Definition :- Asthma is an intermittent, reversible, obstructive airway disease, it ismanifested by a narrowing of airway resulting indyspnea, cough and wheezing.Asthma can begin at any age about half of the cases develop in childhood and anther thirdbefore age 40.Asthma is often characterized as allergic, idiopathic Or mixed
Exercise Stress or emotional upset Medications Aspirin and non steroid anti-inflammatory chugs (NSAlDs), beta-blockers (including eye drops),cholinergic drugs (to promote bladder contraction andas eye drops for glaucoma) .Enzymes- including those in laundry detergents.. Chemicals- toluene and others used in solvents, paints, and plastics
The common symptoms of asthma are cough, dyspnea & wheezing.Asthma attacks frequently occur at night.Attacks starts suddenly with coughing & a sensation of tightness in thechest.Cyanosis secondary to sever hypoxia. Symptoms of carbon dioxide retention - sweating, tachycardia.
Un Status asthmatics occurs in which therapeutic measures fail &thepatient has repeated attacks or continuous asthma.Allergic reaction eczema, urticaria, edema.
1-Acomplete history. 2- Reaction skin test. 3-Assessment of environmental factors, including seasonal changes, mold and pollens. Climatechanges.4-Occupation- related chemicals & compounds (metal salts, wood & vegetable dust,pharmacological a gents, industrial chemicals,biologic enzymes - including laundry detergents 5-5-Chest X-ray.6- Sputum examination. Pulmonary function studies
There are five categories of drugs used in the treatment of asthma:Beta antagonist brortchodilatots:eg pinephrine. Methylxanthines - bronchodilator e.g aminophylline Ant cholinergic - broncho-dilatition effect e.g. tropine. Corticosteroids - reduce inflammation & broncho- constrictione.g. hydrocortisone prednisone.5- Mastcell inhibitors: broncho-dilatition g.cromolyn sodium.
Assessment :-ASSESS THE PATIENT RFOR :- History of asthma onset & duration Precipitating factors Current medications Medications used to relieve asthma symptoms Any recent changes in medication regimen , Self-care methods used to relieve symptoms: Assess General appearance. Assess vital signs. Assess laboratory findings.
Pneumonia is an inflammatory illness of the lung. Frequently,it is described as lungparenchyma/alveolarinflammation and abnormalalveolar filling with fluid
Classification according to the causative agent:1- Bacterial pneumonia (common * streptococcus;)2- Viral Pneumonia 3- Mycoplasma Pneumonia 4-Aspiration pneumonias syndrome 5-Chemical pneumonia, after ingestion of kerosene or irritation gases
Risk factor/groups: Patients with conditions that produce bronchial obstruction -cancer Immunosuppressed patients Smokers Bed ridden patients Very ill patients who are on nothing by mouth ,Over dose of sedatives- respiratorydepressionAssociated with congestive heart failure diabetes, alcoholism
A lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Lobar pneumonia is often due to Streptococcus pneumonia (though Klebsiella pneumonia is also possible.) Multilobar pneumonia involves more than one lobe, and it often causes a more severe illness.
pneumonia by clinical them into characteristics, dividing1-"acute" (less than three weeks duration) Streptococcuspneumonia2- "chronic" pneumonias.
is infectious pneumonia in a person who has not recently been hospitalized.Streptococcus pneumonia is the most common cause ofcommunity-acquiredpneumonia
called Nosocomial pneumonia, is pneumoniaacquired during or afterhospitalization for anotherillness or procedure withonset at least 72 hrs afteradmission.
risk factors for pneumonia, including mechanical ventilation,prolonged malnutrition, underlyingheart and lung diseases,decreased amounts of stomachacid, and immune disturbances.
1- Pneumonia arises from aspiration of flora present in the oropharynx. &blood borne organisms that enter thepulmonary circulation 2-An inflammatory reaction can occur alveoli, producing exudates that in theaffect on ventilation 3-White bloodcells, mostly neutrophils, migrate intothe alveoli. Areas of the lung are notadequately ventilated because ofsecretions and mucosal edema thatcause partial occlusion of the bronchi
4- Venous blood entering the pulmonary circulation to theleft side of the heart poorlyoxygenated. The mixing ofoxygenated and unoxygenatedblood eventually results inarterial hypoxemia.
Pneumonia Clinical manifestations: 1-Cough producing greenish or yellow sputum, 2- high fever that may be accompanied byshaking chills. 3- Shortness of breath4-pleuritic chest pain, a sharp or stabbing pain,either experienced during deep breaths orcoughs or worsened by them.5- cough up blood, 6-headaches, or develop sweaty and clammy skin.7- Other symptomsare loss of appetite, fatigue, blueness of theskin, nausea, vomiting, mood swings, and jointpains or muscle aches.
1-Medical interventionDiagnosis:- patients symptoms and findings from physical examination,chest X-ray and blood tests arehelpful, and sputum cultures chest CTscan or other tests may be needed todistinguish pneumonia from otherillnesses. A complete blood countindicating the presence of an infectionor inflammation, in some people withimmune system problems
Management: 1-Administration of appropriate antibiotics as PenicillinTypically, oral antibiotics, rest, fluids, and home care2-people with other medical problems and the elderly may needtreatment that is more advanced. 3-If the symptoms worse, the pneumonia does not improve withhome treatment, or complicationsoccur, the person will often have tobe hospitalized.
Prevention 1-treating underlying illnesses (such as AIDS) 2-Smoking cessation 3-Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis, and then giving antibiotic treatment 4 Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia. 5-Vaccination is important for preventing pneumonia in both children and adults.Vaccinations against Haemophilusinfluenza and Streptococcus pneumonia inthe first year of life.
Assessment: . The nurse should monitor the - following: • Changes in temperature and pulse • Amount, odor, and color of secretions • Frequency and severity of cough • Degree of Tachypnea or shortness of breath • Changes in physical assessment findings (primarily assessed by inspecting and auscultation the chest)• Changes in the chest x-ray findings
NURSING DIAGNOSES Based on the assessment data, the patient’s major nursing diagnose smay include: - •1- Ineffective airway clearance related to copious tracheobronchial secretions •2- Activity intolerance related to impaired respiratory function • 3-Risk for deficient fluid volume related to fever and dyspnea • 4-Imbalanced nutrition: less than body requirements• 5-Deficient knowledge about the treatment regimen and preventive health
Planning and Goals :- The major goals for the patient may include 1- improved airway patency, rest to conserve energy, 2- maintenance of proper fluid volume, maintenance of adequate nutrition, 3- an understanding treatment protocol and preventive measures, 4- absence of complications.
Nursing Interventions:- 1- IMPROVING AIRWAY PATENCY 2- PROMOTING REST AND CONSERVING ENERGY. 3- PROMOTING FLUID INTAKE 4- MAINTAINING NUTRITION 5- PROMOTING THE PATIENT’S KNOWLEDGE 6- MONITORING AND MANAGING POTENTIAL COMPLICATIONS7- PROMOTING HOME AND COMMUNITY- BASED CARE &Teaching PatientsSelf-Care.
EXPECTED PATIENT OUTCOMES a -Has normal vital signs, pulse oximetry, and arterial blood gas measurements b. Reports productive cough that diminishes over time c. Has absence of signs or symptoms of shock, respiratory failure, or pleural effusion d. Remains oriented and aware of surroundings e. Maintains or increases weight 8. Complies with treatment protocol and prevention strategies.