REASONS: stressful situations, physical activity, diseases of the heart, breathing, etc.

Pathological shortness of breath is characterized by:

Type of shortness of breath	Inhale	Exhalation
Inspiratory	difficult
Expiratory		difficult
Mixed	difficult	difficult

2. Choking -severe shortness of breath with deep inhalations, exhalations, increased respiratory movements. Painful feeling of tightness in the chest, lack of air

Asthma - a suddenly developing attack of suffocation.

cardiac

Asthma by origin

bronchial

Regardless of the origin of the asthma attack, patients require emergency assistance.

Nursing care for a suddenly developing attack of suffocation.

Purpose of care:

· stop an attack of shortness of breath;

Care plan:

· assess functional status;

· report to the doctor;

· provide first aid;

· follow the doctor's orders.

Nursing interventions:

Independent:

1. assess the functional state: calculate respiratory rate, examine pulse and blood pressure;

2. report to the doctor;

3. give an elevated position (Fowler's position);

4. free from restrictive clothing;

5. provide access to fresh air;

6. prepare medicines.

Dependents:

1. Follow the doctor's instructions:

· administration of parenteral drugs;

· administer oxygen therapy;

· use a pocket inhaler.

Interdependent:

1. prepare the patient for consultation: allergist, pulmonologist, etc.;

2. prepare the patient for sputum collection for various types of tests;

3. prepare the patient for R - respiratory examinations, etc.

3. Cough - a protective reflex act aimed at removing sputum or foreign bodies from the bronchi and upper respiratory tract.

wet (with sputum production)

Cough

dry (no sputum production)

Nursing care for dry cough.

Purpose of care:

· after 3-4 days the cough will be wet.

Care plan:

1. assess the patient's well-being;

2. carry out doctor's orders;

3. teach “coughing technique”;

4. provide a spittoon.

Nursing interventions .

Independent:

1. Report to the doctor.

2. Provide a spittoon and familiarize with the rules for its use.

3. Teach coughing technique

a/ explain the purpose: to cough up sputum;

b/ demonstrate the “coughing technique”:

· take a deep breath;

· hold your breath for 2-3 minutes;

· open your mouth and clear your throat while exhaling;

c/ evaluate the learning process;

4. Monitor the patient for compliance with the prescribed drainage position.

Dependents: Run:

1. Doctor's order:

a/ monitor the intake of alkaline solutions and expectorants;

b/ carry out alkaline inhalations;

c/ put jars, mustard plasters, etc.;

d/ place the patient in a draining position (for natural discharge of sputum).

Interdependent:

1. Prepare the patient for R -methods for studying the respiratory organs.

Sputum - pathological secretion of the lungs and respiratory tract.

The very fact of the appearance of sputum indicates disease. By nature, mucous, serous, purulent, mixed, and bloody sputum are distinguished.

Sputum examination is carried out for atypical cells, for the presence of tuberculosis bacilli, for sensitivity to antibiotics, for bacteriological analysis, and for determining the daily amount.

To prevent infection of others
the nurse should teach the patient
Handle phlegm correctly:

· Do not spit sputum into a handkerchief, because it can get on the patient’s clothes and during washing serve as a source of infection for others;

· Do not spit sputum on the floor, because when it dries, it infects the air;

· try not to cough when in close proximity to healthy people; if you cannot stop the cough, then cover your mouth with a handkerchief so that phlegm particles do not fall on another person;

· collect sputum in a spittoon with a tight-fitting lid.

Disinfection of sputum:

· the spittoon is served filled with 1/4 of the volume with a 3% chloramine solution;

· the sputum is discharged into the sewer network;

· sputum of tuberculosis patients is disinfected with a 5% chloramine solution - 240 minutes or burned in ovens, first sprinkled with sawdust.

Disinfection of spittoons:

· empty daily;

· washed in a solution of 3% chloramine (if VC is present, then use a 5% solution of chloramine);

· disinfected in a solution of 3% chloramine - 1 hour (for VK - infection, 5% solution of chloramine - 240 minutes).

