Comprehensive Nursing Care of a Patient with Obstructive Airway : Airway Management : Nursing Interventions : Clinical Nursing :

 

Nursing Care of a Patient with Obstructive Airway :

1. Assessment

2. Use of Artificial Airway

  • Purpose: To maintain airway patency, prevent aspiration, and ensure effective ventilation.
  • Types:
    • Oropharyngeal Airway: For unconscious patients without a gag reflex.
    • Nasopharyngeal Airway: Used in semi-conscious patients with intact gag reflex.

3. Endotracheal Intubation, Tracheostomy, and Its Care

  • Endotracheal Intubation:

    • Indications: Airway obstruction, respiratory failure, or surgery.
    • Care: Maintain tube position, secure tubing, and suctioning to prevent secretions.

  • Tracheostomy:

    • Indications: Long-term ventilation, upper airway obstruction.
    • Care:
      • Clean and inspect the site regularly.
      • Use sterile techniques for dressing changes and suctioning.
      • Monitor for bleeding, infection, or tube displacement.

4. Complications, Minimum Cuff Leak, Securing Tubes

  • Complications:
    • Obstruction by mucus plugs, infections, tracheal stenosis, and pressure injuries.
  • Minimum Cuff Leak Technique:
    • Inflate the cuff until there is a minimal audible leak during peak inspiration, reducing tracheal injury risk.
  • Securing Tubes:
    • Use tape or specialized tube holders; inspect regularly for displacement.

5. Oxygen Delivery Systems

  1. Nasal Cannula:

    • Flow Rate: 1–6 L/min (24%–44% FiO2).
    • Advantages: Comfort, mobility, low cost.
    • Disadvantages: Dryness, limited oxygen delivery.
    • Nursing Implications: Ensure proper fit, provide humidification.

  2. Oxygen Mask:

    • Flow Rate: 5–10 L/min (40%–60% FiO2).
    • Advantages: Higher oxygen delivery.
    • Disadvantages: Discomfort, muffled communication.

  3. Venturi Mask:

    • Flow Rate: Precise FiO2 (24%–50%).
    • Advantages: Accurate oxygen delivery.
    • Disadvantages: Bulky, less comfortable.

  4. Partial Rebreathing Bag:

    • Flow Rate: 6–10 L/min (40%–70% FiO2).
    • Advantages: Moderate oxygen delivery.
    • Disadvantages: CO2 retention risk.

  5. Bi-PAP and C-PAP Masks:

    • Purpose: Non-invasive ventilation for obstructive sleep apnea, COPD.
    • Advantages: Avoids intubation.
    • Disadvantages: Skin irritation, discomfort.
              ( BiPAP and CPAP devices differ primarily in their air pressure delivery. BiPAPs provide distinct air pressure levels for inhalation and exhalation, whereas CPAPs maintain a constant fixed pressure throughout each breath. Both BiPAPs and CPAPs can enhance sleep quality and overall well-being. )

6. Mechanical Ventilation

  • Principles:

    • Provide controlled oxygenation and ventilation.
    • Adjust settings based on ABG and clinical condition.

  • Types:

    • Invasive: Endotracheal or tracheostomy tube.
    • Non-Invasive: Bi-PAP, C-PAP.

  • Modes of Ventilation:

    • Assist-Control (A/C): Full support.
    • SIMV (Synchronized Intermittent Mandatory Ventilation): Allows spontaneous breaths.
    • Pressure Support (PS): Reduces work of breathing.
    • PEEP (Positive End-Expiratory Pressure): Prevents alveolar collapse.

  • Advantages: Life-saving, precise control.

  • Disadvantages: Risk of barotrauma, ventilator-associated pneumonia.

7. PEEP Therapy

  • Indications: ARDS, pulmonary edema, severe hypoxemia.
  • Physiology: Maintains alveoli open at end expiration.
  • Complications: Hypotension, barotrauma.

8. Weaning Off the Ventilator

  • Gradually reduce support as patient improves.
  • Monitor for signs of fatigue or hypoxemia.
  • Perform trials of spontaneous breathing (T-piece or low-level SIMV).

