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Other Drugs: Second-line medications include cycloserine, ethionamide, and capre-omycin sulfate. Mucolytics are used to thin secretions and facilitate expectoration. Increased fluid intake decreases secretions. Bronchodilators increase the lumen size of the bronchial tree and decrease resistance to airflow. Corticosteroids are used in extreme cases when inflammation causes life-threatening hypoxia. Newer drugs: rigapentine and immune amplifiers.

Independent

Nursing priorities are to maintain and achieve adequate ventilation and oxygenation; prevent the spread of infection; support behaviors to maintain health; promote effective coping strategies; and provide information about the disease process, prognosis, and treatment needs.

Use respiratory isolation precautions (masks only) for all patients with pulmonary TB who require hospitalization. Whenever they leave their rooms or receive treatment from the hospital staff, patients should wear masks to help prevent transmission of TB. The masks need to fit tightly and not gap. Teach the patient to cover the mouth when coughing and to dispose of all tissues. For patients with excessive secretions or those who are unable to cooperate with respiratory isolation, gowns and gloves may be necessary for hospital staff. The nurse should always remember to wash the hands before and after patient contact.

Position the patient in a Fowler or semi-Fowler position, and assist with coughing and deep-breathing exercises. Demonstrate and encourage pursed-lip breathing on expiration, especially for patients with fibrosis or parenchymal destruction. Promote bedrest and activity restrictions, and assist with self-care activities as needed.

Teach the patient and family how to use proper protection methods to prevent infection or reinfection. In the case of treatment at home, the family has probably already been exposed to the patient before diagnosis, so wearing masks is not necessary. Advise the family members that they need regular TB testing to ensure that they have not contracted TB. Teach the patient about complications of TB, such as recurrence and hemorrhage, and the need for proper nutrition.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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