· washed under running water;

· dried.

Nursing care for wet cough.

Purpose of care:

· improve sputum discharge;

· teach the patient how to use the spittoon.

Care plan:

· provide a spittoon;

· teach the rules of using a spittoon;

· teach coughing techniques;

· follow the doctor's orders.

Nursing interventions.

Independent:

1. Report to doctor.

2. Provide a spittoon and familiarize with the rules for its use.

3. Teach coughing technique.

4. Provide plenty of alkaline drinks (mineral water in any form, milk with soda).

Dependents:

1. Follow the doctor's instructions:

a/ conducting distraction therapy;

b/ carrying out alkaline inhalation;

c/ performing vibration massage on the chest;

d/ providing postural drainage;

d/ preparing the patient for collecting sputum for various types of tests.

Interdependent:

1. Prepare the patient for various types of examination.

4. Blood spitting - presence of a small amount of blood in the sputum. Hemoptysis of any origin may be preceded by pulmonary hemorrhage.

Pulmonary hemorrhage is characterized by the release of scarlet, foamy sputum.

Nursing care for hemoptysis .

Purpose of care:

· provide assistance with pulmonary hemorrhage.

Care plan:

1. Call a doctor.

2. Assess the patient's functional status.

3. Prepare a first aid kit for emergency assistance.

4. Provide first aid.

Nursing interventions:

Independent:

1. Assess functional status: measure blood pressure and P S, NPV.

2. Create physical and psychological peace.

3. Report to doctor.

4. Give a semi-sitting position.

5. Provide flow, napkin.

6. Give cold drink.

7. Prepare hemostatic agents: syringes, tampons, etc.

Dependents:

1. Follow the doctor's instructions.

After providing medical care, the patient can be fed easily digestible food in semi-liquid form, in small portions.

5.Pain in the chest - occurs during pathological processes of the pleura.

Things to consider:

· localization of pain;

· intensity and nature of pain;

· the reason for the increase or decrease in pain.

Nursing care for chest pain.

Purpose of care:

· relieve pain.

Implementation:

Independent:

1. Report to doctor.

2. Place the patient in a position to reduce the feeling of pain (lay him on the sore side, which somewhat limits the friction of the pleura and the pain decreases).

3. Explain and teach the patient to breathe shallowly.

Dependents:

1. Follow the doctor's instructions:

· administration of painkillers;

· carrying out distracting procedures (placing mustard plasters, etc.).

6.Hyperter mia - (increase in temperature), which occurs as an active protective and adaptive reaction of the body in response to pathogenic stimuli. These include microbes, toxins, vaccines, serums, etc.

There are 3 periods in the development of fever :

I period - rise in body temperature;

II period - relative constancy;

gradual decline

t 0 body - lysis

III period - decrease in body temperature

sharp decline

t 0 body - crisis

Patient's problems Iperiod of fever:

· chills;

· headache;

· weakness, malaise.

Purpose of care:

· alleviate the patient's condition.

Nursing intervention:

Independent:

· report to the doctor;

· put the patient to bed, cover him warmly;

· a heating pad to your feet;

· remove light irritants (light, radio, TV, etc.);

· give sweet, hot tea (or coffee, if there are no contraindications);

· provide care items (bed, urinal, etc.);

· regularly assess the patient’s functional status;

· note the data of the functional state in the patient's medical history.

Patient's problems IIperiod of fever:

· feeling of heat, headache;

· decreased appetite;

· motor agitation (delusions, hallucinations);

· dry mouth, formation of cracks on the lips;

· aches all over the body.

Purpose of care:

· alleviate the patient's condition;

· prevent complications.

Nursing interventions:

Independent:

· monitor compliance with the physical activity regime;

· cover the patient with a light sheet;

· change bed and underwear;

· wipe the skin with a dry cloth;

· treat the oral cavity, lubricate lips with Vaseline;

· give plenty of fortified drinks up to 2.5-3 liters per day (fruit drinks, compotes, juices, etc.);

· feed easily digestible food in small portions (diet No. 13);

· put a cold compress on your forehead;

· periodically assess the functional state of the body: measure blood pressure, PS, t 0 body;

· enter data into the nursing care record;

· provide care items;

· prepare antipyretics;

· disinfect care items.

