Acute Care Respiratory Disorders and Transition Support Program

This article provides nursing assessment for patients with respiratory disorders and helps in developing patient care plans. It covers the pathophysiology, environment, patient knowledge, and other assessment findings for two patients with respiratory disorders. The subject is Acute Care Respiratory Disorders and Transition Support Program.

Acute Care Transition Support Program

Table of Contents
Activity 1 and 2................................................................................................................................3
Nursing Assessment (Patient 1)..............................................................................................3
Nursing Assessment (Patient 2)..............................................................................................8
Activity 3.......................................................................................................................................12
Activity 4.......................................................................................................................................13
Activity 5.......................................................................................................................................15
Activity 6.......................................................................................................................................17
Activity 7.......................................................................................................................................19
Activity 8.......................................................................................................................................20
Activity 9.......................................................................................................................................25
Activity 10.....................................................................................................................................25
REFERENCES..............................................................................................................................27

Activity 1 and 2
Nursing Assessment (Patient 1)
Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective Data to
assist in developing the patient care plan/s
PATHOPHYSIOLOGY IN
RELATION TO
RESPIRATORY
DISORDER
Diagnosis of Respiratory Disorder
Is it Restrictive; Obstructive; infective; sleep disorder; or
Pulmonary Malignancy?
The patient BMI is
overweight. Any gain in
weight will result in , cardiac
problem, week immunity
system, which increases the
patient susceptibility towards
the triggers. Excess weight
around the chest and abdomen
is making it more harder to
breathe.
The diagnosed report states that the patient is suffering from from
Non-infectious, obstructive Asthma and experiencing sleep
disorder.
Height: 180cm, Weight:90 kg, BMI: 27.8, Age: 22 year (M)
Allergies from cleansing fragrance.
Never consumed any drugs and nicotine
drink occasionally.
Environment / Social Situation Various pathophysiological
reasons are may be
responsible for the asthma
which may include some
A 22 year old boy living in small town with his five more friends.
He has irregular and unhygienic food habits. He daily went to
field with his friends for cricket practice. From last few weeks he

is not sleeping well and experiencing shortness of breath and
feeling stressed. He noticed red inflammation his feet. One of his
friend is dealing with Eczema.
environmental factor also.
Such as Mold and moisture,
excess dusts, cleansing
product, fragrance product,
odours, some extra heating
sources, pollutions, unhealthy
diet, weak immune system.
These are the allergens and
irritants, which increases the
asthma symptoms, as they
lead to airway inflammation,
bronchial
hyperresponsiveness. In this
case the Eczema may be the
cause of his asthma
Patient Knowledge
The Responses by the patient in a discussion about his asthma
reflects that he has lack of understanding about the critical triggers
stimulating the asthma and the symptoms which should be noticed
on priority basis. This ignorance result in failure of worsening of
his asthma conditions.
The patient confirmed that he has no idea about the triggers
related to his asthma. He does not follow a healthy lifestyle and
don't know about the healthy environmental condition according
to his condition. The patient does not know hoe to use and safely
keep a inhaler.
Also, he is not taking the prescribed medicine properly and does
not following the guidelines provided by the healthcare.
It is important for patient to
understand asthma in order to
manage it. Patients need to be
educated about the triggers
and safe environment. Proper
explanation about the inhaler
use and care.
Also, provide the information
about the management of
asthma in emergency and the
further causing illness.

Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective
Data to assist in developing the patient care plan/s
SIOLO
R
PATHOPHYSIOLOGY IN
RELATION TO
RESPIRATORY
DISORDER
Neurological/Peripheral & Central Nervous system Inflammation in air ways affects
neuronal activity including
sensory nerves and synaptic
transmission within autonomic
ganglia.
Asthma affect neural activity, disturb neural reflex pathway
Cardiovascular / circulatory
Patient had a palpitation and on examination patient is found in
hypertension with blood pressure of 142/89. heart rate is found
120 bpm. Capillary refill time is more than 2 sec.
High Blood shows that lungs
are not able to pull in enough
amount of air then the heart will
pump at higher speed to get
enough oxygen , as a result
blood pressure will go up.
Prolonged capillary refill time
indicate peripheral perfusion.
(Eger and Bel, 2019).
Respiratory Inside wall of lungs airways
gets swollen and restrict the air
flow. The congestion and cough
along with wheezing suggest a
The patient has exhibited congested upper airway, cough and
wheeze. Shortness of breath with 38 breaths/ min. the oxygen

