TEACHING RESPIRATORY
ASTHMA
Asthma I
SN instructed patient/caregiver about Asthma that is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath. Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust your treatment as needed.
Asthma Signs and Symptoms
SN instructed patient/caregiver about Asthma. Symptoms of asthma vary from person to person. Asthma signs and symptoms include: shortness of breath; chest tightness or pain; wheezing when exhaling, which is a common sign of asthma in children; trouble sleeping caused by shortness of breath, coughing or wheezing; coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.
Asthma Ricks Factors
SN instructed patient/caregiver about Asthma. A number of factors are thought to increase your chances of developing asthma. They include: having a blood relative with asthma, such as a parent or sibling; having another allergic condition, such as atopic dermatitis — which causes red, itchy skin-or hay fever-which causes a runny nose, congestion and itchy eyes; being overweight; being a smoker; exposure to secondhand smoke; exposure to exhaust fumes or other types of pollution; exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing.
Asthma Complications
SN instructed patient/caregiver about Asthma. Some complications of Asthma include: signs and symptoms that interfere with sleep, work and other activities; sick days from work or school during asthma flare-ups; a permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe; emergency room visits and hospitalizations for severe asthma attacks; side effects from long-term use of some medications used to stabilize severe asthma. Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.
Asthma Preventions
SN instructed patient/caregiver about Asthma. While there’s no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks. Some steps are: Follow your asthma action plan. Get vaccinated for influenza and pneumonia. Monitor your breathing. Identify and treat attacks early. Identify and avoid asthma triggers. Take your medication as prescribed. Pay attention to increasing quick-relief inhaler use. Identify and treat attacks early.
TRACH
Tracheostomy I
SN instructed patient/caregiver about tracheostomy. A tracheostomy is a small opening through the skin into the windpipe (trachea). This opening is called a stoma. A small plastic tube called a tracheostomy tube is placed through the stoma to help you breathe. A tracheostomy is often called a “trach.” The tube is often called a “trach tube.” SN educated that patients with a tracheostomy have altered upper airway function and may have increased oral care requirements. Mouth care should have assessed by the nurse caring for the patient.
Tracheostomy Contact Your Healthcare Provider
SN instructed patient/caregiver about signs and symptoms of difficulty breathing are: retractions, pulling of the skin between the ribs, under the breastbone or around the trach itself. In addition, symptoms of difficulty breathing are: sweaty and pale skin, a person is sweaty and pale and seems to be working hard to breathe while at rest, dusky lips or nail beds. The lips or nail beds look dark, dusky or blue. Contact your healthcare provider or physician immediately: if you have an irregular heart rate, your fluids or using cool mist humidification. If you have any other problems or concerns. If you feel increased pain or discomfort.
Tracheostomy Infection Prevention
SN instructed patient/caregiver that is important to routinely clean the skin around the opening of the tracheostomy (stoma). This will help prevent skin irritation and the build-up of secretions and to contact the doctors or nurse if there are any signs of infection at the stoma site including any redness, odor, swelling.
Post-tracheostomy Procedure
SN instructed patient/caregiver that it is normal to feel some pain and discomfort for about a week after the tracheostomy procedure. If you have difficulty breathing and it is not relieved by your usual method of clearing secretions when secretions become thick, if crusting occurs or mucus plugs are present. Your physician may recommend increasing. Instructed patient/caregiver that long term complications include acute airway obstruction, blocked tube, Infection localized to stoma or tracheo-bronchial.
BRONCHITIS
Bronchitis I
SN instructed patient/caregiver about of bronchitis. Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic. Acute bronchitis, also called a chest cold, usually improves within a week to 10 days without lasting effects, although the cough may linger for weeks. However, if you have repeated bouts of bronchitis, you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD).
Bronchitis II
SN instructed patient/caregiver in chronic bronchitis the importance of avoiding bronchopulmonary irritants such as cigarettes smoking, industrial air pollutants, dust, powders, perfumes, aerosol sprays. The patient was encouraged to use of bronchodilator nebulizers. The patient was taught in adaptive breathing techniques such as deep-breathing exercises, coughing techniques, pursed-lip breathing, and abdominal breathing. The patient was reviewed to avoid persons with infections, especially upper respiratory tract infections. The patient was advised the importance of taking vaccines for influenza and pneumococcal pneumonia. The patient was recommended on cleaning of all home respiratory equipment. The patient was taught in the importance of environmental control, avoid dry air, avoid going out in cold temperatures.