Dependents:

· carry out doctor's orders;

Patient problems IIIfever period :

· profuse sweating;

· weakness;

· a sharp decrease in blood pressure (collapse).

Purpose of care:

· prevent complications (collapse);

· alleviate the condition.

Types of interventions

Lysis

Crisis

Independent

· change bed linen;

· toilet the skin;

· expand the mode of physical activity;

· transfer to diet No. 15;

· control blood pressure, PS, t 0 body;

· enter data into the medical history.

· measure blood pressure, PS, t 0 of the body;

· report to the doctor;

· raise the foot end of the bed;

· remove the pillow and - under the heads;

· cover with heating pads;

· give strong tea, coffee, etc. to drink;

· prepare medicines (camphor, sulphocamphocaine)

Dependents

· carry out doctor's orders

Cough — a complex reflex whose task is to clear the airways. Thanks to coughing, the respiratory tract gets rid of irritants, saliva or foreign bodies that may have entered there during inhalation (aspiration), as well as secretions, cell fragments and microorganisms secreted by lung tissue or cells of the bronchial tree. A cough can be involuntary as a reaction to the entry of a foreign body (including food fragments) or voluntary as a conscious action designed to clear the larynx of mucus.

How does ALS affect the severity of a cough?

Maintaining a clear airway is of utmost importance, and the cough reflex serves as the primary means of achieving this. Because ALS causes decreased muscle strength, a person's ability to cough voluntarily and involuntarily is also impaired. The main muscles that provide ventilation to the lungs include the diaphragm, intercostal muscles and neck muscles. In addition, ALS can also affect the muscles in the mouth and throat (bulbar) area that control voice and swallowing, making it impossible to close, open, and protect the glottis located between the vocal cords.

Cough includes three phases:

inhale;
forced exhalation with a closed glottis;
opening of the epiglottis with a sharp release of air from the larynx, usually accompanied by a characteristic sound.

Each of these phases involves specific muscles:

diaphragm and intercostal muscles in the inhalation phase;
throat muscles when closing the glottis, while the diaphragm and chest muscles create increased pressure;
When the glottis is opened, solid particles and secretions are removed from the respiratory tract due to the force created by the expelled air.

The purpose of a cough is to protect the airways from food particles, liquids or secretions, in other words, it is needed to prevent food from going down the wrong throat. Coughing also helps clear the lower respiratory tract from the accumulation of secretions in the alveoli, which is a condition for adequate exchange of oxygen and carbon dioxide between the lungs and the blood. Deep breathing and coughing help maintain adequate ventilation. Keeping your airways clear reduces the risk of pneumonia.

People with ALS often have trouble maintaining a strong enough cough due to an inability to take deep breaths, weak exhalations, and weakness in the muscles involved in swallowing. A decrease in physical activity or fluid intake can cause impaired shallow breathing and thickening of secretions. In this case, more effort is required to clear the airways.

Coughing techniques

There are techniques that can be used to achieve deeper inhalation and greater cough strength. One exercise involves a person with ALS taking a series of short breaths — until the lungs are fully expanded — followed by a sharp exhalation, accompanied by a cough. In another case — the caregiver helps.

Third technique — mechanical hyperinflation of the lungs. It is similar to the previous one, however, unlike the first method, it involves the use of an Ambu bag and a mask or mouthpiece to achieve a deep breath. A caregiver can help the person with ALS use these devices.

Automatic insufflators-exufflators (coughers) Philips Cough Assist™ or Hill-Rom Vital Cough™ are effective when the cough is insufficient. By creating positive pressure, the device provides a deep breath through a mouthpiece or mask, then switches to negative pressure, simulating a normal cough and allowing secretions to move up the respiratory tract.