saturation is found 92 %. severe infection. Low oxygen
saturation is making the patient
breathe with difficulties.
Gastrointestinal Travel of small particle of acid
from stomach to the airways
and causing air tightness thus
leads to Disturbance in
Gastrointestinal.
Assessment of the patient suggest that Diarrhoea and abdominal
pain frequently. Patient have also a feeling nauseous and
vomiting frequently.
Genitourinary Continuous coughing leads to
leakage in bladder and this leads
to frequent urination due to
which patient is also facing
disturbance in sleep.
Patient also have frequent urination issue.
Musculoskeletal (include Functional Status) Consider foot
care
Insufficient supply of air is
causing the cramps and due to
overweight continuous fatigue
is the outcome.
The patient confirmed muscle pain and fatigue.
Swelling in the ankles and feet. Feet's are cold in touch. Cramps
in lower limb.
Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective Data to assist in
developing the patient care plan/s
PATHOPHYSIOLOGY
IN RELATION TO
RESPIRATORY
DISORDER
Integumentary (include condition of any invasive
site(s), incisions) Consider foot care – skin status
Eczema is originated due to
assemblage of genetics, stress,
environmental causing and extra
activation of immune system.
Considering the foot, various
factors are triggering like sweat,
stress, allergic contact or some
time foot mycosis.
During integumentary assessment, patient had a several red and
brownish patches with may leak fluid. The patches are dry and
itchy. It looks like Eczema.

Disequilibrium in Th1 and Th2
cytokines discovered in atopic
dermatitis can lead to
succession in the cell mediated
immune response and can
encourage IgE mediated
hypersensitivity, both of which
appear to play a role in
development of Eczema. Using
of harsh chemical in skin care
products and detergent, lowers
the pH value of skin resulting in
inflammation and triggering the
enzyme activity.
Ophthalmology/Vision
During ophthalmic assessment, patients eye are red and itching.
Patient also have vision difficulties.

Various eye problem comes
along with the Asthma;
 Allergies:- eye allergies
includes burning,
redness, itching. Asthma
an allergies are
interconnected.
 Vision difficulties:-
excessive pressure in
abdomen can lead to
sudden visual loss and
retinal haemorrhage.
 Dry eye:- Asthma
people are at high risk of
developing dry eye.

Mental Health/Cognition Stress leads to inflammation making asthma
treatments more tough. Stress can lead to excess
secretion of histamine, which can lead to asthma
attack. Stress also weaken the immune system of
body thus making the body more susceptible to
asthma triggers. Stress can lead to muscles
constriction, that lead to tighter chest and some
other issues that may trigger asthma. This stress
will result in aggressiveness and further lead to
depression.
Patient wants to sleep and always feel drowsy.
Patient is always in stress and depression.
Patient behavior was also aggressive.
Other assessment findings /
considerations
No
Nursing Assessment (Patient 2)
Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective Data to
assist in developing the patient care plan/s
PATHOPHYSIOLOGY IN
RELATION TO
RESPIRATORY
DISORDER
Diagnosis of Respiratory Disorder; Is it
Restrictive; Obstructive; infective; sleep disorder
Pulmonary Malignancy?
The diagnosed report suggests that the patient is suffering from
infectious, restrictive Pneumonia and experiencing sleep
The patient BMI is very low.
Any additional weight loss
leads to malnutrition, cardiac
issues and Asthmatic history
make him more susceptible to

disorder and this may lead to pulmonary malignancy.
Height: 107cm, Weight:17 kg, BMI: 12.8
Patient is suffering from fever, have cough along with mucus,
experienced chest pain while coughing.
Patient is feeling tired and lost his appetite from last few weeks.
Patient have a history of Asthma.
Pneumonia.
Pneumonia is a inflammatory
response caused by the
infectious organism that reach
the alveoli and fluid gets into
the lungs, which leads to
alveoli to be filled with fluid.
It leads improper gas
exchange (Ho and Ip, 2019).
Environment / Social Situation The indoor air pollution due to
biomass fuel, passive transfer
of smoke due to smoking and
dirty environment, These all
increases the triggers and
symptoms, as they lead to
bronchial
hyperresponsiveness, airway
inflammation.
This 5 year boy lives in small village in a family of 4 member.
The village is in backward area with not much facilities. Woods
and dungs are used for the cooking purpose. The surrounding is
not hygienic as well . Child father is also addicted to smoking.
Patient Knowledge
The Responses by the patient and the family in a discussion about
his pneumonia reflects that he has lack of understanding about the
critical triggers stimulating the pneumonia and the symptoms
which should be noticed on priority basis. This ignorance result in
failure of worsening of his pneumonia as well as asthmatic
conditions.
The patient confirmed that he has no idea about the triggers
related to his pneumonia. He does not follow a healthy lifestyle
and don't know about the healthy environmental condition
according to his condition. The family also does not how the
It is important for patient to
understand pneumonia in
order to manage it. Patients
need to be educated about the
triggers and safe environment.
Also, provide the information
about the management in
emergency and the further
causing illness.

