Thoracentesis: Procedure and Positioning

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Questions and Answers

What is the generally accepted maximum amount of fluid that can be removed during a single thoracentesis to minimize the risk of cardiovascular collapse?

  • 500 to 750 mL
  • 1200 to 1500 mL (correct)
  • 1800 to 2000 mL
  • 800 to 1000 mL

During a thoracentesis, what instruction should the nurse provide to the patient to minimize the risk of accidental injury to the lung?

  • Cough forcefully to help expel any trapped air.
  • Remain as still as possible. (correct)
  • Breathe deeply to expand the lungs fully.
  • Alert the team of any pain felt.

After a thoracentesis, which assessment finding should be promptly reported to the health care team?

  • A small amount of serous drainage from the puncture site
  • The presence of blood in the sputum. (correct)
  • Mild discomfort at the puncture site
  • Slight decrease in oxygen saturation

Before a thoracentesis, what is the nurse's responsibility?

<p>Collecting baseline data on the patient. (C)</p> Signup and view all the answers

A patient with a history of COPD and recent pneumonia reports increased shortness of breath and thick, yellow secretions. Which of the following is the most appropriate nursing diagnosis?

<p>Ineffective Airway Clearance (A)</p> Signup and view all the answers

Which of the following outcomes indicates improved gas exchange in a patient with an alteration in oxygenation and perfusion?

<p>Pulse oximetry reading of more than 95%. (A)</p> Signup and view all the answers

What is the primary focus of nursing interventions related to oxygenation and perfusion?

<p>To promote optimal functioning of the cardiopulmonary systems. (B)</p> Signup and view all the answers

Which of the following is the best way to prevent the flu?

<p>Getting vaccinated annually (C)</p> Signup and view all the answers

What should adults minimally engage in per week for physical activity?

<p>Moderate effort activity, such as walking, for 2.5 to 5 hours (A)</p> Signup and view all the answers

What is a pollution-free environment particularly important for?

<p>People with cardiopulmonary problems (C)</p> Signup and view all the answers

A patient reports working in an environment with exposure to gaseous fumes. Which intervention is most important for the nurse to recommend?

<p>Restricting exposure to the fumes (B)</p> Signup and view all the answers

What is the impact of cigarette smoke inhalation on the respiratory system?

<p>It increases airway resistance. (B)</p> Signup and view all the answers

Which environmental factor is most critical for a nurse to address when teaching a patient with asthma about managing their condition?

<p>Strategies for creating a pollution-free environment (B)</p> Signup and view all the answers

What should be included in a healthy daily eating pattern?

<p>Variety of foods across food groups (C)</p> Signup and view all the answers

According to the information provided, what is the primary role of nurses in smoking cessation?

<p>To provide accurate information and support (A)</p> Signup and view all the answers

What is the position typically used for a patient undergoing a thoracentesis to optimize access and comfort?

<p>Sitting with arms and shoulders raised and supported (D)</p> Signup and view all the answers

Which action takes place immediately after the needle is inserted into the patient's pleural space?

<p>Needle is inserted between ribs (A)</p> Signup and view all the answers

A nurse is caring for a patient who expresses anxiety about upcoming cardiac catheterization results. Which nursing intervention is most appropriate to reduce the patient's anxiety?

<p>Providing factual information about the procedure (C)</p> Signup and view all the answers

Which population is at the greatest risk of serious illness and death from pneumococcal disease?

<p>Older adults (A)</p> Signup and view all the answers

If a nurse notes a patient is experiencing increased work of breathing, and SpO2 is 82% despite being on oxygen, which of the following should the nurse do first?

<p>Perform a thorough respiratory assessment, including auscultation of lung sounds (C)</p> Signup and view all the answers

When preparing a patient for thoracentesis, the nurse explains the procedure, including positioning and breathing instructions. What is the primary reason for instructing the patient not to cough or breathe deeply during the procedure?

<p>To reduce the risk of accidental injury to the lung. (A)</p> Signup and view all the answers

A nurse is providing discharge teaching for a patient with COPD. Which statement by the patient indicates a good understanding of health literacy principles related to their condition?

