Tension pneumothorax is a life-threatening condition where built-up air pressure interferes with heart and lung filling.

Causes of Pneumothorax

• Include chest trauma (laceration of lung, puncture of pleura, fractured ribs), ruptured bleb (emphysema), injury from subclavian line insertion, and spontaneous occurrence.

Clinical Manifestations of Pneumothorax

• Recent chest injury may be present.
• Absent or decreased breath sounds occur on the affected side.
• May experience sharp, pleuritic pain with dyspnea, diaphoresis and tachycardia, and tachypnea.
• Abnormal chest movement, sucking sounds with penetrating injury on inspiration, hypoxia and mediastinal shift to the unaffected side with compression of great vessels; hypotension can occur due to decreased venous return.

Pneumothorax Assessment

• Subjective, inquire about recent chest injury or severe coughing, also reports chest pain, sudden shortness of breath, and anxiety.
• Objective, unequal or absent breath sounds on the affected side, monitor for penetrating or blunt chest wounds and unequal chest movement, assess respiratory and cardiac rate and rhythm, monitor vital signs frequently; note sputum color, characteristics, and amount.
• Hemoptysis and cough may be present.

Pneumothorax Diagnostic Tests

• Chest x-ray reveals decreased lung expansion, fractured ribs, or mediastinal shift.
• ABG will show decreased pH (acidotic) and PaO2 (hypoxemia), with increased PaCO2 (retention).

Pneumothorax Medical Management

• Implementation of chest tube insertion with water-seal suction to allow for full lung expansion and healing.
• Heimlich valve can be used temporarily.
• Needle thoracostomy is performed for emergency decompression of a tension pneumothorax: large bore angiocath is inserted in the 2nd intercostal space, mid-clavicular line, on the affected side.
• A chest tube must be inserted after needle decompression.

Pneumothorax Nursing Interventions

• Maintain airway patency and adequate oxygenation, and assess and document chest tube system patency, note color and amount of chest tube drainage.
• Monitor vital signs frequently, maintain patient in high Fowler's to promote airway clearance and lung expansion, provide analgesics, assist with coughing and deep breathing, splint or support injured chest area, and observe for respiratory compromise.
• Patient education includes rationale for chest tube and oxygen therapy, limit exposure to respiratory infections, avoid smoking, increase fluid intake, avoid fatigue, and report recurrence.
• Nursing Diagnoses, ineffective breathing pattern related to non-functioning lung.
• Interventions, assess respiratory rate and rhythm, provide chest tube care, facilitate optimal ventilation, suction as needed, and encourage adaptive breathing.
• Fear related to feeling of air hunger, interventions, assess feelings of fear, identify positive coping methods and support, and determine support systems.

Lung Cancer Etiology/Pathophysiology

• Leading cause of cancer death, with tumors which might be primary or metastatic (colon and kidney are common sites).
• Approximately 87% of lung tumors are linked to smoking; the risk increases with smoking duration and amount.
• Other causes include passive smoking, occupational exposures, and air pollution.
• Mortality depends on cancer type and tumor size at diagnosis.

Types of Lung Cancer

• Small cell lung cancer (20% of cases).
• Non-small cell lung cancer (30-32%), including adenocarcinoma.
• Squamous cell carcinoma (30% of cases).
• Large cell (9% of cases).

Lung Cancer Clinical Manifestations

• Peripheral lesions have few symptoms, may cause pleural effusion and severe pain. Central lesions can cause obstruction or erosion of bronchus, hemoptysis, dyspnea, fever, chills, wheezing, and phrenic nerve involvement (paralysis of the diaphragm).
• Metastasis can cause weight loss, and may involve the liver, bone, esophagus, brain, and pericardium.
• Assessment, subjective: chronic hoarseness, chronic cough, smoking history, weight loss, and fatigue.
• Objective: hemoptysis, shortness of breath, unilateral wheeze, pleural effusion, edema of face and neck (superior vena cava syndrome), friction rub, clubbing of fingers, and pericardial effusion.

Diagnostic Tests for Lung Cancer

• Includes a chest x-ray, CT scan (more precise), MRI, bronchoscopy, fine needle aspiration, biopsy, mediastinoscopy, and scalene lymph node biopsy.

Lung Cancer Medical Management

• One-third of patients are inoperable at diagnosis, another third during exploratory thoracotomy.
• Surgical treatment: pneumonectomy (removal of entire lung), lobectomy, segmental resection, and video-assisted thorascopic surgery.
• Radiation and chemotherapy, often with surgery.
• Chemotherapy and radiation for SCLC.

