UNIT 13 RESPIRATORY Lyari.pptx back to you should get the above y of the diagnosis of it and

Getting a face mask with fabric ties with the above is a y of the diagnosis of it and long term care plan to use a photo therapy

1. Paediatric Health Nursing Respiratory Dysfunction in Children: FAUZIA RAFIQ Nursing Instructor M-CON LYARI, SGLGH G- BSN. Year III, Semester V Date : 12 -10-2025

2. Objectives At the end of this unit the learner willbe able to: Commonly occurring Respiratory problems in Pediatrics Upper and Lower Respiratory Tract Infections: 1. Pharyngitis 2. Tonsillitis 3. Otitis media 4. Bronchiolitis 5. Pnemonia 6. Asthma 7. Croup Syndrome 8. Cystic fibrosis 9. Reactive Airway Diseases (RAD)  Caring for pediatric client on Mechanical ventilator  Nursing care aspects, pharmacological and other medical management for the paediatric patients with the above disorders.

3. Characteristics of the Pediatric Respiratory System A child airway is shorter and narrower than adult creates increased potential for obstruction Trachea is higher and at different angle causes increased risk for right main stem obstruction Newborns are obligatory nose breathers. Do not open mouth if nose is obstructed. Newborns does not have enough smooth muscle bundles to help trap airway invaders increases possibility of upper respiratory infection Until age 6 the child uses the diaphragm for breathing observe the abdomen to count respiration

4. Respiratory Tract Infection Infections of the respiratory tract are described according to anatomical area of involvement. The upper respiratory tract consist of: Pharynx, larynx, and upper part of the trachea. The lower respiratory tract consist of: Lower trachea, bronchi, bronchioles,and the alveoli.

5. Upper Respiratory Tract Infections Upper respiratory tract infections includes Tonsillitis Croup syndrome Pharyngitis Laryngitis Sinusitis Otitis media, Influenza Common cold

6. Tonsillitis Tonsils are masses of lymphoid tissue located in the pharyngeal cavity. Tonsillitis is the inflammation of the tonsils. Incidence Uncommon < 1 year child Peak incidence is 5-15 years winter and early spring Etiology Viral Bacterial Tonsillitis often occurs with pharyngitis

7. Acute tonsillitis Classification: A cute catarrhal or superficial tonsillitis: Here tonsillitis is a part of generalized pharyngitis and seen in viral infections A cute follicular tonsillitis: In which tonsillar crypts become filled with purulent materials. Acute parenchymatous tonsillitis: Here tonsils are uniformly enlarged and red Acute membranous tonsillitis: The exudates in the crypts coalesces to form membrane on the surface

8. Acute Folliculer Tonselitis Acute Membranous

9. Acute catarhal tonselitis

10. Chronic tonsillitis Types: Chronic follicular tonsillitis Chronic parenchymatous tonsillitis Chronic fibroid tonsillitis

11. Clinical manifestations Dysphagia Cough Fever Sore throat Loss of appitite Malaise Nausea Vomiting Adenoiditis S t e r to r o u s b r e a thi n g - s n o r i n g , na s a l qual i ty s p ee c h P ai n in e ar , r ec u rr i n g otitis med i a

12. Differnce between viral and bacterial tonsilitis

13. Therapeutic Management Analgesics Antipyretics Antibiotics Surgical Managment Tonsillectomy Adenoidectomy

14. Nursing Care for the Tonsillectomy & Adenoidectomy Patient Providing comfort and minimizing activities or interventions that precipitate bleeding Place on abdomen or side until fully awake Ma n ag e ai r w a y Mo n itor b leedi n g , es p . n e w b leedi n g Ice c o lla r , p ai n me d s Avoiding orally fluids until fully awake --then liquids and soft cold f o o d s . A v o i d cit r us j u ice s , m i lk Do not use straws or put tongue blade in mouth, no smoking (in teenagers).

