Ineffective Airway Clearance Research Articles

NURSING CARE OF PATIENT WITH SEPSIS DUE TO BLAST INJURY

Blast injury is an injury due to the mechanism of barotrauma (involving excessive pressure) which results in organ trauma. Trauma and extensive injury can progress to sepsis condition to the patient. A man is hospitalized due to blast injury. The patient suffered a third-degree burn involving 18% total body surface area locate in the abdomen and right thigh, and right femoral trauma. The patient has right hip disarticulation and abdominal wound debridement surgery. After surgery, the patient has decreased consciousness and respiratory failure so that he was treated in the intensive care unit. The nursing assessment identified that patient has sepsis conditions. Nursing problems of the patient are ineffective airway clearance, impaired spontaneous ventilation, the risk for shock, and impaired tissue integrity. The nurse performs nursing care to maintain airway patency, provide adequate ventilation, maintain hemodynamic stability, and optimize the wound healing process of the patient.

The Pathogenesis Characteristics and Symptom of Covid-19 in the Context of Establishing a Nursing Diagnosis

Covid-19 is a disease that causes a global health emergency, caused by SAR-CoV2 and transmitted through droplets. Viruses attached to host cells are strongly bound to ACE2 causing excessive inflammatory reactions (Cytokine Storm). The incubation period 1-14 days, causing signs and symptoms of the respiratory syndrome, fever, leukopenia, thrombocytopenia, and in severe conditions multi-organ failure that ends in death. In May 2020 the world mortality rate increased by 15.45%, which previously was March 2020 at 3.4%. The concept of pathogenesis is needed as an effort to provide understanding in handling Covid-19 so that mortality can be controlled. Tracing and understanding the characteristics of Covid-19 pathogenesis that gives rise to various pathological responses of the body becomes an interesting analytical study to establish an appropriate diagnosis, including nursing diagnoses in order to develop a comprehensive nursing plan. This study aims to review the characteristics of covid-19 pathogenesis in the context of establishing a nursing diagnosis according to the Indonesian Nursing Diagnosis Standards. A literature study is done by analyzing the characteristics of COVID-19 signs and symptoms and comparing the major and minor data groupings that exist in the Indonesian Nursing Diagnosis Standard. Characteristic pathogenesis results from mild, moderate and severe symptoms. Grouping results refer to nursing diagnoses including ineffective airway clearance, ventilator weaning disorders, gas exchange disorders, ineffective breathing patterns, the risk of spontaneous circulatory disorders, hyperthermia and anxiety. Keywords: Nursing diagnosis Covid-19, signs anda symptome covid-19, pathogenesis Covid-19, SAR-CoV2

Nursing outcome "airway permeability" in postoperative patients.

to evaluate the evolution of clinical indicators that characterize airway permeability in patients in the postoperative period of thoracoabdominal surgeries and to analyze their relationship with the occurrence of the diagnosis "ineffective airway clearance". descriptive, quantitative, longitudinal research with 60 patients who were followed for five consecutive days. Eleven indicators of the nursing outcome "respiratory status: airway permeability" were used. on the first day of evaluation, the most compromised indicators were: respiratory rate, cough, depth of breath and use of accessory muscles. During follow-up, most of the indicators presented a slight deviation from normal variation and, in the last evaluation, there was a predominance of indicators with some degree of impairment. with the aid of the Nursing Outcomes Classification, it was observed that patients submitted to thoracoabdominal surgeries may present compromised airway permeability even days after surgery.

DEVELOPMENT OF PERIOPERATIVE CARE INSTRUMENTS BASED ON SDKI SLKI SIKI IN OPERATING ROOM

Standard nursing language is now a global trend in the nursing profession with the aim of uniting the terminology used in nursing practice. This study aimed to compile the development an Indonesian Standard of Nursing diagnostic, outcomes and intervention-based perioperative nursing care instrument. Research and Development study of 106 medical records with sample size 21 participants for FGD and 33 respondents in model trial were selected using purposive sampling. The variable in this study was the development of perioperative nursing care instruments and collected using observation sheet and questionnaire, data analysis used descriptive approach. Preoperative nursing care instruments developed were: anxiety, acute pain, risk of infection, knowledge deficit, and risk of perioperative hypothermia. Intraoperative nursing care instruments developed were: ineffective airway clearance, risk of perioperative hypothermia, risk of aspiration, risk of bleeding, anxiety, risk of infection, acute pain, risk of fluid imbalance, and risk of falls. The postoperative nursing care instruments developed were: ineffective airway clearance, risk of infection, acute pain, risk of falls, risk of perioperative hypothermia, and risk of aspiration. Preoperative nursing care instruments developed were 10 instruments consisting of preoperative, intraoperative, and postoperative. The trial results of the instrument showed good results and positive opinions expressed by nurses at the hospital. © 2020 EManuscript Technologies. All rights reserved.