<p>&quot;I will ask my doctor to explain my COPD to me using simple terms so I can understand it better.&quot; (B)</p> Signup and view all the answers

A nurse is caring for a client who has a nursing diagnosis of 'Impaired Gas Exchange'. Which of the following nursing interventions would be most appropriate for this diagnosis?

<p>Elevating the head of the bed. (C)</p> Signup and view all the answers

Which intervention is most important for the nurse to include in the plan of care for a patient who has Impaired Breathing related to anxiety about upcoming cardiac surgery?

<p>Teaching effective coping mechanisms and relaxation techniques. (C)</p> Signup and view all the answers

How many years should adults younger than 65 who smoke cigarettes, and people ages 2 through 64 years with certain medical conditions receive pneumococcal vaccines

<p>Under 65 that smoke and 2-64 need the vaccine (D)</p> Signup and view all the answers

Which of the following actions does the nurse need to take, in order, when caring for the patient?

<p>Assess, Address, Monitor (A)</p> Signup and view all the answers

Mr. Romanov was diagnosed with COPD. He tells the nurse that he doesn't really think that he can use "all these medications, especially that breathing thing," and doesn't really understand what COPD is. He asks, "Do you think my smoking is making me worse?" What should the nurse do, in order, to help the patient?

<p>Give easy read info; have him ask provider (A)</p> Signup and view all the answers

According to one of the authors, which 3 questions should patients routinely ask?

<p>What is my main problem; What do I need to do; Why is it important for me to do this? (B)</p> Signup and view all the answers

A client with shortness of breath related to anxiety may benefit most from an intervention that focuses on:

<p>Coping mechanism education. (D)</p> Signup and view all the answers

Which of the following patients may benefit most from intervention from all disciplines related to oxygenation and perfusion?

<p>40 year old post MI who continues to smoke, refuses to follow instructions, and won't attend group. (A)</p> Signup and view all the answers

Which intervention is the least likely to create supportive environment for patients dealing with anxiety?

<p>Being judgmental regarding harmful habits. (A)</p> Signup and view all the answers

What is the underlying mechanism behind the increased risk of serious illness from COVID-19 in individuals with cardiovascular disease?

<p>The virus triggers systemic inflammation exacerbating existing heart conditions and increasing risk of complications. (D)</p> Signup and view all the answers

When managing a patient post-thoracentesis, which sign or symptom indicates a priority need for immediate intervention due to a potential complication?

<p>Sudden onset of sharp chest pain and increasing dyspnea. (D)</p> Signup and view all the answers

According to the American Lung Association, which of the following diseases is smoking the leading cause of?

<p>COPD (B)</p> Signup and view all the answers

A patient with COPD is being discharged home. Which statement indicates the best understanding of how to prevent further cardiopulmonary problems?

<p>&quot;I will continue to monitor my symptoms and make lifestyle changes to reduce symptom severity.&quot; (A)</p> Signup and view all the answers

How often, at least, should the office and home be cleaned if a patient has cardiopulmonary problems?

<p>Twice per week (C)</p> Signup and view all the answers

A patient that is on comfort care tells the nurse to stop resuscitation if they were to stop breathing, what response is accurate?

<p>The nurse needs to act ethically and legally to ensure the patient's rights. (B)</p> Signup and view all the answers

What is the correct order for inserting a needle between ribs, into the intercostal muscles and fascia?

<p>Once spot is identified, antiseptic. Local anesthesia takes effect, needle inserted. (C)</p> Signup and view all the answers

According to the CDC, what age is considered eligible and encouraged to get the COVID-19 vaccine?

<p>Everyone ages 5 years and older is eligible (C)</p> Signup and view all the answers

Which of the following is NOT a fine pollutant that needs to be monitored?

<p>Radon (C)</p> Signup and view all the answers

Which of the following is NOT improved by having a well balanced diet?

<p>Increase the likelihood of a car accident (B)</p> Signup and view all the answers

As of 2020 what number of people had severe illness or death that would be categorized as a cardiopulmonary issue?

