To promote airway clearance in a patient with pneumonia, encourage the use of deep breathing exercises and incentive spirometry to enhance lung expansion and mobilize secretions. Positioning the patient in an upright or semi-Fowler’s position can facilitate better lung drainage. Additionally, chest physiotherapy techniques, such as percussion and postural drainage, may be beneficial in helping to clear mucus. Hydration should also be emphasized to thin secretions, making them easier to expectorate.
The priority nursing diagnosis for pneumonia is "Ineffective Airway Clearance." This diagnosis is crucial because pneumonia can lead to the accumulation of secretions in the lungs, which impairs gas exchange and can result in respiratory distress. Nurses must assess the patient's ability to clear secretions, implement interventions to promote airway clearance, and monitor respiratory status closely to prevent complications.
Impaired gas exchange Ineffective airway clearance Activity intolerance
Impaired gas exchange /ineffective airway clearance /ineffective breathing
a temporary infiltration of eosinophils into the lungs. The patient will feel tired, have a cough, spasms of the bronchial airway, and difficulty breathing. Loffler's pneumonia will clear spontaneously
scientific reason of ineffective airway clearance
Ineffective airway clearance related to thick secretions or blood secretions, weakness, poor cough effort, edema, tracheal / pharyngeal.Goals :After a given airway hygiene nursing actions effectively, with the result criteria:Maintain the patient's airway.Removing secretions without help.Demonstrate behaviors to improve airway clearance.Participate in treatment programs as needed.Identify potential complications and appropriate action.Read More : http://all-nurses.blogspot.com/2012/05/ineffective-airway-clearance-related-to.html
Nursing goals for ineffective airway clearance focus on improving the patient's ability to clear respiratory secretions and maintain adequate oxygenation. Specific goals may include increasing the patient's secretion clearance through effective coughing techniques, positioning, and the use of suctioning when necessary. Additionally, ensuring optimal oxygenation levels and monitoring respiratory status are crucial to prevent complications. Education on deep breathing exercises and the importance of hydration can also support these goals.
Suctioning a ventilated patient is indicated when there are signs of airway obstruction or increased airway secretions, which can manifest as decreased oxygen saturation, increased respiratory effort, or audible wheezing and gurgling sounds. Additionally, suctioning may be necessary when the patient exhibits signs of infection or when there is a need to clear secretions to improve ventilation and prevent complications such as atelectasis or pneumonia. Regular assessment of the patient's condition is crucial to determine the need for suctioning.
No, a nasopharyngeal airway should not be used in a patient with an endotracheal tube in place. The endotracheal tube already secures the airway and provides ventilation, making the use of a nasopharyngeal airway unnecessary and potentially harmful. Introducing a nasopharyngeal airway could cause trauma to the airway or displace the endotracheal tube.
In an unconscious patient, the tongue can fall back and obstruct the airway due to loss of muscle tone and reflexes. This occurs especially when the patient is in a supine position, allowing the tongue to block the oropharynx and impede airflow. Additionally, the lack of protective reflexes increases the risk of aspiration, further complicating airway management. Proper positioning or airway adjuncts, like an airway adjunct or intubation, may be necessary to secure the airway.
Suction is used for airway management when the patient can't manage his or her own secretions.
Because even though it is recommended for an unconscious patient, if the patient has sustained to severe of a trauma the nasal airway could damage the patient more than help them.