MONITORING AND NURSING CARE FOR PATIENTS WITH RESPIRATORY DISEASES Practical lesson № 11 MONITORING AND NURSING CARE FOR PATIENTS WITH RESPIRATORY DISEASES

CONTROL QUESTION Pulmonology, Respiration, Inhalation, Exhalation, Ventilation (definition). Regulation of Breathing. Characteristics of Respiration (The type of breathing, rate, depth, rhythm and easiness of respiration). Eupnea (definition). Types of breathing. Rate of respiration (Tachypnea, Bradypnea, Apnea), factors affecting respiratory rate. Regular and irregular Respiratory rhythm. Types periodic respiration (Biot's respiration, Cheyne-Stokes' breathing, Grocco’s respiration (wave-like), Kussmaul’s respiration). Easiness of respiration. Dyspnea. Orthopnea. Breath Sounds (Audible without Amplification). Symptom and Sign. What is the difference between a symptom and a sign? Main and secondary symptoms. Dyspnea classification. Cough. Classification of cough. Pain in the chest. Peculiarities of pain syndrome in respiratory organs. Standard of nursing Care Pulmonary bleeding, clinic, premedical aid. Bronchial asthma attack, clinic, premedical aid. Oxygen therapy, definition, purpose. Oxygen delivery. The types of oxygen delivery systems. Methods of oxygen administration. Postural drainage, definition, purpose, general rules. PRACTICAL SKILLS Assessing respirations Use inhaler (closed-mouth method) Postural Drainage Positions Method of collecting sputum (specimen expectorated specimen) Throat culture collection

ASSESSING RESPIRATIONS 1. Perform hand hygiene and observe appropriate infection control procedures. Rationale: Protects both the client and the nurse from infection. 2. Provide for client privacy. Rationale: Reduces client embarrassment and increases client comfort. 3. Observe or palpate and count the respiratory rate. - Place a hand against the patient's chest to feel the chest movements with breathing, or palpate the pulse and observe the chest movements. Rationale: The client's awareness that the nurse is counting the respiratory rate could cause the client to purposefully alter the respiratory pattern. - Count the respiratory rate for 30 seconds if the respirations are regular. Count for 60 seconds if they are irregular. An inhalation and an exhalation count as one respiration. 5. Assessment : Type of breathing Rate of respiration. Regularity or rhythm of respiration. Easiness of respiration. Movement of the muscles of the chest, nose and abdomen (рarticipation of accessory muscles in the breathing act). Position of the client during breathing. Breath Sounds.

Postural drainage Postural drainage is putting yourself in certain positions, so the force of gravity will help drain mucous from your lungs. It may help: Treat or prevent an infection Make breathing easier Prevent more problems with the lungs

Postural Drainage Positions Left Lower Lobe Lie on your right side with your head down and a pillow under your hips and legs. Percuss the left side from the armpit to the bottom of your ribs. Bend your left leg and rotate your body so your chest is pointing down. Percuss the back on the left side from shoulder blade to bottom of the ribs.

General rules of Postural drainage: Session of Postural drainage can last for 20 to 40 minutes. Postural Drainage is best done before meals or one and a half to two hours after eating to decrease the chance of vomiting. Early morning and bedtimes usually are performed.

Diagnostic Studies (Collection of sputum specimen for laboratory studies)

METHOD OF COLLECTING SPUTUM SPECIMEN Expectorated Specimen: PURPOSE Reasons for cytology study. Identify blood or pus in the sputum. Identify pathogenic microorganisms and/or cancerous cells in the tracheobronchial tree. Determine sensitivity of bacterial cells to antibiotics.

EQUIPMENT/SUPPLIES Sterile, closed system specimen collection container. One pair of disposable gloves. Waterproof disposable sputum cups or wide-mouth containers are used to collect sputum specimen.

PROCEDURE To prepare your patient, have him drink plenty of fluids on the evening before the test. Nurse should wash their hands. Instruct the patient: Obtain the sample first in the morning en collected in the morning. Sputum is collected on an empty stomach. Patient should in the morning to brush your teeth for 2 hours before the collection of sputum. Before sputum collection to rinse your mouth with boiled water. 4. Wear gloves. 5. Expectorated specimen: Open container, not to touch the inside of the container. To obtain sputum, the patient should take a few deep breaths, hold your breath and expectorate sharply. 6. Collect 2 to 10 ml or 1 to 2 teaspoons of sputum. 7. Tightly secure top on container. 8. Refer to Hand Washing procedure. 9. Deliver specimen to laboratory. 10. Remove gloves. Wash hands.

THROAT CULTURE COLLECTION EQUIPMENT Tongue depressor (spatula) Swab sticks (“orange” stick with cotton swab) Viral Transport Medium (VTM) PREPARATION Antiseptic mouthwash should be avoided before this test. Patient should also tell your doctor if have been taking any antibiotics because this could affect the test results. Procedure 1. Provide explanation and obtains consent from parents and /or patients. 2. Get a swab stick for use readily. 3. Instruct the patient to open his mouth widely. 4. Use tongue depressor (spatula) to depress the tongue slightly to allow easier access to pharynx. 5. Put a swab stick into oral cavity and swab the lateral wall of pharynx (i.e “tonsillar” area) without touching the buccal mucosa or tongue (figure ). 6. Remove the swab stick from the oral cavity carefully without touching the buccal mucosa or tongue. 7. Put the swab stick immediately into VTM

USE INHALER (Closed-Mouth Method) 1. Снимите крышку. 2. Встряхните ингалятор хорошо. 3. Держите ингалятор в вертикальном положении. 4. Слегка наклонить голову назад. 5. Выдыхайте медленно. 6. Поместить ингалятор в рот. Закрой рот (губы плотно вокруг мундштука ингалятора). 7. Как человек начинает дышать медленно, нажмите на ингалятор один раз. 8. Вдохните медленно, считая до 3 до 5 сек. 9. Задержите дыхание на медленно сосчитайте до 10 (10 секунд). 10. Если больше затяжек прописаны, ждем около минуты между каждой затяжкой. 11. Продолжать использовать ингалятор, если дышать по-прежнему проблема/ 12. Полоскание и полоскание с водой после использования ингалятора любого стероида (даже в сочетании с другим препаратом). PROCEDURE Remove the cap. Shake inhaler well. Hold the inhaler upright. Tilt your head back slightly. Breathe out slowly. Place the inhaler in your mouth. Close your mouth (lips tightly around inhaler mouthpiece). As the person starts to breathe in slowly, press down on inhaler one time. Breathe in slowly for a count of 3 to 5seconds. Hold your breath for a slow count to 10 (10 seconds). If more puffs are prescribed, waiting about one minute between each puff. Continue Using Inhaler if Breathing Is Still a Problem/ Rinse and gargle with water after using any steroid inhaler (even when it’s combined with another medicine).