Podcast
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?
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?
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?
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?
Before a thoracentesis, what is the nurse's responsibility?
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?
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?
Which of the following outcomes indicates improved gas exchange in a patient with an alteration in oxygenation and perfusion?
Which of the following outcomes indicates improved gas exchange in a patient with an alteration in oxygenation and perfusion?
What is the primary focus of nursing interventions related to oxygenation and perfusion?
What is the primary focus of nursing interventions related to oxygenation and perfusion?
Which of the following is the best way to prevent the flu?
Which of the following is the best way to prevent the flu?
What should adults minimally engage in per week for physical activity?
What should adults minimally engage in per week for physical activity?
What is a pollution-free environment particularly important for?
What is a pollution-free environment particularly important for?
A patient reports working in an environment with exposure to gaseous fumes. Which intervention is most important for the nurse to recommend?
A patient reports working in an environment with exposure to gaseous fumes. Which intervention is most important for the nurse to recommend?
What is the impact of cigarette smoke inhalation on the respiratory system?
What is the impact of cigarette smoke inhalation on the respiratory system?
Which environmental factor is most critical for a nurse to address when teaching a patient with asthma about managing their condition?
Which environmental factor is most critical for a nurse to address when teaching a patient with asthma about managing their condition?
What should be included in a healthy daily eating pattern?
What should be included in a healthy daily eating pattern?
According to the information provided, what is the primary role of nurses in smoking cessation?
According to the information provided, what is the primary role of nurses in smoking cessation?
What is the position typically used for a patient undergoing a thoracentesis to optimize access and comfort?
What is the position typically used for a patient undergoing a thoracentesis to optimize access and comfort?
Which action takes place immediately after the needle is inserted into the patient's pleural space?
Which action takes place immediately after the needle is inserted into the patient's pleural space?
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?
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?
Which population is at the greatest risk of serious illness and death from pneumococcal disease?
Which population is at the greatest risk of serious illness and death from pneumococcal disease?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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
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
Which of the following actions does the nurse need to take, in order, when caring for the patient?
Which of the following actions does the nurse need to take, in order, when caring for the patient?
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?
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?
According to one of the authors, which 3 questions should patients routinely ask?
According to one of the authors, which 3 questions should patients routinely ask?
A client with shortness of breath related to anxiety may benefit most from an intervention that focuses on:
A client with shortness of breath related to anxiety may benefit most from an intervention that focuses on:
Which of the following patients may benefit most from intervention from all disciplines related to oxygenation and perfusion?
Which of the following patients may benefit most from intervention from all disciplines related to oxygenation and perfusion?
Which intervention is the least likely to create supportive environment for patients dealing with anxiety?
Which intervention is the least likely to create supportive environment for patients dealing with anxiety?
What is the underlying mechanism behind the increased risk of serious illness from COVID-19 in individuals with cardiovascular disease?
What is the underlying mechanism behind the increased risk of serious illness from COVID-19 in individuals with cardiovascular disease?
When managing a patient post-thoracentesis, which sign or symptom indicates a priority need for immediate intervention due to a potential complication?
When managing a patient post-thoracentesis, which sign or symptom indicates a priority need for immediate intervention due to a potential complication?
According to the American Lung Association, which of the following diseases is smoking the leading cause of?
According to the American Lung Association, which of the following diseases is smoking the leading cause of?
A patient with COPD is being discharged home. Which statement indicates the best understanding of how to prevent further cardiopulmonary problems?
A patient with COPD is being discharged home. Which statement indicates the best understanding of how to prevent further cardiopulmonary problems?
How often, at least, should the office and home be cleaned if a patient has cardiopulmonary problems?
How often, at least, should the office and home be cleaned if a patient has cardiopulmonary problems?
A patient that is on comfort care tells the nurse to stop resuscitation if they were to stop breathing, what response is accurate?
A patient that is on comfort care tells the nurse to stop resuscitation if they were to stop breathing, what response is accurate?
What is the correct order for inserting a needle between ribs, into the intercostal muscles and fascia?
What is the correct order for inserting a needle between ribs, into the intercostal muscles and fascia?
According to the CDC, what age is considered eligible and encouraged to get the COVID-19 vaccine?
According to the CDC, what age is considered eligible and encouraged to get the COVID-19 vaccine?
Which of the following is NOT a fine pollutant that needs to be monitored?