9. Nursing Assessment and Interventions for Ventilated Patients

  • Assessment:

    • Monitor ABG, SpO2, respiratory rate, and ventilator settings.
    • Inspect for skin integrity and signs of infection.

  • Interventions:

    • Ensure tube patency with suctioning.
    • Reposition to prevent pressure ulcers.
    • Provide emotional support and communication aids.

Nursing Care Plan for Patient with Obstructive Airway Disorder

Nursing Diagnosis

Goal / Objective

Nursing Interventions

Rationale

Evaluation

1. Ineffective Airway Clearance related to increased mucus production, bronchospasm, or airway obstruction

To maintain a clear airway and normal respiratory pattern

- Assess breath sounds, respiratory rate, depth, and effort.
- Encourage coughing and deep breathing exercises.
- Administer prescribed bronchodilators and mucolytics.
- Provide chest physiotherapy and postural drainage if ordered.
- Encourage fluid intake (if not contraindicated).

To promote airway clearance and improve gas exchange.

Airway is clear; patient breathes easily with normal oxygen saturation.

2. Impaired Gas Exchange related to ventilation–perfusion imbalance

To improve oxygenation and prevent hypoxia

- Monitor oxygen saturation, ABG results, and respiratory pattern.
- Administer supplemental oxygen as prescribed.
- Place patient in high Fowler’s position.
- Teach pursed-lip and diaphragmatic breathing techniques.
- Reduce anxiety and conserve energy.

To enhance oxygen exchange and lung expansion.

Patient maintains SpO₂ > 95%; ABG values within normal limits.

3. Ineffective Breathing Pattern related to bronchial constriction, fatigue, or anxiety

To establish effective breathing pattern and ease of respiration

- Observe for use of accessory muscles and signs of respiratory distress.
- Assist patient in assuming position of comfort (sitting upright, leaning forward).
- Encourage slow, deep breathing exercises.
- Administer medications as prescribed (bronchodilators, corticosteroids).

To promote effective ventilation and reduce work of breathing.

Respiratory pattern becomes regular; no dyspnea or cyanosis noted.

4. Activity Intolerance related to imbalance between oxygen supply and demand

To enable the patient to perform activities without excessive fatigue or dyspnea

- Assess activity tolerance and plan care to allow rest between activities.
- Assist with self-care needs.
- Gradually increase activity level as tolerated.
- Monitor response to activity (vitals, respiratory rate, fatigue).

To conserve energy and prevent oxygen desaturation.

Patient performs ADLs with minimal fatigue or shortness of breath.

5. Anxiety related to difficulty in breathing and fear of suffocation

To reduce anxiety and promote relaxation

- Stay with the patient during acute episodes.
- Explain procedures and treatments clearly.
- Provide calm, reassuring environment.
- Encourage relaxation techniques such as guided breathing or music therapy.

Anxiety increases oxygen consumption; calmness promotes better breathing control.

Patient verbalizes reduced anxiety and demonstrates relaxed breathing.

6. Deficient Knowledge related to lack of understanding about disease and management

To enhance patient’s understanding and promote self-care

- Educate patient about condition, triggers, and management (e.g., avoiding allergens, smoking cessation).
- Demonstrate proper inhaler or nebulizer use.
- Stress importance of medication adherence and follow-up.

Informed patients are more likely to manage symptoms and prevent exacerbations.

Patient demonstrates correct inhaler use and explains preventive strategies.

🩺 General Health Teaching / Discharge Instructions

  • Encourage adequate hydration to thin secretions.
  • Advise avoiding exposure to smoke, dust, allergens, and pollutants.
  • Instruct on proper use of inhalers, nebulizers, and oxygen therapy.
  • Emphasize early recognition of exacerbation signs (wheezing, dyspnea, chest tightness).
  • Encourage regular follow-up with healthcare provider.
  • Promote balanced nutrition and energy-conserving techniques during daily activities.

 


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