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Chronic Bronchitis Nursing Care Plan & Management

Notes

Description
  • Is an inflammation of the inferior airways characterized by superabundant secretion of mucus, hypertrophy of mucous glands, and recurring contamination, growthing to narrowing and hinderance of airflow.
Causes/ Endanger Factors
  • The primitive force of continuous bronchitis is smoking or pitfall to some design of respiratory galling. Established endanger factors enclose a truth of smoking, occupational pitfalls, air stain,abject lung administration, and soondity. Children of parents who steam are at loftier endanger for pulmonary contaminations that may manage to bronchitis.
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Pathophysiology
Assessment
  1. Signs and indications of continuous bronchitis (artful aggression):
    • Productive cough permanent at lowest 3 months during a year for 2 successive years.
    • Thick, albuminous sputum (deep equalitys performed during superimposed contaminations).
    • Dyspnea and wheezing as indisaspect growthes.
Diagnostic Evaluation
  1. Pulmonary administration tests, to conduct airflow hinderance-abject constrained expiratory tome in 1 remedy (FEV1), FEV1 to constrained inseparable size ratio; acceptiond residual tome to entirety lung size (TLC) ration, haply acceptiond TLC.
  2. Chest X-rays to descry hyperinflation, lifelesstened diaphragm, acceptiond retrosternal ground, impaird vascular markings, feasible bullae (all in past stages).
  3. Arterial order gases, to descry impaird arterial oxygen urgency (PaO2), pH, and acceptiond arterial carbon dioxide urgency (Paco2).
  4. Sputum smears and cultures to warrant pathogens.
Primary Nursing Diagnosis
  • Impaired gas substitute kindred to occupied airways
Therapeutic Intervention / Medical Management
  1. Smoking suspension to plug the gradation and preserve-safe lung size.
  2. Low-flow oxygen to set-suitable censorious hypoxemia in a coerceled form and minimize carbon dioxide remonstrance.
  3. Home oxygen therapy, distinctly at death to thwart turnal oxygen desaturation.
  4. Pulmonary rehabilitation to impoverish indications that stipulation spectre.
  5. Chest natural therapy, including postural drainage and lively retraining.
  6. Lung transport in censorious cases of alpha1-antitrypsin imperfection.
Pharmacologic Intervention
  1. Bronchodilators to impoverish dyspnea and coerce bronchospasm delivered by metered-dose inhaler, other handheld devices, or nebulization.
  2. Inhaled corticosteriods may be productive for some succeeding a occasion censorious airflow stipulationation and numerous exacerbations.
  3. Corticosteroids by perforation or I.V. in quick exacerbations.
  4. Antimicrobials to coerce remedyary bacterial contaminations in the bronchial tree, thus clarification the airways.
  5. Alpha1-antitrypsin retrieval delivered by I.V. document.
Nursing Intervention
  1. Monitor for redundant goods of bronchodilators-tremulousness, tachycardia, cardiac arrhythmias, accessible terse arrangement stimulation, hypertension.
  2. Monitor oxygen saturation at suspension and succeeding a occasion spectre.
  3. Eliminate all pulmonary gallings, chiefly cigarette steam. Smoking suspension despicablely impoverishs pulmonary womanishness, sputum formation, and cough. Preserve the resigned’s ground as dust-unoccupied as feasible.
  4. Use postural drainage aspects to succor unobstructed secretions legitimate for airway hinderance.
  5. Teach coerceled coughing.
  6. Encourage violent lifelessten of running incatch (8 to 10 glasses; 2 to 2.5 L daily) succeeding a occasionin lifelessten of cardiac securityraint.
  7. Give lifes of nebulized remarkable to humidify bronchial tree and melt sputum. Add humidity (humidifier, vaporizer) to indoor air.
  8. Avoid dairy products if these acception sputum formation.
  9. Encourage the resigned to feign snug aspect to impair dyspnea.
  10. Use pursed lip lively at intervals and during periods of dyspnea to coerce blame and profoundness of respiration and mend respiratory muscle coordination.
  11. Discuss and conducts recreation exercises to impoverish urgeure, strain, and solicitude.
  12. Encourage numerous debile meals if the resigned is dyspneic; en a debile acception in abdominal solution may urge on diaphragm and defer lively.
  13. Offer clear nutritional supplements to mend caloric incatch and hinder gravity damage.
  14. Avoid foods unresisting abdominal disquiet.
  15. Encourage use of manageable oxygen arrangement for ambulation for resigneds succeeding a occasion hypoxemia and notable impotency.
  16. Encourage the resigned in expiration deeptenance techniques.
Documentation Guidelines
  • Respiratory standing of the resigned: Respiratory blame, expiration sounds, use of oxygen, perversion of nail beds and lips; melody any respiratory mortify
  • Response to spectre: Designation of deficiency of expiration succeeding a occasion any effort,designation of weary
  • Comfort, substantiality atmosphere
  • Response to medications, oxygen,and lively bargainments
  • Need for succor succeeding a occasion activities of daily deeptenance
  • Response to sustenance and acceptiond caloric intake, daily gravitys
Discharge and Home Healthcircumspection Guidelines
  1. Medications. Be confident that the resigned understands all medications, including the dosage, path, force, and redundant goods. Patients on aminophylline should accept order lifelesstens drawn as ordered by the physician. Before entity executed from the hospital, the resigned should demon- stblame the appertinent use of metered-dose inhalers.
  2. Complications. Instruct resigneds to apprise their primitive healthcircumspection agreer of any transmute in the perversion or material of their secretions. Green-colored secretions may point-out the pres- ence of a respiratory contamination. Patients should to-boot ment compatible, protracted periods of dyspnea that are unrelieved by medications.
  3. Follow-up. Consider that resigneds succeeding a occasion censorious indisaspect may scarcity succor succeeding a occasion activities of daily deeptenance succeeding execute. Melody any referrals to gregarious services. Send resigneds home succeeding a occasion a sustenance, granted by the sustenanceitian and reinconstrained by the tolerate, which agrees a violent-caloric intake. Toletrounce the resigned to secrete the aspect succeeding a occasion a scarf if he or she goes out-of-doors in the well-balanceding. If the resigned continues to steam,agree the designate of a smoking suspension program or a succor assembly. Toletrounce the resigned to quit gallings in the air.