Which of the following is NOT a fine pollutant that needs to be monitored?
Which of the following is NOT improved by having a well balanced diet?
Which of the following is NOT improved by having a well balanced diet?
As of 2020 what number of people had severe illness or death that would be categorized as a cardiopulmonary issue?
As of 2020 what number of people had severe illness or death that would be categorized as a cardiopulmonary issue?
What is the primary purpose of using a nasal cannula with incorporated CO2 sampling?
What is the primary purpose of using a nasal cannula with incorporated CO2 sampling?
Standard precautions are not necessary during a thoracentesis because the cavity being entered is sterile.
Standard precautions are not necessary during a thoracentesis because the cavity being entered is sterile.
Describe the typical positioning of a patient undergoing a thoracentesis.
Describe the typical positioning of a patient undergoing a thoracentesis.
The maximum amount of fluid generally removed during a thoracentesis at one time is between 1,200 to ______ mL.
The maximum amount of fluid generally removed during a thoracentesis at one time is between 1,200 to ______ mL.
Match the nursing responsibilities with their description:
Match the nursing responsibilities with their description:
Which of the following is a potential complication to assess for after a thoracentesis?
Which of the following is a potential complication to assess for after a thoracentesis?
A chest radiograph is typically done before a thoracentesis to verify the absence of complications.
A chest radiograph is typically done before a thoracentesis to verify the absence of complications.
List three potential signs and symptoms of Impaired Gas Exchange.
List three potential signs and symptoms of Impaired Gas Exchange.
Hyperventilation and tachypnea are potential signs and symptoms of impaired ______.
Hyperventilation and tachypnea are potential signs and symptoms of impaired ______.
Match the following interventions with their purpose in oxygenation and perfusion deficits:
Match the following interventions with their purpose in oxygenation and perfusion deficits:
When caring for patients with alterations in oxygenation and perfusion, general expected outcomes should list specific behaviors and criteria individualized for each patient situation.
When caring for patients with alterations in oxygenation and perfusion, general expected outcomes should list specific behaviors and criteria individualized for each patient situation.
Name three healthy lifestyle choices that can help prevent and manage cardiopulmonary diseases.
Name three healthy lifestyle choices that can help prevent and manage cardiopulmonary diseases.
Teaching patients with problems of oxygenation about ______ environments is an important part of respiratory management.
Teaching patients with problems of oxygenation about ______ environments is an important part of respiratory management.
Match each team member with their potential role in addressing oxygenation/perfusion:
Match each team member with their potential role in addressing oxygenation/perfusion:
Which of the following is a key consideration when caring for a patient with COPD to improve health literacy?
Which of the following is a key consideration when caring for a patient with COPD to improve health literacy?
All adults, regardless of age or health status, should receive the pneumococcal vaccine.
All adults, regardless of age or health status, should receive the pneumococcal vaccine.
List two types of people who are considered at high risk of serious complications from influenza.
List two types of people who are considered at high risk of serious complications from influenza.
COVID-19 is caused by a novel ______.
COVID-19 is caused by a novel ______.
Match preventative measures to correct disease.
Match preventative measures to correct disease.
Which population group is NOT explicitly mentioned as being at increased risk of getting sick and dying from COVID-19?
Which population group is NOT explicitly mentioned as being at increased risk of getting sick and dying from COVID-19?
As of early 2022, scientists and health care providers are complete with studying the effects of COVID-19 and vaccination.
As of early 2022, scientists and health care providers are complete with studying the effects of COVID-19 and vaccination.
List three fine pollutants that pose a hazard to health.
List three fine pollutants that pose a hazard to health.
[Blank] smoking causes reduced circulation by narrowing the blood vessels.
[Blank] smoking causes reduced circulation by narrowing the blood vessels.
Match the American Lung Association and American Heart Association with their offers.
Match the American Lung Association and American Heart Association with their offers.
Which action does NOT play a key role in nurses presenting information about the effects of smoking?
Which action does NOT play a key role in nurses presenting information about the effects of smoking?
It is not important to create an environment that is likely to reduce anxiety.
It is not important to create an environment that is likely to reduce anxiety.
Beneficial behaviors such as healthy eating should be incorporated into a patient's what.
Beneficial behaviors such as healthy eating should be incorporated into a patient's what.
Fine pollutants in the United States include carbon monoxide, sulfur dioxide, total suspended particulates, ______, and nitrogen dioxide that pose a hazard to health.