<p>The document doesn't state directly (B)</p> Signup and view all the answers

What is the primary purpose of using a nasal cannula with incorporated CO2 sampling?

<p>To monitor carbon dioxide levels during oxygen administration. (B)</p> Signup and view all the answers

Standard precautions are not necessary during a thoracentesis because the cavity being entered is sterile.

<p>False (B)</p> Signup and view all the answers

Describe the typical positioning of a patient undergoing a thoracentesis.

<p>Sitting on a chair or the edge of the bed with the legs supported and the arms and shoulders raised, or lying on the unaffected side.</p> Signup and view all the answers

The maximum amount of fluid generally removed during a thoracentesis at one time is between 1,200 to ______ mL.

<p>1,500</p> Signup and view all the answers

Match the nursing responsibilities with their description:

<p>Before the procedure = Collect baseline data and prepare the patient physically and emotionally. During the procedure = Observe the patient's reactions and monitor vital signs. After the procedure = Assess for complications and monitor the puncture site.</p> Signup and view all the answers

Which of the following is a potential complication to assess for after a thoracentesis?

<p>Pneumothorax (B)</p> Signup and view all the answers

A chest radiograph is typically done before a thoracentesis to verify the absence of complications.

<p>False (B)</p> Signup and view all the answers

List three potential signs and symptoms of Impaired Gas Exchange.

<p>Pursed-lip breathing, sitting hunched forward, altered blood gases showing respiratory acidosis</p> Signup and view all the answers

Hyperventilation and tachypnea are potential signs and symptoms of impaired ______.

<p>breathing</p> Signup and view all the answers

Match the following interventions with their purpose in oxygenation and perfusion deficits:

<p>Promote optimal functioning = Aim to improve the function of the cardiopulmonary systems and promote comfort. Control coughing = To remove irritants and secretions from the airways Suctioning the airway = To clear obstructions and improve breathing</p> Signup and view all the answers

When caring for patients with alterations in oxygenation and perfusion, general expected outcomes should list specific behaviors and criteria individualized for each patient situation.

<p>True (A)</p> Signup and view all the answers

Name three healthy lifestyle choices that can help prevent and manage cardiopulmonary diseases.

<p>Healthy eating, maintaining a healthy weight, regular exercise</p> Signup and view all the answers

Teaching patients with problems of oxygenation about ______ environments is an important part of respiratory management.

<p>pollution-free</p> Signup and view all the answers

Match each team member with their potential role in addressing oxygenation/perfusion:

<p>Nurses = Assess, address, and monitor oxygenation/perfusion-related care issues Respiratory therapists = Manage respiratory therapies and equipment Physicians = Diagnose and prescribe treatments</p> Signup and view all the answers

Which of the following is a key consideration when caring for a patient with COPD to improve health literacy?

<p>Providing easy-to-read information and encouraging questions. (C)</p> Signup and view all the answers

All adults, regardless of age or health status, should receive the pneumococcal vaccine.

<p>False (B)</p> Signup and view all the answers

List two types of people who are considered at high risk of serious complications from influenza.

<p>Young children, pregnant women</p> Signup and view all the answers

COVID-19 is caused by a novel ______.

<p>coronavirus</p> Signup and view all the answers

Match preventative measures to correct disease.

<p>Influenza = Yearly vaccine Pneumococcal disease = Vaccine recommended for children under 2 and adults over 65. COVID-19 = Vaccines available for people 5 years and older.</p> Signup and view all the answers

Which population group is NOT explicitly mentioned as being at increased risk of getting sick and dying from COVID-19?

<p>Individuals with high blood pressure (C)</p> Signup and view all the answers

As of early 2022, scientists and health care providers are complete with studying the effects of COVID-19 and vaccination.

<p>False (B)</p> Signup and view all the answers

List three fine pollutants that pose a hazard to health.

<p>Carbon monoxide, sulfur dioxide, ozone</p> Signup and view all the answers

[Blank] smoking causes reduced circulation by narrowing the blood vessels.

