1.

Determine related factors and nursing diagnosis(es) for client receiving

this procedure.

Related Factors:

• Chronic obstructive pulmonary disease (COPD), asthma,

pneumonia, or other respiratory conditions: The client may be receiving
medications via a nebulizer to treat or manage these conditions.

• Ineffective airway clearance: The procedure can help clear

mucus or improve lung function.

• Increased work of breathing or respiratory distress: Nebulizer

treatments can help relieve symptoms and improve respiratory function.

Nursing Diagnosis(es):

• Ineffective airway clearance: Related to accumulation of

secretions or bronchospasm.

• Impaired gas exchange: Due to reduced lung function or

airway constriction.

• Ineffective breathing pattern: Resulting from the need to

increase effort for breathing.

2. Discuss the importance of inhaling slowly through the mouth and

holding each breath for 5 to 10 seconds before exhaling.

Inhaling Slowly: Inhaling slowly allows the medication to be more

effectively absorbed in the lungs. Rapid inhalation may cause the
medication to be deposited in the upper airways rather than reaching the
deeper parts of the lungs, where it is most effective.

Holding the Breath: Holding the breath for 5 to 10 seconds allows the
medication time to settle and be absorbed by the lung tissues, maximizing
its effectiveness. This brief retention prevents the medication from being
exhaled immediately, improving drug delivery to the airways.
3. State the length of time of this procedure.

The procedure typically takes 10 to 15 minutes, depending on the type

and amount of medication, as well as the nebulizer device used. It may
take slightly longer if the patient requires multiple medications.

4. Give information that should be included in the documentation of this

procedure.

Documentation should include:

• Date and time of the nebulizer treatment.

• Medications used, including the type and dose.

• Client’s response to the treatment (e.g., improvement in

breathing, reduction in wheezing, no adverse reactions).

• Assessment of lung sounds before and after the procedure.

• Duration of the procedure and any difficulties encountered

(e.g., difficulty in inhaling or coughing).

• Client education provided, including correct technique for

using the nebulizer at home.

5. Relate the nursing intervention associated with a client reporting that

nebulizer doesn’t smell or taste the way it usually does.

If a client reports that the nebulizer doesn’t smell or taste the way it
usually does, the nurse should:

• Assess the nebulizer equipment to ensure it is functioning

correctly (check for clogs or malfunctioning parts).

• Check the medication to ensure it is not expired or improperly

stored.
 • Ensure that the client is using the nebulizer properly (correct
technique and positioning).

• Assess the client’s respiratory status to ensure they are

receiving the correct amount of medication.

• Report any abnormalities or concerns to the healthcare

provider or respiratory therapist.

6. Compare and contrast the responsibilities of the LVN and that of the
respiratory therapist in carrying out pulmonary procedures.

Licensed Vocational Nurse (LVN):

• Assist in administering nebulizer treatments under the

direction of a registered nurse or physician.

• Monitor patient response during and after the procedure,

including respiratory rate, lung sounds, and overall status.

• Educate the patient on proper use of nebulizer equipment and

adherence to prescribed therapies.

• Document the procedure, including patient response and any

issues encountered.

Respiratory Therapist (RT):

• Perform advanced respiratory assessments and manage more

complex pulmonary procedures, such as administering respiratory
therapies (e.g., CPAP, BiPAP, mechanical ventilation).

• Set up, monitor, and adjust nebulizer treatments, ensuring

correct medication administration.

• Interpret clinical data such as oxygen saturation, ABG results,

and pulmonary function tests.

• Provide advanced patient education on breathing techniques,

medications, and long-term respiratory management.
REVIEW QUESTIONS

1. Why are fluids encouraged in most patients with pulmonary

problems?

Fluids are encouraged in patients with pulmonary problems to thin the

mucus in the airways, making it easier to clear. Hydration helps maintain
the viscosity of the mucus at a manageable level, promoting easier
expectoration. Additionally, fluids help prevent dehydration, which can
worsen symptoms like dry mouth or increased thickening of respiratory
secretions.

2. Describe the differences between the use of expectorants, anti-

tussives, and mucolytic agents.

a. Expectorants:

• Purpose: Expectorants help to loosen and thin mucus in the

airways, making it easier to cough up and clear secretions.

• Example: Guaifenesin (commonly found in over-the-counter

products like Mucinex).

