Practical Nursing Theory 2 - Week 8 (Centennial College) PDF

lOMoARcPSD|6358820 Theory 2 week 8 practical nursing theory 2 (Centennial College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Roja Yasmin (roja.yasmi...

lOMoARcPSD|6358820 Theory 2 week 8 practical nursing theory 2 (Centennial College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Respiratory Diseases Normal respiratory process Ventilation: movement of air into and out of the lungs and has two phases 1. Inspiration (movement of air into the lungs) 2. Expiration (movement of air out of the lungs) These two phases make up a breath, which normally occur 12-20 per minute Inspiration Diaphragm contracts and relaxes and flattens Intercostal muscles contract; increases size of chest cavity The lungs stretch and volume increases The pressure in lungs is slightly less than atmospheric pressure (this causes air to rush in). Expiration Passive Muscles relax Diaphragm rises Ribs descend Lung recoil The pressure in the chest cavity increases (compressing the alveoli) Pressure in lungs greater than atmospheric causes gases to flow out of the lungs FACTORS AFFECTING RESPIRATION Airway resistance Respiratory center of the brain Chemoreceptors in the brain, aortic arch, and carotid arteries Compliance Elasticity Surface tension of alveoli Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 FACTORS AFFECTING RESPIRATION Airway Resistance Resistance to airflow (the narrower the airway, the greater the resistance to flow) Determined by size of the airway through which the air is flowing ↑resistance results in a greater than normal respiratory effort to enable ventilation. Some factors that directly affect airway resistance: → Thickening of bronchial mucosa (chronic bronchitis) → Obstruction of the airway (by mucus) → Contraction of bronchial smooth muscle (asthma) → Loss of lung elasticity (emphysema) Compliance (of lung) The dispensability of the lung, or how well the lung stretches. A measure of the elasticity, and the ability of the lung to expand. (consider an elastic band, when it is stretched it returns to its normal shape) Compliance is normal if the lungs and thorax easily stretch and distend when pressure is applied. (↑or ↓ compliance occurs if lungs have lost elasticity e.g., pneumothorax, atelectasis, pulmonary edema). PHYSIOLOGICAL FACTORS AFFECTING RESPIRATIONS Increased metabolic rate Hypoxia Hyper/hypoventilation Hypercapnia Anemia Fever : ↑ metabolic rate = increase tissue O2 demand Airway obstruction High altitude: atmospheric O2 concentration ↓ AGE RELATED CHANGES The older adult experiences multiple changes to the respiratory system: Decreased elastic recoil Decreased cilia Less effective cough force Chest wall becomes stiffer Decrease response to hypoxemia Decrease functioning alveoli Decrease cell mediated immunity and alveolar macrophages. Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 NURSING ASSESSMENT OF THE RESPIRATORY SYSTEM The nurse must: Obtain both subjective and objective data Subjective Data Past Health history (of any resp disorders, dyspnea etc.) Medications Surgery Lifestyle (smoker) Current health history: cough (dry/productive) Immunization status Objective Data Physical assessment of the skin, inspection of the nose, mouth, pharynx and neck. Breathing patterns (observe) Palpation of the trachea Percussion Auscultation (review HA notes) CLUES TO RESPIRATORY PROBLEMS Dyspnea (SOB) Wheezing (may be described as ‘chest tightness’ Pleuritic chest pain (sharp pain during inspiration) Cough Sputum production Hemoptysis (blood-tinged sputum) Audible changes (hoarseness, stridor or barking cough) Fatigue Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 ABNORMAL ASSESSMENT FINDINGS Inspection: Pursed-lip breathing Tripod position; inability to lie flat Accessory muscle use; intercostal retractions Splinting Increased anteroposterior Tachypnea Kussmaul’s respirations Cyanosis Clubbing of fingers Abdominal (inward movement during inspiration) Palpation: Tracheal deviation (shift from midline, pneumothorax?) Altered tactile fremitus (increase/decrease in vibrations) Altered chest movement (asymmetrical) Percussion: Hyper-resonance (Loud, lower-pitch sound) (possible lung collapse, COPD) Dullness (medium-pitch; indicative of pneumonia, pleura effusion) Breath sounds DIAGNOSTIC TESTS Labs (CBC, ABG) Oximetry Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Sputum culture Chest Xray Skin testing (tuberculin for TB) Pulmonary Function Test Computed Tomography Bronchoscopy Biopsy Thoracentesis (needle insertion through the chest wall into pleural space to remove fluid) Diagnostics and Nursing Responsibilities Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 PNEUMONIA An acute inflammation of the lung parenchyma resp bronchioles and alveoli) caused by a microbial agent Infection of the lower respiratory tract caused by a variety of microorganisms including, bacteria, viruses, fungi, mycoplasma, protozoa, and parasites These organisms can reach the lung via: -Aspiration -Inhalation -Hematogenous spread (from primary infection in the body) TYPES OF PNEUMONIA Community Acquired (CAP) Hospital-Acquired (HAP) Aspiration Pneumonia Ventilator-associated (VAP) Bacterial, Viral, Fungal, and Opportunistic pneumonia Pneumonia Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Trigger: Infectious organisms or inhaling irritating agents → Organisms penetrate the airway mucosa and multiply in the alveolar spaces → WBC migrate to area of infection, causing local capillary leak, edema, and exudate → These fluids collect in and around the alveoli, and the alveolar wall thickens reducing gas exchange = hypoxemia → RBC and fibrin move into the alveoli and capillary leaks spread the infection; lung stiffens reducing compliance and decrease vital capacity = pneumonia. PREDISPOSING FACTORS Impaired defence mechanisms (overcome by virulence or quantity of the infectious agent) Decreased LOC (depresses cough and epiglottal reflexes; ↑risk of aspiration) Client with tracheal intubation Exposure to air pollution, cigarette smoking, URIs and aging. Malnutrition (leukocytes impaired) Presence of diseases (leukemia, DM, alcoholism) Antibiotic therapy (decrease in oropharyngeal flora) RISK FACTORS Smoking Toxic inhalation COPD Previous episodes of pneumonia Malnutrition HIV infection Tracheal Intubation URTI (upper resp tract infection) Altered LOC Bedrest and prolonged immobility Chronic diseases (DM, lung disease, cancer, ESRD) Immunosuppressive drugs (chemo drugs, corticosteroids, Intestinal and gastric feedings (NG and G-tube) Decreased GI motility Prolonged hospitalization CLINICAL MANIFESTATIONS OF PNEUMONIA Sudden onset of fever, chills Pleuritic chest pain Cough (can be dry/productive) Confusion or stupor (esp. in the older adult) Dullness to percussion Adventitious breath sounds (i.e., crackles) Fatigue, weakness, malaise Headache, sore throat, N&V (atypical pneumonia) Dyspnea, nasal congestion, pain with breathing Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 TYPES OF PNEUMONIA Pneumonia can be caused by bacteria, viruses, fungi, parasites, Mycoplasma, and chemicals Community Acquired or Hospital Acquired Fungal Pneumonia Aspiration Pneumonia Opportunistic Pneumonia (occurs primarily in individuals who are immuno-compromised). Ventilator-Associated RISK FACTORS FOR HEALTH CARE-ACQUIRED PNEUMONIA The following factor may place the client at an increased risk: Is an older adult Has a chronic lung disease Has an altered level of consciousness Has had a recent aspiration event Has a tracheostomy, or nasogastric tube (NG) Has poor nutritional status Has reduced immunity (from disease or drug therapy) Uses drugs that increase gastric pH (histamine blockers, antacids) or alkaline tube feedings. Client on a mechanical ventilation. Complications of Pneumonia Complications tend to develop more often in clients with underlying chronic illnesses. Pleurisy (inflammation of the pleura) Pleural effusion Atelectasis (collapsed , airless alveoli; can be resolved with coughing, and DB) Delayed resolution (seen mostly in the elderly, COPD, and malnourished) Lung abscess ( local area of necrosis and pus formation in the lung; not very common) Empyema (purulent exudate in the pleural cavity) Pericarditis (inflammation of the pericardium of heart) Meningitis Endocarditis DIAGNOSTIC TESTS FOR PNEUMONIA Client history, physical examination, and diagnostic tests are used to establish the diagnosis. Chest X-Ray (fluid, infiltrates, consolidation and atelectasis) Sputum gram stain Sputum C&S CBC with WBC differential Pulse oximetry ABGs Bronchoscopy Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 THE NURSING PROCESS: ASSESSMENT Health History (Subjective): Focus on current symptoms and duration, the presence of other chronic diseases, current medications and allergies. Physical Assessment (Objective): The client’s general appearance, restlessness, lethargic. Vital signs (including temp; may be febrile) Respiratory assessment (crackles, decreased air entry; use of accessory muscle use; ability to speak in a full sentence) Cardiovascular (tachycardic) Neuro (LOC) Review lab work results and analyze ABG **Remember to compare findings with client’s baseline** NURSING DIAGNOSIS Common Nursing Diagnosis for the client with pneumonia include: Ineffective breathing pattern Acute pain Activity intolerance Impaired gas exchange Risk for injury Nutrition imbalance NURSING PLANNING Some of the priority collaborative problems for clients with pneumonia include: Decreased gas exchange, potential for airway obstruction, hypoxemia, risk of sepsis and other complications. Thus, the overall client goals will include: Maintaining airway patency Maintain adequate gas exchange (SPO2 or at least 95%, absence of crackles, and wheezes) Normal breathing patterns (12-20 bpm) No signs of hypoxia Normal CXR Effective cough Promoting rest to reduce metabolic and O2 demands No complications related to pneumonia IMPLEMENTING NURSING PLAN Improve Gas Exchange Assess respiratory status frequently (at least every 2 to 4 hours) Oxygen therapy as needed Incentive spirometry (to help prevent atelectasis, mobilize secretions; usually Q1H) Deep breathing and coughing exercises, frequent turning Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Bronchial hygiene Semi-fowlers position Increase fluid intake to up to 2.5 L daily unless contraindicated Administer prescribed medications (bronchodilators, IV steroids, expectorants) Effective Breathing Chest physiotherapy Provide for rest periods Assess respiratory rate, depth and lung sounds Q4H Teach relaxation techniques to reduce anxiety. Assist with physical activities (i.e., ADLs) Health Promotion Modifying risk factors (smoking cessation, decreasing alcohol intake) Practice good health habits(proper diet, good oral hygiene, adequate rest and regular exercise). Vaccinations (annual flu vaccine (>6 mth old); pneumococcal vaccine (for high risk and clients > 65- year old or resides in LTC Avoid exposure and practice infection control principles (hand hygiene etc.) Evaluate the expected goal outcomes: Cyanosis and dyspnea reduced; SPO2 improved or within normal ranges. Client is able to cough effectively; absence of crackles. Client is more comfortable; denies pain Normal respiratory rate and breathing pattern; no use of accessory muscles Adequate hydration status (as indicated by pink, moist oral mucous membrane) Little to no sputum (thin, clear) Improved activity intolerance Client able to list ways to decrease risk for pneumonia Client completed entire course of antibiotic therapy. HOMECARE MANAGEMENT The nurse must ensure that: The client is aware of the recovery phases of pneumonia (duration, may take weeks to get back to baseline health, esp. elderly) The client gets adequate rest to maintain recover progress and avoid relapse. The client and family is aware of the importance of taking all medications prescribed and to follow-up with their primary care provider. The client knows about possible interactions (food, drug) with prescribed antibiotic. The client knows to notify the HCP if they have chills, fever, persistent, cough, dyspnea, or increasing fatigue returns or fails to go away completely. The client knows to avoid crowds, exposure to irritants (smoke), and to ensure a Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 balanced diet and adequate fluid intake THE CLIENT WITH PNEUMONIA: CASE STUDY 65-year-old Diane is admitted with CAP. She says, “My chest hurts from coughing so much.” She is coughing up thick, green sputum. She is becoming confused and has lost her appetite. Physical Assessment Findings: Confused, temp 38.1, HR 125, pulse weak, RR 24; BP 96/58. Cheeks are flushed; fatigued and reported pain of 6/10. The client is dyspneic, anxious. Bilateral crackles and wheezing; dull percussions and pale oral mucous membrane. Questions: 1. List some of the factors that could possibly confirm a pneumonia diagnosis. 2. What are some diagnostic test that may be ordered for this client? 3. Identify Two nursing priority diagnoses. 