Adult mid

Gas Exchange & Respiratory Function: Upper Respiratory Tract Disorders

• Upper respiratory disorders (URD) involve the nose, paranasal sinuses, pharynx, larynx, trachea, or bronchi.
• URDs can range from minor conditions treated outside healthcare settings to severe, life-threatening issues.
• Effective assessment skills are crucial for differentiating between various URDs.
• Patient education is a key aspect of managing URDs.

Upper Respiratory Tract Infections

• URTIs are a common reason for people getting sick.
• URTIs affect most people occasionally, depending on individual triggers, stimulants, or allergies.
• The duration of infections varies; some are acute lasting for several days, while others are chronic and recurrent.
• A common URTI is the common cold.

Specific Infections:

• Rhinitis.
• Sinusitis: acute, chronic.
• Pharyngitis: acute, chronic.
• Tonsillitis, adenoiditis.
• Peritonsillar abscess.
• Laryngitis

Rhinitis

• Rhinitis involves inflammation and irritation of the nasal mucous membrane and can be acute or chronic.
• It may be allergic or non-allergic in nature.
• Commonly associated with the common cold or seasonal allergies.
• Recurrent rhinitis occurs throughout the year.

Rhinitis Clinical Manifestations:

• Rhinorrhea (excessive nasal drainage).
• Nasal congestion.
• Nasal discharge (more pronounced with bacterial rhinitis).
• Sneezing.
• Pruritus (itching) of the nose, roof of the mouth, throat, eyes, and ears.
• Headache

Rhinitis Medical Management:

• Treatment depends on identifying and addressing the cause.
• History and assessments are conducted to determine the underlying issue.
• For viral rhinitis, medications are prescribed to relieve symptoms.
• Allergen types are identified to guide treatment.
• Immunizations may be recommended.
• Corticosteroids can be used.
• Antimicrobial agents are administered when appropriate.
• Analgesics are used for pain relief.
• Surgery may be considered for nasal structural problems.

Rhinitis Patient Education & Self-Care:

• Allergic rhinitis patients should avoid allergen and irritant exposure (dust, molds, animals, fumes, odors, powders, sprays, tobacco smoke).
• Control environmental factors at home and work.
• Saline nasal sprays can soothe mucous membranes, soften crusted secretions, and remove irritants.
• Instruct patients on proper nasal medication administration techniques.
• Patients should blow their nose before using nasal medications for maximal relief.
• Reading drug labels is important to prevent potential OTC medication interactions.
• Patients should keep their head upright and spray quickly and firmly into each nostril, away from the nasal septum.
• A one-minute interval should be observed before administering a second spray.
• The container should be cleaned after each use and not shared to prevent cross-contamination.
• Teach hand hygiene and the use of tissues to prevent virus spread through coughing and sneezing.
• The value of annual influenza vaccination should be emphasized.
• Provide both verbal and written information to assist in prevention and management.

Rhinosinusitis

• Rhinosinusitis, formerly termed sinusitis, is inflammation of the paranasal sinuses and nasal cavity.
• Classified by symptom duration:
  • Acute: less than 4 weeks.
  • Chronic: more than 12 weeks.
• Etiology: Can be due to bacterial or viral infection.

Acute Rhinosinusitis

• Acute bacterial Rhinosinusitis (ABRS).
• Acute viral Rhinosinusitis (AVRS).
• Recurrent acute rhinosinusitis: four or more acute ABRS episodes per year; discussed as chronic rhinosinusitis.

Acute Rhinosinusitis Clinical Manifestations:

• ABRS includes purulent nasal drainage, nasal obstruction, facial pain/pressure, and diffuse headache.

Acute Rhinosinusitis Assessment and Diagnostic Findings:

• Tenderness to palpation over the infected sinus area.
• Percussion of sinuses to assess the pain response.
• Sinus aspirates may be obtained.
• Flexible endoscopic culture techniques can be used.

Acute Rhinosinusitis Medical Management:

• Treatment depends on the cause.
  • Goals:
    • Shrink the nasal mucosa.
    • Relieve pain.
    • Treat infections.
  • Management:
    • Antibiotics for bacterial causes.
    • Oral corticosteroids for inflammations.
    • Nasal saline lavage for symptom relief and clearing of mucus.
    • Decongestants/Antihistamines/Antimicrobials.