Sources: ADAM for Images Nursingcrib.com Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed

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Nursing Circumspection Plan

Inefficient Airway Clearance
Assessment
Patient may manifest
  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Incrlull RR aloft recognized range
Nursing Diagnosis
  • Inefficient Airway Clearance
Outcomes
  • Patient earn conduct efficient clarification of secretions.
  • Patient earn conduct efficient airway unobstructedance.
Nursing Interventions
  • Position carryer midline succeeding a occasion intermission on mismisembezzle for age/condition
    • Rationale: To bring-about or conduct public airway
  • Elevate HOB
    • Rationale: To impair urgency on the diaphragm and enhancing drainage
  • Observe S/Sx of contaminations
    • Rationale: To warrant transmitted process
  • Auscultate expiration sounds & assess air mov’t
    • Rationale: To detect standing & melody growth
  • Instruct the resigned to acception running intake
    • Rationale: To succor to melt secretions.
  • Demonstblame efficient coughing and deep-lively techniques.
    • Rationale: To maximize effort
  • Keep end dry
    • Rationale: To thwart raise complications
  • Turn the resigned q 2 hours
    • Rationale: To thwart feasible aspirations
  • Demonstblame chest physiotherapy, such as bronchial tapping when in cough, appertinent postural drainage.
    • Rationale: These techniques earn thwart feasible aspirations and thwart any unpropitious complications
  • Administer bronchodilators if prescribed.
    • Rationale: Raise fetid measures to conduct airway patency.

Inefficient Lively Pattern
Assessment
Patient may manifest
  • Wheezes/crackles on auscultation on the BLF
  • Subcostal retraction
  • Nasal flaring
  • Presence of non-productive cough
  • Incrlull RR aloft recognized range
Nursing Diagnosis
  • Inefficient Lively Design RT Retained Secretions
Outcomes
  • Patient earn mend lively design.
  • Patient earn conduct a respiratory blame succeeding a occasionin recognized stipulations.
Nursing Interventions
  • Place resigned in semi-fowlers aspect
    • Rationale: To accept a utmost lung annotation
  • Incrlull running incatch as applicable
    • Rationale: To melt secretions
  • Keep resigned end dry
    • Rationale: To quit stasis of secretions and quit raise complication
  • Change aspect complete 2 hours
    • Rationale: To arrange secretion mov’t and drainage
  • Perform CPT
    • Rationale: To unoccupied secretion
  • Place a pillow when the client is latent
    • Rationale: To agree courteous lung annotation occasion latent.
  • Instruct how to splint the chest rampart succeeding a occasion a pillow for lull during coughing and raising of carryer balance substantiality as misappropriate
    • Rationale: To advance physiological lull of maximal inspiration
  • Maintain a ambiguous airway, suctioning of secretions may be done as ordered
    • Rationale: To suppress secretions that obstructs the airway
  • Provide respiratory succor. Oxygen life is granted per doctor’s order
    • Rationale: To aid in relieving resigned from dyspnea
  • Administer prescribed cough suppressants and analgesics and be timid, at-last, beforce opioids may deurge respirations raise than desired.
    • Rationale: To advance deeper respirations and cough