Lung Cancer Nursing Interventions

• Improves quality of life, and helps patient and family cope with diagnosis.
• Monitor side effects of anti-neoplastics, plan activities to reduce exertion and conserve patient's energy, assist with nutrition, monitor for recurrence, relieve pain with analgesics.
• Encourage smoking cessation and identify community resources.

Lung Cancer Nursing Diagnoses

• Ineffective airway clearance related to lung surgery.
• Interventions: Facilitate optimal breathing, elevate the head of the bed, encourage early ambulation, assist with position changes, promote cough and deep breathing, and assess breath sounds. Fear related to cancer, treatment, and prognosis.
• Interventions: Explain treaments, listen to the patient, encourage verbalization of feelings, assist in identifying support services, and monitor for signs of worthlessness, anxiety and powerlessness.
• Prognosis: only 15.9% of lung cancer patients live for 5 years or longer.

Pulmonary Edema Etiology/Pathophysiology

• Accumulation of serous fluid in interstitial lung tissue and alveoli, caused by severe left ventricular failure, inhalation of irritating gases, rapid IV fluid administration, or barbiturate/opiate overdose.
• Increased pulmonary capillary pressure forces fluid into the alveoli, severely affects gas diffusion leading to respiratory distress which is acute and can lead to death if untreated.

Pulmonary Edema Clinical Manifestations

• Dyspnea and labored respirations, tachypnea, tachycardia, hypoxia, cyanosis, pink frothy sputum, restlessness, and agitation.

Pulmonary Edema Assessment

• Subjective: dyspnea and feelings of impending death.
• Objective: signs of respiratory distress (nasal flaring, sternal retractions, rapid/snoring respirations), hypertension, tachycardia, restlessness, and disorientation, wheezing and crackles on auscultation, weight gain (fluid retention), decreased urinary output, productive cough with frothy, pink sputum.

Pulmonary Edema Diagnostic Tests

• Chest x-ray: fluid infiltrates, pleural effusion, cardiomegaly.
• ABG: hypoxia, PaCO2 varies (respiratory alkalosis initially, then acidosis).

Pulmonary Edema Medical Management

• Oxygen therapy may require intubation for positive pressure ventilation.
• Medications:
  • Lasix (reduces edema, dilates pulmonary vasculature).
  • Morphine sulfate (reduces anxiety, respiratory rate, venous return, dilates vascular beds).
  • IV Nipride (vasodilator, reduces pulmonary congestion).
  • Digoxin ( for underlying cardiac dysfunction).

Pulmonary Edema Nursing Interventions

• Frequent respiratory status assessment (breath sounds, oxygenation via pulse oximetry and ABG), strict I&O.
• Oxygen therapy (Venturi mask, possible mechanical ventilation), maintain proper positioning for gas exchange (high Fowler's), maintain IV access for medication administration, and Heplock or TKO all fluids.
• Patient teaching, effective breathing techniques, medications, low-sodium diet, and fluid restriction.
• Prognosis, is guarded if not treated emergently.

Pulmonary Embolus (PE) Etiology/Pathophysiology

• Passage of a foreign substance (blood clot, fat, air, or amniotic fluid) into the pulmonary artery, or its branches causing obstruction.
• Risk factors, thrombophlebitis, recent surgery, pregnancy/childbirth, contraceptives, CHF, obesity, immobilization from fracture, venous stasis, wall injury, and increased coagulability cause thrombus formation (usually in deep veins of lower extremities).
• Obstruction hinders oxygenation of blood and leads to atelectasis, increased pulmonary vascular resistance, and arterial hypoxia.

Pulmonary Embolus (PE) Clinical manifestations

• Sudden, sharp, constant, non-radiating chest pain worsening on inspiration.
• Acute, unexplained dyspnea.
• Tachypnea with hemoptysis, diminished lung sounds and wheezes, elevated temperature, hypertension and diaphoresis, bronchoconstriction, atelectasis, pulmonary edema, and decreased surfactant.

Pulmonary Embolus (PE) Assessment

• Subjective is based on the degree of dyspnea, chest pain, and risk factors.
• Objective signs include pleuritic chest pain, cough, tachypnea, tachycardia, signs of hypotension, crackles or decreased breath sounds, pleural friction rub, and anxiety.