4. List 2 client outcomes for each priority. 5. List 2 nursing interventions to meet the goal outcomes you identified. 6. Identify Two members of the interprofessional team that would be included in Diane’s care. The client spend 7 days in the hospital and will be discharged later today. Discuss ways the nurse can help to promote health maintenance in the home environment. Identify community resources that may be helpful for the client and family to promote optimal health outcome and full recovery COPD What is COPD? A combination of chronic bronchitis and/or emphysema Chronic bronchitis: chronic productive cough for 3 months over 2 yrs. Emphysema: destruction of the alveoli (with loss of lung elasticity and hyperinflation of the lung). Involves persistent airflow limitation and is progressive. Chronic inflammatory response in airways and lungs. Caused primarily by cigarette smoking. Disease is one of periodic exacerbations related to respiratory infections Risk Factors Smoking (cigarette smoke, stimulates inflammatory response, causes hyperplasia of goblet cells, and destroy cilia) Heredity: Alpha1-antitrypsin deficiency (enzyme usually present in the lungs; inhibits excess protease (enzymes from neutrophils) activity to protect lung structures). Aging Occupational Chemicals and Dusts Infection (recurring) Pathophysiology Review Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Chronic inflammation in the airways and lung parenchyma Airflow obstruction caused by mucus, hypersecretion, mucosal edema, and bronchospasm. Disease process starts with inhalation of irritant (smoke)→inflammatory response→ tissue destruction that disrupts the normal defence mechanisms of the lungs. Attraction of other inflammatory mediators→ prolongs inflammation → structural changes in the lung. Inhibition of antiproteases → breakdown of lung connective tissues. Inability to expire air; airflow limitation due to remodelling → air trapping. With disease progression → impaired gas exchange → hypoxemia and hypercapnia Excess mucus production → chronic productive cough (may not occur in all individuals with COPD) Clinical Manifestations of COPD Intermittent cough with small amt of sputum (usually in the morning, earliest symptom) Later, productive cough Dyspnea on exertion (that is progressive) Barrel chest Increased sputum production Weight loss (advanced) Fatigue Prolonged expiratory phase, wheezes or decreased breath sounds. Tripod position Pursed lip breathing Cyanosis Diagnostic Tests History and physical examination Pulmonary Function Test Serum a1-antitrypsin levels Chest X-Ray Sputum specimen for gram stain and culture ABGs ECG (if required) CBC with differential Ventilation-perfusion scanning The Nursing Process: Assessment History(subjective): Current symptoms, including cough, sputum production, dyspnea, activity tolerance, frequency of resp infection, current medications, smoking history, and/or exposure to smoke and other pollutants. Ask about weight loss, anxiety, and fear r/t feelings of breathlessness, activity limitations and use of support groups and community services. Physical Assessment (objective): General appearance; weight, mental status Vital signs; skin colour, poor skin turgor Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Resp assessment: breathing pattern, depth, rate, use of accessory muscles, nasal flaring or pursed lip breathing, crackles, clubbing of fingers, shape of chest Cardio: neck veins, apical pulse, heart sounds, peripheral edema, cyanosis Nursing Diagnosis Activity intolerance Risk for infection r/t compromised pulmonary function Ineffective airway clearance r/t bronchoconstriction and ineffective cough Imbalance nutrition r/t insufficient dietary intake, decreased energy levels Impaired gas exchange r/t alveolar hypoventilation Ineffective breathing patter r/t to airflow limitation Ineffective coping r/t to the stress of living with chronic disease, loss of independence Nursing Process: Planning The client with COPD is expected to attain and maintain adequate gas exchange at his/her baseline level. Maintains clear airway with normal breath sounds. Prevention of disease progression Relief from breathlessness and other respiratory symptoms Treatment and prevention of exacerbations. Improvement in exercise tolerance Ability to perform ADLs Improved overall quality of life Decrease risk of premature