Positioning a person with ALS while sleeping or sitting, as well as following a diet and using safe swallowing techniques can reduce the workload on the respiratory muscles required to maintain adequate breathing and a clear airway. With the help of medications and physiotherapeutic procedures, it is possible to reduce the secretion of the glands of the oral cavity and bronchi, and the use of equipment for assisted breathing will help maintain adequate lung volume.

Talk to your healthcare provider for more information about how to reduce the strain on your breathing muscles, maintain a clear airway, and use breathing or coughing techniques.

Drug therapy

Dehydration, mouth breathing, and evaporation of saliva contribute to the accumulation of thick saliva and mucus in the mouth and at the back of the throat. This can lead to the formation of thick mucus and blockage of the airways. The medications listed in the table below provide some relief.

Attention! Use with caution in cases of severe weakness of the respiratory muscles.

*Preparation*	*Dosage forms and comments*
Mucolytics — agents that help thin saliva.	Acetylcysteine — ACC — tablets or powder
	Bromelaine — dietary supplement
	Papain tablets or Papaya-GIT (or papaya fruit) — Take papaya-derived preparations at times of day when sticky saliva is most bothersome. The enzyme papain helps make viscous saliva more fluid. Wipe your mouth or drink juice.

increased amount of fluid — drink more liquid, preferably add ice;
reduce your intake of dairy products;
consume less caffeine and alcohol;
Avoid using mouthwashes that contain alcohol (try a solution of 1 teaspoon salt, 1 teaspoon baking soda, and 4 cups warm water instead);

Nursing process for COPD (chronic obstructive pulmonary disease) is designed to improve quality of life. It has several stages.

Process steps:

Examination.
Diagnosis.
Planning.
Nursing care.
Assessing nurse performance.

Survey

The goal is to identify violated human needs.

Objective methods: thermometry, pressure measurement, percussion, inspection and observation. Particular attention is paid to the condition of the skin and oral mucosa; the presence of cyanosis, edema; chest shape; listening to wheezing, whistles, duration of exhalation time; characteristics of sputum (quantity, consistency, color, presence of blood).

Subjective methods: survey to obtain information about well-being, the presence of chronic lung diseases in relatives, bad habits, occupational exposures, past illnesses, conditions for the occurrence of cough and shortness of breath.

Laboratory and instrumental methods:

General clinical blood test.
Cytology of sputum.
Checking external respiration functions.
Radiology.
Bronchoscopy.
Blood gas study.

Purpose: to determine the characteristics of care for a specific patient.

Based on survey data, emergency conditions are identified, the most painful, leading to deterioration of health, and interfering with self-care. Disturbances can be either physiological, associated with the disease, or psychological, social, or spiritual.

Intervention methods:

first aid;
fulfillment of medical prescriptions;
providing comfortable conditions;
psychological support;
technical manipulations;
prevention of complications;
health promotion;
consulting and training.

Implementation of the plan

Types of nursing interventions (NI):

Dependent SV. Fulfilling doctor's orders for drug therapy and physiotherapeutic procedures. The nursing process involves:

compliance with the treatment regimen prescribed by the doctor;
monitoring changes in the patient’s condition as a result of taking medications, preventing the occurrence of side effects.

Features of drugs used for chronic obstructive pulmonary disease:

Drugs that dilate the bronchi (anticholineergics) - reduce the influence of the vagus nerve, which causes spasm of smooth muscles. It is necessary to monitor possible side effects: constipation and dry mouth, impaired urination and vision.
Beta-agonists (beta-adrenergic receptor stimulants), relaxing the muscles of the bronchi. Increased blood pressure, palpitations, and anxiety may occur.
Corticosteroids are hormones that reduce inflammation and block immune responses. They require monitoring of changes in the basic functions of the body (cardiac activity, pressure, blood composition).
Mucolytics dilute bronchial exudate and accelerate its excretion (carbocysteine, ambroxan, acetylcysteine, ambrobene).
Herbal preparations that relieve expectoration (licorice, thermopsis, elecampane, thyme).
A course of antibiotics is prescribed by a doctor for fever, signs of intoxication, weakness, and severe fatigue.
Oxygen therapy for respiratory disorders. In a medical institution, it is carried out with a gas mixture with an increased oxygen content, passed through a Bobrov apparatus for humidification. Methods of oxygen therapy:

through nasal catheters (cannulas);
using masks;
through tracheostomy and endotracheal tubes;
in oxygen tents.