Pulmonary Embolus (PE) Diagnostic Tests

• ABG: hypoxia, respiratory alkalosis initially, then acidosis.
• Chest x-ray: usually normal initially, may show infiltrates or enlarged pulmonary artery after 24 hours.
• CT angiogram (replacing V/Q scan), V/Q scan (smaller facilities), pulmonary arteriogram (leading test for detecting PE), D-dimer (detects fibrin degradation products, indicates a thrombus), and venous ultrasound (confirms DVT).

Pulmonary Embolus (PE) Medical Management

• Medications:
  • Anticoagulants: Heparin, Lovenox, Coumadin prevent further clot formation.
  • Thrombolytics: dissolve PE.
• Filter device in the inferior vena cava to block emboli.
• Embolectomy (surgical removal of large thrombus).

Pulmonary Embolus (PE) Nursing Interventions

• Assess sensorium for worsening hypoxemia and monitor cardiorespiratory status (vital signs, pulse oximetry, capillary refill, peripheral pulses).
• Elevate HOB 30 degrees, administer oxygen therapy, monitor pulses in the affected lower extremity and calf measurements, and DVT treatment: bedrest, TED hose.
• Assess for bleeding from anticoagulation.
• Patient teaching, avoid venous stasis, proper application of antiembolism hose, medication information (low molecular weight heparin, Coumadin), and reasons to return to the physician.
• Nursing Diagnoses:
  • Impaired gas exchange related to alteration in pulmonary vasculature.
  • Interventions: Assess sensorium and vital signs, elevate head of bed, administer oxygen, and monitor ABG's.
  • Ineffective perfusion, related to risk of prolonged bleeding or hemorrhage secondary to anticoagulation therapy.
  • Interventions: Monitor vital signs, check stool, urine, sputum and vomitus for occult blood.
• Prognosis, untreated PE carries 30% mortality, reduced to 2-8% with early diagnosis and treatment.

Acute Respiratory Distress Syndrome (ARDS) Etiology/Pathophysiology

• Also called Non-cardiogenic Pulmonary Edema.
• Syndrome of intrapulmonary shunting, hypoxemia, reduced lung compliance, and lung damage.

The Three Phases of ARDS

• Acute phase: uncontrolled inflammation, damage to pulmonary capillary endothelium, platelet aggregation, intravascular thrombi, and release of serotonin.
• Proliferative phase: pulmonary edema resolves, a fibrin matrix (hyaline membrane) forms, and hypoxemia worsens.
• Fibrotic phase: fibrosis obliterates alveoli, bronchioles, interstitium, decreased functional residual capacity, severe right-to-left shunting, inflammation, and narrows airways.
• Causes include viral or bacterial pneumonia, chest trauma, aspiration, inhalation injury, near drowning, fat emboli, sepsis, shock, overdoses, renal failure, and pancreatitis.
• Altered alveolar capillary membrane permeability, causing leakage of plasma and blood into interstitial space resulting in pulmonary edema and hypoxia.

Clinical Manifestations for ARDS

• Manifests within 12 to 24 hours post-injury.
• Respiratory distress with altered breath sounds within 5 to 10 days.
• Altered sensorium due to elevated PaCO2 and decreased PaO2.
• Tachycardia, hypotension, and decreased urinary output.

ARDS Assessment

• Subjective: obtain information on recent illness.
• Objective: does not respond to supplemental oxygen therapy, assess respiratory rate, rhythm, and effort, signs of dyspnea, auscultate lungs for crackles and wheezing, assess the level of consciousness, pulse, and temperature, and elevation of peak inspiratory pressure if intubated.

ARDS Diagnostic Tests

• Pulmonary function tests (ability for gases to diffuse across the alveoli).
• Arterial blood gases: decreased PaO2 and HCO3, increased PaCO2, and decreased pH.
• Chest X-ray: thickened bronchial margins, and diffuse bilateral infiltrates (white out).

ARDS Medical Management

• Supportive treatment, maintain adequate oxygenation, and treat the cause.
• Mechanical ventilation, positive end-expiratory pressure (PEEP) to open alveoli and improve oxygenation.
• Medications: Diuretics, Morphine sulfate (sedation), Digoxin (cardiac function), Antibiotics.