mortality Implementing Nursing Plans Teach the client how to be a partner in COPD management Maintain airway patency by: monitoring breathing technique, positioning, effective coughing, oxygen therapy, suctioning, and increased hydration (unless client has CHF). Teach appropriate breathing techniques (Lewis text, p. 678-679); pursed-lip breathing, huff coughing, and diaphragmatic (abdominal breathing). Nutritional therapy to maintain a BMI between 21-25 kg/m2 ; eat up to six small meals per day to avoid feeling of bloating, and to help conserve energy. High-calorie, high-protein diet. Can offer liquid nutritional supplements Allow the client to express feelings; explore factors that contribute to anxiety, and discuss positive coping mechanisms. Pace activities with rest periods to conserve energy Medication therapy (bronchodilators (short-acting/long-acting, inhaled corticosteroids as prescribed) Health promotion: smoking cessation, prevention of infections (pneumonia vaccination, and avoid crowds, proper hand hygiene). Client and family teaching: COPD disease process, Medications, non- pharmacological therapies, correct use of inhaler with spacers, home oxygen use, healthy nutrition, COPD management plan, and end of life and advanced planning Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Evaluation Evaluate the care of the client with COPD based on the identified priorities. The key expected outcomes of care are that the client should: Attain and maintain gas exchange at a level within his/her chronic baseline values (88-92% or MD will state) Maintain a patent airway; so client should be coughing up secretions; decreased crackles/wheezing). Achieve an effective breathing pattern that decreases the work of breathing Report decreased dyspnea, effectively using pursed-lip breathing Tolerate small, frequent meals; weight stable (within normal range for sex, height, and age) Has normal serum protein and albumin levels. No fever or change in sputum Report walking longer distances without tiring; able to complete ADLs with rest periods. Express feelings about living with chronic disease; seeks support group. Reports improved sleep pattern. COPD- Home care management Most clients may require long-term use of oxygen at home Clients with advanced disease may require 24-hour care for ADLs (PSW support at home or placement in LTC) Nurse may collaborate with discharge planner, OT, PT, dietician, and RT to provide necessary equipment at home to support the client (hospital bed, a nebulizer, transfer bath chair etc.) Scheduled visits from a home care nurse for monitoring and evaluation. Financial concerns often increase anxiety; client may not be able to work and will require disability (coordination with the social worker or LHIN case manager) Self-management education; teach client to recognize and report evidence of possible infection (fever, ++sputum, fatigue, and increased dyspnea). Other community resources: COPD support group, Meals on Wheels Community supports: Pulmonary Rehabilitation programs to help the client maintain an active lifestyle Asthma A chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Spasm of the bronchial muscle; edema and swelling of the mucosa; production of thick secretions →air flow is obstructed →air enters and is trapped →characteristic wheeze accompanies attempts to exhale through narrowed bronchi→ breathing is Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 labored. The airways are in a persistent state of inflammation. During symptom-free periods, airway inflammation in asthma is subacute or quiet. Signs and symptoms: Chest tightness with non-productive cough (early symptom, at night or early am) Tachycardia and tachypnea with prolonged expiration due to air trapping. Wheezing may be noted with auscultation or heard audibly. Inspiratory and expiratory wheezing, but wheezing is most noticeable during expiration Marked respiratory effort manifested by nasal flaring and used of accessory muscles. (intercostal retractions) Fatigue (important late symptom), anxiety and apprehension Severe dyspnea (pt. only able to speak one or two words between breaths) Dyspnea caused by increased airway resistance from bronchoconstriction, mucosal edema, and mucus secretion. Coughing with moderate or no sputum production. Increased airway pressure potential for barotraumas. Exercise