Fisioterapi Dada dan Batuk Efektif sebagai Penatalaksanaan Ketidakefektifan Bersihan Jalan Nafas pada Pasien TB Paru di RSUD Kota Kendari

Backgorund: Pulmonary tuberculosis is an infection disease with the highest prevalence in the world and being the third largest in Indonesia with 1.02 million cases. The core problem of pulmonary tuberculosis patient is ineffective airway clearance characterized by dyspnea, ronchi, excessive sputum, ineffective cough. Nursing intervention to manage the problem is chest physiotherapy and effective coughing. Objective: This study aims to obtain an overview of the application of chest physiotherapy and effective coughing as ineffective airway clearance management on pulmonary tuberculosis patient. Method: Method used descriptive case study with structured interview, studies document and observations. Participants in this study is pulmonary tuberculosis patient which is given three days and twice a day session of chest physiotherapy and effective coughing. Results: Patency of the airway is improve after chest physiotherapy and effective coughing which characterized by normal respiratory frequencies, normal respiratory rythms, no ronchi and able to remove sputum from airway. Conclusion: Chest physiotherapy and effective coughing is applicable as ineffective airway clearance management on pulmonary tuberculosis patient.

Nurse Trend in Writing Objectives and Outcome Criteria of Nursing Diagnosis in Patients With Pulmonary Tuberculosis at The Government Hospital in Salatiga Indonesia

Background. Writing nursing goals and outcome criteria found in nursing care documentation was very varied and not appropriately, it needs to be explored more deeply about the phenomenon. The Study objective was to determine the writing of nursing goals and the outcome criteria for nursing diagnoses. Methods. Research design was qualitative research with a direct observation approach. Data was taken in the MDR TB ward, samples were 100 documentation of pulmonary TB patients. Sampling technique was nonprobability sampling. Result. The goal of nursing diagnosis of ineffective airway clearance was airway clearance effectively again, the problem was resolved, the patient's airway returned to normal and coughing the patient returns to normal, etc. The goal of nursing diagnosis of ineffective breathing patterns was effective breathing patterns, ineffective breathing patterns resolved, etc. The outcome criteria of nursing diagnosis ineffective airway clearence was negative cough, normal respiratory rate, normal vital signs, negative sputum, shortness of breath, coughing resolved, comfortable patients, patients can demonstrate coughing effectively, sputum can come out, breath was relieved, sputum can come out, etc. The outcome criteria for nursing diagnosis ineffective breathing patterns are normal respiratory rate, normal vital signs, respiratory rate was 20 x/minute, it was not weakness, It was not nausea, etc. Recomendation. Nurses are advised to be given trainings, sosialisation, or workshops related to the goals and outcome criteria of nursing diagnoses, and are expected to use NANDA and NIC-NOC references.

Ineffective Airway Clearance in Surgical Patients: Evaluation of Nursing Interventions and Outcomes.

To evaluate the benefits of NIC interventions in postoperative patients with ineffective airway clearance (00031). Quasi-experimental study with interrupted time-series design. A total of 101 patients were evaluated during 4 days based on the nursing outcome Respiratory Status: Airway Patency (0410). Interventions such as cough enhancement (3250), ventilation assistance (3390), and airway management (3140) contributed to significative improvements of the patients' airway patency. Site of surgery and patients' intrinsic characteristics were proven to have influence in the NOC ratings. Interventions implemented during the research contributed to improvement of clinical indicators of airway patency. Postoperative respiratory complications can be minimized by the use of standardized nursing languages.

Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery.

To determine associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery. Cross sectional quantitative study. Participants were 312 adult patients within the first 48 hours after thoracic or upper abdominal surgery. Patients were examined by the research team using an instrument with variables related to the respiratory function. The research team established the presence/absence of three nursing diagnoses and proposed interventions using the NANDA-I classification and the Nursing Interventions Classification. Correlations were tested using the chi-square or Fisher's test. From the total 312 examinations, ineffective airway clearance was present in 185 (59.3%) assessments, ineffective breathing pattern in 123 (39.4%), and impaired gas exchange in 141 (45.4%). Significant correlations showed that patients with ineffective airway clearance were more likely to require pain management (or: 2.27), chest physiotherapy (or: 2.96), and positioning (or:1.8), while patients with impaired gas exchange were less likely to require airway management (or: 0.13) and chest physiotherapy (or: 0.28). Patients with ineffective airway clearance had more chances of requiring pain management, chest physiotherapy, and positioning, while the nursing diagnosis impaired gas exchange was related with airway management and chest physiotherapy. The findings provide basis for nurses to develop effective care plans and to minimize postoperative respiratory complications.