Inhalations. Used:

balloon sprays (MDI - metered aerosol inhalers);
spacers - auxiliary devices to facilitate the use of pMDIs;
masks - intended for seriously ill patients;
nebulizers are devices for creating an aerosol with the required particle size.

Independent SV. First aid, monitoring the reaction to treatment, providing hygiene measures, counseling, prevention, teaching new techniques, organizing leisure activities. The nurse explains the nature and causes of the disease, methods of its treatment and prevention, the need to get rid of bad habits, professional and everyday influences, selects the optimal mode of physical activity, teaches special breathing exercises, recommends a diet, and instructs on the use of inhalers, spacers and nebulizers. The necessary information is provided to the patient's relatives.

Nursing care for patients with COPD

The productive cough technique is demonstrated:

The first technique is two forced exhalations in a row after a normal inhalation, the second is a slow deep intake of air, holding the breath, three cough shocks.
Find a drainage position in which the bronchi are released effectively, and maintain it for up to half an hour a day.
If there is shortness of breath, the person is given a semi-sitting position and ventilation is activated.
In case of respiratory failure, oxygen therapy is performed.
Inhalations with medications, saline, mineral water, Ringer's solution up to 3 times a day for a week.
Familiarization with breathing exercises. Inflating balloons.
Explaining the need for a functional position in bed.
Chest massage.
Regular ventilation of the room.
The absence of strong odors in the room so as not to provoke coughing attacks.

Infection safety measures:

Individual spittoons with a solution of 5% chloramine, their daily emptying and disinfection.
If your temperature rises or your cough changes, inform your doctor and prevent the spread of infection (isolation, masks, treatment).
Pay attention to the appearance of night sweats, poor appetite, weakness, weight loss, and a rise in temperature in the first half of the day.

From admission to discharge, the nurse keeps an observation chart (temperature sheet), where the main indicators of the body’s condition are recorded.

There is also interdependent SV. Collaboration with members of the medical team: preparation for examinations, joint work with a nutritionist, physiotherapist, physical therapy doctor.

The duty of the nurse is to advise on the specifics of preparation for each examination, and to monitor compliance with all rules by the patient and staff.

For example: sputum collection is carried out in the morning, after brushing your teeth and rinsing your mouth.

The container must be sterile and its edges must not be touched with lips.

The required amount is 4-5 ml. Explain to the patient that what is being tested is not saliva or mucus from the nasopharynx, but the result of coughing.

In the nursing care plan, goals are defined for each impaired need, that is, the results that need to be achieved. Short-term goals should be achieved by the end of the first week of treatment, long-term goals should be achieved by the time of discharge from the hospital. Each goal consists of an action (the patient will learn to use an inhaler with a spacer), a date of achievement (in a week), and a condition (demonstration and training). Goals must be achievable and deadlines must be realistic. It is advisable for the patient to participate in the discussion of actions aimed at solving the assigned problems.

Video about the dangers of COPD:

Before discharge, the results are analyzed and the number of restored needs is determined. A positive balance confirms an increase in quality of life.

Affiliate Material

How to cough correctly

A cough is an increased exhalation through the mouth, which occurs when the airways try to free themselves from an extraneous irritant. A cough is caused by contraction of the muscles of the respiratory tract due to irritation of special receptors. Dust, dry air, pieces of food, mucus, and pus can act as irritants.

Coughing is a protective reflex of the body that ensures airway patency.

The cough mechanism is as follows:

Foreign agent enters the respiratory tract
Respiratory clearance decreases
The cough receptor is stimulated
A cough occurs

Coughing is usually an involuntary reaction of the body, but can also be forced.

