Saturday, September 22, 2012

Ineffective airway clearance related to hypersecretion

Nursing Interventions for Tuberculosis

Nursing diagnosis: ineffective airway clearance related to hypersecretion

characterized by a thick secretions or blood.

Objective:
  • ffective airway clearance.
Expected outcomes:
  • Finding a comfortable position that allows increased air exchange.
  • Demonstrate effective cough.
  • Stated strategy to reduce the viscosity of secretions.
Plan of Action:

1. Explain to the client about the use of effective coughing and why there is a buildup of secretions in the respiratory tract.
Rationale: Knowledge that will hopefully help develop adherence to the treatment plan.

2. Teach the client about the proper method of controlling cough.
Rationale: Uncontrollable cough is exhausting and ineffective, causing frustration.

3. Breath deeply and slowly when sitting as upright as possible.
Rationale: Allows greater lung expansion.

4. Perform respiratory diaphragm.
Rationale: Respiratory diaphragm lower frequency of breath, and increased alveolar ventilacion.

5. Hold your breath for 3-5 seconds and then slowly remove as much as possible through the mouth. Do a second breath, hold it and batukan of the chest by two short and strong cough.
Rationale: Increasing the volume of air in the lung secretions facilitate spending.

6. Auscultation of the lungs before and after coughing clients.
Rationale: This helps evaluate the effectiveness.

7. Teach client action to reduce secretion: adequate hydration, increase fluid intake 1000 till 1500 cc / day if not contraindicated.
Rational: viscous secretion is difficult to dissolve and can cause blockage of mucus that leads to atelectasis.

8. Perform chest physio claping / vibrating.
Rationale: With a gravity discharge will come out to big and ease spending alveol secretions.

9. Collaboration with other health team physicians, radiology.
  • Giving expectoran.
  • Giving antibiotics.
  • Consul thorax X-ray.
Rational: Expektoran to facilitate mucus and evaluate client improvement of lung development.

No comments:

Post a Comment

Search This Blog