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Nursing Care Plan - Assessment Part 1

Problem: Ineffective airway clearance

Underlying cause or reason: J is suffering from ineffective airway clearance. The symptom generate due to narrow and congested airways. This further cause bronchi and bronchioles blocked with excessive sputum

Goal of care

Nursing interventions/actions

Rationale

Indicators your plan is working

J is suffering from purulent sputum, and irritating cough. She is unable to move movement and wanted to get rest. However, mobilising her and making her to sit properly with head slightly flexed, flexed knees, and relaxed shoulders. This sitting position will help effective purulent sputum release and ensure proper airway clearance. 

• Assist her to maintain proper and comfortable position, which facilitate her breathing. The positions includes leaning on-over bed; sitting on edge of bed; and elevating head of bed (Doenges, Moorhouse, & Murr, 2015)

• Encourage and assist her for abdominal and pursed-lip breathing exercise (Ealias & Babu, 2015).

• Provide warm liquids and highly recommended fluids intake between meals

• Administer the medications

• Adopt various bed position (trendlenburg position, orthoponic position, semi-fowler position, sim lateral, and prone position) (British Columbia Institute of Technology. 2015)

• Provide supplemental humidification if required e.g., neutraliser in respiratory (Carvalho et al, 2015).

• Changing the bed position will assist J to expel sputum from the lungs (Doenges, Moorhouse, & Murr, 2015). 

• The pursed lip prolongs exhalation prevents bronchiolar collapse and air trapping. This relieves shortness of breath and promotes comfort by reducing hyperventilation and increasing CO2 levels in the alveoli (Ealias & Babu, 2015).

• Bed position will provide patient comfort in proper inhaling air and allow her to mobilise sputum release. (British Columbia Institute of Technology, 2015).

• For the prevention of hypothermia and disruption of airway epithelium, Humidification is a necessary approach. It also prevent bronchospasm, atelectasis, and airway obstruction (Carvalho et al, 2015).

• Medication will assist to open J’s airways and reduce her effot for extreme coughing and pain

Managing and making her reluctant to intake higher volume of fluids and warm liquids help in easy removal of sputum. This will help her to lessen pain due to coughing and chest infection.

• Her pain is reduce and her coughing is deep and effective

• Sputum is coming up efficiently

• Shortness of breath is reduced

• Airway is cleared

• Now, she is able to cough and breathe properly. J participates well in breathing and drainage exercises 

• She is feeling better and energetic as now she can move from her bed

 

Problem: Infection (Bronchitis)

Underlying cause or reason: J was diagnosed with an ineffective bronchitis. She is an asthmatic and a smoker for longer time. This further makes her to feel short of breath, wheezing, purulent sputum, and wheezing.

Goal of care

Nursing interventions/actions

Rationale

Indicators your plan is working

J is suffering from bronchitis. she is suffering from bronchochitis infection because she is a heavy smoker and smoked for many years. The care includes encouragement and mobilization of secretion; proper and good diet rich in antioxidants; effective airway clearance; better and improved breathing pattern; relief from anxiety and fatigue; control of nosocomial spread of infection

• Note the quality, rate, depth, pattern, flaring of nostrils, dyspnea on exertion. Also, check for the evidence of splinting.

• Perform chest physiotherapy (Nursing care of child, 2015)

• Provide appropriate bronchodilator as per requirement

• Assist J to perform deep breathing and coughing exercise for postural drainage. Also recommend to use incentive spirometer, blowing bubbles, blowing balloons (Solomen & Aaron, 2015).

• Check and assess the type of cough (moist type, dry type, hacking type, paroxysmal type, brassy type, and croupy type): check for the onset, duration, frequency of cough within the day,; mucus production. Also keep an eye on the amount, consistency, and color of sputum (clear, yellow , green). Check if J has the ability to expectorate or swallowing secretions. See and make a check on her stuffy nose or nasal drainage (Kinkade & Long, 2016).

• Bronchodilator usage will make her to feel better. It can be administered orally, rectal, IV, or inhaled as per the physician prescription. Oral bronchodilators was given at the time interspersed with the action of nebulizer, MDI which would extend the effectiveness of the drug

• Coughing is practice, which help in clearing the secretions from body. J develops an ineffective cough which cause her to compromises on the airway clearance and prevents mucus from expulsion. Some of the cause of ineffective cough includes bronchospasm, respiratory muscle fatigue. (Kinkade & Long, 2016).

• Deep breathing and blowing exercise will cause the development of vibration in body. Vibration loosens, and dislodges the secretions and make, and gravity generated help in draining the airways. This finally help in sputum clearance.

