assess respiratory status, every 1 to 2 hours or is indicated.
Monitor ABG results
weight daily,, intake and output,mucous membrane assessment and turgor
fluid intake 2000 2500 mils per day
Fowlers or high Fowlers position, or orthopneic position(head and arms supported on the overbid table). Activity helps mobilize secretions.
Coughing, and deep breathing every two hours while awake, position client seated upright leaning forward during coughing/promotes chest expansion increases effectiveness/reduces work involved.
Referred to respiratory therapist/4, percussion, and postural drainage.
Administer expectorate and bronchodilator/correlate with respiratory treatments.
Provide supplemental oxygen as ordered
provide tissues and paper bag, dispose of secretions.
self-care abilities - ambulation, ADLs.
Exercising activity pattern - type in regularity of exercise, perceived and actual energy.
Assistive devices required- shower bars will cheer team supplemental oxygen scale to monitor weight.
Home environment - cigarette smoke, dust allergens, lack of humidity, stairs.
Current level of knowledge - avoid smoking and pollutants. Dietary salt and other restrictions appropriate, medications.
Caregiver availability skills - ability to help with ADLs.
Family role changes in coping - financial status, relationships,sexuality.
Alternate potential primary respite caregivers -
environmental assessment - usual temperature and humidity, presence of air pollutants.
urrent knowledge and experience with community resources - supply companies respiratory physical therapy, local pharmacies, financial assistance, support and educational organizations.