Respiratory System Lecture 2025 - Nursing Care, Symptoms, and Diagnosis of Respiratory Disorders

Respiratory System Influenza Pneumonia Tuberculosis Restrictive Lungs Disease COPD By Professor Ruth Thuo MSN RN 2 Learning Objectives 1. Explain key terms and medical terminology related to selected respiratory disorders. 2. Apply knowledge of the pathophysiology of selected respiratory...

Respiratory System Influenza Pneumonia Tuberculosis Restrictive Lungs Disease COPD By Professor Ruth Thuo MSN RN 2 Learning Objectives 1. Explain key terms and medical terminology related to selected respiratory disorders. 2. Apply knowledge of the pathophysiology of selected respiratory disorders in the adult pneumonia, aspiration, lung abscess, TB, Lung CA, COPD, oxygenation and occupational diseases. 3. Apply the nursing process in the maintenance of health and promotion of self care of the adult patient with respiratory disorders. 4. Relate diagnostic tests to the patient with respiratory disorders. 5. Apply pharmacotherapeutics to the treatment of the adult patient with respiratory disorders. 3 Learning Objectives 6. Determine the normal developmental changes and the changes of aging as they pertain to the patient with respiratory disorders. 7. Articulate nursing responsibilities regarding nutritional requirements of the patient with respiratory disorders. 8. Develop health promotion and maintenance practices as they relate to the patient with acute and chronic respiratory disease. 9. Determine unique teaching/learning needs of the patient with selected respiratory disorders. 4 Learning Objectives 10. Demonstrate the ability to deliver dignified nursing care which considers the diverse cultural needs of the patient with respiratory conditions. 11. Utilize verbal and non-verbal communication techniques effectively when delivering care to patients experiencing common health care deviations. 12. Discuss principles of safety and efficient use of systems resources in the care of the patient experiencing common health care deviations related to air. Normal Anatomy and Physiology 1, 2 5 6 Nursing Health History Risk factors  Smoking and 2nd hand smoking  Family history  Genetics  Allergens/pollutants  Exposure….. occupatio nal General Signs and Symptoms 7  Dyspnea-Shortness of breath, DOE-dyspnea on exertion, Orthopnea, PND-paroxysmal nocturnal dyspnea- may be cardiac, waking up suddenly and having extreme difficulty with breathing  Wheezing  Club Fingers  Cough- Does the coughing cause chest pain or is there chest pain when the person coughs (Pleuritic)  Sputum production/ vs Hemoptysis- could be cardiac, pulmonary, nasal, stomach or gums  Cyanosis- very late sign  Chest pain 8 Objective Assessment Symmetry: Normal antero-posterior to lateral (ratio 1:2) Assess spine. Respiratory pattern: Rate, depth, rhythm and accessory muscle use Breathing Patterns: Tachypnea- rapid >20, Bradypnea- slow Exp: Heard over lung fields Bronchovesicular- 1st and 2nd interspaces anteriorly Bronchial- Over Manubrium Tracheal- Over the trachea Remember: Three lobes on the right side and 2 lobes on the left Abnormal (adventitious) breath sounds: Crackles (fine, coarse), Wheezes, Friction rubs 9  Changes with Aging Alveolar surface area decreases, Elastic recoil decreases Chest wall compliance decreases, Vital capacity decreases while residual volume increases Efficiency of the O2/CO2 exchange decreases Respiratory muscle strength decreases Large bronchi and alveoli become enlarged Ciliary (cilia numbers) mobility decreases Vascular resistance increases Vital capacity is Total Volume+ Inspiratory Reserve+ Expiratory Reserve 10 11 Crackles Primarily heard during inspiration : CHF, COPD, PNA From collapsed or waterlogged alveoli Fine: beginning of fluid buildup or atelectasis Coarse: greater volume of fluid buildup Management  Manage fluids and Promote expectoration  Wheezes Sonorous wheezes (rhonchi)- deep, low-pitched, during expiration, narrowed passages due to secretions usually. Sibilant wheezes- continuous, high- pitched, whistle-like sounds. I & E. Narrowed passageways (secretions, broncho-spasms). Interventions  Deep Breathing & cough, hydration (2-3 liters per day), humidify air, mobilization of secretions, possibly bronchodilation. 