15. COMPLICATION Chronic tonsillitis with recurrent acute attacks Peritonsillar abscess Parapharyngeal abscess Cervical abscess Acute otitis media Rheumatic fever Acute golomerulonephritis Sub acute bacterial endocarditis

16. Nurse Alert for Post-Op T/A surgery Most obvious sign of early bleeding is the child’s continuous swallowing of trickling blood. Note the frequency of swallowing and notify the surgeon immediately Indications of Respiratory Distress Nasal F la r ing C i rcum o ra l c y an o sis Expir a t o r y g r u n ting Retractions Sub s te r nal, l o w er in tercostal, Tachypnea Rep ir a tions g r e a ter t han 60

17. Apn e a Defined as : Del a y o f b r e a thing o v er 2 sec o n d s Ad d itio n a l Si g ns a n d S y m p t oms: Cyanosis Mar k ed pall o r Hypotonia Bradycardia Treatment and Nursing Care Admit to hospital for cardiorespiratory monitoring Teach parents home care instructions in the use of an apnea monitor Enc o ura g e par en t s to le a r n C P R.

18. Pharyngitis Pharyngitis is inflammation of the pharynx—the back of the throat. This can cause a sore throat, as well as scratchiness in the throat and difficulty in swallowing.

19. Causes of Pharyngitis Viruses are the most common cause of sore throats, but some sore throats are caused by bacterial infections. Individuals who are frequently exposed to colds and flus, such as healthcare workers or children in day care are the most likely to develop pharyngitis. Individuals who have allergies, experience frequent sinus infections, or who have been exposed to second-hand smoke are also more likely to develop pharyngitis.

20. What Are the Symptoms of Pharyngitis The symptoms that accompany pharyngitis vary depending on the underlying condition In addition to a sore, dry, or scratchy throat, a cold or flu may cause: sneezing runny nose headache cough fatigue body aches chills fever (low grade with cold but higher with flu)

21. Diagnose Physical examination, white patches, swelling, and redness. To check for swollen lymph nodes. Throat Culture Blood Tests

22. Treatment Taking over-the-counter medication such as acetaminophen and ibuprofen to ease pain and reduce fever Drinking plenty of fluids to prevent dehydration Gargling with warm salt water Using throat lozenges Using a humidifier Resting until you feel better

23. Pharyngitis Prevention Maintaining proper hygiene can prevent many cases of pharyngitis. To prevent pharyngitis: Avoid sharing food, drinks, and eating utensils Avoid individuals who are sick wash your hands often, especially before eating and after coughing or sneezing Use alcohol-based hand sanitizers when soap and water are unavailable Avoid smoking and inhaling second-hand smoke

24. Nasopharyngitis Young child: fever, sneezing, vomiting or diarrhea Older child: dryness and irritation of nose/throat, sneezing, aches, cough Pharyngitis Y oung child : f e v e r , mal a ise, ano rex i a, hea d ach e s Older child: fever, headache, dysphagia, abdominal pain Tonsillitis Masses of lymphoid tissue in pairs Often occurs with pharyngitis Characterized by fever, dysphagia, or respiratory problems forcing breathing to take place through nose

25. Otitis Media Is an inflammation of middle ear, it is one of the most prevalent disease of early childhood. 70% of child have one episode in the first year of life and 50% of them have 2-3 episode by 3 years of age. The heighest incident at 6 months to 2 years. It caused by streptococcus pneumonia, hemophilic influenza, staphylcoccous. Factors that increased Risk: Child with smolker person Bottle feed during sleep Children who use pacifiers for several hours daily. More common in winter Children with cleft lip or palate Down syndrome.