indoor air pollution and smoking can affects the child's health.
Also, he is not taking the prescribed medicine properly and does
not following the guidelines provided by the healthcare for his
asthmatic conditions.
Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective
Data to assist in developing the patient care plan/s
SIOLO
R
PATHOPHYSIOLOGY IN
RELATION TO
RESPIRATORY
DISORDER
Neurological/Peripheral & Central Nervous system With the occurrence of the lung
infection, the infection can
spread to the whole CNS means
brain and spinal cord. The
symptoms are headache. Which
can further lead to encephalitis,
cerebellar ataxia and Meningitis
Inflammation in the brain and spinal cord is found during
assessment of the patient.
Cardiovascular / circulatory
Assessment shows weakness of cardiac muscle, cholesterol
deposition in the artery.
Plague in the artery that resist
the blood flow into the lungs
will affect the heart rate.

Respiratory
this decrease of lung capacity
and also develops many bacteria
and viruses. Alveoli get filled
up with the pus which make
breathing painful and limits the
oxygen intake.
Infraction in the lungs, weakness of lungs, asthma
Gastrointestinal Diarrhoea can cause many
symptoms like vomit, nausea
etc. that have more chances of
develops microbial
contamination like
streptococcus pneumonia that
can causes pneumonia.
Nausea and vomiting Diarrhoea, slow ADME process, Diarrhea, slow
Genitourinary The infection is carried from
lungs to blood streams m from
their to kidney, causing urinary
tract infections.
The assessment detect UTI
Musculoskeletal (include Functional Status) Consider foot
care
Functions are not proper
working and results in weakness
of immunity that can directly
affects on the respiratory
problems.
.
Looseness of muscles, tendons and ligaments.
Nursing Assessment
Complete one table for each patient
Include all Subjective & Objective Data to assist in
developing the patient care plan/s
PATHOPHYSIOLOGY IN
RELATION TO
RESPIRATORY DISORDER

Integumentary (include condition of any invasive
site(s), incisions) Consider foot care – skin status
The inability of the patient body
to heal the wounds, and dry skin
shows that the immunity system
of the patient body is week and
body lacks nutrients. (Lee and
Lee, 2020).
During integumentry assessment, the patient skin was dry.
Patients skin have rashes and some scratches and unhealed
wounds.
Ophthalmology/Vision
The patients eye is red, itchy and watery stating conjunctivitis The excessive coughing and
fever had made a pressure on
the optic nerves which leads to
connectivities.
Mental Health/Cognition Improper sleep, fever and
difficulties in breathing is
making the patient like this.
Treatments can leads to
subsequent depression and
cognitive impairment.
The patient is very confused and irritated. While assessment, the
patient is quite aggressive as well.
Other assessment findings /
considerations
No
Activity 3
3.1-
COPD is a chronic obstructive pulmonary disease is an common, preventable and a disease that
can be treated and is characterized by persistent respiratory symptoms and limits the air flow due
to which alveolar abnormalities occur by significant exposure to noxious particles or gases. Mr
Green have been admitted with an exacerbation of COPD. He got the best treatment in the
healthcare and now he is going to be discharged. For his better health condition he need to use
the MDI properly and understand its importance. A metered – dose inhaler is a device used to

deliver a specific amount of drugs to the lungs. It is recommended that use the MDI with a spacer
which is a plastic tube that holds the sprays from inhaler. MDIs are compact, convenient and
portable also, It is capable of multi dose delivery, Bacterial contamination can be avoided with
the MDI and suitable for emergency situations (Shah, 2021). Mr. Green Should follow this step ;
 Insert the inhaler in the spacer and shake it for 5 sec.
 Breath out
 Put the spacer mouthpiece near the mouthpiece.
 Press the inhaler once downside
 for 3-5 sec, breathe in slowly
 hold the breathe for 10 sec.
It slow down the speed of the aerosol coming from the inhaler, due to which minimum amount of
medication is required for lungs and results in less side effects.
3.2
In order to care the spacer at home, Mr Green should;
 clean the spacer once in a week
 with a little detergent and mild shop in warm water, make the spacer apart and wash in it.
 Do not rinse the spacer as medicine get trapped to the walls of spacer, instead of going to
lungs.
 Allow the spacer to drip dry, can be left for overnight.
 Do not allow anyone else to use the spacer.
3.3
Two outcome of success are;
 Mr. Green is taking his own comfortable time for the inhalation of drugs.
 Mr. Green does not need any assistance while taking the MDI and due to its convenient
and portable size, he used to carry it everywhere in case of any emergency.
Activity 4
4.1
the main aim behind the treatment of chronic obstructive pulmonary disease (COPD) is to stop or
control the symptoms, lower the frequency and sternness of complications and enhance the
general health status and tolerance. To achieve this aim, behavioural therapy along with the
pharmacological treatment For example, bupropion, an antidepressant and nicotine for