12 13 Friction Rub A creaking, leathery, grating sound heard at the end of inspiration and beginning of expiration Caused by rubbing of inflamed pleural surfaces against lung tissue Interventions- CXR to diagnose, anti-inflammatory medications (such as steroids) 14 Diagnostic Tests Pulmonary function tests -Also looking at height, weight and trending changes Sputum (not saliva) tests- May need to suction or do during an endoscopy Chest X-ray- 2 views PA and Lateral, can view densities, fluid (pleural effusion), collapse such as Pneumothorax or atelectasis Blood Cultures Pulse Oximetry 95-100%  Other Diagnostic Tests ❖Computed tomography (CT) ❖Magnetic resonance imaging (MRI) ❖Fluoroscopic studies and angiography- Dyes ❖Radioisotope procedures (lung scans)- ❖V/Q scan- (Ventilation perfusion abnormalities), ❖Gallium scan- (Inflammations, abscess), ❖PET (Cancer nodules) ❖Biopsies 15 Thoracentesis:  Remove pleural fluid to improve O2, Biopsy, Study fluid (cultures and cytology)  Instill medication to Treat pneumothorax 16  Pressure, bed rest, CXR  Observe for complications- distress, asymmetry, bleeding, infection If cancer, can instill cytotoxic meds directly. 17 Arterial Blood Gases and ROME Measures arterial O2 and CO2 levels. Assess adequacy of alveolar ventilation and ability of the lungs to provide O2 and remove Assess acid-base balance and kidney function 18 Nursing responsibilities pre & post- bronchoscopy Assure surgical consent NPO x 6 hours pre procedure Remove dentures Patient teaching- IV Local Anesthetic Preop meds- Conscious Sedation/ Atropine Cold vs the Flu 19 Influenza  Highly contagious infection that is rapidly spread from one individual to another.  Influenza A is most severe due to mutation  Mutation of flu viruses makes people susceptible lifelong  Risk factors: old or young age, occupation, close living quarters, immunocompromise, chronic illness, pregnancy  Influenza infection is the aerosolization of small droplets  Fomites are inanimate objects that can carry organisms and facilitate their transfer from one person to another, such as stethoscopes, scissors, or pens.  Influenza Treatment & Complications  Prevent by annual vaccination Treatment  Antipyretics/analgesics for fever and aches, adequate fluid intake to avoid dehydration, and rest are typically prescribed.  Antiviral medications for prophylaxis or treatment  Start within 24-48 hours of symptom start  Major complication: progressive SOB, persistent fever, and cardiovascular compromise, bacterial pneumonia and Streptococcus pneumoniae. Antivirals  Rimantadine (Flumadine) -Used to control outbreaks of Influenza A  Oseltamivir (Tamiflu)- Used to treat flu virus Reduction of recovery for 1-2 days Take with or without food Life threatening arrhythmias (rare but serious)  Amantadine (Symmetrel)- Blocks the uncoating of the virus, preventing penetration to the host Side effects o Dizziness o Lightheadedness o Nervousness with anxiety o Inability to concentrate  Zanamivir (Relenza) Disk inhaler delivery system Use cautiously with COPD and asthmatic patients  Question The nurse understands that teaching has been effective when the patient verbalizes the following regarding influenza vaccinations: a) “If I have already had the vaccine last year, it is not recommended that I get it again this year.” b) “Since the vaccine is the live virus, I can expect to be ill for 4-7 days after receiving my shot.” c) “Influenza vaccines are a cure for the flu.” d) “The vaccine is an inactivated virus but may cause some mild cold-like symptoms.” Pneumonia 24  Pneumonia- PNA: Most common cause of death amongst the elderly 25  Types of Pneumonia (PNA)  CAP- Community Acquired Pneumonia- within 48 hours after Hospitalization  HCAP- Health Care Associated Pneumonia (Multi Drug Resistance) 26  HAP- Hospital Acquired Pneumonia  VAP- Ventilator Acquired Pneumonia Aspiration Pneumonia- Aspiration- Careful with Tube Feedings Staph pneumoniae, H. Influenza, Staph aureus), or stomach contents, chemicals, gases.  PCP: Pneumocystis Jirovecii Pneumonia (immunocompromised people)  Pathophysiology of PNA: Organisms enter via airways or bloodborne route and become trapped in the pulmonary capillary bed Acute inflammation of the lung parenchyma (Lung Tissue)-Many are bacterial *** Viral with kids) Microbes spread in alveoli activating an inflammatory and immune response Edema due to Antigen/ Antibody Ag/Ab response- damage to membranes of bronchioles and alveoli. (Antigen- Exposure, Antibody- Reaction Cellular debris and exudate fill/clog alveoli resulting in impaired gas exchange. 