tyNURSING CARE PLAN: INEFFECTIVE AIRWAY CLEARANCE CUES SUBJECTIVE Nabudlayan ako mag ginhawa kay naatake ako

ka hapo ko. OJECTIVE Orthopnea Wheezing Dyspnea Use of accessory muscles when breathing RR 30 bpm Productive cough (-) Chest X-ray results Peak flow reading yellow zone Obstructive pattern on spirometry (+) Allergy skin test NURSING DIAGNOSIS Ineffective airway clearance related to asthma as manifested by orthopnea, wheezing, dyspnea, use of accessory muscles when breathing, productive cough and RR of 28 bpm. OUTCOME CRITERIA After 30 minutes of nursing interventions, airway patency will be achieved and respiratory rate should be within normal range. INTERVENTIONS INDEPENDENT Monitor respirations and breath sounds. Assist client in a position appropriate for age and condition. Encourage deep breathing exercises. Keep environment allergen free. DEPENDENT Administer bronchodilators as ordered.. Administer analgesics prn. COLLABORATIVE Provide nebulization as ordered through pulmonary personnel. Work hand-in-hand with the dietary department on diet specific for clients condition. Aids in promoting effective airway clearance. Reduces pain due to persistent coughing. Indicative of respiratory distress. To open or maintain an open airway. Promotes lung expansion. To not further exacerbate clients condition. RATIONALE EVALUATION After 30 minutes of nursing interventions, the goals are met as evidenced by maintenance of airway patency and respiratory rate is within normal range. DISCHARGE PLANNING The client will continue to take his/her medications such as bronchodilators, analgesics and antihistamine as ordered by the doctor. Shall see to it to avoid crowded places and would maintain as much as possible an allergen free environment at home. Should an asthma trigger, take inhalers/ puffs as ordered. If difficulty of breathing occurs, elevate head with 3 pillows or assume sitting position or have steam inhalation. Have follow up check-up on the scheduled day. Avoid foods that can trigger asthma such as seafoods, nuts and the like. Take as much as possible the recommended hypoallergenic diet. Have family members available for support.

For better and faster expectoration. To minimize foods that triggers asthma attack.