26. Causes non infectious Type is unknown , but many risk factors: Blocked Eustachian tube Edema or infections of URTI Allergic rhinitis Hypertropic adenoids Methods of feeding( breast feeding infant less like to developm OM because the breast milk have IgA limits the exposure of th the Eustachian tubes to microbial pathogenes)

27. Otitis Media I n fl a mm a tion of the midd l e ear some t imes a c c om p anie d b y in f ec t ion . Common Causes Enla r ged ade n oi d s Aller g ic r h in i tis Eusta c hian t u be d ys f u n c t ion P r e vious URI c ause s m ucou s membrane s of the e us ta c hian tube to bec o m e edema tous an d b lo c ks tub e . Pacifier use raises soft palate and alters dynamics in the eus t a c hian t u be

28. Acute Otitis Media : characterized by abrupt onset, pain, middle ear effusion, and inflammation. Note the in j ected v essels an d al t er ed sh a pe of c o ne of ligh t .

29. Se r ou s Ot i tis Media Note effusion on otoscopy by fluid line and air bubbles N ote that the light reflex is not in the expected position due to a change in tympanic membrane shape from air bubbles.

30. Etiology of (O .M) Obs t r uc tion of Eust . T ube b y edem a t o us m uc osa d u r ing URI o r enl a rge d ade n o id. Eusta c hian t u be o b st r uc tion lead t o high – v e p r essur e in the midd l e ear c a vity lead t o occ urance of tras u d a ti v e mid d l e ear (ME) e f f u sio n . Organisms reach ME cavity by: REFLUX from nasopharynx Particularly if drum is perforated. ASPIRATION: due to high –ve middle ear pressure INSUFFLATION during : Crying, Nose- blowing Sneezing Swallowing

31. Pathophysiology: Otitis media is the result of dysfunctioning Eustachian tube. The Eustachian tube, which connects the middle ear to the naso-pharynx, is normally closed, narrow &, directed downward, preventing organisms from the pharyngeal cavity from entering the middle ear. It opens to allow drainage of secretions produced by middle ear mucosa & to equalize air pressure between the middle ear & outside environment. Impaired drainage causes the pathological condition due to retention of secretion in the middle ear.

32. Types of O.M. Acu t e o titi s media ( A OM ) : - It implies rapid onset of disease associated with 1 or more of t h e f oll o wing sy m pt o m s : Irritability,vigrous crying,rolling head ,rubbing ear (in y o u ng c hild). Plus sha r p pa in d u e to p r essur e on mast o id a r ea. Otalgia, Fever, otorrhea, recent onset of anorexia, vomiting, & d ia r rhea ( in ol d er c hild ) . Acute Otitis media (AOM): These symptoms are accompanied by abnormal otoscopic findings of the tympanic membrane (TM), which may include the following: Opacity, Bulging, Erythema Middle ear effusion (MEE)

33. 2. Otitis media with effusion (OME): Is middle ear effusion (MEE) of any duration that lacks the associated signs and symptoms of infection (e.g., fever, otalgia, irritability). OME usually follows an episode of AOM. 3- Chronic otitis media: Is a chronic inflammation of the middle ear that persists at least 6 weeks and is associated with otorrhea through a perforated TM, an indwelling tympanostomy tube (TT).

34. Complications of O.M Extr-acranial complication:- Hea r ing loss Ch r o n ic su p p u r a ti v e O .M Adhesi v e o t itis F a c ial palsy Perforation Mastoiditis Tympanosclerosis

35. Evaluation and therapy Treatment has always been directed toward antibiotic therapy; however, recently concerns about drug-resistant streptococcus pneumoniae have caused medical professionals to re-evaluate therapy ( APA, 2004) No clear evidence that antibiotics improve OM Waiting up to 72 hrs for spontaneous resolution is now recommended in healthy infants When antibiotics are warranted, oral amoxicillin in high dosage is given

36. Therapeutic management of otitis media: Administration of antibiotic (Ampicillin or Amoxicillin). Anti-inflammatory (analgesic & antipyretic). Myringotomy: A myringotomy or pin hole is made in the ear drum to allow fluid removal. Air can now enter the middle ear through the ear drum, by-passing the Eustachian tube.The myringotomy tube prevents the pin hole from closing over. With the tubes in place, hearing should be normal and ear infections should be greatly reduced.