27  Pneumonia (PNA)Pathophysiology Organisms inflame the tissue of the lung (Parenchyma) Causes swelling Impaired gas exchange. 8th Leading cause of death 28 Pneumonia- Outcomes/ Goals of care Prevention of Improved airway clearance complications Adequate rest and energy conservation Septic Shock Adequate fluid volume Respiratory Adequate nutrition Failure Knowledge of care and future prevention Pleural Effusions Absence of complications 29 Empyema  Aspiration  Aspiration occur when the protective airway reflexes are decreased or absent resulting in inhalation of foreign material (e.g., oropharyngeal or stomach contents, colonized oral or pharyngeal material) into the lungs causing pneumonia.  Complication of aspiration that can cause pneumonia can result in tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potentially death.  Pathophysiology  The primary factors responsible for death and complications after aspiration are the volume and character of the aspirated contents. The pathologic process involves an acute inflammatory response to bacteria and bacterial products. Most commonly, the causative organisms in community-acquired aspiration pneumonia may include S. aureus, S. pneumoniae, H. influenzae, and Enterobacter species.  Prevent Aspiration  Maintain head-of-bed elevation at an angle of 30 to 45 degrees, unless contraindicated  Use sedatives as sparingly as possible  Before initiating enteral tube feeding, confirm the tip location  For patients receiving tube feedings, assess placement of the feeding tube at 4-hour intervals, assess for gastrointestinal residuals (2 days  Maintain endotracheal cuff pressures at an appropriate level, and ensure that secretions are cleared from above the cuff before it is deflated.  Lung Abscess  A lung abscess is a localized collection of pus caused by aspiration of anaerobic bacteria. The chest x-ray demonstrates a cavity of at least 2 cm.  Patients who are at risk for aspiration of foreign material and development of those with impaired cough reflexes who cannot close the glottis and those with swallowing difficulty, CNS disorders (e.g., seizure, stroke), Substance use disorder, compromised immune function; Patients without teeth and those receiving nasogastric tube feedings; Patients with an altered state of consciousness due to anesthesia (Bartlett, 2019a).  Pathophysiology Most lung abscesses are caused by aspiration of oral anaerobes into the lung due to mechanical or functional obstruction of the bronchi by a tumor, foreign body, or bronchial stenosis, or from necrotizing pneumonias, TB, pulmonary embolism (PE), or chest trauma. Tuberculosis (TB)  Nonproductive cough at first Frequent cough with copious frothy pink sputum History of exposure to someone who has 34 TB 1/18/18 + Mantoux test  TB Statistics 1/3 of world infected, leading cause of death from an infectious disease. Formerly called Consumption. It is communicable and reportable. Pulmonary TB- Affects the lungs, but it can affect other areas of the body such as kidneys, bone and cerebral cortex. Occurs 2-10 weeks after exposure 35 36 What is it?  Mycobacterium tuberculosis- acid-fast gram- positive bacillus (meaning when gram stained it is not readily decolorized). It is light and heat sensitive.  Can be airborne/droplet spread- looking at time of exposure, close contact, closed off environment.  Ghon tubercle- seen on CXR. It is a granulomatous Mass fibrous & dormant. But it can reactivate, ulcerate and spread, the person is contagious. (calcification remains of the primary lesion)  Risk factors for TB Medically underserved Recent immigrants from countries with high rate of TB Domestic or occupational contact with TB- health workers Long term care facilities, prisons, shelters Frequent close contact to infected persons Alcoholics and IV drug abusers Chronic disease persons that are immunosuppressed 37  Mantoux Test:  CDC guidelines” results are interpreted Within context of social history.  +5 mm with HIV or Immunosuppressed (such as an organ transplant)  +10 mm if high risk job, children < 4- HR living or Work environment  +15 mm in anyone else- no risk factors  If +10 mm, CXR within 72 hours.  