Diagnosa Keperawatan yang Sering Ditegakkan Perawat Pada Pasien Tuberkulosis Paru di Rumah Sakit

Penyakit tuberculosis merupakan salah satu masalah kesehatan yang paling besar di seluruh dunia. Penyakit ini juga merupakan penyebab kematian dan morbiditas yang tertinggi pada negara-negara berkembang, seperti Indonesia. Sebagian besar perawat tidak melakukan rencana perawatan pada pasien tuberkulosis paru karena tidak ada standar struktur meskipun ada pedoman bagi manajemen keperawatan pasien TB paru. Tujuan penelitian ini adalah untuk mengetahui diagnosa keperawatan yang sering ditegakkan perawat pada pasien tuberkulosis paru. Penelitian dilaksanakan di ruang rawat inap Rumah Sakit. Penelitian ini menggunakan pendekatan deskriptif observasional dan deskriptif eksploratif. Sampel adalah dokumentasi askep pasien TBC dengan cara nonprobability sampling yaitu purposive sampling jenuh. Analisis data dengan analisa univariat dengan distribusi frekuensi. Hasil penelitian adalah perumusan diagnosa keperawatan adalah tidak efektif bersihan jalan nafas (52%), penulisan 1 (satu) diagnosa tidak efektif bersihan jalan nafas menjadi 13 bentuk nama diagnosa yang berbeda. Perawat menuliskan diagnosa pola nafas tidak efektif terdapat 7 bentuk penulisan diagnosa. Perawat juga menuliskan diagnosa nyeri akut terdapat 5 bentuk penulisan diagnosa keperawatan, dan menuliskan diagnosa hipertermi terdapat 2 bentuk penulisan diagnosa keperawatan. Rekomendasi penelitian adalah manajemen rumah sakit diharapkan untuk meningkatkan kemampuan skill perawat dalam penulisan diagnosa keperawatan yang terkini, memonitoring dan mengevaluasi baik secara kualitatif maupun kuantitatif penulisan diagnosis keperawatan, menerapkan standar diagnosa keperawatan yang terkini. Perawat pengelola pasien diharapkan dapat menggunakan diagnosa keperawatan terkini sesuai dengan penggunaan NANDA.

Classification tree to screen for the nursing diagnosis Ineffective airway clearance

to identify the defining characteristics of Ineffective airway clearance with better predictive power using classification trees. the predictive power of the defining characteristics of Ineffective airway clearance was evaluated based on classification trees generated from the data of 249 children with acute respiratory infection. Ineffective cough and adventitious breath sounds were identified as the main defining characteristics when screening for Ineffective airway clearance in accordance with trees based on three different computational algorithms. Ineffective coughing and adventitious breath sounds had better predictive capacity for Ineffective airway clearance in the sample.

SEQUÊNCIA DE ROBIN ISOLADA: DIAGNÓSTICOS DE ENFERMAGEM

RESUMO Objetivo: identificar os diagnósticos de enfermagem em lactentes com Sequência de Robin isolada. Método: estudo descritivo desenvolvido em um hospital especializado em anomalias craniofaciais e síndromes relacionadas, no período de novembro de 2015 a março de 2016. Participaram 20 lactentes com Sequência de Robin isolada. Para a coleta de dados utilizou-se o histórico de enfermagem. Os diagnósticos de enfermagem foram elencados segundo a Nanda-Internacional. Para confecção dos resultados utilizou-se a análise estatística descritiva. Resultados: foram identificados oito diagnósticos, sendo cinco com foco no problema e três de risco, incluindo: risco de aspiração (n=20, 100%); risco de infecção (n=20, 100%); amamentação ineficaz (n=19, 95%); nutrição desequilibrada: menor do que as necessidades corporais (n=19, 95%); padrão ineficaz de alimentação do lactente (n=19, 95%); risco de integridade da pele prejudicada (n=18, 90%); desobstrução ineficaz das vias aéreas (n=11, 55%) e ventilação espontânea prejudicada (n=11, 55%). Conclusão: lactentes com Sequência de Robin isolada apresentaram diagnósticos de enfermagem que se relacionaram a problemas respiratórios, alimentares, de segurança e conforto e favoreceram o planejamento e implementação dos cuidados de enfermagem ao traçarem um perfil assistencial.

