Ineffective Airway Clearance - Empyema Nursing Care Plan
Ineffective Airway Clearance - Empyema Nursing Care Plan Nursing Diagnosis Ineffective airway clearance related to : bronchus spsame, increased production of secretions, weakness Objectives: Effective Airway Clearance Characteristics: Verbally expressed difficulty in breathing Use of auxiliary respiratory muscles Wheezing, Ronchi, cracles Cough (persistent) with / without sputum production Expected Results : The sound of breathing clean Effective Cough Wheezing (-), Ronchii (-) Cracles (-) Nursing Intervention and Rational for Ineffective Airway Clearance - Empyema Nursing Care Plan 1. Auscultation of breath sounds: note the presence of breath sounds, assess and monitor breathing sounds R /: To determine the presence of airway obstruction, tachipneu a degree found the process of acute infection. 2. Assess the frequency of respiratory R /: The process of acute infection (tachipnea) 3. Note the presence or degree of dyspnoea, restlessness, anxiety, and respiratory distress R /: respira