Acute Rhinosinusitis Patient Education & Self-Care:

• Methods to promote sinus drainage: humidification and warm compresses.
• Avoid swimming, diving, and air travel during acute infection.
• Smoking cessation is advised.
• Educate patients on correct nasal spray use through demonstration and return demonstration.
• Instruct about side effects from incorrect usage: nasal irritation, burning, bad taste, drainage, or epistaxis.
• Teach about rebound congestion from decongestant overuse.

Chronic Rhinosinusitis

• Diagnosed when a patient experiences 2 or more of the following symptoms for at least 12 weeks:
  • Mucopurulent drainage
  • Nasal obstruction
  • Facial pain-pressure-fullness or decreased sense of smell
• Possible presence of nasal polyps

Chronic Rhinosinusitis Clinical Manifestations:

• Impaired mucociliary clearance & ventilation
• Cough
• Chronic hoarseness
• Chronic periorbital headache
• Facial pain
• Mouth breathing
• Snoring
• Sore throat
• Fatigue & nasal congestion
• Sense of fullness in the ear

Chronic Rhinosinusitis Medical Treatments:

• Similar to those for acute disease.
• Early identification of causes.
  • Antimicrobials.
  • Antihistamines.
  • Nasal sprays.
  • Decongestants.
  • Analgesics.
• Surgical interventions: cauterizing nasal polyps, correcting a deviated septum, incising and draining the sinuses.

Acute Pharyngitis

• Sudden inflammation of the pharynx.

Acute Pharyngitis Causes:

• Viral (adenovirus, influenza virus, herpes).
• Bacterial (streptococci).
  • Results in pain, fever, edema, vasodilation, and tissue damage.

Acute Pharyngitis Clinical Manifestations:

• Same as other upper airway infections.

Acute Pharyngitis Assessment & Diagnostic Findings:

• Lab test: rapid strep test (RST).

Acute Pharyngitis Medical Management:

• Viral pharyngitis: supportive measures.
• Bacterial pharyngitis: antibiotics.

Acute Pharyngitis Nutritional Therapy:

• Encourage fluid intake, orally or IV.

Chronic Pharyngitis

• Persistent inflammation of the pharynx.
• Common in adults:
  • Who work or live in dusty surroundings.
  • Excessive use of the voice.
  • Suffer from chronic cough.
  • Excessive use of alcohol or tobacco.

Chronic Pharyngitis Clinical Manifestations:

• Irritation & fullness of the throat.
• Excessive mucus.
• Persistent cough.
• Postnasal drip that causes irritation.

Chronic Pharyngitis Nursing Management:

• Instructs the patient to stay in bed during the febrile stage of illness.
• Dispose of used tissues properly to prevent the spread of infection.
• Use warm saline/water gargles or throat irrigations to reduce spasm in the pharyngeal muscles and relieve soreness of the throat.
• Resume activity gradually.
• It is important to take the full course of therapy to avoid potential complications of strep infection such as nephritis and rheumatic fever, which may have their onset 2 or 3 weeks after the pharyngitis has subsided.

Chronic Pharyngitis Nursing Management:

• Instructs the patient about preventive measures that include not sharing eating utensils, glasses, napkins, food, or towels; using a tissue to cough or sneeze; disposing of used tissues appropriately; and avoiding exposure to tobacco and secondhand smoke.
• Teach the patient with pharyngitis, especially streptococcal pharyngitis, to replace the toothbrush with a new one.

Chronic Pharyngitis Medical Management:

• Goals are to: relieve symptoms, avoid exposure to irritants, and correct any problem related to respiratory problems.
• Nasal congestion relieved by short-term use of nasal spray.
• Allergies treated with antihistamine decongestant drugs.
• Anti-inflammatory and analgesics (Aspirin or Acetaminophen) may be given.

Chronic Pharyngitis Nursing Management:

Teaching the patient self-care:

• Avoid contact with others.
• Avoid use of alcohol and tobacco.
• Avoid exposure to cold or pollutants.
• Encourage plentiful fluid intake.
• Gurgle with warm saline/water solutions.

Tonsillitis & Adenoiditis

• The tonsils are composed of lymphatic tissues and are situated on each side of the oropharynx.
• Acute tonsillitis can be confused with Pharyngitis.
• The adenoids (Pharyngeal tonsils) consist of lymphatic tissue near the center of the posterior wall of the nasopharynx.
• Group A Beta-hemolytic streptococcus is the most common organism associated with tonsillitis and adenoiditis.

