Nursing Care Plan

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Nursing Care Plan for Risk for Altered Respiratory Function

Nursing Care Plan for Risk for Altered Respiratory Function

Definition

A situation where individuals at risk of a threat in the air path through the respiratory tract and the gas exchange (O2-CO2) between the lungs and vascular system.

Related Factors

Pathophysiology
Related to the secretion is thick or excessive secretions
Infection
Cystic Fibrosis
Influenza
Related to immobility, static secretions, and ineffective cough
Neurological disease (Guillain Barre Syndrome, myasthenia gravis)
Central nervous system depression / trauma to the head
Cerebrovascular injury (stroke)
Quadriplegia
Action
Related to immobility
Effect of sedation medication
General or spinal anesthesia
Related to the suppression of cough reflex
Related to decreased oxygen in inspired air.
Situational (Personal, environmental)
Related to immobility
Surgery or trauma
Pain, fear, anxiety
Fatigue
Damage to the perception / cognition
Related to very high humidity or low
Related to loss of cilia clearance mechanisms, inflammatory response, and increased mucus formation.
Smoke


Expected Outcomes Nursing Care Plan for Risk for Altered Respiratory Function

Individuals will:
1. Perform breathing exercises every hour (sigh) and coughing exercises as needed.
2. Achieve the lung function of the maximum.
3. Expresses the importance of exercise every day lungs.


Nursing Intervention Nursing Care Plan for Risk for Altered Respiratory Function

1. Assess for the presence of an optimal decrease in pain with periods of fatigue or respiratory depression is minimal.
2. Give spirit to perform consistent with ambulation immediately after medical treatment plan.
3. If you can not walk, set a rule to come down from the chair bed several times a day.
4. Increase activity gradually, explain that the respiratory function will increase and dispneu will decline by doing exercises.
5. Help for repositioning, changing the body position with frequently from one side to the other.
6. Give spirit to exercise a deep breath and cough are controlled exercise 5 times per hour.
7. Teach individuals to use the inflatable bottle or spirometer every hour while awake.
8. Auscultation of lung fields every 8 hours, increase the frequency if any interference breath sounds.

Nursing Care Plan for Ineffective Breathing Pattern