Fine pollutants in the United States include carbon monoxide, sulfur dioxide, total suspended particulates, ______, and nitrogen dioxide that pose a hazard to health.
Match the following terms with what they modify:
Match the following terms with what they modify:
Which of the following is NOT a recommendation for patients to help facilitate appropriate blood glucose level?
Which of the following is NOT a recommendation for patients to help facilitate appropriate blood glucose level?
Smokers do not need encouragement from nurses because they already know the effects of smoking.
Smokers do not need encouragement from nurses because they already know the effects of smoking.
Name 3 of the major 8 types of cancers that are greatly affected with an increase exposure to cigarette smoking.
Name 3 of the major 8 types of cancers that are greatly affected with an increase exposure to cigarette smoking.
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
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
Match the following disease/ailment with the most impacted group:
Match the following disease/ailment with the most impacted group:
A person with a history of chronic COPD and pneumonia exhibits which signs and symptoms?
A person with a history of chronic COPD and pneumonia exhibits which signs and symptoms?
A nurse should tell a patient with shortness of breathe due to anxiety of cardiac catheterization to lay down.
A nurse should tell a patient with shortness of breathe due to anxiety of cardiac catheterization to lay down.
What are the two types of pneumococcal vaccines available in the United States, each protecting against different numbers and types of pneumococcal bacteria.
What are the two types of pneumococcal vaccines available in the United States, each protecting against different numbers and types of pneumococcal bacteria.
When lung was punctured, ______ distress becomes acute.
When lung was punctured, ______ distress becomes acute.
Match the following term with their meanings:
Match the following term with their meanings:
Flashcards
Thoracentesis
Thoracentesis
A procedure to remove fluid or air from the pleural space using a needle.
Asepsis in Thoracentesis
Asepsis in Thoracentesis
Surgical asepsis is required due to entering a sterile cavity, plus standard and transmission-based precautions.
Patient Instructions During Thoracentesis
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
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
Post-Thoracentesis Assessment
Assess for pneumothorax, pain, hypotension, and pulmonary edema.
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Maximum Fluid Removal in Thoracentesis
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
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
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
Improve Patient Health Literacy
Teach, support, and refer patients to improve patient health literacy.
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Pneumococcal Disease
Pneumococcal Disease
The infection caused by a type of bacteria called pneumococcus.
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Influenza
Influenza
A contagious respiratory illness that causes mild to severe illness, and even death
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Teach about Pollution-Free Environments
Teach about Pollution-Free Environments
Isolate triggers, adjust to factors.
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Maintaining Good Nutrition
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
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
COVID-19
An infection caused by a novel coronavirus (SARS-CoV-2).
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Nasal Cannula with CO2 Sampling
Nasal Cannula with CO2 Sampling
Facilitates oxygen administration and CO2 sampling.
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Patient Position for Thoracentesis
Patient Position for Thoracentesis
Sitting with arms and shoulders raised or lying on the unaffected side.
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Post-Thoracentesis Monitoring
Post-Thoracentesis Monitoring
Check vital signs, lung sounds; watch for cough, dyspnea, or blood in sputum
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Impaired Gas Exchange
Impaired Gas Exchange
Compromised oxygen and carbon dioxide exchange in the lungs.
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Interventions: Oxygenation and Perfusion
Interventions: Oxygenation and Perfusion
Techniques to clear secretions and promote effective breathing.
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Interprofessional Collaboration
Interprofessional Collaboration
Teamwork and collaboration among professionals for care.
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Pneumonia
Pneumonia
Lung infection caused by bacteria, viruses, or fungi.
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Preventing Respiratory Infections
Preventing Respiratory Infections
Vaccination is a key strategy.
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Environmental Pollutants
Environmental Pollutants
Harmful substances in the air that can damage the lungs.
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Harmful Effects of Smoking
Harmful Effects of Smoking
Avoid smoking to promote lung function.
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Reducing Anxiety
Reducing Anxiety
Create a calm and supportive atmosphere.
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Promoting Optimal Function
Promoting Optimal Function
Lifestyle habits to maintain healthy oxygenation and perfusion.
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Ineffective Airway Clearance
Ineffective Airway Clearance
Problem clearing secretions from the airways.
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Impaired Breathing
Impaired Breathing
Difficulty breathing or the feeling of being short of breath.
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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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