Tonsillitis & Adenoiditis Clinical Manifestations:

• Tonsillitis: Sore throat, fever, snoring, difficulty in swallowing.
• Adenoiditis: Mouth breathing, earache (pain in the ear), draining ears, bronchitis, foul smelling breath, voice impairment, otitis media, sleep apnea.

Tonsillitis & Adenoiditis Medical Management:

• Use of supportive measures: Increase fluid intake, analgesics, salt water gargles, rest.
• Bacterial tonsillitis treated with Penicillin first line of treatments.
• Repeated tonsillitis treated with surgical interventions (Tonsillectomy & Adenoidectomy).

Tonsillitis & Adenoiditis Nursing Management:

Providing postoperative care:

• Continuous observation for the risk of bleeding.
• Prone position with head turned to the side is recommended immediately.
• Ice collar to the neck.
• If bleeding is excessive, inform the surgeon.
• Refrain from talking and coughing too much.

Teaching patient self-care:

• Outpatient surgery with a short length of stay.
• Understand signs and symptoms of bleeding.
• Alkaline mouth wash preferred for mouth thick secretions.
• Liquid and semi-liquid diet given for several days.
• Ice cream and milk products may be restricted.
• Avoid vigorous tooth brushing and gurgling to avoid bleeding.

Laryngitis

• An inflammation of the larynx.
• Often occurs as a result of voice abuse or exposure to dust, chemicals, smoke & other pollutes.
• Isolated infections involved vocal cord.
• Laryngitis may be a complication of a URI.

Laryngitis Clinical Manifestations:

• Acute Laryngitis: Hoarseness or aphonia (complete loss of voice), severe cough.
• Chronic Laryngitis: Persistent hoarseness, sore throat at morning, dry cough, edematous uvula.

Laryngitis Medical Management:

• Resting the voice/ Avoiding irritants.
• Appropriate antimicrobial drugs.
• Topical corticosteroids or by inhalation.

Laryngitis Nursing Management:

• Rest the voice and maintain a well-humidified environment.
• Expectorant agents with daily fluid intake of 2-3 L to thin secretions.
• Identify signs and symptoms that require contacting the healthcare team provider.
• Hoarseness that persists for more than 5 days should be reported.

Nursing Process: Care of Patients with Upper Respiratory Infections

Assessment:

• Health history
• Assessment of signs and symptoms: headache, cough, hoarseness, fever, stuffiness, generalized discomfort, and fatigue.
• Allergies
• Inspection of nose, neck, throat
• Include palpation of lymph nodes

Nursing Diagnosis:

• Based on the assessment data, major nursing diagnoses may include the following:
  • Ineffective airway clearance
  • Acute pain
  • Impaired verbal communication
  • Deficient fluid volume
  • Deficit of knowledge related to prevention, treatment, surgical procedure, postoperative care

Collaborative Problems / Potential Complications:

• Sepsis
• Meningitis
• Peritonsillar abscess
• Otitis media
• Sinusitis

Planning & Goals:

• Maintenance of patent airway
• Relief of pain
• Maintenance of effective communication
• Normal hydration
• Knowledge of how to prevent upper airway infections
• Absence of complications

Interventions

Interventions to maintain patent airway:

• Increase fluid intake.
• Use a room vaporizer or stream inhalation.
• Best position.
• Medications to relieve throat congestion.

Promote comfort:

• Analgesics
• Gargles for sore throat
• Use of hot packs for sinus congestion or ice collar to reduce swelling, bleeding post tonsillectomy and adenoidectomy

Interventions cont’d

• Promoting communication:
  • Rest
  • Refrain from speaking, use alternative communication.
• Encouraging fluid intake:
  • Liquids: 2 to 3 L a day, appropriate foods.
• Teaching patient self care
• Monitoring and managing potential complications

Patient Education:

• Prevention of upper airway infections
• Emphasize frequent hand washing to prevent transmission of infection.
• When to contact healthcare provider
• Need to complete antibiotic treatment regimen
• Annual influenza vaccine for those at risk

Practice:

• The school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus in the acute stage?
  • C) Stay home when symptomatic

Nursing Management & Health Education for Patients with Chest & Lower Respiratory Tract Disorders

Objectives:

• Assess patients with lower respiratory disorders
• Define chronic obstructive pulmonary diseases (COPD & asthma)
• Explain the risk factors, pathophysiology, clinical manifestations, and complications of COPD & asthma.
• Use the nursing process as a framework for caring for patients with COPD & asthma.
• Develop a teaching plan for patients with COPD & Asthma

Review Functions of the Respiratory System:

• Gas Exchange (ensure patent, clear airway for adequate gas exchange)
• Supply oxygen to body for energy production to meet organ needs, tissue perfusion, and maintain activity level
• Remove waste product (carbon dioxide)
• Maintain homeostasis (pH or acid-base balance) of arterial blood
• Regulating Ph (Pco2 inversely proportional with the Ph means High Pco2 retention in blood cause a decrease in PH which means Respiratory Acidosis

Normal Physiology:

• Patent Air Way: To ensure the gas exchange and adequate gas exchange produce enough oxygen supply
• Breathing pattern: Normal breathing is soundless, effortless, equal in rate, rhythm, and depth

Oxygen supply needed for:

• Adequate tissue perfusion reflected on saturation in %, pulse rate, maintain organ function
• Energy expenditure required for exerting efforts
• Ability to perform self-care
• Good sleeping pattern (sleep pattern disturbance caused by shortness of breath)

Assessment of Respiratory Disorders:

History:

• Ask the patient about the experience of:
  • Shortness of breath/Dyspnea
  • Chest pain with breathing – mainly with inspiration
  • Activity restrictions
  • Cough, (dry or wet), characteristics of sputum, timing
  • Smoking habits
  • Environmental exposure to toxins
  • History of respiratory infections, allergies, asthma, COPD, pneumonia, TB
  • Self-care behaviors & checkup as -last TB skin test, chest X ray, influenza vaccination

Normal Physiology:

Normal Physiology:

Normal Physiology:

Normal Physiology:

Diagnostic Evaluation:

• Pulmonary Function Tests (PFTs ) performed using a spirometer Spirometer used as:
  • A diagnostic method to measure the volume of the inspired and expired air by the lungs.
  • Therapeutic method: for breathing exercises and improve lung expansion.
• Arterial Blood Gas Studies
  • Measurements of blood pH and of arterial oxygen and carbon dioxide tensions .
  • Help assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide
  • Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SpO2 or SaO2).
• Sputum Studies
• Chest X-Ray
• Computed Tomography (CT) & Magnetic Resonance Imaging (MRI)
• Fluoroscopy: chest needle biopsy or transbronchial biopsy
• Thoracentesis: aspiration of pleural fluid for diagnostic or therapeutic purposes).

Endoscopic Procedures:

• Direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiber optic bronchoscope

Common Respiratory Nursing Diagnoses:

• Ineffective Airway Clearance: RT…..as manifested by
• Ineffective breathing pattern
• Impaired gas exchange
• Ineffective peripheral tissue perfusion
• Activity intolerance
• Self acre deficit
• Imbalanced Nutrition
• Disturbed sleep pattern
• Ineffective Coping

Summary of NCP:

• Remember
  • When you collect history, ask the patient about the known causes of the suspected disorder
  • If the patient has bronchial asthma or allergy the nurse should ask about the indoor and outdoor allergens, smoking history.
  • When you plan for the patient education you should consider these causes to include in your plan of nursing intervention, and patient education.
  • In the above example, the nurse should teach the patient how to avoid the trigger of asthma and the need to quitting smoking

Management of Patients With Chronic Obstructive Pulmonary Disease (COPD):

Chronic Obstructive Pulmonary Diseases (COPD):

• Progressive obstruction of airflow in the lungs, mainly expiratory airflow.
• Results in retention/increase in CO2, hypercapnia, respiratory acidosis.
• Smoking is the most common cause of COPD.

COPD - Pathophysiology:

• Airways are narrowed and gradually obstructed by
  • Inflammation
  • Excess mucous production
  • Thickness of the airway wall with loss of elastic tissue and alveoli
  • Two conditions happen:
  • Chronic bronchitis
  • Emphysema
• Causes
  • Tobacco use causes 80-90% of COPD cases, (Passive smoking)
  • Occupational exposure and air pollution
  • Genetic abnormalities ( alpha1-antitrypsine deficiency)
    • Alpha1-antitrypsine protects tissues from enzymes of inflammatory cells

Chronic Bronchitis:

• Chronic inflammatory airway disorder that characterized by:
  • Excessive secretion of thick tenacious mucus
  • Productive cough lasting 3 or more months in 2 consecutive years
  • Narrowed airways with excess secretions.
  • Expiratory airflow affected (Increase co2 retention)

Chronic Bronchitis Sign and Symptoms:

• Productive cough
• Dyspnea in exertion
• Cyanosis
• Prolonged expiration
• Crackles, rhonchi, and wheezing
• Cardiac dysrhythmias (Due to decrease oxygen supply)
• Peripheral edema.