ARDS Nursing Interventions

• Provide adequate oxygenation, ventilation, and treat multi-system responses to ARDS.
• Monitor respiratory status, vital signs, position for optimal ventilation.
• Prone positioning (for more than 12 hours decreases mortality, facilitates secretion removal, and improves oxygenation).
• Ensure skin integrity with prone position- Place hydrocolloid or silicone dressing on chest, pelvis, elbows, and knees.
• Nursing Diagnoses:
  • Impaired gas exchange, related to tachypnea.
  • Interventions: Monitor ABGs, check pulse oximetry, administer oxygen, report changes in vital signs and level of consciousness.
  • Ineffective breathing pattern, related to respiratory distress.
  • Interventions: Assess respiratory rate, rhythm and effort, facilitate optimal ventilation by proper positioning and maintain airway patency.
  • Nitric oxide (experimental treatment, vasodilation).

Acute Respiratory Failure Etiology/Pathophysiology

• Inability of the respiratory system to provide oxygenation and/or remove carbon dioxide.
• Ventilation failure (hypercapnia and hypoxemia) or oxygen failure (hypoxemia).

Other Acute Respiratory Failure Info

• Occurs rapidly, intrapulmonary shunting, diffusion defects, low cardiac output, and low hemoglobin. Assessment:
• Subjective indication is a change in mental status.
  • Objective: altered LOC (anxiety, restlessness, confusion, lethargy), shallow respirations, respiratory fatigue. Diagnostic Tests:
• Pulmonary Function tests, chest x-ray, CBC/BMP (hemoglobin/hematocrit, electrolytes), ABG, and pulse oximetry.

ARF Interventions-Concerns, Symptoms, and Nursing Actions

• Treat the cause, maintain patent airway (intubation and mechanical ventilation), optimize oxygen delivery, provide adequate rest, and prevent complications.
• *Respiratory muscle fatigue, diaphoresis, nasal flaring, tachycardia, abdominal paradox, muscle retractions, and central cyanosis.
  • Actions, improve O2 delivery, administer O2, ensure adequate cardiac output and blood pressure, correct low hemoglobin, administer bronchodilators, decrease O2 demand, provide rest, reduce fever, relieve pain and anxiety, position patient, and prepare for intubation and mechanical ventilation.
• Cerebral hypoxia and CO2 narcosis: Lethargy, somnolence, coma, and respiratory acidosis.
  • Maintain airway patency, prepare for intubation and mechanical ventilation.

Chronic Obstructive Pulmonary Disorder (COPD): Emphysema

• Symptoms develop in 40s, and disability in 50s and 60s.
• Changes in alveolar walls and capillaries, abnormal, permanent enlargement of alveoli, its destruction, overlap between chronic bronchitis and emphysema, inflamed bronchi, bronchioles, and alveoli; air is trapped, and alveolar distention.
• Alveoli rupture and scar, losing elasticity, decreased oxygen, increased carbon dioxide, primarily from cigarette smoking.

COPD Emphysema

• May lead to cor pulmonale.
• Risk factors: the same as chronic bronchitis plus heredity (deficiency of ATT).

COPD Emphysema Clinical Manifestations

• Exertional dyspnea, sputum minimal at onset, but copious later.
• Accessory muscle use, pursed-lip breathing, and barrel chest.
• Wheezing and chronic weight loss with emaciation.

COPD Emphysema Assessment

• Subjective: onset of symptoms (dyspnea, cough, and sputum), history of smoking, and family history.
• Objective: tachycardia, tachypnea, orthopnea, peripheral cyanosis, clubbing of fingers, and barrel chest.

COPD Emphysema Diagnostic Tests

• PFT: decreased total lung capacity, increased residual volume and compliance, and increased airway resistance. ABG: decreased PaO2, increased PaCO2, low-normal or elevated pH, and increased HCO3.
• Chest x-ray: hyperinflation, widened intercostal spaces, and flattened diaphragm.
• Labs: Alpha1-antitrypsin (ATT) assay, and CBC (elevated erythrocytes, hemoglobin, and hematocrit).
• Medical Management: long-term management with home oxygen and chest physiotherapy, mechanical ventilation during acute exacerbations.

COPD Emphysema Medications and Interventions

• Bronchodilators (beta-adrenergic agonists, theophyllines, anticholinergics), antibiotics, corticosteroids (during exacerbations), diuretics, oxygen therapy, and anti-anxiety agents.
• Nursing Interventions: decrease anxiety, promote optimal air exchange, elevate the head of the bed, and low flow oxygen (1-2 liters nasal cannula.)
• Patient Teaching: nutrition, smoking cessation, infection control, and relaxation techniques.