The most common cause of cough is a cold or viral infection.

A cough due to a cold can be divided into three stages:

2-3 days – dry, non-productive cough without clearing the throat
up to 14 days – acute bronchitis, cough with sputum and mucus
up to 8 weeks – mild cough, coughing

What is a cough like?

Cough can be productive or unproductive.

Productive- This is a wet cough in which the mucus secreted is easily coughed up. Along with the secreted mucus, pathogens are removed from the body. Therefore, a productive cough should not be suppressed.

Unproductive- This is a dry cough. With this cough, you feel severe irritation in the throat, a dry urge to cough, but no coughing occurs. Such a cough must be converted into a productive one.

It is important to know that any type of cough is a cause for concern, since cough is not a disease itself, but a symptom of a disease. If you are coughing, you need to see a doctor for a diagnosis and proper treatment.

How to cough correctly if you have a productive wet cough

How to help your body with a cough

A productive cough is characterized by coughing up sputum and mucus. It should not be suppressed with antitussive drugs, which block the cough reflex and thus prevent coughing. Mucus should flow freely from the respiratory system, thus cleansing it.

For a productive cough:

When you feel the mucus rising high in your throat, take a short, deep breath for 2-3 seconds. This will lead to contraction of the laryngeal muscles and increased tone of the bronchial muscles. Then the abdominal muscles reflexively contract and forced exhalation occurs. Along with it, mucus separates and comes out.
Do not press your lips tightly as this will prevent mucus from coming out.

In order to ease a productive cough, it is recommended to perform the “Coachman” exercise:

Sit on a chair
Place your feet shoulder width apart
Lean forward slightly
Keep your back straight
Rest your elbows on your knees
Hands pointing forward
The neck is relaxed

How to cough correctly if you have a non-productive dry cough

A nonproductive dry cough often causes painful contractions of the diaphragm without clearing the throat. It may be accompanied by a tickling in the throat and severe soreness. This is due to inflammation of the mucous membrane of the respiratory tract.

To relieve a dry cough, follow these recommendations:

Drink plenty of water.
Breathe frequently, shallowly. Deep breaths provoke the cough reflex.
Swallow saliva while holding your breath, in several stages.

In order to relieve a non-productive cough, it is recommended to perform the “Wall” exercise:

Approach the wall at a distance of approximately 30 cm.
Move one leg forward, slightly bend the knee
Raise your arms up, bend your elbows
Place your hands on the wall
Place your head in your hands
Keep your back straight
Take 10 deep breaths through your nose

Also, for a dry cough, you can try the “Rider” exercise:

Sit facing the back of a chair
Bend your arms at the elbows, place them on the back of the chair
Lean forward slightly, keep your back straight
Lay your head in your hands
Take 10 deep breaths through your nose

How to treat a cough

Natural cough remedy Prospan, plant-based

For dry coughs, agents that promote sputum separation are also recommended. Such remedies transform a non-productive cough into a productive one and promote a speedy recovery. The use of cough suppressants may be indicated for dry, frequent coughs that lead to vomiting, sleep disturbances and appetite disturbances.

Most patients in our country prefer herbal cough medicines. These drugs are generally well tolerated.

Among the herbal medicines for cough, one can highlight Prospan, a herbal preparation based on standardized ivy extract E.A. 575®. Prospan dissolves mucus, reduces its viscosity and promotes coughing, and also relieves spasm of the bronchial muscles and inflammation, which makes breathing easier during coughing. Prospan is available in five forms for all ages.

NEED FOR NORMAL BREATHING

1. Initial assessment

Risk factors for respiratory dysfunction are chronic obstructive pulmonary disease, tracheostomy, nasogastric tube, vomiting, trauma or surgery on the neck, face, oral cavity, etc.

To assess the satisfaction of the need for normal breathing (providing sufficient oxygen), the nurse must be able to conduct both a subjective (questioning) and an objective (examination) examination of the patient.