Chronic Bronchitis:

• Normally, blood circulation is from venous at the right side of the heart to the lung for gas exchange.
• In the case of lung congestion, pulmonary hypertension, COPDs, the lungs will not be able to receive more blood from the right side of the heart to perform its normal function of adequate gas exchange
• This will leads to:
  • Right side congestion may lead to right side heart failure (Cor-Pulmonale)
  • Backflow of blood from the right side of the heart to venous blood
  • Bilateral peripheral pitting edema
  • Fluid volume Excess
  • Weight gain

Emphysema:

• Destruction in the alveolar walls and abnormal distention of the airspaces lead to decreases in-surface area for gas exchange.
• Air trapping and Barrel chest
• Impaired oxygen perfusion leads to hypoxemia
• Impaired carbon dioxide elimination leads to hypercapnia
• Right side heart failure (Cor-Pulmonale)

Emphysema Sign and Symptoms:

• Dyspnea
• Tachypnea
• Barrel chest, (Increased anteroposterior (AP) diameter)
• Use of accessory muscles, shoulders leave upward
• Decreased breathing sounds with expiratory wheezes
• Patient lips may look pink and puffy.
• Leans forward while sitting (tripod position ).
• Breathing through pursed lips to prolong the time of expiration through a whistle lipst

COPD – Diagnostic Tests:

• Pulmonary function tests using spirometry
• Ventilation/perfusion scan
• Serum alpha1-antitrypsin levels
• CT scan - CXR
• Pulse oximetry
• ABG - decreased pao2; Increased pco2

COPD - Treatment:

Medications:

• Bronchodilators: relieve Broncho-spasm and increase O2 distribution.
• Corticosteroids: decrease inflammation of epithelial cells.
• Antibiotics: may also be given if an infectious process is suspected.
• Mucolytic: used in case of productive cough thick secretion to dissolve secretions.
• Antitussive Agents: Used to suppress the dry cough
• Influenza and pneumococcal vaccination
• Oxygen therapy
• Begin O2 therapy based on the patient's condition
• If the patient is in respiratory failure, begin high-flow oxygen delivery regardless of history.
• Smoking cessation
• Fluid and nutritional support
• Airway clearance procedures (Chest Physiotherapy).
• Breathing exercises

Collaborative Problems:

• Respiratory insufficiency or failure
• Atelectasis: the collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression. This leads to:
  • Create a positive pressure surrounding the lung
  • Decrease the lung capacity and lung expansion
• Pulmonary infection
• Pneumonia
• Pneumothorax.
• Cor-Pulmonale (Pulmonary hypertension): is a condition in which the right ventricle of the heart enlarges with or without right-sided heart failure secondary from a disease that affects the lung and its vasculature.

Nursing management

Assessment:

• History: smoking history, exposure to allergy, positive family history of respiratory disease, onset of dyspnea.
• Physical examination:
  • Assessment of the airway
  • Cyanosis
  • Dyspnea
  • Observe amount, color, and consistency of sputum.
• Evaluate for the:
  • Increased respiratory effort
  • Decreased LOC
  • Accessory muscle use
  • Decreased breath sounds
  • Decreased oxygen saturation

COPD – Nursing Diagnoses:

• Ineffective Airway Clearance related to broncho-constriction, increased sputum production, ineffective cough

• Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction, airway irritants

• Impaired gas exchange related to ventilation perfusion inequality

• Altered peripheral tissue perfusion

• Activity intolerance related to imbalance between oxygen supply with demand.

• Imbalanced Nutrition less than body requirements related to anorexia

• Self-care deficit related to fatigue secondary to increased respiratory effort

• Ineffective Coping

• Decisional Conflict - smoking

• Disturbed sleep pattern related to discomfort, sleeping position.