If symptomatic, Sputum culture X3 38 Mantoux Tests: False Positives  Will be a false positive with BCG vaccine Bacilli Calmette Guerin which has been given in Canada, Europe, Latin America (76% effective)  False negs- immunosuppressed, recent live virus vaccination such as measles or smallpox,  Anergy- False negative due to the inability to produce a reaction 39  Diagnostic Studies  PPD for screening (two step protocol for new employees  CXR for baseline if positive  Sputum for gram stain (acid-fast bacillus)or M. Tuberculosis-Definitive Diagnosis  QuantiFERON-TB Gold Test- (QFT-G) are not affected by the BCG vaccine 40  Medication combinations- Careful 41 with compliance and resistance Active Disease Treatment Initial- Isoniazid (INH), Rifampin (RIF) Pyrazinamide(PRZ) & ethambutol X 8 weeks Continuation- INH, RIF for 18 weeks, Vitamin B6 50 mg (prevents leg numbness as tingling). Latent Disease- prophylaxis INH for 6- 9 months: Decreases vitamin B6 High risk- INH for 12 months Per CDC- CX done q2-4 weeks, Active TB when + CX. Masks in public. Non-infectious after 3 neg cultures. Decreased transmission risk after 3 weeks of antibiotics. http://www.cdc.gov/tb/publications/factsheets/default.htm 42 Nursing care of patient with TB Preventing spread of TB Precautions  Private room with negative airflow system, Specially fitted N95 Respirator Mask, Masks for visitors  Gowns and masks for secretions  Infection control  Medication compliance is key  Airway clearance- Sputum cultures  Activity promotion and Nutrition 43 Occupational Lung Diseases; Pneumoconioses  Causative agents- Exposure to mineral or inorganic dust damaging the parenchyma and causing pulmonary fibrosis. For example, coal miners, talc, toxic fumes. Substance is deposited and tissue damaged. Cumulative effect with smoking as well.  Role of the Occupational Health nurse as employee advocate  Role of nurse in health education and in teaching of preventive measures  Role of implementing OSHA standards 44 Restrictive Lung Diseases: Coal Worker’s pneumoconiosis- Black Lung Disease Restrictive Lung Diseases: Silicosis 45  Restrictive Lung Diseases: Asbestosis: Asbestosis- asbestos dust from demolition. Risk for lung CA. Progressive and destructive. Asbestos was part of insulation- fibrous incombustible form of magnesium and calcium silicate- no longer sold in the US. 46 Restrictive Lung Diseases: Prevention and Causes Lung CA (bronchogenic carcinoma)  #1 Killer and #1 Cancer of people in their 50’s  Causes: By a single cell, “allowed” to replicate  Tends to arise from scarred tissue (ie Fibrosis)  Cigarette Smoking- 90% of cases  Radon, Asbestos, Genetics  Diet: Low in Fruits and Vegetables (Antioxidants) 47 Classification of Lung Cancers: Type of Lung CA  Small cell (SCLS) 10-15% vs Non-small cell (NSCLC) 85-90%  NSCLC- Squamous Cell Carcinoma- centrally located- Bronchi  NSCLC- Large Cell Carcinoma- Fast growing, arises peripherally  NSCLC- Adenocarcinoma- Most prevalent- Occurs peripherally, often metastasizes  NSCLC-Bronchoalveolar- Terminal Bronchi and alveoli- slower growing 48 49 Stages 1-4 of Lung CA  Size of the tumor, location, lymph node involvement and metastasis  Often Lung Cancer has metastasized to lymph nodes before it is diagnosed  Stage 1- Earliest Stage, highest cure rate  Stage 4- Metastatic Spread  Common symptoms of lung cancer Cough or change in a chronic cough Hemoptysis, SOB Hoarseness Wheezing Recurrent PNA or bronchitis 50 Swelling of neck and face Loss of appetite Weight loss Fatigue Chest or shoulder pain: Late sign Diagnosis  Chest x-ray- Pulmonary Density, Atelectasis, Infection  CT Scan- Smaller nodules that may not be picked up by chest x-ray  Bronchoscopy with biopsy, scans  Fine needle Aspiration  Sputum cytology rarely used 51 Management of lung cancer Treatment  Surgery - Lobectomy, Wedge Resection, Pneumonectomy- Can be done Laparoscopically  Laser Therapy to open airways, that are blocked  Stent Placement  Radiation- To reduce size or cure  Chemotherapy- Reduce size that may be pressing on another organ  Palliative care- End Stage care 52 Nursing Care of the patient with Lung CA  Psychological support  Pain Management  Airway clearance of Secretions with deep breath and cough, Chest PT  Suctioning and Oxygen as needed  Fatigue- allow for plenty of rest  Dyspnea- Airway clearance, positioning, lung expansion exercises such as Incentive Spirometry 53 Question A patient with a diagnosis of lung cancer is receiving chemotherapy and reports nausea and loss of appetite resulting in decreased food intake. What should the healthcare provider recommend to promote adequate nutrition? Advise the patient to: a) Eat only favorite foods to increase appetite. b) Eat small meals throughout the day. c) Eat large meals but less frequently throughout the day. d) Eat only when feeling hungry. Chronic Obstructive Pulmonary Disease (COPD) 56 Chronic Obstructive Pulmonary Disease (COPD)  Global Initiative for Chronic Obstructive Lung Disease  (GOLD). Evidence-based initiative. A disease state characterized by airflow limitation that is not fully reversible (GOLD)  COPD is currently the fourth leading cause of death in US. Personal, social, economic burden.  COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders.  Asthma is now considered a separate disorder but can coexist with COPD. Pathophysiology of COPD  Airflow limitation  Progressive Condition  Abnormal Inflammatory response to the airways to noxious agents  Scar tissue and narrowing occur in the airways  Damage to lung parenchyma (lung tissue).  Damaged pulmonary vasculature. 57  With sputum Dusky color High CO2 levels: 58 Respiratory Acidosis 59 COPD- Chronic Bronchitis:  Cough and sputum production for at least 3 months in each of 2 consecutive years  Chronic Inflammation- Irritation of airways results in inflammation and hypersecretion of mucus.  Hyperplasia of mucus glands- Mucus-secreting glands and goblet cells increase in number.  Cilia disappear- Ciliary function is reduced, bronchial walls thicken,bronchial airways narrow, and mucus may Plug airways.  Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes.  Increased susceptibility to respiratory infections.  Pathophysiology of Chronic Bronchitis Goblet cells develop in increase mucus, which effects airways, impaired airflow Decreased 60 oxygen levels- Polycythemia 1/18/18 Question The nurse is visiting a COPD patient at home. The patient is on 2 L NC and Respiratory rate is 24. Which of the following is the most appropriate nursing intervention? a) Call for emergency help b) Increase the O2 to 4 L NC c) Tell the patient to relax d) Complete a thorough respiratory assessment  Emphysema Bronchitis Problem is with exhalation Dusky to Cyanotic Minimal cough Increased Mucous/ Cough Barrel Chest/ Thin Hypercapnia (High CO2 appearance levels) Emphysema/ Pursed lip breathing, Prolonged Exhalation, Hypoxia, High Resp Rate, Resp Acidosis Bronchitis High Resp Rate Hyper resonant lung High Hgb Levels, sounds Polycythemia Vera 62 Emphysema:  Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli  Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion- AIR TRAPPING.  Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.  Hypoxemia & Hypercapnia also is the result in later stages.  May cause right-sided heart failure (cor pulmonale). 64 Changes in Alveolar Structure with Emphysema Panlobular- Enlargement of the whole Alveoli with minimal Inflammation, Barrel Dead space is chest, DOE, Wgt loss, active expiratory nonfunctioning phase Hyperinflated Lungs Centrilobular- Center of Alveolus is affected Outside part of is ok AIR TRAPPING OCCURS Harder to breath, resp distress 65  Normal Chest Wall and Chest Wall Changes with Emphysema Note the AP Diameter Lungs hyperinflated Decreased surface area for gas exchange Airways tend to collapse due to loss of elasticity Hard to exhale- more work Trapped air prone to infections 66 1/18/18 67 Typical Posture of a Person with COPD Pursed lip breathing Breath sounds diminished – wheezes or crackles. Anxious CXR will show hyperinflated lungs with a flat diaphragm Question The nurse is education a COPD patient on pursed-lip breathing. Which of the following is the primary reason for pursed-lip breathing with emphysema? a) To promote oxygen intake b) To strengthen the intercostal muscles c) To strengthen the diaphragm d) To promote carbon dioxide elimination Risk Factors for COPD: Tobacco smoke causes 80- 90% of COPD cases! Passive smoking 69 Occupational exposure Ambient air pollution Genetic abnormalities  Alpha1-antitrypsin- Usually protects the lung parenchyma breakdown Medical management- Reduce Risk- Smoking  Surgical management: Bullectomy- Remove overdistended subsections of the lung: video assisted thorascope  Lung volume reduction surgery  Lung transplant  Referral for pulmonary rehabilitation- Program lasts two months  O2 used for PO2 levels < or = to 60, Long term O2 < or = to 55, intermittent which drop with activity and exercise 70 71 PHARMACOLOGY: COPD Prevention and treatment Bronchodilators are used to prevent and treat bronchoconstriction: Administer first before the Anti- Inflammatories Anti-inflammatories are used to prevent and