Bronchitis Signs and Symptoms
SN instructed patient/caregiver about of bronchitis. Acute bronchitis or chronic bronchitis, signs and symptoms may include: cough; production of mucus (sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood; fatigue; shortness of breath; slight fever and chills; chest discomfort. Chronic bronchitis is defined as a productive cough that lasts at least three months, with recurring bouts occurring for at least two consecutive years.
Bronchitis Prevention
SN instructed patient/caregiver that bronchitis is an inflammation of the bronchi; rest is needed for extended period to help body to recover. Measures to prevent or manage bronchitis such as getting adequate rest, eating a well-balanced diet, and avoiding all respiratory irritants (smoke, dust, air pollution, etc.), get vaccinated (many cases of acute bronchitis result from influenza, a virus), wash your hands and wear a surgical mask.
Bronchitis Complications
SN instructed patient/caregiver about of bronchitis. Although a single episode of bronchitis usually isn’t cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease (COPD). See your doctor if your cough: lasts more than three weeks; prevents you from sleeping; is accompanied by fever higher than 100.4 F (38 C); produces discolored mucus; produces blood; is associated with wheezing or shortness of breath.
EMPHYSEMA
Emphysema
SN instructed patient/caregiver that Emphysema is a type of COPD that causes a permanent enlargement of the airways in your lungs. It is accompanied by destruction of the walls of the alveoli, the tiny air spaces in the lungs where oxygen and carbon dioxide are exchanged during the breathing process. When the alveoli are destroyed, it makes it difficult for the person with emphysema to breathe, which is one of the hallmark symptoms of emphysema.
Emphysema Managing/Controlling
SN instructed patient/caregiver on some measures aimed to managing/controlling Emphysema, such as: report immediately to physician, nurse or other health care provider if fever, change in amount or color of sputum and/or increased shortness of breath occur. Also, avoid or control stress, which can exacerbate disease, avoid/decrease exposure to excessive heat (which increases oxygen requirements) and avoid/decrease exposure to excessive cold (which increases possibility of bronchospasm), among others.
Emphysema Ricks Factors
SN instructed patient/caregiver about Emphysema. Factors that increase your risk of developing emphysema include: smoking; exposure to secondhand smoke; age; occupational exposure to fumes or dust; exposure to indoor and outdoor pollution.
Emphysema Complications/Preventions
SN instructed patient/caregiver about Emphysema. People who have emphysema are also more likely to develop: Collapsed lung (pneumothorax); heart problems (cor pulmonale); large holes in the lungs (bullae). To prevent emphysema, don’t smoke and avoid breathing secondhand smoke. Wear a mask to protect your lungs if you work with chemical fumes or dust.
PNEUMONIA
Pneumonia I
SN instructed patient/caregiver about Pneumonia that is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you’ve had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
Pneumonia Ricks Factors
SN instructed patient/caregiver about factors that increase risk for pneumonia, such as smoking and air pollution, upper respiratory infections, prolonged immobility, malnutrition; chronic diseases: diabetes, cancer, renal disease, cardiac disease; exposure to cold, damp weather, inhalation of noxious substances, use of immunosuppressive drugs; age: very young or very old, frequent intoxication from alcohol.
Pneumonia Signs and Symptoms
SN instructed patient/caregiver about signs and symptoms of pneumonia: high fever and chills, chest pain, cough that may be productive, green, yellow or rust-colored sputum, malaise, loss of appetite, rapid pulse and rapid breathing. Also, lower than normal body temperature (in adults older than age 65 and people with weak immune systems), nausea, vomiting or diarrhea, shortness of breath. For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening condition.
Pneumonia Complications
SN instructed patient/caregiver about complications of pneumonia. Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including: bacteria in the bloodstream (bacteremia); difficulty breathing; fluid accumulation around the lungs (pleural effusion); lung abscess.