AROMATERAPI PEPPERMINT TERHADAP MASALAH KEPERAWATAN KETIDAKEFEKTIFAN BERSIHAN JALAN NAFAS ANAK DENGAN BRONKOPNEUMONIA

<p><em>Bronchopneumonia is an infectious disease that may be caused by morbidity and mortality in children under 5 years old. Basic Health Research survey in 2013 found that bronchopneumonia was the second cause of death in children in Indonesia. The highest incidence occurred in children at 12-23 months. It was around 21.7%. A common problem often found in bronchopneumonia is ineffective airway clearance. One way to overcome this problem is by using peppermint aromatherapy. This study aims to determine the effect of peppermint aromatherapy on ineffective road cleaning in 1-5 years old children with bronchopneumonia in Padang Panjang Hospital in 2018.The design of this research was Quasi Experiment with One Group Pretest-Posttest design. Accidental sampling techniques had been used in this reseach. Then, 10 respondents had been chosen as the samples.The data were collected trough physical examination and observation. Next, it was analyzed by Wilcoxon Sign Rank test.The results of this reseach obtained that p= 0.002 <0.05. It means that there was influence of peppermint aromatherapy on airway cleaning nursing problems in 1-5 years old children with bronchopneumonia.In short, peppermint aromatherapy can be used as a non-pharmacological therapy to overcome airway cleaning problems ineffective in pediatric patients with bronchopneumonia.</em></p><p> </p><p><em><strong>Keywords: Bronchopneumonia, Ineffective Airway Clearance, Peppermint Aromatherapy</strong></em></p><p><em><br /></em></p>

Advances in Pulmonary Care in Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a degenerative neuromuscular disease leading to progressive muscle weakness and loss. This review discusses advances in understanding the natural history of DMD, as well as recent pharmacotherapies. Decline in expiratory and inspiratory pulmonary function results in ineffective airway clearance, sleep-disordered breathing and nocturnal and daytime respiratory failure. Routine measures of pulmonary function include forced vital capacity (FVC) and peak expiratory flow (PEF). Both measures follow parallel trajectories and relentlessly decline, reaching the lower limit of normal of 80% of predicted at early teenage years. Moreover, decline in PEF and FVC are closely correlated with respiratory complications and clinically relevant thresholds for FVC are defined in standard of care recommendations. Glucocorticoids (GCs) delay the onset of pulmonary function decline, but once patients have reached the 80% of predicted threshold the decline of FVC and PEF in GC users and patients not using GCs is comparable. In the successful phase III DELOS trial in DMD patients not using GCs, the short-chain benzoquinone idebenone (Raxone®, Santhera Pharmaceuticals, Liestal, Switzerland) has demonstrated statistically significant and clinically relevant efficacy on expiratory and inspiratory function in patients in the pulmonary function decline stage. These results indicate that idebenone can modify the natural course of respiratory disease progression, which is relevant in clinical practice where loss of respiratory function continues to be a predominant cause of early morbidity and mortality in DMD.

Clinical indicators of ineffective airway clearance in children with acute respiratory infection.

The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.

Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery

AimThe aim of this study is to analyze the accuracy of the defining characteristics of ineffective airway clearance (IAC) in patients after thoracic and upper abdominal surgery. BackgroundAlthough numerous studies have described the most prevalent respiratory NANDA-I diagnoses, only few investigates the precision of nursing assessments. MethodsA cross-sectional study was conducted with 192 patients in a surgical clinic. Accuracy measures were obtained by the latent class analysis method. ResultsIAC was present in 46.73% of the sample. The defining characteristics with better predictive capacity were changes in respiratory rate and changes in respiratory rhythm. However, other defining characteristics also had high specificity, such as restlessness, cyanosis, excessive sputum, wide-eyed, orthopnea, adventitious breathing sounds, ineffective cough, and difficulty vocalizing. ConclusionResults can contribute to the improvement of nursing assessments by providing information about the key clinical indicators of IAC.