treat inflammation of the airways; reducing inflammation also reduces bronchoconstriction by decreasing mucosal edema and mucous secretions Examples of Metered-Dose Inhalers and Spacers- see Chart 24-2 #5, 6 72  Beta 2-adrenergic agonists- Sympathomimetic effects- Bronchodilation  “EROL”s: short-acting beta2-adrenergic agonists most often taken by inhalation; drug of choice to relieve acute asthma/ COPD Albuterol (Ventolin)- Quick relief Fenoterol (Alupent)- Short duration Salmeterol (Serevent diskus)- Maintenance Terbutaline (Brethine)- Short or long: Preterm labor is an unlabeled use  Metaproterenol- Medium acting for acute bronchospasm, exercise induced asthma 73  Anticholinergics: Bronchodilator  Block action of acetylcholine in bronchial smooth muscle preventing bronchoconstriction when given by inhalation: Reduces GMP- Quanosine Monophosphate- Bronchoconstrictor Ipratropium (Atrovent) is used for maintenance therapy for chronic bronchitis and emphysema; it acts synergistically with adrenergic bronchodilators, and they may be used together: 4x a day: short duration Tiotropium (Spiriva)- long term maintenance for COPD to decrease bronchospasm: Long term 1x per day. 74  Methyl Xanthines (“-ophyllines”) Second Line Treatment Theophylline (Theo-Dur, Theobid) -Is the main xanthine used clinically for bronchodilation, and increases cilia’s ability to clear mucus, strengthens contractions of the diaphragm, and decreases inflammation  Increases cardiac output, causes peripheral vasodilation, exerts mild diuretic effect, and stimulates CNS  Monitor blood levels- Narrow therapeutic range, may alter or other meds may alter levels ie  Dilantin decreases Theophylline levels  Used cautiously with heart problems, HTN, liver disease, renal problems and diabetes.  Caffeine is a xanthine; caffeine-containing products may produce weak broncho-dilating effects75  Anti-Inflammatory Agents: Corticosteroids  Suppress inflammation by inhibiting movement of fluid and protein into tissues  Migration and function of neutrophils and eosinophils  Synthesis of histamine in mast cells  Production of proinflammatory substances  Increase the number and sensitivity of beta2-adrenergic receptors 76 Anti-Inflammatory Agents: Corticosteroids  Topical Corticosteroids (Inhalation) Beclomethasone, budesonide, flunisolide, fluticasone (Flovent), and triamcinolone Minimize systemic absorption and adverse effects  Systemic Corticosteroids Hydrocortisone, prednisone, and methylprednisolone Increase risk of side effects Advance chronic respiratory illness or during exacerbation  Improving Gas Exchange- Teaching  Proper administration of bronchodilators and Corticosteroids. Side Effects- Increased heart rate/palpitations, Tremors, nervousness, anxiety, or restlessness Cough, dry mouth, nausea, or upset stomach, Headache, dizziness, or light-headedness  Reduction of pulmonary irritants  Directed coughing, “huff” coughing  Deep breaths with 2-3 coughs or exhalations  Chest physiotherapy  Breathing exercises to reduce air trapping  Diaphragmatic breathing Pursed-lip breathing  Use of supplemental oxygen, careful of oxygen “toxicity” 78 Improving Activity Tolerance Focus on rehabilitation activities to improve ADLs and promote independence. Pacing of activities, Exercise training, Walking aids Set realistic goals: may not improve. Enhance coping strategies. Avoid extreme temperatures. Monitor for and manage potential complications: changes in POX, temp, vs, immunize vs flu and pneumonia, 79be aware of air quality forecasts. 80 Patient Teaching  Disease process, Medications Procedures, When and how to seek help  Prevention of infections  Avoidance of irritants; indoor and outdoor pollution and occupational exposure  Lifestyle changes, including cessation of smoking 81 82 Oxygen Therapy:  Nasal Cannula- 2-6 liters  Venturi Mask- 4-6 Liters: 24%, 26%, 28% Oxygen 30%, 35%, 40% O2,  Simple Face Mask- 6-8 Liters: 40-60% Oxygen  Mask Partial Rebreathing: 8-11 Liters: 50-75% Oxygen: Bag must remain inflated during inspiration and expiration  Partial NonRebreather- 12 Liters: 80- 100% Oxygen 83 Review basic fundamental nursing care: Ineffective Airway Clearance:  Monitor respiratory status  Hydration- 2-3 Liters per day  Coughing and deep breathing, Chest PT and suctioning when Elevate head of bed 30 Degrees (Semi- Fowlers)  Oxygen Therapy and humidification  Promoting rest  Nutrition and oral hygiene  Smoking Cessation JUST BREATH