<p>Cigarette</p> Signup and view all the answers

Match the American Lung Association and American Heart Association with their offers.

<p>American Lung Association = Offers free educational materials online to aid and support patients who are trying to stop smoking. American Heart Association = Offers free educational materials online to aid and support patients who are trying to stop smoking.</p> Signup and view all the answers

Which action does NOT play a key role in nurses presenting information about the effects of smoking?

<p>Discouraging to never start smoking. (B)</p> Signup and view all the answers

It is not important to create an environment that is likely to reduce anxiety.

<p>False (B)</p> Signup and view all the answers

Beneficial behaviors such as healthy eating should be incorporated into a patient's what.

<p>daily activities</p> Signup and view all the answers

Fine pollutants in the United States include carbon monoxide, sulfur dioxide, total suspended particulates, ______, and nitrogen dioxide that pose a hazard to health.

<p>ozone</p> Signup and view all the answers

Match the following terms with what they modify:

<p>cigarette smoking = major risk factor in cardiopulmonary diseases inhalation of cigarette smoke = increases airway resistance diet = can help patients reduce their risk for chronic diseases</p> Signup and view all the answers

Which of the following is NOT a recommendation for patients to help facilitate appropriate blood glucose level?

<p>avoid intake of fruits (B)</p> Signup and view all the answers

Smokers do not need encouragement from nurses because they already know the effects of smoking.

<p>False (B)</p> Signup and view all the answers

Name 3 of the major 8 types of cancers that are greatly affected with an increase exposure to cigarette smoking.

<p>Cancers of the oral cavity, throat, larynx</p> Signup and view all the answers

Patients should continue to eat healthy patterns that include: fruits and vegetables, ______ dairy products, whole grains, a variety of protein foods, and reduced amounts of saturated fats and trans fats, added sugars, and sodium

<p>low-fat</p> Signup and view all the answers

Match the following disease/ailment with the most impacted group:

<p>Influenza = young children Pneumonococcal Disease = older adults COVID-19 = people with disabilities</p> Signup and view all the answers

A person with a history of chronic COPD and pneumonia exhibits which signs and symptoms?

<p>Reports shortness of breath for 1 week (A)</p> Signup and view all the answers

A nurse should tell a patient with shortness of breathe due to anxiety of cardiac catheterization to lay down.

<p>False (B)</p> Signup and view all the answers

What are the two types of pneumococcal vaccines available in the United States, each protecting against different numbers and types of pneumococcal bacteria.

<p>There are two main pneumococcal vaccines: PCV13 and PPSV23.</p> Signup and view all the answers

When lung was punctured, ______ distress becomes acute.

<p>respiratory</p> Signup and view all the answers

Match the following term with their meanings:

<p>Ineffective Cough = Inability to clear secretions from the airway Circumoral Cyanosis = Bluish discoloration around the mouth due to lack of oxygen Tachypnea = Rapid breathing rate</p> Signup and view all the answers

Flashcards

Thoracentesis

A procedure to remove fluid or air from the pleural space using a needle.

Asepsis in Thoracentesis

Surgical asepsis is required due to entering a sterile cavity, plus standard and transmission-based precautions.

Patient Instructions During Thoracentesis

Administer analgesics and encourage the patient not to cough or breathe deeply and remain as still as possible

Monitoring During Thoracentesis

Monitor color, pulse, O2 saturation, respiratory rates, and be alert for fainting, nausea, or vomiting.

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Post-Thoracentesis Assessment

Assess for pneumothorax, pain, hypotension, and pulmonary edema.

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Maximum Fluid Removal in Thoracentesis

The maximum amount of fluid removed at one time is generally 1,200 to 1,500 mL, to reduce the risk of cardiovascular collapse from rapid removal of too much fluid

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Expected Outcomes of Oxygenation/Perfusion Interventions

To maintain or restore optimum function, alleviate symptoms, or prevent complications related to oxygenation and perfusion.