37. Nursing care Apply hot water bag over the ear with the child lying on the affected side may reduce the discomfort (applied during the attack of pain). Put ice bag over the affected ear may also be beneficial to reduce edema (between pain attacks). For drained ear; the external canal may be frequently cleaned using sterile cotton swabs (dry or soaked in hydrogen peroxide). Excoriation of the outer ear should be prevented by frequent cleansing & application of zinc oxide to the area of oxidate. Give special attention to th tympanostomy tube i.e., avoid water entering the middle ear and introducing bacteria. Educate family about care of child, & keep them aware with the p o t en t il c o mplic a tio n s of a c u t e o t itis medi a e . g ., c o n d uc ti v e hea r ing l o s s . P r o vi d e em o tio n a l s u p p o r t t o t he c hild & his f ami l y .

38. Mastoiditis Infection of the mastoid bone Mastoiditis is an infection of the mastoid bone, which is located behind the ear. It typically occurs when an infection from the middle ear spreads to the mastoid area. Morbidity/mortality Hea r ing lo s s Exten s ion of the i n fec t io u s p r oces s b e y o n d t he ma s toid system, resulting in intracranial complications Age s a f fe c ted The inci d ence of mastoid itis parallels th a t of oti t is m e dia, affecting mostly young children and peaking in those aged 6-13 months. M a y occur in heal t h y adult s a s w ell

39. Nursing care for the child with mastoiditis M o nit o r vital signs Asses s f o r c ha n g e s in la b v al u es Medicate aggressively with abx as ordered (usually IV if bac te r ial spr ead to mast o id) D r u g s of c hoi c e: Timen t in and Ge n tami c in Assess for complications (hearing loss, tinnitus)

40. C r oup Refers to a group of viral and bacterial syndromes La r y n g o tra c he o b r o n c hitis, Bac t e r ial tra c heitis a n d epi g lo t titis a re the “big th r ee” Initial symptom of all three is stridor, a seal- like barking c o u g h and hoa r seness

41. Croup vs. Epiglotitis Croup Viral/Bacterial Fever Hoarseness Resonan t cou gh Stridor (inspiratory) Ris k fo r significant na r r o wing air w a y wi t h infl a m m a tion Humidity f or t r e a tme nt Epiglottitis Bacterial High f e v er Ra p id l y p r o g r e s si v e cou r se D ysphagia D rooling D ysphonia D is t r e s s e d inspir a to r y eff o r ts Antibiotic s needed

42. Medi c ati o ns Bet a - a g o n ist / B r o n c ho d il a t o r – Al b u t e r ol Corticosteroids Epinepherin nebulization Nursing Care : Main t ai n p a te n t air w a y Oxy g en wi t h h u mid i fic a tion K eep r es u sci t a tion equ ip m ent a t t he b ed side A s ses s V S ( T emp 102 f or >, an d R> 60 ) Nothin g s h o u l d be p lace d in t he m o uth Me e t fl u id a n d n u t r itio n a l ne e d s Co o l , n o ncar b o n a ted, n o n - aci d d r in k s A s ses s for diffic u lt y s w all o wing – m a y need IV thera p y

43. Bronchitis Rarely occurs in childhood as isolated problem Can be present with other respiratory illness M o st o f ten viral Ca n be r esp o nse to allergen Symptoms include coarse, hacking cough (increases at night), f a tig ue , sore r ibs, r espir a tio n s deep and r a t t lin g , au d i b le wheezing

44. Bronchiolitis / RSV RS V is r hino sy n c y t ial vi r us Af f e c ts 2 - 6 mo n th olds p r ima r i l y I n fe c tion of b r o n c hial m uc osa le a ding to obs t r uc tion Starts out with Upper Respiratory Infection and progresses to Respir a t o r y Dist r es s . Diagn o sed with a RS V w ash