Impaired Gas Exchange
Assessment
Patient may manifest
  • Appearance of cerulean extremities when in cough (cyanosis), lips
  • Lethargy
  • Restlessness
  • Hypercapnea
  • Hypoxemia
  • Abrecognized blame, rhythm, profoundness of lively
  • Diaphoresis
Nursing Diagnosis
  • Impaired Gas Substitute RT Altered Oxygen Balance
Outcomes
  • Patient earn mend scent and courteous oxygenation of tissues
  • Patient earn minimize or entiretyly be unoccupied of indications of respiratory mortify.
Nursing Interventions
  • Monitor lifelessten of perception or intangible standing
    • Rationale: Restlessness,anxiety, indistinctness, somnolence are vulgar explanation of hypoxia and hypoxemia.
  • Assist the client into the High-Fowlers aspect
    • Rationale: The upsuitable aspect allows ample lung trip and enhances air substitute
  • Incrlull resigned’s running intake
    • Rationale: To succor melt secretions
  • Encourage expectoration
    • Rationale: To enucleate crowded, stubborn, enlarged secretions which assist for the debility of gas substitute.
  • Encourage numerous aspect transmutes
    • Rationale: To advance drainage of secretions
  • Encourage courteous suspension & stipulation activities to succeeding a occasionin client tolerance
    • Rationale: Helps stipulation oxygen scarcitys/consumption
  • Promote calm/restful environments
    • Rationale: To set-right/mend true deficiencies
  • Administer suppleintangible oxygen judiciously as point-outd
    • Rationale: May set-suitable or thwart worsening of hypoxia.
  • Administer meds as point-outd such as bronchodilators
    • Rationale: To bargain the underlying condition

Sleep Design Disturbance
Assessment
Patient may manifest
  • Irritability
  • Restlessness
  • Lethargy
  • Changes in posture
  • Difficulty of lively which worsens at death
Nursing Diagnosis
  • Sleep Design Disturbance RT Inaptitude of Breathing
Outcomes
  • Patient earn warrant partially mismisembezzle interventions to advance doze.
  • Patient earn be able to ment mendments in doze/suspension design.
Nursing Interventions
  • Monitor lifelessten of perception or intangible standing
    • Rationale: Restlessness, solicitude,confusion, somnolence are vulgar explanation of hypoxia and hypoxemia.
  • Promote lull measures such as end rub and transmute in aspect as necessary
    • Rationale: To agree non pharmacologic management
  • Observe eatables of moving succor
    • Rationale: Lack of instruction and drifts, relationships may beget strain. Interfering succeeding a occasion doze routines lowd on adult schedules may not encounter cadet’s scarcitys.
  • Provide lull environment.
    • Rationale: To advance an environment productive to doze.
  • Incrlull resigned’s running intake
    • Rationale: To succor melt secretions
  • Encourage expectoration
    • Rationale: To enucleate crowded, stubborn, enlarged secretions which assist for the DOB
  • Limit the running incatch in well-balanceding if nocturia is a drift
    • Rationale: To impoverish scarcity for deathseason elimination
  • Obtain feedend from SO in-reference-to despicable bedtime, rituals/routines
    • Rationale: To determine despicable doze designs & agree proportionately lowline
  • Provide insurance for resigned doze season insurance
    • Rationale: To advance lull/safety
  • Recommend mid dawning nap if one required
    • Rationale: Napping esp. in the succeedingnoon can dismember recognized doze design
  • Administer aversion medication as ordered.
    • Rationale: To succor dislull and catch utmost service of anodyne effect

Risk for Extend of Infection
Assessment
Patient may manifest
  • Body atmosphere aloft recognized range
  • Dehydration
  • Incrlull WBC count
  • Presence of acception mucus formation
Nursing Diagnosis
  • Risk for Extend of Contamination RT Stasis of Secretions & Decreased Ciliary Action
Outcomes
  • Patient earn warrant interventions to thwart and/or impoverish the endanger of contamination
  • Patient earn accept minimize or entiretyly be unoccupied from the endanger of contamination.
Nursing Interventions
  • Review weight of lively exercises, efficient cough, numerous aspect transmutes, and courteous running intake
    • Rationale: These activities advance mobilization and expectoration of secretions to impoverish the endanger of unfolding pulmonary contamination.
  • Turn the resigned q 2 hours
    • Rationale: To arrange secretion mov’t and drainage
  • Encourage acception running intake
    • Rationale: To melt secretions
  • Stress the weight of handwashing to SO’s
    • Rationale: Handwashing is the primitive resistance abutting the extend of contamination
  • Teach the SO’s how to circumspection for and cleansedsed respiratory equipment
    • Rationale: Water in respiratory equipment is a vulgar fountain of bacterial growth
  • Teach the SO’s the explanations of pulmonary contaminations (transmute in perversion of sputum, passion, chills) , self-circumspection and when to persuade the physician
    • Rationale: Early acknowledgment of explanations can manage to a speedy personality.
  • Recommend rinsing perforation succeeding a occasion water
    • Rationale: To thwart endanger of unwritten candidiasis.
  • Administer antimicrobial such as cefuroxime as point-outd.
    • Rationale: Given prophylactically to impoverish any feasible complications

Other Feasible Nursing Circumspection Plans
  • High endanger for suffocation
  • High endanger for aspiration
  • Anxiety RT quick lively difficulties
  • Activity Prejudice RT unwell-balanced oxygenation
  • Imbalanced Nutrition: Less than substantiality requirements RT abject proclivity and dyspnea (for emphysema)

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