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General Expected Outcomes for Patients with Oxygenation/Perfusion Alterations

Demonstrates improved gas exchange, relates causative factors, preserves cardiopulmonary function, prevents further cardiopulmonary problems

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Improve Patient Health Literacy

Teach, support, and refer patients to improve patient health literacy.

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Pneumococcal Disease

The infection caused by a type of bacteria called pneumococcus.

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Influenza

A contagious respiratory illness that causes mild to severe illness, and even death

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Teach about Pollution-Free Environments

Isolate triggers, adjust to factors.

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Maintaining Good Nutrition

Follow healthy eating patterns, nutrient-dense foods and beverages, fruits and vegetables, whole grains and variety of protein foods.

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Patient Asks Questions

Ask: What is my main problem? What do I need to do? Why is it important for me to do this?

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COVID-19

An infection caused by a novel coronavirus (SARS-CoV-2).

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Nasal Cannula with CO2 Sampling

Facilitates oxygen administration and CO2 sampling.

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Patient Position for Thoracentesis

Sitting with arms and shoulders raised or lying on the unaffected side.

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Post-Thoracentesis Monitoring

Check vital signs, lung sounds; watch for cough, dyspnea, or blood in sputum

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Impaired Gas Exchange

Compromised oxygen and carbon dioxide exchange in the lungs.

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Interventions: Oxygenation and Perfusion

Techniques to clear secretions and promote effective breathing.

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Interprofessional Collaboration

Teamwork and collaboration among professionals for care.

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Pneumonia

Lung infection caused by bacteria, viruses, or fungi.

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Preventing Respiratory Infections

Vaccination is a key strategy.

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Environmental Pollutants

Harmful substances in the air that can damage the lungs.

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Harmful Effects of Smoking

Avoid smoking to promote lung function.

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Reducing Anxiety

Create a calm and supportive atmosphere.

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Promoting Optimal Function

Lifestyle habits to maintain healthy oxygenation and perfusion.

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Ineffective Airway Clearance

Problem clearing secretions from the airways.

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Impaired Breathing

Difficulty breathing or the feeling of being short of breath.

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Study Notes

Thoracentesis Procedure and Patient Positioning

  • A thoracentesis is typically performed with the patient sitting on a chair or the edge of the bed, with arms and shoulders raised, supported by a pillow on a bedside table.
  • If the patient cannot sit up, they may lie on their unaffected side with the affected side's hand raised above the shoulder.
  • A local anesthetic is used to minimize pain and discomfort during the procedure.

Needle Insertion and Fluid Removal

  • The needle insertion location depends on where fluid is present and accessible.
  • The skin is cleansed with an antimicrobial agent before needle insertion.
  • After the anesthetic takes effect, the needle is inserted between the ribs, through intercostal muscles, fascia, and into the pleura.
  • After needle removal, a sterile dressing is placed over the entry site.
  • The fluid can be removed from the pleural cavity with a syringe or by draining it into a vacuum-sealed bottle where a plastic catheter may be threaded through the needle, reducing the possibility of puncturing the lung.
  • A calibrated bottle is used to collect drainage, allowing the determination of fluid amount removed.
  • The maximum fluid amount removed at one time is 1,200 to 1,500 mL to reduce the risk of cardiovascular collapse.

Nursing Responsibilities During Thoracentesis

  • The nurse is responsible for collecting baseline data and preparing the patient physically and emotionally for the procedure.
  • The patient should be instructed not to cough or breathe deeply during the procedure and to remain still as possible to diminish the risk for accidental injury to the lung.
  • Administer analgesics as ordered before the procedure.
  • The nurse should monitor the patient's color, pulse, oxygen saturation, and respiratory rates during the procedure and communicate any deviations from the patient's baseline to the healthcare team.
  • Fainting, nausea, and vomiting may occur.
  • If not applied already, dress the wound with a sterile dressing.
  • Ensure any extracted specimens are taken to the laboratory immediately.