replacement therapy have shown positive results (Zeder and et.al., 2021). Drug generally
recommended for the COPD treatment are:
 Glucocorticoids
 Bronchodilators such as anti-cholinergic anti-muscarinic agents, selective beta-2
antagonist and methyl xanthines.
 Some another type of medication like antibiotics, vaccines, mucolytic agents, α1-anti-
trypsin augmentation therapy, antioxidants, antitussive, immuno-regulators, and
vasodilators .
Control symptoms of COPD with pharmacological treatment should use the following proposals:
1. stepwise increase in the treatment in accordance with the severity of diseases.
2. Treatment necessarily be chronic and retained at the same plane for long periods of time,
unless important side effects or complications occur.
3. It is essential to monitor pharmacological aid nearly,and, if required, modify it frequently.
Since patient outcome to the pharmacological aid is uncertain.
Non-pharmacological treatments have developed speedily as an necessary part of COPD therapy.
They are specially important as additional interference in severe disease. The most utilized non-
pharmacological aid for severe COPD patients are rehabilitation, surgery, long-term oxygen
therapy, supportive nutrition , non-invasive positive pressure ventilation (Skolnik and et.al.,
2018). All of these interference are used during end-stage disease, to encourage self-efficacy,
relieve symptoms and prevent foster impairment.
4.2
A team of healthcare provider is involved in the treatment of COPD. Every individual has
unique and important role in COPD management (So and et. al., 2018). Patient's COPD
treatment team may include
 Primary care physician – they are responsible for the initial care or initial diagnosis of
chronic obstructive pulmonary disease (COPD). Almost 80% of the care is provided by
the primary care physician. They perform physical examination and prescribe medicine or
supplemental oxygen, which is required in some COPD cases.
 Pulmonologist – These are specialist who focuses on respiratory system, which figure out
everything from windpipe to lungs. A pulmonologist develops a detailed treatment plan
and best management of symptoms. These includes Pulmonary rehabilitation, oxygen

therapy, Medicine to facilitate breathing, Quitting smoking, Emotional support, Starting
an exercise routine.
 Respiratory therapist - they are assigned for those who face difficulties in breathing. They
have different job like, teaching different methods of technique, giving breathing tests
and teaching supplemental oxygen use.
 Dietician or nutritionist – A healthy body weight is an important part for managing
COPD. Dietician will provide guidance about the designing and maintaining a diet which
will provide a right amount of nutrition and energy according to the needs.
 therapist or counsellor – Mental health problem are common issue in COPD patient. A
therapist and counsellor will help in managing the mental health problems. They will
provide individual or family therapy. They will manage a support group for COPD
patients.
 Palliative care specialist – This are called as support care group also. This palliative
group will consider patients needs and expectations. This specialist will work with
doctors and pulmonologist and determine the best and easiest way to reach them.
Activity 5
Attachment 3: Relevant Respiratory Assessment & Investigations (Patient 1)
Name of
investigation
ordered/taken
Patient specific
Rationale for
Test
Pathology
/diagnostic
Result
 Include
date of
test
 compare
with
normal
value
What do the
results mean?
Limitations of
assessment/
investigation
Follow-up
measures
needed and/or
additional
diagnostic tests
expected
Spirometry  Measures
the
exhalation
Date of test :-
20-07-2022
Normal Value :-
Blockage in
airways.
(Asthma)
Limitations:
outcome changes
if patient has

rate and
the
capacity
of lungs to
hold air.
 To
smoothen
a upheld
slow deep
breath.
FEV1/FVC = >
80%
Result Value:-
FEV1/FVC = <
70%
 chest pain
 fatigue
 dizziness
 bronchos
pasm
Additional test
needed is FeNO
test as it measure
the amount of
nitric oxide
causing the
inflammation.
Attachment 3:Relevant Respiratory Assessment & Investigations (Patient 2)
Name of
investigation
ordered/taken
Patient specific
Rationale for
Test
Pathology
/diagnostic
Result
 Include
date of
test
 compare
with
normal
value
What do the
results
mean?
Limitations of
assessment/
investigation
Follow-up
measures
needed and/or
additional
diagnostic tests
expected
Chest X-ray Enable to detect
the infections or
collected air
around the lungs.
Date of test :-
20-07-2022
Findings :-
Infiltrates
White spots in
lungs and fluids
around the lungs
shows Pneumonia
This test method
cannot detect the
initial stage or it
can not detect the