• Knowledge deficit

COPD – Nursing Goals:

• Reverse airflow obstruction/Improving Airway Clearance
• Improve gas exchange/Improve tissue perfusion
• Smoking cessation
• Maximal self-management
• Improvement in activity tolerance
• Maintain adequate, balanced nutrition
• Attainment of optimal level of coping
• Adherence to therapeutic regimen and home care
• Absence of complications

Improving Gas Exchange:

• Proper administration of bronchodilators and corticosteroids
• Reduction of pulmonary irritants
• Directed coughing, “huff” coughing is a gentle way of coughing, which speeds air flow while you keep the throat open. To save energy and oxygen
• Chest physiotherapy
• Breathing exercises to reduce air trapping
  • Diaphragmatic breathing
    • Reduce RR, Increase AV, and helps expel air during expiration
  • Pursed-lip breathing:
    • Slow expiration and prevent collapse of airways
• Prolonged time of expiration Use of supplemental oxygen

Nursing Interventions: Achieving Airway Clearance:

• Directed and controlled coughing
• Chest physiotherapy
• Postural drainage
• Intermittent positive pressure breathing (IPPB) therapy
• Increase fluid intake
• Aerosol with normal saline

Nursing Interventions: Smoking cessation:

• Education regarding the hazards of smoking
• Discuss smoking cessation strategies with patient
• Inform the patient that continue smoking impair the mechanisms used to clear the airway
• Provide resources regarding smoking cessation
• Formalize program available in the community

Nursing Interventions: Improving Breathing Pattern:

• Inspiratory muscle training
• Breathing retraining
  • Diaphragmatic breathing
  • Pursed lip breathing
    Improving Activity Tolerance
• Focus on rehabilitation activities to improve activities of daily living (ADL) and promote independence.
• Priorities the activities (pacing of activities - period of efforts alternated with rest.
• Exercise training - walking aides
• Utilization of a collaborative approach from another Health Team Member

Nursing Interventions: Enhancing self-care strategies:

• Set realistic goals
• Avoid extreme temperatures (lead to o2 consumption)
• Modifying lifestyle
  • Moderate activity, avoid emotional disturbances
• Enhancement of coping strategies
• Monitor for and management of potential complications

Recognition of symptoms

• Medication administration Nutrition and fluid intake Stress reduction

Patient education:

• Disease process
• Medications
• Procedures
• When and how to seek help
• Prevention of infections
• Avoidance of irritants; indoor and outdoor pollution and occupational exposure
• Keep patient’s room as dust-free as possible.
• Lifestyle changes, including cessation of smoking

Improving Activity Tolerance: Focus on rehabilitation activities to improve ADLs and promote independence.

• Pacing of activities
• Exercise training
• Walking aids
• Use a collaborative approach.
• Avoid extreme temperatures.

Evaluation: Expected Outcomes

• Normal breath pattern and sounds
• Effective coughing
• Return of PaO2 to the normal range
• Improved mental status
• Feeling of being rested
• Improvement in sleep pattern
• Awareness of need to seek medical attention
• No infection

Respiratory Care Modalities The goal of chest physiotherapy

• Remove bronchial secretion Maintain the clear airway Improve ventilation, breathing and gas exchange Increase the efficacy of respiratory muscles

Chest Physiotherapy Two major categories:

I- Mobilization of secretions:

Moving of secretions from narrow alveoli to the wide alveoli to be expectorated out of the respiratory tract by:

• Postural drainage
• Chest percussion
• Chest vibrations
• Coughing exercises
  Suctioning

II- Humidification (Or Liquefaction) of secretions:

Keeps secretions liquid (thin) this to facilitate the easiest expectoration and clearing the air wayBy:

• Humidified oxygen Nebulizer
• Aerosol procedures increase intake of fluid

Chest physiotherapy Postural drainage Employ chest wall percussion and postural drainage when appropriate to loosen and mobilize secretions.

Improving Gas Exchange “continue”:

• Keep secretions liquid
  • Encourage high level of fluid intake (8 to 10 glasses; 2 to 2.5 L daily) within the level of cardiac reserve.
  • Provide inhalations of nebulized water to humidify the bronchial tree and liquefy sputum.

Asthma:

• Chronic inflammatory disease of the airways that causes hyper-responsiveness, mucosal edema, and mucus production
• Asthma differs from the other obstructive lung diseases in that it is reversible, either spontaneously or with treatment.
• Inflammation leads to cough, chest tightness, wheezing