• Action: Increases the hydration of mucus, making it less thick

and easier to expectorate.

b. Anti-tussives (Cough Suppressants):

• Purpose: Anti-tussives suppress or reduce coughing. These are

typically used for dry, non-productive coughs.

• Example: Dextromethorphan, codeine (in prescription form).

• Action: They work by suppressing the cough reflex in the

brain, which helps relieve the urge to cough.

c. Mucolytic Agents:
 • Purpose: Mucolytics break down and thin mucus in the lungs,
making it easier to expectorate or clear the airways.

• Example: Acetylcysteine (Mucomyst), hypertonic saline.

• Action: Mucolytics work by chemically breaking the bonds in

the mucus, reducing its thickness and viscosity, which helps to clear the
airways more effectively.

3. How does Maslow’s hierarchy relate to the needs of the individual with
chronic pulmonary disease?

Maslow’s Hierarchy of Needs is a theory that prioritizes human needs in

five levels, starting from basic physiological needs to self-actualization.
For a patient with chronic pulmonary disease:

• Physiological Needs: The patient’s primary needs are oxygen,

nutrition, hydration, and the ability to breathe comfortably. This is the
most basic level of need for individuals with pulmonary conditions.

• Safety Needs: Ensuring the patient feels safe in their

environment, which may include reducing environmental triggers (like
smoke or allergens) and providing appropriate medical equipment (e.g.,
oxygen therapy, nebulizers).

• Love and Belonging Needs: Patients with chronic pulmonary

disease may experience isolation or depression due to limited physical
abilities. Emotional support and social connections are vital for overall
well-being.

• Esteem Needs: The patient may need encouragement to

maintain independence and dignity despite their condition, promoting self-
esteem by helping them adapt to changes.

• Self-Actualization: This refers to achieving personal growth

and purpose. For individuals with chronic illness, this may involve
managing their condition effectively and engaging in activities that
improve their quality of life, despite limitations.

Chronic pulmonary disease can impact all levels of Maslow’s hierarchy,

with priority given to ensuring physiological and safety needs are met
first.
4. How might chronic pulmonary conditions affect growth and
development of the adult?

Chronic pulmonary conditions can affect an adult’s growth and

development in several ways:

• Physical Health: Chronic respiratory conditions (such as COPD

or asthma) can limit physical activity, leading to muscle weakness,
fatigue, and reduced stamina, which can negatively impact overall
physical development and aging.

• Psychosocial Impact: Adults may experience anxiety,

depression, or social isolation due to physical limitations and fear of
respiratory exacerbations, which can affect their emotional and
psychological development.

• Career and Lifestyle: Chronic illness may limit career choices

or the ability to maintain employment, impacting financial stability, social
interactions, and life satisfaction.

• Cognitive Functioning: Lack of oxygen (hypoxia) in severe

cases or side effects of medications may affect cognitive function,
concentration, and decision-making abilities.

5. Explain why initial humidification therapy may increase breathing

difficulty temporarily.

What instructions will you give your client?

Humidification therapy can temporarily increase breathing difficulty

because:

• Moisture in the airways may cause the mucus to become more

fluid, which can initially increase the feeling of congestion as the mucus
becomes easier to move and clear.
 • The added moisture may trigger airway constriction in
sensitive individuals, especially those with asthma or chronic obstructive
pulmonary disease (COPD), leading to temporary difficulty in breathing.

Instructions for the client:

• Take deep, slow breaths during humidification to help your

airways adjust to the increased moisture.

• Monitor symptoms closely: If you feel that your breathing is

worsening or if you experience wheezing or coughing, stop using the
humidifier and notify your healthcare provider.

• Gradual adjustment: Start with short periods of humidification

therapy and gradually increase the duration as tolerated.

6. Your client is on steroids to treat a chronic lung condition.

a. What observations will you make and why?

• Weight gain: Steroids can lead to fluid retention and increased

appetite, causing weight gain.

• Blood glucose levels: Steroids can raise blood sugar levels, so

you should monitor for signs of hyperglycemia, especially in diabetic
patients.

• Signs of infection: Steroids suppress the immune system,

making the patient more susceptible to infections.

• Mood changes: Corticosteroids may cause mood swings,

irritability, or even depression.