Which can lead to
collapse of lungs
as well as more
complications.
pleural effusion conditions. overall part of
infected lungs.
A additional
diagnostic test
should be done
like CT of the
lungs as it enables
to detect the finer
details in the
lungs.
Activity 6
For spirometry, the clinical skills assessment tool which are used includes, Accredited spirometry
training programmes followed by refresher training of one year after the initial training and after
every 3 years (Suissa, Dell’Aniello and Ernst, 2019).
PATHWAY FOR CERTIFICATION IN AUSTRALIA
It is the role of specialist organizations generally referred to as the ‘Certifiers’, for awarding
spirometry certification in recognition of capability. The certifiers will have the resources to
acquire applications for certification, keep a database of certified operators and competent
assessors, obtain uploaded assessment evidence and outcomes, give assistance to operators and
assessors and send out the reminders for re-certification, fields enquiries (Sakao, 2019)
(Jantunen and et. al., 2019) . There are four stages to attaining ability and certification which are
mentioned below. In developing, Best exercise assisting principles of flexibility, validity,
reliability and equity of assessment were considered. The assessment tools includes data for
certifiers, candidates and assessors; and further information about the ability framework are
provided in Auxiliary Information. Candidates for certification will be evaluated against specific
spirometry ability elements and performance criteria by autonomous assessors.
Stage 1: Spirometry training and assessment
Candidates are informed to complete a spirometry training programme that includes the
compulsory factors, outlined in the ANZSRS (Australian and New Zealand Society of

Respiratory Science ) spirometry training. Base level skills and knowledge are provided by the
spirometry training (Gonçalves and Romeiro 2019) . More significantly, Skills to be applied are
provided by the training that incorporates a portfolio assessment tool and combined in the
workplace. An experienced operator without having completed recent training may go for for
Certification. even so, foster training will be considered during the process, when there is
indication of unsecured practice session.
Stage 2: Work experience and skill development
The candidate’s confidence and experience in performing quality spirometry are built by
the experiences at workplace. It is suggested that, Before applying for certification, candidates
have to go on a period of work-based practices after finishing the spirometry training
programme. A logbook of spirometry tests performed in the workplace should be maintained by
the candidates. Which would be verified by a workplace supervisor or mentor and also provides
evidences for the perpetual spirometry practice (Baker, Donnelly and Barnes, 2020) .
Stage 3: Portfolio assessment
It is compulsory for the candidates to give a portfolio of a minimum of 10 client tests
executed in the workplace, considering an evaluation on the assessment of quality, control
measures and spirometry ability elements, interpretation and quality. When the candidate has
accomplished a training programme that considers a workplace portfolio then this may give the
evidences which are requisite for the portfolio submission. When capability is not shown in the
proposed portfolio, then the candidate will submit further 10 tests until they have fulfilled the
required standard. From the feedback given to the candidate while Re-submission, it will provide
a learning opportunity for the candidate. The candidates will progress to the practical assessment
after the successfully winding up the portfolio (Matera, Cazzola and Page, 2021) .
Stage 4: Practical assessment
The candidate’s ability to execute spirometry with a client in the workplace accordant
with the current standards and spirometry capability elements are well evaluated by the practical
assessment. It is also necessary for the candidate to demonstrate practical application of
constituted quality assurance, quality control and infection control procedures. The practical
assessment may be conducted through a virtual platform instead of a physical face-to-face
observation in order to provide accessibility to rural and remote candidates.
APPLYING FOR CERTIFICATION

Initial application
The candidate will go for certification with the certifiers. Elaborated instructions and
description of the attestation obligatory by the certifiers will be made accessible to the candidate.
The attestation obligatory to acknowledge spirometry capability will include:
1. Certificate of completion of spirometry training and a logbook of the definite quantity of
spirometry tests performed at the workplace.
2. Portfolio assessment completion or test results of portfolio .
3. Details practical assessment completion.
The candidate should submit the evidence to the certifiers. When the evidence provided is
enough to acknowledge the candidate as capable to execute spirometry to current standards, then
the candidate will be awarded certification for a period of 3 years.
Re-certification
Spirometry operators will need to be re-certified after every three years. The evidence
compulsory to display maintenance of capability may include a spirometry portfolio, spirometry
refresher training certificate, record of frequency of practice, spirometry auditing or other
evidence consider as appropriate by the certifiers (Ti and et. al., 2019) .
Activity 7
7.1
The main addictive component part in the tobacco is the Nicotine. The Nicotine present
in the Cigarette or cigar gets quickly absorbed from the lungs and distributed readily into the
brain, where it get into the nicotinic acetyl choline receptor. Nicotine are present in, charged and
uncharged form in blood stream. The uncharged form of nicotine directly diffuses into the lipid
membranes and the charged form of nicotine gets attached to the nicotine receptor. Five subunits
composed ligand gated channel complex is the nicotinic acetyl choline receptor, which are
present in abundance in the brain. This subtypes are believed to play a role in mediating state of
dependency on nicotine. The release of dopamine and some other neurotransmitter are the effect
of nicotine acetyl choline receptor stimulation in the brain, which are accountable for the feeling
of pleasure (Sharma and et. al., 2020) . This chronic vulnerability of brain to nicotine, results in
adaptation and required increased demands of nicotine for normally functioning of brain.
Therefore stopping the smoking habit suddenly leads to withdrawal symptoms of anxiety,