45. Nursing Care for Child with RSV Medication therapy B r o n c ho dil a to r s – Steroids Beta-antagonists Antiviral Virozole (Ribavirin) Prevention drug – Synagis (palivizumab) given IM. and Re s p i G am ( RSV i m m u n e glo b ulin) g i v e n I V . Droplet and contact isolation

46. Reactive Airway Disease (asthma) Chronic inflammatory disorder affecting mast cells, e o sin o phils, a n d T l y m ph o c y t es . Inflammation causes increase in bronchial hyper responsiveness to variety of stimuli (dander, dust, pollen, smoke) Most common chronic disease of childhood; primary cause of s c ho o l abse n ces

47. Asthma Facts About 17 million Americans have asthma, including about 5 Million children. It is the most common chronic childhood disease. Asthma causes more hospital stays than any other childhood disease. Population Disparities in Asthma Current asthma prevalence is higher among Children than adults Boys than girls Women than men

48. Etiology/Pathophysiology of Asthma Ob s t r ucti v e airfl o w l imit a tion du e to: Mucosal edema - membranes that line airways Bronchospasm (bronchoconstriction) Mucus plugging (thicker) causes : Incr eased air w a y r esis tance Dec r eased fl o w r a tes Incr eased w ork of b r e a thin g Progressive decrease in tidal volume and expiratory volume A r te r ial pH ab n o r malitie s d u e to: Increase in number of poorly ventilated alveoli Increase in hypoxemia Car b on di o xide re t en t io n Respiratory acidosis

49. Common Asthma Triggers Allergens: Dust Animals Pollen Food Irritants: Secondhand smoke Strong odors Ozone Chemicals Cleaning compounds Viral respiratory infections colds flu often worse at night after lying down

50. Exercise Changes in weather cold air humidity

51. Diagnosing Asthma Medical History Symptoms Coughing Wheezing Shortness of breath Chest tightness Symptom Patterns Severity Family History

52. Investigations Confirm with PFT Consider Allergy testing if the child also has significant allergic rhinitis. Wheezing sounds during normal breathing Hyperexpansion of the thorax Increased nasal secretions or nasal polyps Atopic dermatitis, eczema, or other allergic skin conditions CBC S.IgE. Levels Chest X. Rays Spirometry

53. Interpreting Peak Expiratory Flow Rates Green: (80-100% of personal best) signals all clear and asthma is under reasonably good control Yellow (50-79% of personal best) signals caution; asthma not well controlled; call dr. if child stays in this zone Red (below 50% of personal best) signals a medical alert. Severe airway narrowing is occurring; short acting b r o n c ho d il a t o r is in dic a ted

54. Medications to treat Asthma Reliever or Rescue Meds S h o r t ac t ing bet a - agonists - A l b ut e rol Corticosteroids- Prednisone, Beclomethasone for short term therapy Antichol iner g ic age n ts : Atr o v ent Preventer / Controller Medications Mast-cell inhibitors (Cromolyn) Leukotriene modifiers – (Singulair) Inhal e d ste r o id s ( A d v ai r , P ulm o co r t , A z mac o r t) Asthma treatment by severity: Mild, intermittent. 2; Mild, persistent. 3; Moderate Persistent. 4; Severe Persistent.

55. Nu r sin g Inte r v entio n : Teach child and family correct use of bronchodilator, corticosteroids. Teach child and family how to avoid conditions or circumstances that precipitate asthmatic attack. Assist parents in eliminating allergens or other stimuli that trigger attack. Meal planning to eliminate allergic food. Rem o v a l o f pet s . Modification of environment (allergy proof) home es p ecial l y n o smoking in hom e . A v oid ex t r emes of e n vi r o n men t a l tem p er a t u r e . A v oid u n der ex c iteme n t a n d/or p h ysic a l e x e r tio n . Assist parents in obtaining and/or installing device to control environment. (Humidifier air conditioner, electronic air filter). Teach child to understand how equipment works. T ea c h c hild c o r r ect use of inhale r s .