Diagnósticos de enfermagem mais frequentes em uma unidade de terapia intensiva pediátrica

Aim: to identify the ten most frequent nursing diagnosis in hospitalized patients in a Pediatric Intensive Care Unit. Method: cross-sectional study with 30 patients in a Pediatric Intensive Care Unit. The data were collected during the January and February 2013. Results: the nursing diagnosis, according to the taxonomy of North American Nursing Diagnosis Association: Risk of infection (86,67%), Dysfunctional gastrointestinal motility (60%), Ineffective airway clearance (53,3%), Risk of impaired skin integrity (40%), Risk of vascular trauma (40%), Risk of electrolyte imbalance (36,67%), Impaired spontaneous ventilation (36,67%), Acute pain (33,3%), Constipation (33,3%), Impaired skin integrity (26,67%). Conclusions: the identification of the nursing diagnosis can contribute to implementation of the Nursing Care Systematization at the Pediatric Intensive Care Unit, allowing that assistance to be targeted and specified to actual and potential health problems of the subject to be cared

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Profile of nursing diagnoses in patients with respiratory disorders.

Identify the profile of nursing diagnoses in patients with respiratory disorders. A descriptive and cross-sectional study involving 38 patients with respiratory problems, of referral hospitals, in a city in northeastern Brazil, in the period from August to October, 2012. Data collection was performed using a form and diagnostic inference was made according with the Taxonomy II of NANDA I. The average age of the patients was 46 years and males predominated (60.5%). The most frequent nursing diagnoses were: Risk for infection (97.3%), Acute pain (68.4%), Poor knowledge (68.4%), Sedentary lifestyle (65.7%), Ineffective airway clearance (65.7%), Risk-prone health behavior (63.1%), Activity intolerance (52.6%) and Disturbed sleep pattern (33.3%). Evaluated patients exhibited an average of 8.6 nursing diagnoses (SD = 2.8). With respect to the defining characteristics and related factors the average per person was 7.2 and 9.3, respectively. In this group of patients the most frequent diagnoses were the domain activity/rest. Knowledge of nursing diagnoses profile presented by people with respiratory disorders is important, because it is part of the Nursing Process and nurses who take care of such patients should exercise them in their care practice. Knowledge of the mains nursing diagnosis presented by patients with respiratory disorders are important for the practice of nurses who care for these patients, because it allows the choice of responses to problems of their clientele.

Idebenone as a Novel Therapeutic Approach for Duchenne Muscular Dystrophy

Progressive loss of pulmonary function leads to early morbidity and mortality in Duchenne muscular dystrophy (DMD) due to both expiratory impairment with ineffective airway clearance, and inspiratory impairment leading to nocturnal and daytime hypoventilation and respiratory failure. Glucocorticoid steroids have become a mainstay of DMD therapy with well-documented efficacy on muscle strength and respiratory function. However, the side-effect profile restricts their long-term use, particularly in non-ambulant patients. Idebenone improves secondary mitochondrial dysfunction caused by dystrophin deficiency, intracellular calcium accumulation and increased reactive oxygen species (ROS). Idebenone-mediated improved bioenergetics leads to enhanced adenosine triphosphate (ATP) production and reduced ROS. Based on this rationale, idebenone has been investigated clinically for efficacy on reducing respiratory function decline in exploratory phase II (DELPHI) and confirmatory phase III (DELOS) trials. Idebenone significantly reduced the loss of respiratory function in 8–18-year-old DMD patients who were not using concomitant glucocorticoids. These results indicate that idebenone can modify the natural course of respiratory disease progression in DMD, which is relevant in clinical practice where loss of respiratory function continues to be a predominant cause of early morbidity and mortality in DMD.

Systematic review and meta-analysis of the accuracy of clinical indicators for ineffective airway clearance.

To report quantitative evidence for the accuracy of the defining characteristics of ineffective airway clearance in different settings and populations. Defining characteristics are tests used by nurses to clinically indicate the presence or absence of a particular nursing diagnosis. A few studies have reported the accuracy of certain defining characteristics of ineffective airway clearance, but these studies address specific populations with particular needs. A systematic review with meta-analysis was conducted to provide a synthesis and critical appraisal of the included studies. The electronic databases CINAHL, PubMed, Scopus and LILACS were searched using a systematic search strategy for studies published in any year. The last search was performed on 31 July 2013. Using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy and the Standards for Reporting of Diagnostic Accuracy (STARD), a systematic review was conducted using studies investigating the presence of ineffective airway clearance and its defining characteristics. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to evaluate the quality of the studies. Seven papers met the search criteria. The studies were developed in different clinical settings and most of them fulfilled QUADAS criteria. Summary measures indicated the following defining characteristics with higher accuracy values: adventitious breath sounds, changes in respiratory rate, difficult vocalizing, diminished breath sounds, dyspnoea, ineffective cough, orthopnoea and restlessness. This systematic review showed that the variability in clinical indicators of ineffective airway clearance is related to differences in the clinical settings and patients.