Pneumonia Prevention
SN instructed patient/caregiver about measures to prevent or treat pneumonia: eating well balanced meals, adequate rest, avoiding upper respiratory infections or getting promptly treatment for early symptoms, drinking large amounts of fluids to thin secretions and replace fluid loss, avoiding spread of infections by washing hands and properly dispose of tissues. Avoid smoking; perform coughing and deep breathing exercises.
COPD
COPD I
SN instructed patient/caregiver about COPD (Chronic obstructive pulmonary disease). COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.
COPD II
SN instructed patient/caregiver that COPD (chronic obstructive pulmonary disease) is a group of lung diseases that cause obstruction of the airways. This results in a decreased ability to move air in and out of the lungs. Diseases classified under the heading of COPD include emphysema, chronic bronchitis, and bronchiectasis. Even with treatment, COPD is not completely reversible and usually worsens over time.
COPD Prevention
SN instructed patient/caregiver about the importance of avoiding bronchopulmonary irritants such as cigarettes smoking, industrial air pollutants, dust, powders, perfumes, aerosol sprays in the COPD. The patient was encouraged to use of bronchodilator nebulizers. The patient was taught in adaptive breathing techniques such as deep-breathing exercises, coughing techniques, pursed-lip breathing, and abdominal breathing. The patient was reviewed to avoid persons with infections, especially upper respiratory tract infections. The patient was advised the importance of taking vaccines for influenza and pneumococcal pneumonia. The patient was recommended on cleaning of all home respiratory equipment. The patient was taught in the importance of environmental control, avoid dry air, avoid going out in cold temperatures.
COPD Avoid Acute Exacerbations
SN instructed patient/caregiver on ways to avoid acute exacerbations of COPD by recognizing early warning signs and then taking action to stop them in their tracks. The best way to do this is to work with your health care provider on an action plan so you know what to do to treat an exacerbation before it becomes serious. SN instructed on early warning signs of an acute exacerbation: Wheezing or more wheezing than what’s normal for you, coughing more than usual, shortness of breath that is worse than usual, an increase in the amount of mucus, change in the color of your mucus to yellow, green, tan, or bloody, shallow or rapid breathing, more than what’s normal for you, fever, confusion or excessive sleepiness, and swelling in your feet or ankles.
COPD Management
SN instructed patient/caregiver about breathing tips for people with COPD get fresh air, try to avoid other things that can bother your lungs, too. Stay inside on days when you know pollution or pollen is bad. Stay away from fumes and dust, exercise it can be hard to move when you can’t catch your breath. But regular exercise can improve your endurance and strengthen the muscles that help you breathe. Ask your doctor which exercises are right for you; eat healthy food you’re probably using more energy to help you breathe. A well-rounded diet will give you the strength you need to stay active and healthy.
COPD Emphysema and Chronic Bronchitis I
SN instructed patient/caregiver that Emphysema and chronic bronchitis are two types of COPD that often coexist. Sometimes, it is difficult to understand the differences between the two, but both cause difficulty breathing and other lung related symptoms.
COPD & Lung Cancer
SN instructed patient/caregiver that COPD is currently the fourth leading cause of death in the United States, and is also a risk factor for developing lung cancer so routine medical checkups with your physician are important.
COVID-19
COVID-19 I
SN instructed patient/caregiver on Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
COVID-19 Symptoms I
SN instructed patient/caregiver about people with covid-19 have had a wide range of symptoms reported ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have covid-19: fever or chills, cough, shortness of breath or difficulty breathing, fatigue muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting & diarrhea.
COVID-19 Symptoms II
SN instructed patient/caregiver that if you develop fever, cough and difficulty breathing, seek medical advice promptly as this may be due to a respiratory infection or other serious condition. Call in advance and tell your provider of any recent travel or contact with travelers. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also help to prevent possible spread of COVID-19 and other viruses.
COVID-19 Prevent Spread I
SN instructed patient/caregiver on how to prevent spread COVID-19 clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, counter tops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them. Use detergent or soap and water prior to disinfection.