56. Emergency situations of asthma Acute episode of reactive disease: bronchioles may close rapidly, causing severe airway obstruction, anxiety, restlessness, and fear.Will need to be seen in ER if not relieved by med Status asthmaticus: medical emergency with severe edema , profuse s w e a tin g , respi r a to r y f ai l ure and de a t h if untreated. Becomes seriously hypoxic…immediate intervention needed

57. Six Key Messages Inhaled Corticosteroids Asthma Action Plan Asthma Severity Asthma Control Follow-up Visits Allergen and Irritant Exposure Control Source: http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf

58. Prevention Do not let anyone smoke around your child: Keep all follow-up visits: Avoid triggers: Breastfeed your infant: Help your child get enough exercise and eat healthy foods: Avoid spreading illness

59. Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alvoli. It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other c o n d itions su c h a s au t oim m u n e disease s . Sign and symptoms Fever P r o d uc ti v e c o u g h Ches t pain Techypnea Tachycardia Nasal f la r ing Sh o r t n ess of b r e a th Ches t indr a wing

60. Pathogenetic MECHANISM Frequency Inhalation of infectious particles Common Aspiration oforopharyngeal or gastric contents Common Hematogenous deposition Uncommon Invasion from infection in contiguous structures Rare Direct inoculation Less common Reactivation More common in immunocompromised hosts PATHOPHYSIOLOGY

61. Diagnostic tests CBC Bloo d C/S X - r a y c hes t ABGs Sputum culture. Bronchoscopy P h ysical examin a tion Complications: Shock and respiratory failure. Atelectasis and plueral effusion.

62. Treatment P r e v ention t h r ough v ac c ine Amoxicilline Erythromycin Klthromycin Cephalosporins Carbapenems Fluroquinlones Aminoglycosides Vancomycin Linzolid

63. Nursing Management: Administer medications as prescribed (antibiotics, antipyretics) Improving gas exchange. Observe for cyanosis, dyspnea, hypoxia, & confusion. Checking ABG ’ s. Administer oxygen. Place patient in an upright position. 3. Improving airway patency. Encourage pt. to cough. Suctioning. Encourage increased fluid intake. Humidify air or oxygen therapy. Chest physiotherapy. Changing pt. position frequently.

64. Relieving pleuritic pain. Place patient in semi – Fowler position. Administer analgesics as prescribed. (avoid opioids in patient's with a history of COPD) Avoid suppressing a productive cough. 5. Monitoring for complications. 6. Patient education. Advise smoking cessation, and excessive alcohol intake, and heavy exercises. Advise the patient to keep up natural resistance with good nutrition, adequate rest. Encourage breathing exercises.

65. Cystic fibrosis Cystic fibrosis  is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In people with CF, mutations in the cystic fibrosis  trans-membrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. F a c t o r r esp o nsi b l e f o r mani f est a tio n s of t he disease is mechanical obstruction caused by increased viscosity of m uc o u s gla n d sec r etio n s Mucous glands produce a thick protein that accumulates and dil a tes th e m Passages in organs such as the pancreas become obstructed Fi r st ma n ifest a tion is me c o n iu m ileus in n e wbo r n

66. Cystic fibrosis (CF) is an inherited disease characterized by an abnormality in the body's salt, water-making cells and mucus-making cells. Many children are diagnosed with CF before they show symptoms due to newborn screening programs that have been implemented.