• Gastric distress: Steroids can irritate the stomach lining,

potentially causing ulcers or gastritis.

• Osteoporosis: Long-term steroid use can lead to decreased

bone density, increasing the risk of fractures.

b. What precautions must your client be aware of in the use of steroid

therapy?
 • Take with food: To minimize stomach irritation, steroids should
be taken with food or milk.

• Avoid sudden discontinuation: Do not stop steroids suddenly

without medical guidance as this can cause adrenal insufficiency.

• Increase calcium and vitamin D intake: Steroid therapy can

weaken bones, so clients should consume adequate amounts of calcium
and vitamin D.

• Monitor for infections: Be vigilant for signs of infection (fever,

sore throat) due to immune suppression.

• Watch for signs of high blood sugar: Clients with diabetes or at

risk should monitor their blood glucose levels closely.

7. What will you teach the client about using hand-held nebulizers?

• Proper Positioning: Instruct the client to sit up straight and

hold the nebulizer mouthpiece between their lips tightly to avoid
medication loss.

• Breathing Technique: Advise the client to inhale slowly and

deeply through the mouth, holding each breath for a few seconds before
exhaling.

• Cleaning the Nebulizer: Teach the client to clean the nebulizer

after each use, including the mouthpiece, chamber, and tubing, with warm
water and mild soap to prevent infections or buildup.

• Medication Administration: Instruct the client on how to

prepare and administer the prescribed medication correctly.

• When to Seek Help: Advise the client to contact their

healthcare provider if they experience any difficulty using the nebulizer or
if symptoms persist despite treatment.

8. Why should bronchodilating inhalants be used before steroid inhalants?

Bronchodilators should be used before steroid inhalants because:

 • Bronchodilators open up the airways: They relax the smooth
muscles around the airways, making it easier for the steroid medication to
reach deeper into the lungs and exert its anti-inflammatory effects.

• Improved drug delivery: When the airways are dilated, steroid

medication can be better absorbed in the lungs, increasing its
effectiveness.

• Timing: Using bronchodilators first allows for better

penetration of the steroid medication and reduces the risk of airway
irritation from the steroids.

1. Define the meaning of the following abbreviations:

a. ETT (Endotracheal Tube): A tube inserted into the trachea to provide an

airway and facilitate mechanical ventilation or oxygenation.

b. PEEP (Positive End-Expiratory Pressure): A mode of ventilation where

pressure is applied to the airway at the end of expiration to prevent the
alveoli from collapsing, thus improving oxygenation.

c. CPAP (Continuous Positive Airway Pressure): A type of non-invasive

ventilation that maintains continuous positive pressure to keep the
airways open, often used in conditions like obstructive sleep apnea.

d. MAP (Mean Airway Pressure): The average pressure in the airways

during a complete respiratory cycle, reflecting the overall effectiveness of
ventilation.

e. I:E (Inspiration to Expiration Ratio): The ratio of the duration of

inspiration to expiration during mechanical ventilation, which helps
regulate the amount of time the patient spends inhaling versus exhaling.

f. SaO2 (Arterial Oxygen Saturation): The percentage of hemoglobin that is

saturated with oxygen in the arterial blood, measured via arterial blood
gas (ABG).
g. SpO2 (Peripheral Oxygen Saturation): The oxygen saturation of
hemoglobin in the peripheral blood, usually measured non-invasively with
a pulse oximeter.

h. FiO2 (Fraction of Inspired Oxygen): The percentage or concentration of

oxygen that is delivered to the patient via mechanical ventilation or
supplemental oxygen.

2. Relate at least three (3) conditions in each of the following categories

that can cause respiratory failure.

a. Disorders of CNS (Central Nervous System):

• Head injury (trauma to the brain can impair the respiratory

centers).

• Stroke (can affect respiratory control centers in the

brainstem).

• Drug overdose (opioids, sedatives can depress the respiratory

drive).

b. Disorders Associated with Neuromuscular Function:

• Guillain-Barré Syndrome (autoimmune disorder causing

muscle weakness and paralysis, including respiratory muscles).

• Amyotrophic Lateral Sclerosis (ALS) (degenerative disease

affecting motor neurons, including those controlling respiratory muscles).