• Vibration also promotes deeper breathing by enlarging tracheobronchial and develop cough reflex to remove secretions (Solomen & Aaron, 2015)

• Increase intake of fluids help her to attain proper electrolyte balance in body

• Exercise is helping in clearing secretions

• Bronchodilator reduce pain

• Proper airway clearance was maintained 

• Shortness of breath is reduced

• Airway is cleared

 

Problem: Immobility

Underlying cause or reason: J feels immobility due to shortness of breath, fever, and fatigue

Goal of care

J diagnosed with infective bronchitis. This condition causes her to suffered immobility. The immobility result due to shortness of breath, fatigue, and fever

The goal of care includes proper fluid intake and diet; exercises; regular medication; healthcare guided movements; care plan for ineffective gas exchange

Nursing interventions/actions

· Proper diet with fruits and vegetables must be implemented. Encourage patient to have small and frequent meal (File, 2019)

· Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery (Akhavan & Brar, 2016)

· Regular medication for fever and fatigue

· Pulmonary rehabilitation and adoption of healthcare professional guided exercise including physical therapy, occupational exercise, isometric exercise, and non-aerobic exercises (Elhabashy, 2016)

• Intake the fluid diet

• Pain management (Tollefson & Hillman 2016)

Rationale

· Fruits and vegetables are rich in antioxidants which provide energy to human body and decrease immobility

· Regular exercise improve shortness of breath and sputum secretion, which in turn increases physical movement (Akhavan & Brar, 2016)

· Proprioceptors help to respond for the body movements such as exercise, which cause an increase in ventilation and body response. Thus, variety of motion exercises in an immobile patient help in stimulate breathing (Elhabashy, 2016)

· Increase fluid intake will help to liquefy secretions and protect against dehydration brought by fever and fatigue (Elhabashy, 2016)

· J might have inflamed airways due to infection and coughing, this causes her to do exercises reluctantly and regularly. Further, it help in coughing and eliminating sputum. This help in managing her pain also in eliminating sputum secretion (Tollefson & Hillman 2016).

Indicators your plan is working

· Exercise promote her to move out of her bed and developed self-confidence

· Proper diet show positive impact on health, as they made to feel better and energetic

· Regular healthcare assisted walking improves the J’ s mobility

· Proper medication cure her from fever and fatigue which in turn increase mobility

Nursing Care Plan - Assessment Part 2

  • Prednisone

Prednisone is an oral steroid, which is indicated for the treatment for asthma. It is a systemic anti-inflammatory corticosteroid which helps in reducing the airway inflammatory symptoms in asthma patients (Drugs.com). Prednisone mimic glucocorticoid hormone which is naturally secreted by human body, in response to stress formed during Asthma. Through mimicking, prednisone effect on immune response and inflammation. Prednisone drug dosage is given on individualised dosage dependent on the basis of severity of condition and patient’s response. Tapered drug with varying does must be prescribed and as it may cause kidney dysfunction and other endocrine complication. Nurse should taper doses when discontinuing high dose to adrenal insufficiency. Its registered nurse responsibility that she should report and administers various symptoms of patient post medication including unusual weight gain, muscle weakness, swelling of extremities, stools colour, colds, and prolonged sore throat (Carplan, Fett, Rosenbach, Werth, Micheletti, 2017). Prednisone reduces the immune system such as swelling, allergic type reactions, wheezes, and asthma attacks (Abrams, Becker, & Szefler 2018).

  • Ipratropium Bromide Delivered with A Spacer

Ibratropium is a short acting aetylcholine antagonists which is available as an oral inhaler, nebulizer solution or a nasal spray. It is a bronchodilator which works on lungs to dilate the airways in lungs. Its ability to block cholinergic receptors decreases the development of cyclic guanosine monophosphate, which further leads to decreased contraction in smooth muscle. Nurse should intstruct the patient to rinse mouth with water so as to avoid mouth dryness, (Saab, H., and Aboeed, A. 2019). She should use a first dose under medical supervision so that paradoxical bronchospasm should not occur with nebulised solution. She should notice and monitor any kind of respiratory issue such as auscultate lungs, exacerbation of respiratory symptoms, nasal dryness, urinary retention, and nausea. Interventions associated with spacer includes are: ensure adequate hydration, prevent hyperpyrexia, make patient void before mediation so as to avoid urinary retention, teach patient about the proper use of inhaler, and must protect the solution from light (LeMone, P., Burke, K., 2018).

  • Oral Amoxicillin

Amoxicillin is a broad spectrum, semi synthetic amiopencillin and is an analogue of ampicillin. The drug is active against aerobic gram positive and aerobic gram negative bacteria. It inhibits mucoprotein synthesis in bacterial cell wall, which further helps in reducing the infection rate. The nurse should make sure that amoxicillin medicine is not missed and also should take a note for the onset of diarrheal and other symptoms of super infection (Carter, E. J., et al, 2018). She should also make a periodic assessment of renal, hepatic, and hematologic functions in patient. Monitor for hyprsensitivity sign and symptom such as unusual rash, fever, wheezing, generalised itching, and dyspnea. Other than this, she should also keep an eye on diarrhea condition to rule out pseudoembraneous colitis (Robholland). Amoxicillin act as an effective antibiotic therapy for bronchitis treatment. It was found that the drug shorten the course of treatment and also improve the health condition of individual (Smith, Fahey, Smucny, & Becker, 2017).

Nursing Care Plan - Assessment Part 3

Promoting adequate nutritional intake to meet her metabolic needs and to address her Diabetes and weight gain.