The most common signs indicating insufficient oxygen supply to the human body are shortness of breath, cough, hemoptysis, chest pain, and tachycardia.

Dyspnea- subjective feeling of difficulty breathing. The patient, as a rule, says that he does not have enough air, that he cannot breathe. Signs of shortness of breath are increased breathing, changes in its depth (superficial or, conversely, deeper) and rhythm. It is imperative to clarify under what circumstances shortness of breath occurs. Shortness of breath can be physiological, if it appears after physical activity or in a stressful situation, and pathological (with diseases of the respiratory system, circulatory system, brain, blood, etc.).

In some cases, a nurse can identify a pathological disturbance in the rhythm and depth of breathing, which is observed in diseases of the brain and its membranes (brain hemorrhage, brain tumor and trauma, meningitis, etc.), as well as in severe intoxications (uremic, diabetic coma and etc.).

Depending on changes in the depth of breathing, the tidal volume of the lungs may increase or decrease; breathing may be shallow or deep. Shallow breathing is often combined with a pathological increase in breathing, in which inhalation and exhalation become shorter. Deep breathing, on the contrary, in most cases is associated with a pathological decrease in breathing.

Sometimes deep breathing with large respiratory movements is accompanied by a loud noise - big breath Kussmaul , characteristic of deep coma (prolonged loss of consciousness).

With certain types of shortness of breath, the rhythm of respiratory movements may be disrupted. Violation of the function of the respiratory center causes a type of shortness of breath in which, after a certain number of respiratory movements, an extension of the respiratory pause or short-term breath holding (apnea) occurs that is noticeable to the eye (from several seconds to a minute). This type of breathing is called periodic breathing. There are two types of shortness of breath with periodic breathing.

Breath Biota characterized by rhythmic movements that alternate at equal intervals with long (up to 30 s) breathing pauses.

Cheyne-Stokes breathing differs in that after a long respiratory pause (apnea), silent shallow breathing first appears, which quickly increases in depth, becomes noisy and reaches a maximum on the 5-7th breath, and then decreases in the same sequence until the next short pause. During a pause, patients are sometimes poorly oriented in their surroundings or completely lose consciousness, which is restored when breathing movements are resumed.

Cough - a protective reflex act aimed at removing sputum and foreign bodies from the bronchi and upper respiratory tract. The cough impulse is a fixed, sonorous exhalation.

The cough can be dry (without sputum production) or wet (with sputum production). Sputum may vary according to consistency(thick, liquid, foamy), blossom(transparent, yellow-green, with blood) and smell(odorless, fetid, putrefactive).

You should know that the effectiveness of a cough depends on several factors: the viscosity of the sputum, the closure of the glottis, the patient’s ability to take a deep breath and tense the auxiliary respiratory muscles to obtain high pressure in the airways.

If the nerve centers are damaged, muscle weakness, intestinal paresis, pain syndrome, the presence of an endotracheal tube or tracheostomy, as well as non-closure of the vocal cords, clearing the lungs by coughing is impossible.

Hemoptysis - discharge of blood or bloody sputum during coughing.

Chest pain usually occurs when the pleura is involved in the pathological process.

You should check with the patient:

localization of pain;
intensity and nature of pain;
the reason for the increase or decrease (for example, he lies on the sore side or presses the sore side with his hand) of pain.

Signs of any pain (by localization) can be:

Facial expression (grimace of pain, clenched teeth, wrinkled forehead, tightly closed or wide open eyes, clenched teeth or wide open mouth, biting lips, etc.);

Body movements (restlessness, immobility, muscle tension, continuous rocking back and forth, scratching, movements to protect the painful part of the body, etc.);

Reduced social interactions (avoiding conversations and social contacts, engaging in only those forms of activity that relieve pain, narrowing the range of interests).

Smoking, especially over a long period of time and in large quantities, causes chronic obstructive pulmonary disease and lung cancer. These diseases lead to disruption of the body's oxygen supply, i.e. interfere with the need for normal breathing. An unfavorable environment (gas pollution, dust, tobacco smoke, etc.) can have a similar effect.