intolerance. Hypoxemic signs of air hunger. Restlessness Key characteristics: Episodic and reversible nature of the airway obstruction along with associated symptoms Episode may resolve spontaneously or with treatment An attack that is difficult to control and is resistant to all forms of treatment is status asthmaticus. The leading cause of chronic illness in children Hyper-responsiveness or "twitchiness" is a hallmark of asthma Directly linked to airway inflammation The more airway inflammation, the more hyper-responsive the airways are to endogenous or exogenous stimuli/triggers Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Triggers of Asthma Dust mites Moulds Pollen Animals/Pet Allergens (i.e., dander) Food Allergies/Additives (i.e., sulphites) Cockroaches Other Allergens Common Non-Allergic Triggers Exercise (Exercise induced bronchospasm, EIB) Respiratory infections (especially viral ones) Nose and Sinus Problems Drug and food Addictives Gastro-esophageal Reflux Disease Air Pollutants Emotional Stress Exercise Acute airway narrowing during physical exercise (Exercise Induced Bronchospasm, EIB) EIB occurs after no during exercise Pronounced during activities in the cold or dry air SOB, cough, wheeze sensation of chest tightness or combination Warm-up period before exercise; breathe through scarf or mask during exercise in the cold; use inhaled short acting Beta- adrenergic antagonist to relieve symptom or 10-20 mins before to prevent symptoms Respiratory Infections Most common triggers of worsening asthma (Viral) Caused incread inflammation in the tracheo-brocial system Can last 2.8 weeks Encourage proper handwashing Recommend the influenza vaccine Nose and Sinus Problems Some clients may have chronic sinus and nasal problems Includes: allerginic rhinitis = seasonal, perennial, nasal polyps Cause - inflammation of mucous membranes Must treat comorbidities to prevent poor asthma control Drug and Food Additives May be sensitive to Drugs (nasal polyps) Asthma Triad: nasal polyps, asthma, & sensitivity to acetylsalicylic (ASA) e.g., Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) e.g., ibuprofen & Motrin Salicylic can be found in some foods, beverages and flavourings – may cause wheezing within 2 hours, tearing, facial flushing Beta-Adrenergic blockers (oral form) e.g., metoprolol or topical eye drops e.g., Timolol may trigger bronchospasm Angiotensin-converting enzyme inhibitors e.g., lisinopril: may induce cough Gastro-esophageal Reflux Disease Exact mechanism which gastro-esophageal reflux disease (GERD) triggers asthma is unknown Suggested that reflux of stomach acid into the esophagus can be aspirated in the lungs > reflex vagal stimulation and brochoconstriction H2-histamine blockers or proton pump inhibitors are given to lessen symptoms Air pollutants Cigarettes, vehicle exhaust, elevated ozone levels, sulphurdioxide, wood smoke can trigger asthma Emotional Stress Physiological stress > emotional responses e.g., crying, laughing, anger, fear > hyperventilation and hypercapnia > narrowing of airways. Asthma exacerbation can result in panic/anxiety attack Varies by person and episodes Asthma affects more than 3.8 million Canadians, including 850,000 children under the age of 14. In Canada, asthma is the third-most common chronic disease. Every day, over 300 Canadians are diagnosed with asthma. Tragically every year an estimated 250 Canadians die from an asthma attack. Diagnostic Test: To determine the degree of airway involvement during/between acute episodes Identify causative factors Pulmonatry function test - to evaluate degree of airway obstruction Arterial blood gas – blood sample taken during acute attack (hospital) to evaluate CO2 elimination & acid-base status Routine labs & test for immunoglobulin E (allergies) Challenge or bronchial provocation testing – inhales substance such as methacholine or histamine with PFTs to confirm asthma dx to detect airway hyperresponsiveness Skin testing – detect if specific allergen is the trigger Nursing and Interprofessional care Downloaded by Roja Yasmin ([email protected])  lOMoARcPSD|6358820 Treatment goals are focused on controlling symptoms and preventing acute attacks Maintaining airway patency and optimal ventilation Promote effective breathing pattern Reduce anxiety Promote adherence to treatment plan Downloaded by Roja Yasmin ([email protected])