I will make her understand the importance of adequate nutritional intake though which she can meet her metabolic need. Diet and nutrition are the important factors, which can be modified easily for the development, progression, and management of lung disease such as infection bronchitis. It also make patient healthier physically and mentally. I will forced her to follow proper dietary pattern which may consist of high intake of minimally processed plant foods such as vegetables, fruits, cereals, seeds, nuts, and moderate intake of dairy foods, fish, poultry and low intake of red meat (Berthon and Wood, 2015). I will recommend her to intake those foods that are rich in dietary antioxidant. These antioxidants would have beneficial effect on respiratory health, or person suffering from asthma and other chronic obstructive pulmonary disease. Antioxidants such as vitamic C, Vitamin E, flavanoids are present in vegetables, nuts, cocoa, green tea, red wine, and citrus fruits (Wood, 2015). I had prepared a do’s and don’ts chart along with the proper diet plan for J which she can easily adopt at home herself without any supervision needed.

Moreover, I will recommend her to adopt Mediterranean dietary pattern. The Mediterranean diet promotes meals based on variety of fruits, vegetables, and cereals. The med diet plans includes the adoption of legumes, eggs, nuts, seeds, white meat and wholegrain cereals. These components are good source of long-chain fatty acids, proteins and vitamins. Airway inflammation and sputum product could be decrease with the adoption of tomato juice, fruit juice, vegetable juice, and high fibrous salad intake. This intake will allow her to reduce the chronic inflammation of airway and sputum neutrophil elastase activity (Guilleminault, Williams, Scott, Berthon, Jensen, & Wood, 2017).

Some of these do’s and don’ts list can be briefed as below:

Don’ts:

  • Avoid smoking and drinking alcohol as both are associated with development of diseases and sustain disease for longer time
  • Do not dehydrate your body
  • Do not intake carb diets more

Do’s:

  • Regular exercise
  • Proper intake of water and sugarless energy drink
  • Intake of fruits and leafy vegetables

The plan comprise of all those food which will promote the adequate nutritional intake which meet the metabolic needs and also help her to address her diabetes and weight gain.

References for Nursing Care Plan

Abrams, E. M., Becker, A. B., Szefler, S. J. (2018), Use of corticosteroids in wheezy toddler. The Journal of Paediatrics, 201, 1-5.

Berthon, B. S. And Wood, L. G., 2015. Nutrition and respiratory health – feature review. Nutrients, 7, 1618-1643.

British Columbia Institute of Technology. (2015). Clinical position for safer patient care. Retrieved from: https://opentextbc.ca/clinicalskills/chapter/3-4-positioning-a-patient-in-bed/

Carter, E. L. Et al. (2018). Exploring the nurses role in antibiotic stewardship: A multisite qualitative study of nurse and infection preventionists. Americal Journal of Infection Control, 46, 492-497.

Carvalho, O. M C., et al. (2015). Ineffective airway clearance: accuracy of clinical indicators in asthmatic children. Revista brasileira de enfermagem, 68, 580-586.

Caplan, A., Fett, N., Rosenbach, M., Werth, V. P., & Micheletti, R. G. (2017). Prevention and management of glucocorticoid-induced side effects: A comprehensive review. American Academy of Dermatology, 76, 1-9.

Doenges, A. E., Moorhouse, M F., Murr, A. C (2015). Nursing care plans. F. A. Davis Company. Philadelphia. 

Ealiasis, J & Babu, B. (2015). Effectiveness of pursued lip breathing exercises on selected physiological parameters among COPD patients. Intenational Journal of Science and Research, 5, 19-22.

Elhabashy, S. (2016). Bronchial hygiene therapy: modalities and technique Princeton University Press, 1-73.

Guilleminault, L., Williams, E. J., Scott, H. A., Berthon, B. S., Jensen, M., & Wood, L. G. (2017). Diet and asthma: is it a time to adopt our message? Nutrients, 9, 1-25.

Kinnkade, S. & Long, N. (2016). Acute Bronchitis. American Family Physician, 94, 560-565.

LeMone, P., Burke, K. 2018. Medical surgical nursing. Pearson Education India. New Delhi. India.

Nursing care of child. (2015). Retrieved from: http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9780781751155_Kyle/samples/Kyle-3735_19_CH19redo.pdf

Prednisone. Retrieved from https://www.drugs.com/prednisone.html

Robholand. (n.d.) Nursing drug amoxicilin. Retrieved from http://robholland.com/Nursing/Drug_Guide/data/monographframes/A053.html.

Solomen, S & Aaron, P. (2015). Breathing techniques. International Journal of Physical Education Sports, and Health, 2, 237-241.

Saab, H., and Aboeed, A. 2019. Ipratropium. SatPearls Publishing. Treasure Island. Finland. https://www.ncbi.nlm.nih.gov/books/NBK544261/

Smith, S. M., Fahey, T., Smucny, J., Becker, L. A. (2017). Antibiotics for acute bronchitis. Cochrane Library, 1-50.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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