COPD Emphysema Teaching and Prognosis

• Nutrition: Increased protein and calorie needs, divided into 5-6 small meals, fluids are between meals
• Prognosis is irreversible; 3rd leading cause of death in the US.
• Nursing Diagnoses is ineffective airway clearance related to narrowed bronchioles.
  • Interventions: Assess ability to mobilize secretions, encourage coughing and deep breathing, elevate HOB, suction as needed, assist with respiratory treatments, and auscultate lungs.
• Activity intolerance, related to imbalance between oxygen demand. -Interventions: Organize care so periods of activity are interspersed with rest, advise patient to rest 30 minutes before meals, assist with ADLs and exercises, and assess respiratory response to activity.

Chronic Bronchitis Etiology/Pathophysiology

• It's a recurrent chronic productive cough for at least three months for two years.
• Can be the result of physical or Chemical irritants or recurrent lung infections.
• Smoking the majority of causes of this condition.
• Impaired cilia, mucous gland hypertrophy, increased susceptibility to infection, chronic infection leads to scarring causing obstruction, increased airway resistance, bronchospasm, hypoxia, and hypercapnia.

Chronic Bronchitis Clinical Manifestations and Assessments

• Productive cough (most pronounced in the morning), dyspnea, and accessory muscle use.
• Later signs of cough include cyanosis, right ventricle failure (cor pulmonale), and reddish-blue skin from polycythemia and dependent edema.
• Subjective assessment has detailed the smoking history, irritant exposure, and family history of respiratory disease.

Chronic Bronchitis Objective Assessment

• Cough characteristics, sputum amount, severity of dyspnea, wheezing, anxiety, vital signs (tachypnea, tachycardia, and hyperthermia).
• Diagnostic tests, including CBC: polycythemia and elevated WBCs.
• ABG shows respiratory acidosis(may be normal), hypoxia, and hypercapnia.
• Medical management, minimize disease progression and facilitate optimal air exchange.

Medical Interventions and Nursing Diagnoses for Chronic Bronchitis

• Medications: Beta-adrenergic agonists, anticholinergics, corticosteroids, mucolytics, and antibiotics.
• Provide secretion management, adequate hydration, and suction as needed.
• Low-flow oxygen, frequent oral hygiene, rest periods, and a high calorie and high protein diet.
• Nursing Diagnoses:
  • Ineffective breathing pattern related to retained pulmonary secretions. -Assess dyspnea, teach effective breathing techniques, and suction as needed.
  • Interventions implement fatigue, related to increased respiratory effort.
  • Assess fatigue, provide treatment in a calm manner, encourage adequate rest, and identify support systems.

Asthma Etiology/Pathophysiology

• Episodic increased tracheal and bronchial responsiveness.
• Classified as extrinsic (allergens) or intrinsic (upper respiratory infection, emotional upsets), the re-occurrence of attacks is influenced by mental or physical fatigue, and GERD.

More on Asthma

• Airway narrowing resolves spontaneously or with treatment.
• Altered immune response or increased airway resistance and altered air exchange.
• Acute attacks are caused by the antigen-antibody reaction releases histamine; three primary mechanisms: recurrent reversible airway obstruction, increased capillary permeability ad acute inflammatory response.

Asthma Clinical Manifestation and Assessments

• Mild asthma causes dyspnea on exertion and wheezing (controlled with meds).
• Acute attack: tachypnea, tachycardia, diaphoresis, expiratory wheezing, accessory muscle use, nasal flaring, and anxiety (often occurs at night).
• Status asthmaticus is a severe, unrelenting form unresponsive to drugs, leads to exhaustion, and respiratory failure.
• Subjective assessment consists of quality of life, medications, asthma triggers, ad anxiety.

Asthma Assessments and Tests

• Objective assessment consists of signs of respiratory distress is impending failure, cyanosis, amount of respiratory effort, frequent vitals, auscultate for wheezing and decreased air movement, and patient assuming the tripod or hunched position.
• Diagnostic Tests:
  • ABG (hypoxia and hypercarbia).
  • PFT (airway reversibility, peak flow).
  • Chest x-ray (air trapping and hyperinflation), sputum culture.
  • CBC (increased eosinophils), and theophylline level.
  • Medical management, maintenance therapy(prevent or minimize symptoms), Bronchodilators (long-acting beta 2 agonists), inhaled corticosteroids, leukotriene inhibitors.
  • Acute or rescue therapy: Bronchodilators (short-acting beta 2 agonists), corticosteroids, epinephrine, IV aminophylline.
  • Oxygen should be started immediately in an acute attack.
  • A peak flow meter helps to monitor symptom severity.
  • It's important to identify, trigger, and establish nursing interventions.