irritability, hunger, weight gain, difficulty in socialization and difficulties in concentration.
Nicotine dependency is experienced by positive effects of pleasure and exhilaration, and to head
off the harmful effects of nicotine recession.
7.2
Patient who want to quit smoking must be encouraged and enlighten the patients with the
benefits of quitting smoking. Men as well as women of all ages gets immediate health benefits
after quitting smoking. A person can develop a coronary heart disease and also increases the the
risk of stroke and peripheral artery diseases. This risk can be decreased after quitting smoking.
Lungs disease such as chronic obstructive pulmonary diseases, and lungs with a chronic cough
and sputum's and the risk of asthma, person can easily notices rapid improvement in their lungs
condition after quitting smoking. The risk of kung cancer can be reduced within the five year of
stopping smoking (Sirazitdinov and et. al., 2019).
Smoking also increases the risk of peptic ulcer and the risk of osteoporosis, quitting
smoking reverse these risk within few years. Smoking also contributed in several diseases like
type 2 diabetes, teeth and gum issue, sexual problems also, quitting smoking reduces the risk of
developing these problems. The family and friends also get affected by passive smoking like
children who are exposed to smoke can develop asthma, ear infections, sudden infant death
syndrome and cardiovascular disease which later leads to cancer. Those women who are habitual
of smoking have increased rate of miscarriage, preterm labour and stillbirth. Person who want to
quit smoking must be supported (Russell,Genschmer and Blalock, 2022) . Some ways are
mentioned below;
 Person should go through nicotine replacement therapy.
 Person should go for prescribed pills to manage the craving for smoking.
 Person should lean on their loved ones, they will encourage and support in quitting.
 Person should go for a break to get relaxed, as nicotine was helping them to relax
previously.
 Person should avoid alcohol and other triggers, as it influence the non-smoking goal.
Activity 8
Patient 1
Medications Classification Patient Dose Common Specific

(Trade &
Generic)
of medication Specific
Rationale/
Mechanism of
Action, e.g.
1⁄2
life short/long
acting
Route
Time
Frequency
Side Effects/
Observed
Side Effects
Nursing
Implications
in
relation to the
drug.
Generic-
Prednisone
Trade-
Intensol,
winpred
Anti-
muscarinics
Short-acting
drugs
half-life= 2.3-
2.5 hr
act quickly to
relax the air
ways
immediately.
Inhibit
inflammatory
responses by
binding to
intracellular
glucocorticoid
receptor.
5-60mg/day
oral
peak time=1-
2 hr
Common
Side Effects
GIT motility
Increased heart
rate
Glaucoma
Observed
Side Effects
Insomnia
Heartburn
Increased
appetite
GIT motility
Increased heart
rate
Regular
monitoring of
sign and
symptoms
related to
hypotension
and heart
failure
Generic- Leulotriene Long Acting 10mg/day Common Regular

Montelukast
Trade-
singulair
inhibitors Half-life= 2.7-
5.5 hr
Act against the
inflammatory
components of
asthma and
give protection
against
bronchoconstri
ction.
It blocks
leukotriene
receptors and
decreases
inflammation
oral
peak time=
1hr 15 min
Side Effects
Cough
Nasal
congestion
Hepatotoxicity
Observed
Side Effects
Headache
Nausea
Hepatotoxicity
Nasal
congestion
assessment of
liver function
test and
respiratory
status.
Generic-
aminophylline
Trade-
Truphylline
Xanthine Short-acting
Half-life=
female= 6 hr
male= 9 hr
relieve from
bronchial
spasm and
also relax the
smooth
muscles by
blocking
phosphodieste
-rase which
increases
tissue
concentrations
IV
200-500mg/
day in
infusion over
30 min
Common
Side Effects
Nausea
Diarrhoea
Arrhythmia
Palpitation
Observed
Side Effects
Insomnia
Headache
Nausea
Arrhythmia
Monitor serum
theophylline
levels, when
exceeded
reduce the
dosage range.