When assessing the patient's condition, it is necessary to pay attention to his position (for example, forced sitting position orthopnea, forced position on the sore side, high Fowler's position), the color of the skin and mucous membranes (cyanosis, pallor).

When assessing the need for normal breathing, it is necessary to determine the frequency, depth and rhythm of respiratory movements, and also examine the pulse. Normally, breathing movements are rhythmic.

The frequency of respiratory movements in an adult at rest is 16-20 per minute, and in women it is 2-4 more than in men. In a lying position, the number of respiratory movements usually decreases (to 14-16 per minute), and in an upright position it increases (18-20 per minute). Shallow breathing is usually observed at rest, and during a physical or emotional mood it is deeper. It should be remembered that in cases where the need for breathing is not satisfied due to any acute illness and acute respiratory failure (ARF), when assessing the patient's condition, a number of characteristic signs can be identified. ODJ:II1 of them is tachypnea(increased breathing) up to 24 per 1 minute or more. A person’s behavior changes: anxiety, sometimes euphoria, verbosity, and excitement appear. Verbosity caused by fear of death.

It is always very difficult to speak against the background of increased breathing. At high levels, one person gradually loses consciousness and falls into a coma.

The color of the skin also changes. Most often, cyanosis develops, but even more dangerous is gray pallor, the so-called sallow color of cold skin covered with sticky sweat. ARF is accompanied by increased heart rate (tachycardia), sometimes the pulse becomes rapid and non-arrhythmic (takhyarutmiya) or rare (bradycardia). Blood pressure initially rises ( hypertension), then goes down ( hypotension).

A patient with ARF requires emergency assistance from all members of the medical team

2. Patient problems

Based on the data obtained when assessing the patient’s condition, certain patient problems related to the unsatisfaction of the need for normal breathing are formulated.

The patient's problems may be due to reasons such as:

· ignorance, inability, unwillingness or inability to take a position that reduces shortness of breath and pain;

· reluctance to regularly perform breathing exercises;

· inability to use a spittoon;

· inability to use an inhaler;

· risk of respiratory tract infection due to inadequate oral care measures, breathing equipment, etc.;

· decreased physical activity (due to shortness of breath or pain);

fear of death from suffocation;

· the need to quit smoking;

· decreased appetite due to foul-smelling sputum.

· lack of understanding of the importance of regularly taking medications prescribed by a doctor, etc.

· the patient will be able to take measures to reduce the discomfort associated with coughing up sputum;

· the patient will carry out the entire treatment program;

· the patient will carry out prevention of respiratory tract infections, etc.

3. Goals of nursing care

When discussing a plan for future care with the patient (if the need for normal breathing is identified), the patient should achieve one or more goals:

· the patient will know and be able to take a position that facilitates breathing;

· the patient will restore (maintain) physical activity necessary for self-care;

· the patient will be able to independently use the inhaler (spittoon);

· the patient will take medications in accordance with the doctor’s prescriptions;

· the patient quits smoking (reduces the number of cigarettes smoked per day);

The patient will know self-help techniques for an attack of suffocation.

4. Nursing care

Positioning the patient in bed with the head of the bed elevated or using two or three pillows will significantly improve breathing.

Various types of drainage positions improve sputum production and, therefore, promote recovery. Postural drainage will be effective (stimulating the natural discharge of sputum) only if the patient remains in a given position for a long time. Such drainage is prescribed by a doctor, and is performed under the supervision and assistance of a nurse.

Teaching the patient coughing techniques will enable him to expel phlegm most effectively. One way:

Take a slow deep breath;

Hold your breath for 2 s;

Open your mouth and clear your throat while exhaling.

Teaching specific breathing techniques is also aimed at

aimed at improving satisfaction of the patient's needs for normal

flax breath.

One of these techniques is for the patient to exhale

through the lips folded into a tube, while the exhalation is lengthened. At

With this breathing technique, patients cough up phlegm more easily, i.e.

cough becomes more productive.

5. Assessment of nursing care outcomes