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Is

inflammation of the lungs and airways to the lungs ( bronchial tubes ) from breathing in foreign materials such as food, liquids, vomit or fluids from the mouth

Lung Alveoli Bronchi

-and the other organs in the lower respiratory tract

Age

65 years old or older Very young children Impaired consciousness Improper client positioning during tube feeding Esophageal strictures Compromised cough reflex Compromised glottal closure Smoker Client has tracheostomy Alcoholic

Anesthesia Coma Decreased

or absent gas reflex (unconscious or semi-conscious client) Dental problems Disorders that affect normal swallowing (feeling pain when swallowing) Disorder of the esophagus (gastroesophageal reflux) Excessive alcohol use

Bluish discoloration of the skin (lack of oxygen) Chest pain Cough -with foul-smelling phlegm -contains pus or blood -greenish sputum fatigue Fever Shortness of breath Wheezing Having to make unusual movement of the head and neck when swallowing Excessive sweating Difficulty when swallowing

An aspirate with a low pH (less than 2.5) spreading throughout the lung fields may quickly results in adult respiratory distress syndrome The coupling of a low pH and virulent pathogens may quickly overwhelm normal defenses of the lung Aspiration of materials from the oropharynx carries resident flora to the sterile lower respiratory tract. Elderly and hospitalized client shows a prevalence gram-negative bacteria in the oropharynx, which increases the likelihood of gram-negative pneumonias associated with aspiration Aspiration of gastric juices that have a pH less than 2.5 results in a chemical burn to the lung

If

significant of acid aspirate,extensive atelectasis can occur Bronchospasm, epithelial injury and disruption of the alveolar membrane will develop fluid and cellular elements leaking into the interstitial space and to the alveolidecreases surfactant production Aspiration of particular matter may have an immediate life-threatening result if large particles mechanically block the major airways

Antibiotics -e.g clindamycin or aminoglycoside Oxygen therapy Chest physiotherapy -Percussion >performed by rhythmically striking or clapping the chest wall with cupped hands -Vibration >facilitates secretion movement into larger airways -Postural drainage >uses gravity to facilitate removal of secretion from a particular lung segment >semi-prone or prone and Fowlers position

Arterial

blood gases Bronchospasm Sputum culture Swallowing studies Drug therapy -bronchodilators in case of bronchospasm Endotracheal suctioning Computed tomography scan Vaccination

Avoid and stop smoking behaviors Avoid excessive alcohol use Put the patient in proper position during tube feeding Regularly wash hand Get enough rest and moderate exercise and eat a diet rich in fruits, vegetables and whole grains -these measures boost strength and help protect against serious illness and infections Get vaccinated against pneumococcal pneumonia at least once after the age of 65 -Prevnar (pneumonia vaccine) protects young children under the age of 2

ASSESSMEN T Cough

NURSING DIAGNOSIS Disturb sleep pattern related to cough

GOAL

NURSING EVALUATIO INTERVENTI N ON

Client able -put client to sleep on semicomfortably Fowlers position -make sure client do not get dyspnea -ask patient to inform any feeling or restless

ASSESMENT

NURSING DIAGNOSIS

GOAL

NURSING INTERVENTION

EVALUATION

Shortness of breath

Anxiety related to difficulty in breathing

Client do not feels anxiety and can breath easily

-teach client how to do correct breathing and coughing technique -check for clients respiration -gives correct oxygen therapy as doctors ordered