Infection Control Measures for Coronavirus
SN instructed patient/caregiver on Infection Control Measures to follow with the spread of Coronavirus globally and increasing now in our community, explained that hand hygiene is essential, practicing cough etiquette, and keeping social distance is essential, avoiding crowded places. Remain from going out unless strictly necessary, refrain from putting hands/fingers in the face, mouth, eyes. Wash hands frequently and or use hand sanitizer. Instructed to call MD immediately if S/S of FLU and fever develops for further instructions.
COVID-19 Prevent Spread II
SN instructed patient/caregiver on how to prevent spread COVID-19 clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, counter tops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them. Use detergent or soap and water prior to disinfection.
COVID-19 Delta Variant
SN instructed patient/caregiver that the Coronavirus (COVID-19) Delta variant grows more rapidly in the respiratory tract. Typically, vaccinated people are either asymptomatic or have very mild symptoms if they contract the Delta variant. Their symptoms are more like those of a common cold, such as cough, fever or headache, with the addition of significant loss of smell. You should wear a mask, even if you do not feel sick. This is because several studies have found that people with COVID-19 who never develop symptoms (asymptomatic) and those who are not yet showing symptoms (pre-symptomatic) can still spread the virus to other people.
MISCELLANEOUS
Pulmonary Hygiene
SN instructed patient/caregiver on pulmonary hygiene: to always blow nose or cough into tissue, never cough in anyone’s face, and to avoid using other people’s cups, glasses or utensils.
Pursed Lip Breathing
SN instructed patient/caregiver on proper method for pursed lip breathing: Relax all body muscles, especially your neck and shoulder muscles, make your usual inhalation through your nose and from the diaphragm for about two seconds only while keeping your mouth closed, Exhale for about four seconds through pursed lips, while applying very light resistance as if you were going to whistle. Keep in mind that your exhalation should always be about twice as long as your inhalation. This will rapidly increase O2 levels in Pt’s blood supply.
Pursed Lip Breathing/Rational
SN instructed patient/caregiver on The main physiological effect of pursed lip breathing: The reduction of hyperventilation and higher CO2 levels in the Alveoli during and after training increased CO2 levels in the functioning parts of the lungs relaxes and dilates smooth muscles of airways. This technique immediately improves ventilation-perfusion ratio and oxygen levels in the arterial blood.
Shortness of Breath {SOB) I
SN instructed patient/caregiver on shortness of breath that make people feel like they can’t take enough air, the chest feel tight. Sometimes the feeling is worse when active or lying down flat. If experiencing other symptoms like cough, chest pain or a fever tell the nurse or doctor. Avoid irritants/allergens known to increase SOB.
Smoking cessation
SN instructed patient/caregiver on smoking cessation due to known hazardous side effects of smoking with Patient’s current medical condition. Pt is non-compliant, requires further education.
Drink water for sputum
SN instructed patient/caregiver to increased intake of water to help loosen sputum from lungs as well as deep breathing techniques to help raise sputum and expectorate.
Jet Neb Sleep w/ pillows
SN instructed patient/caregiver on the importance of performing deep breathing, cough exercise, and to sleep with the Patient’s head elevated on pillows to facilitate ease of breathing.
Jet Nebulizer I
SN instructed patient/caregiver on the use of Jet Nebulizer: that Rx’s like Albuterol UD and Atrovent UD when admin via Jet neb help to open airways. Instructed Pt to increase intake of water to help loosen sputum from lungs as well as deep breathing techniques to help raise sputum.
Jet Nebulizer Connecting tubing
SN reinforced with Pt/CG on the use of jet nebulizer with emphasis on how to connect the tubing to the machine.
Jet Nebulizer Reinforce
SN instructed patient/caregiver reinforced with use of jet nebulizer. Pt instructed to breathe deeply in and out to help open the lungs and clear out sputum.
Jet Nebulizer Cleaning Device
SN instructed patient/caregiver on the use of jet nebulizer with emphasis on how to clean the connective tubing/ device.
Jet Nebulizer Increase Fluids
SN instructed patient/caregiver that while taking breath treatments Pt should increase intake of water to help loosen sputum from lungs as well as deep breathing techniques to help raise sputum.