67. Signs and symptoms Very salty-tasting skin Persistent coughing, at times with phlegm Frequent lung infections including pneumonia or bronchitis Wheezing or shortness of breath Poor growth or weight gain in spite of a good appetite Frequent greasy, bulky stools or difficulty with bowel movements Breathlessness A decreased ability to exercise Repeated lung infections Inflamed nasal passages or a stuffy nose

68. Patho physiology Cystic fibrosis is caused by defects in the cystic fibrosis gene, which codes for a protein transmembrane conductance regulator ( CFTR ) that functions as a chloride channel and is regulated by cyclic adenosine monophosphate (cAMP). Mutations in the CFTR gene result in abnormalities of cAMP-regulated chloride transport across epithelial cells on mucosal surfaces. Defective CFTR results in decreased secretion of chloride and increased reabsorption of sodium and water across epithelial cells. The resultant reduced height of epithelial lining fluid and decreased hydration of mucus results in mucus that is stickier to bacteria, which promotes infection and inflammation.

69. Physical findings of the CF patient Clu b bing of t he fin g e r s I n c r eased r espir a tio n s, cyanosis P r o d uc ti v e , mois t c o u g h Ba r r el c hest

70. Assessment FTT despi t e high c a lo r ic inta k e . F r eq u e n t r espir a t o r y i n f e c t io n s . Mal a bso r p t ion o f f a ts a n d p r o t eins Mild diarrhea with malodorous stools, steatorrhea. Abn o r mal l y high l e v els of sodium c hlo r ide in s w e a t.

71. Diagnosis : A blood test is available to help detect CF. The test looks for variations in a gene known to cause the disease. Other tests use to diagnose CF include: Immunoreactive trypsinogen (IRT) test is a standard newborn screening test for CF. A high level of IRT suggests possible CF and requires further testing. Trypsin absent in 80% of children with CF Chest x-ray or CT scan Lung function tests Sweat test : Chloride – Normal < 40 mEq/L. Highly suggestive of CF 40-60 mEq/L Diagnostic > 60 mEq/L. (see bags over hands and arms)

72. CF Management Treatment Prevention and treatment of pulmonary infections with antibiotics Ch e s t P h ysi o th e r a p y a t least twic e a d a y t o i ncre a se sputum expectoration Physical exercise important adjunct Management of dietary supplements (enzymes with meals and snacks) Antibiotics to prevent and treat lung infections. Inhaled medicines to help open the airways Oxygen therapy Lung transplant is an option in some cases

73. Chest Physiotherapy cupping and clapping

74. MECHANICAL VENTILATION MECHANICAL VENTILATION : It is a method to mechanically assist or replace spontaneous breathing . It is typically used after an invasive Intubation ,a procedure wherein an Endotracheal or tracheostomy tube is inserted into the airway. Purpose: Ventilators are used to provide mechanical ventilation for patients with respiratory failure who cannot breathe effectively on their own. They are also used to provide stability of the chest wall after trauma or surgery and when patients is sedated or pharmacologically paralyzed.

75. NURSING CARE OF VENTILATED PATIENTS Monitor vital signs continuously Ensure that the endotracheal tube plaster was fully secured . Endo tracheal tube plaster should not be applied too tight over the jugular area . Avoid tight adherence of the tube of the lips . Endo tracheal tubings must be change with in 72 hours. Ensure ventilator settings are adjusted according to doctors order. Suction secretion as needed. Carries out the following hygienic necessities : Oral care every four hour. Changes position 2-3 hourly.

76. Changes dressing per need if ventilator is connected to tracheostomy Evaluates patient’s progress daily. Auscultate chest periodically, noting presence /absence and equality of breath sounds Elevate head of bed. Check ventilator alarms for proper functioning. Check tubing for obstruction.

77. References: Kumar, Vinay ; Abbas, Abul K; Fausto , Nelson; Aster, Jon, eds. (2010). Robbins and Cotran pathologic basis of disease (8th ed.). Saunders. p. 688. Boulet , LP; Boulay , MÈ (June 2011). "Asthma-related comorbidities". Expert review of respiratory medicine 5 (3): Thomson NC, Spears M (2005). "The influence of smoking on the treatment response in patients with asthma". Current Opinion in Allergy and Clinical Immunology 5 (1)