of cAMP Gastric irritation
Patient 2
Medications
(Trade &
Generic)
Classification
of medication
Patient
Specific
Rationale/
Mechanism of
Action, e.g.
1⁄2
life short/long
acting
Dose
Route
Time
Frequency
Common
Side Effects/
Observed
Side Effects
Specific
Nursing
Implications
in
relation to the
drug.
Generic-
Ampicillin
Trade-
Ampysul
penicillin
antibiotic
Half-life= 0.7-
1.5 hr
Get attached
to the
penicillin
binding
protein and
interfere with
the cell wall
synthesis and
peptidoglycan
synthesis and
inactivate the
inhibitor of
autolytic
8–14 g/day
Oral, IV
Common
Side Effects
fever
diarrhea
colon
inflammation
anemia
Observed
Side Effects
dark urine
sore throat
anaemia
Regular
monitoring of
liver function
test
avoid with oral
contraceptives.

enzymes. colon
inflammation
Generic-
Bacampicillin
Trade-
Penglobe
penicillin
antibiotic
Get connected
to the
penicillin
binding
protein and
hinder with
the cell wall
synthesis and
peptidoglycan
synthesis and
deactivate the
inhibitor of
autolytic
enzymes.
400-800mg/
day
Oral
Common
Side Effects
GIT
disturbances
rashes
seizures
shortness of
breath
Observed
Side Effects
disturbance in
GIT motility
loss of breath.
It reduce the
efficacy and
increase the
antibiotic
resistance with
antacids or
multivitamins
Generic-
Gemifloxacin
Trade-
Gametop
fluoroquinolon
-e antibiotic
Half-life= 6-8
hr
It block the
DNA
replication by
binding with
the DNA
gyrase
enzyme.
320mg/day
Oral
Common
Side Effects
headache
dizziness
abdominal pain
low blood
glucose level
Observed
Side Effects
Avoid with
Warfarin, as it
increases the
chances of
bleeding.

abdominal pain
low glucose
level
diarrhoea
Activity 9
9.1
A metered – dose inhaler is a device used to deliver a specific amount of drugs to the lungs. It is
recommended that use the MDI with a spacer which is a plastic tube that holds the sprays from
inhaler (Peng and et. al., 2020) . MDIs are compact, convenient and portable also, It is capable of
multi dose delivery, Bacterial contamination can be avoided with the MDI and suitable for
emergency situations. Steps taken to use the inhaler in a right way;
 Edge in the inhaler in the spacer and shake it for 5 sec.
 exhale
 Put the spacer mouthpiece near the mouthpiece.
 Press the inhaler in downside once
 for 3-5 sec, inhale slowly
 hold the breathe for 10 sec.
It shift down the pace of the aerosol upcoming from the inhaler, due to which minimal quantity
of medication is requisite for lungs and results in less side effects.
9.2
In order to care the spacer at home, Mr Green should;
 Clean the spacer once in a week.
 Make the spacer apart and wash it with a little detergent and mild shop in warm water.
 Do not rinse the spacer, as medicine get trapped to the walls of spacer, instead of going to
lungs.
 Allow the spacer to drip dry, can be left for overnight.

 Do not allow anyone else to use the spacer.
Activity 10
Respiratory management plan
Strategies Action Expected Outcomes
Reduce access to smoking Active awarenesses among the
patient with the help of health
promotion strategies (Lilic,
Stretton and Prakash, 2018).
Providing relevant therapies
for reducing the smoking.
Using nicotinic replacement
therapies
It can improves the health
quality by taking proper
preventions and reducing
smoking. Patient increases the
physical exercise which can
helps to overcome with their
breathing problems.
To promote health Providing the education and
knowledge about the harmful
effects of using cigarette.
This strategies may help
people to avoid the smoking
which will improve their body
function and reduce the risk of
health issues .
There are many intervention which can help patient to start their self care which reduces the
hospital readmission ( Winkelman, 2020) (. The key elements for reducing respiration problems
are-
 Regular exercise
 Healthy balance diet
 Avoid smoking
Evidence helps hospital and service provider to give proper breathing medical treatment
to the patient which are beneficial for the patient. According to the evidence study there are
various strategies and action plan for reducing the respiratory problems in the patient. Physical
exercise which includes breath in and breath out is most effective intervention for improving the
lungs diseases. Eating healthy balanced diet food may reduce the obesity and also helps in
decreasing the risk of causing the lungs problems (A.L.,Baker, and Piper, 2022).

Patient history is most important before starting the medical treatment. Patient history
helps in analysing the patient current situation about their lung functions and their past
medication and treatments. History record helps in identifying the patient lifestyle and how they
impact on the patient health. The negative impact will analysis and doctors can change their
social and physical factors which can positively impact on the patient health.