• Myasthenia Gravis (autoimmune disease that causes

weakness in voluntary muscles, including diaphragm and intercostals).

c. Disorders Resulting in Increased Work of Breathing:

• Chronic Obstructive Pulmonary Disease (COPD) (due to airway

obstruction and hyperinflation, making it harder to breathe).
 • Asthma (airway inflammation and bronchoconstriction lead to
increased effort in breathing).

• Pulmonary edema (fluid accumulation in the lungs increases

resistance to airflow, requiring more effort to breathe).

3. What are some common causes of low and high pressure alarm
situations?

a. Low Pressure Alarm:

• Disconnection of the ventilator circuit (e.g., from the

endotracheal tube or ventilator).

• Leak in the ET tube (such as an improperly inflated cuff).

• Ventilator tubing disconnect or a kink in the tubing.

• Inadequate tidal volume delivery due to leaks.

b. High Pressure Alarm:

• Airway obstruction (e.g., mucus plug, kinked tube, or

bronchospasm).

• Coughing or biting on the ET tube.

• Decreased lung compliance (e.g., in conditions like ARDS or

pulmonary edema).

• Patient’s increased respiratory effort (e.g., anxiety, agitation).

4. What lab values are most appropriate to evaluate while the client is on
a mechanical ventilator?

• Arterial Blood Gases (ABG): To assess oxygenation (PaO2),

ventilation (PaCO2), and acid-base status (pH, bicarbonate).

• Oxygen Saturation (SaO2 and SpO2): To monitor the

oxygenation levels of the blood.
 • End-Tidal CO2 (ETCO2): To monitor ventilation status and
ensure adequate exhalation of CO2.

• Electrolytes: Imbalances in sodium, potassium, and calcium

can affect respiratory muscle function and ventilator settings.

• Hematocrit/Hemoglobin: To evaluate the ability of the blood to

carry oxygen.

• Chest X-ray: To assess lung compliance, ventilation status, and

rule out complications like pneumonia or atelectasis.

5. Differentiate the types of positive-pressure mechanical ventilators.

a. Pressure-Cycled Ventilator:

• Definition: The ventilator delivers a preset pressure with each

breath, regardless of the volume of air that is delivered.

• Characteristics: This type of ventilator is used when

maintaining a constant pressure is more important than ensuring a
specific tidal volume.

• Common Use: For patients with decreased lung compliance

(e.g., ARDS) where pressure-limited ventilation is necessary to avoid
barotrauma.

b. Volume-Cycled Ventilator:

• Definition: The ventilator delivers a preset volume of air with

each breath, regardless of the pressure required to achieve that volume.

• Characteristics: This ventilator is used when a consistent tidal

volume is needed to ensure adequate ventilation.

• Common Use: Often used in conditions where the goal is to

ensure a specific volume of ventilation and to maintain adequate alveolar
ventilation.

6. Relate the process of weaning a client from the mechanical ventilator.

The process of weaning a patient from mechanical ventilation involves
gradually reducing ventilator support while monitoring the patient’s ability
to maintain adequate spontaneous breathing. Key steps include:

• Assessment for Readiness:

• Stable vital signs and oxygenation (adequate SpO2, PaO2, and

stable ABGs).

• Adequate respiratory drive (the ability to initiate breaths).

• Absence of conditions that might impede weaning (such as

fever or infection).

• Improved underlying respiratory condition (e.g., resolution of

pneumonia or bronchospasm).

• Gradual Reduction of Support:

• Synchronized Intermittent Mandatory Ventilation (SIMV) or

pressure support (gradually reduces the number of mechanical breaths
and provides less assistive pressure, allowing the patient to take more
spontaneous breaths).

• T-piece trials: The patient is disconnected from the ventilator

for short periods, breathing room air with the help of a T-piece. The
duration of these trials is progressively increased.

Monitoring During Weaning:

• Arterial blood gases (ABG) to monitor oxygenation and

ventilation.

• Respiratory rate, tidal volume, and work of breathing are

closely monitored.

• If signs of fatigue, respiratory distress, or deterioration in

oxygenation or ventilation are noted, weaning is halted, and the ventilator
support is increased.

Extubation:
 • Once the patient has tolerated spontaneous breathing trials
and shows stable respiratory function, extubation (removal of the
endotracheal tube) is considered.

• After extubation, oxygen therapy (nasal cannula or face mask)

may be used until the patient is able to maintain normal oxygen
saturation levels on their own.