Nursing Interventions- Bronchiectasis (asthma)

• Ineffective breathing patterns are related to a narrow airway.
• Interventions: Assess ventilation and respiratory effort, monitor signs of dyspnea, position to facilitate optimal ventilation, administer medications, assist with respiratory treatments, provide care in a calm manner, attempt to minimize exposure to triggers, and maintain adequate hydration.

Asthma Interventions and Prognosis

• Ineffective health maintenance, related to potential allergens in the home. -Assist in identifying allergens, facilitate allergy test, and teach the importance of allergy avoidance, discuss medication usage, use peak flow meter, and reasons to call the physician.
• The overall Prognosis: The death rate has reduced; however, status asthmaticus is a fatal prognosis if not reversed.

Bronchiectasis

• Clinical manifestations: Signs and symptoms appear after a respiratory tract infection. -Coughing when arising and lying down causes a copious foul-smelling sputum
• Other indicators are fatigue, weakness, loss of appetite, late signs, dyspnea, cyanosis, ad clubbing.
  • Etiology is that it all starts with chronic dilation of the bronchi is destroyed which ultimately degrades lung elasticity.

Bronchiectasis Etiology and Assessments

• This follows repeated lung infections, secondary to the failure of lung tissue defenses (cystic fibrosis, foreign body, or tumor).

• Complication of inflammation altering the pulmonary structures.

• Assessments subjective findings based on the patient stating dyspnea; fever; in addition or in conjunction with reporting a general weight loss. This can be followed by objective assessments signs includes dyspnea-cyanosis: which will then follow the manifestation of clubbing fingers-as well: this will further have paroxysmal coughing - foul-smelling sputum that occurs with both - fatigue, Crackles - wheezing occurs in lower hemoptysis regions- increased hematocrit- and a prolonged expiratory phase occurs.

Bronchiectasis Diagnostic and Treatment

• Diagnostic Testing uses the finding of -x -ray with the normal with noting is a -inflammation-mediational shift found - high-resolution CT scan will be checked -with further culture -sputum samples.

  • medical management: for low hemoptysis can also be increased by checking CT scans/pft(decrease-forcing expiratory)

• Medical management for Bronchiectasis includes

  • Low -Flow ( for hemoptysis to be minimized).
  • Physical therapy with the adequate intake.
  • Medications are given for Mucolytic, agent - bronchodilators and also include Antibiotics- as needed -Lobectomy- as conservative as can be made- that - if that not well as an option.

Nursing Interventions

• Secrete will check for any signs for pneumonia, with Adequate, with monitoring the Cool mist from outside from inside while checking.
• Assess vital, by checking oxygen,
  • coughing if the patient can check deep to promote better breathing or with turning with lung- sounds -Chest physiotherapy. -Maintain on giving - high-flow - or low with the assistance of oral- with the assistance of mouth cleaning with rest periods, with nursing is will provide what has a -ineffective- or what they can or cannot do. -Assess for those moments and will manage any - mobility with patient as is or without- also with assessing those will promote test: where those are not and those who those interventions are.
• The role of the nurse takes that that level of caring, while participating in the care.

Nursing for Respiratory Disorders

• The nursing process involves:
  • Participation in planning patient care, recommending revisions, following prioritizations, and utilizing standard clinical approaches.
• The assessment aims to find out levels of sensitivity that vital sign sounds lung has when they are shortness of breath is felt

-The assessment should consider

• Signs of the respiratory tract infection or distress which include flared nostrils, retrainments, and asymmetric chest expansion. -Patient problems identified are anxiousness, inability to clear airways and/or to maintain breathing patterns, tolerance activity oxygenation is less , nutrition.
• All those need to be meet with patience
• Expected outcomes in planning for lung problems
• A more sensitive breathing pattern requires a cleared airway. The oxygen needs maintain the -tolerance- of the lung -while maintaining tolerance .
• Effective implementation includes with patients tolerance so that they can do simple duties without dyspnea, while also evaluating how things are going by checking if any tolerances are working and lung are fine by listening to the patients the next time or moment needed.