REFERENCES
Books and Journals
Baker, J.R., Donnelly, L.E. and Barnes, P.J., 2020. Senotherapy: a new horizon for COPD
therapy. Chest, 158(2), pp.562-570.
Eger, K.A. and Bel, E.H., 2019. The emergence of new biologics for severe asthma. Current
Opinion in Pharmacology, 46, pp.108-115.
Gonçalves, P.B. and Romeiro, N.C., 2019. Multi-target natural products as alternatives against
oxidative stress in chronic obstructive pulmonary disease (COPD). European journal of
medicinal chemistry, 163, pp.911-931.
Ho, J. and Ip, M., 2019. Antibiotic-resistant community-acquired bacterial pneumonia. Infectious
Disease Clinics, 33(4), pp.1087-1103.
Jantunen, J., Haahtela, T., Salimäki, J., Linna, M., Mäkelä, M., Pelkonen, A. and Kauppi, P.,
2019. Multimorbidity in asthma, allergic conditions and COPD increase disease
severity, drug use and costs: the Finnish pharmacy survey. International Archives of
Allergy and Immunology, 179(4), pp.273-280.
Johnson, A.L., Schlam, T.R., Baker, T.B. and Piper, M.E., 2022. Understanding what changes
adults in a smoking cessation study believe they need to make to quit smoking: A
qualitative analysis of pre-and post-quit perceptions. Psychology of Addictive
Behaviors.
Lee, E. and Lee, Y.Y., 2020. Risk factors for the development of post-infectious bronchiolitis
obliterans after Mycoplasma pneumoniae pneumonia in the era of increasing macrolide
resistance. Respiratory medicine, 175, p.106209.
Lilic, N., Stretton, M. and Prakash, M., 2018. How effective is the plain packaging of tobacco
policy on rates of intention to quit smoking and changing attitudes to smoking?. ANZ
journal of surgery, 88(9), pp.825-830.
Matera, M.G., Cazzola, M. and Page, C., 2021. Prospects for COPD treatment. Current Opinion
in Pharmacology, 56, pp.74-84.
Peng, J., Wang, X., Yang, M.H., Wang, M.J. and Zheng, X.R., 2020. Management plan for
prevention and control of novel coronavirus pneumonia among children in Xiangya
Hospital of Central South University. Zhongguo dang dai er ke za zhi= Chinese journal
of contemporary pediatrics, 22(2), pp.100-105.
Pfeffer, P.E., Mudway, I.S. and Grigg, J., 2021. Air pollution and asthma: mechanisms of harm
and considerations for clinical interventions. Chest, 159(4), pp.1346-1355.
Russell, D.W., Genschmer, K.R. and Blalock, J.E., 2022. Extracellular vesicles as central
mediators of COPD pathophysiology. Annual Review of Physiology, 84, pp.631-654.
Sakao, S., 2019. Chronic obstructive pulmonary disease and the early stage of cor pulmonale: a
perspective in treatment with pulmonary arterial hypertension-approved drugs.
Respiratory Investigation, 57(4), pp.325-329.
Shah, N.J., 2021. Treatment of Asthma and COPD. In Introduction to Basics of Pharmacology
and Toxicology (pp. 533-543). Springer, Singapore.
Sharma, H., Jain, J.S., Bansal, P. and Gupta, S., 2020, January. Feature extraction and
classification of chest x-ray images using cnn to detect pneumonia. In 2020 10th
International Conference on Cloud Computing, Data Science & Engineering
(Confluence) (pp. 227-231). IEEE.

Sirazitdinov, I., Kholiavchenko, M., Mustafaev, T., Yixuan, Y., Kuleev, R. and Ibragimov, B.,
2019. Deep neural network ensemble for pneumonia localization from a large-scale
chest x-ray database. Computers & electrical engineering, 78, pp.388-399.
Skolnik, N and et.al., 2018. COPD Management in the Primary Care Setting. Journal of Family
Practice, 67(10), pp.S27-S27.
So, J.Y., Dhungana, S., Beros, J.J. and Criner, G.J., 2018. Statins in the treatment of COPD and
asthma—where do we stand?. Current Opinion in Pharmacology, 40, pp.26-33.
Suissa, S., Dell’Aniello, S. and Ernst, P., 2019. Comparative effectiveness and safety of LABA-
LAMA vs LABA-ICS treatment of COPD in real-world clinical practice. Chest, 155(6),
pp.1158-1165.
Ti, H., Zhou, Y., Liang, X., Li, R., Ding, K. and Zhao, X., 2019. Targeted treatments for chronic
obstructive pulmonary disease (COPD) using low-molecular-weight drugs (LMWDs).
Journal of Medicinal Chemistry, 62(13), pp.5944-5978.
Winkelman, C., 2020. Chronic Obstructive Pulmonary Disease (COPD)/New Onset Pneumonia
(Acute Care). Clinical Simulations for the Advanced Practice Nurse: A Comprehensive
Guide for Faculty, Students, and Simulation Staff, p.178.
Zeder, K and et.al., 2021. Elevated pulmonary vascular resistance predicts mortality in COPD
patients. European Respiratory Journal, 58(2).