Post-Thoracentesis Assessment

  • Assess the patient for complications such as pneumothorax, pain, hypotension, and pulmonary edema.
  • Monitor vital signs, especially respirations and oxygen saturation.
  • Monitor lung sounds and assess for the presence or worsening of cough or dyspnea.
  • If a large fluid amount was removed, respirations become easier and if the lung was punctured, respiratory distress becomes acute.
  • If blood appears in the sputum or the patient has severe coughing, notify the health care team promptly.
  • Monitor the puncture site and conduct a chest radiograph after the procedure to verify the absence of complications.

Diagnosing Health Problems

  • Assessment of oxygenation and perfusion status leads to identification of potential or actual health problems and needs.
  • The nurse communicates findings to other healthcare professionals through spoken and written word.

Outcomes for Alterations in Oxygen Perfusion

  • Demonstrate improved gas exchange in the lungs by an absence of cyanosis or chest pain and a pulse oximetry reading more than 95%.
  • Relate causative factors and demonstrate coping methods.
  • Preserve cardiopulmonary function by maintaining activity levels.
  • Demonstrate self-care behaviors to prevent respiratory problems

Implementing Plan

  • Methods to improve oxygenation and perfusion include promoting comfort, controlling coughing, suctioning the airway, giving medications, providing oxygen, and managing chest tubes.

Teamwork

  • Nurses, respiratory therapists, physicians, and other professionals assess, address, and monitor oxygenation and perfusion issues.

Promoting Oxygen Function

  • Lifestyle choices include healthy behaviors and vaccinations.
  • Vaccinations can prevent respiratory infections.
  • Teaching patients about pollution-free environments is important.
  • Minimizing patient anxiety promotes optimal functioning.
  • Promoting good nutrition is also a vital part of promoting optimal cardiopulmonary functioning.

Patient Health Literacy: COPD Example

  • COPD affects breathing over time, medication use, smoking.
  • The key questions include: what is main problem?, what do I need to do?, and why is it important?.

Health Lifestyle

  • Patients should practice health-related behaviors and eat a healthy diet.
  • Recommended activity: 2.5-5 hours weekly moderate effort.
  • Monitor cholesterol, triglycerides, HDLs, LDLs, and blood pressure.
  • Encourage lower alcohol intake and smoking cessation.

Vaccinations

  • Flu vaccinations can prevent respiratory illness that causes even death.
  • Everyone ages 6 months plus should get a flu shot each year; children, pregnant women, health issues.
  • Pneumonia vaccinations can prevent severe disease.
  • Recommended for young children, adults 65 and older, adults age 19 to 64 years who smoke.

Covid-19

  • COVID-19 is a disease that became a pandemic in late 2019.
  • Most people infected with the COVID-19 experience mild to moderate respiratory illness.
  • Various groups of people are at increased risk of getting sick and dying from COVID-19.
  • COVID vaccines are effective at protecting patients from getting COVID-19
  • Everyone ages 5 years and older is eligible and encouraged to get a COVID-19 vaccination.

Pollution Free Environment

  • Assess the environment and make adjustments
  • Home and office dusting should be done at least twice a week.
  • Restrict industrial/occupational hazards like paint, varnish, gaseous fumes, and asbestos.
  • When there is a pollution alert, lower activity, stay indoors, use an air conditioner, air cleaner, or air filter.

Smoking

  • Smoking increases airway resistance, reduces ciliary action, increases mucus production, etc.
  • Smoking is the biggest risk factor for COPD and increases the risk for many types of cancer.
  • Provide accurate information about effects of smoking.
  • Encourage the decision to never start smoking or to stop smoking.

Reducing Anxiety

  • Create an environment that is most likely to reduce anxiety.
  • Alleviate discomfort immediately through listening and observing skills.
  • Patients with anxieties are more willing to work toward achieving goals.

Maintaining Good Nutrition

  • Beneficial behaviors, such as healthy eating, should be incorporated into a patient's daily activities.
  • Encourage patients to follow healthy eating patterns that include a variety of nutrient-dense foods and beverages across all food groups.
  • Beneficial to patients for reducing their risk for chronic disease such as cardiopulmonary diseases and diabetes.

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