Cough assessment: 1. Color A lot of yellow phlegm - bronchiectasis, lung abscess Reddish-brown jelly-like sputum - Klebsiella pneumoniae infection Rust-colored sputum - pneumococcal pneumonia (lobar pneumonia) Brown phlegm – amebic lung abscess Rotten peach-like phlegm (jam-like phlegm) - paragonimiasis Gray-black phlegm - air pollution, pneumoconiosis Yellow-green sputum - Pseudomonas aeruginosa infection Pink frothy sputum - pulmonary edema

Volume: 100ml per day

(1) General care ① Environment ② Avoid triggers ③ Diet ④ Posture ⑤ Activities and rest ⑥ Oral care ⑦ Skin care ⑵ Observe ① vital signs ⑶ Promote effective phlegm discharge and keep the respiratory tract open (key point) ⑷ Medication and care ⑸Psychological care

Effective sputum elimination → humidification of the airway (10 to 15 minutes) → chest percussion → postural drainage → mechanical suction of sputum → tracheotomy

Summary of dyspnea: ① Recurrent expiratory dyspnea: bronchial asthma ②Paroxysmal dyspnea at night: acute left heart failure ③Chronic progressive shortness of breath: COPD ④Acute shortness of breath with chest pain: pneumothorax, pleural effusion, pneumonia ⑤Inspiratory stridor: upper airway obstruction caused by laryngeal edema, tumors, and foreign bodies

Repeated hemoptysis: major causes: tuberculosis, bronchiectasis, lung abscess, lung cancer A small amount of hemoptysis is <100 ml per day, a moderate amount of hemoptysis is 100 to 500 ml per day, and a large amount of hemoptysis is >500 ml per day or >300 ml each time.

Hemoptysis care ① People with moderate or above hemoptysis need to stay in bed absolutely, move as little as possible, lie down on their back or on the affected side, with their head tilted to one side ② People with massive hemoptysis should fast ③Use hemostatic drugs, sedatives and cough medicines as directed by the doctor (hemostatic drugs: pituitrin. Irritability: diazepam 5~10mg isn’t st, morphine and pethidine are prohibited to avoid inhibiting breathing) ④ Symptoms of suffocation☆: Observe whether there are signs of suffocation such as emotional tension, pale face, profuse sweating, irritability, poor hemoptysis, sudden expression of fear, chest tightness and shortness of breath, open mouth and staring, hands grabbing, sweating profusely, lip fingering Cyanosis, even loss of consciousness and other symptoms of asphyxia

Timely nursing measures for suffocation: place the patient in a head-down and foot-high position, pat the back gently, quickly expel the blood clots in the airway and pharynx, and use a suction device to suck out the blood clots in the mouth, pharynx, throat, and nose as soon as possible or wrap your fingers in gauze to remove the blood clots in the mouth, pharynx, throat, and nose. If necessary, perform tracheal intubation or tracheotomy to relieve respiratory obstruction

Concept: Chronic obstructive pulmonary disease (COPD), referred to as COPD, is the general name for a group of diseases mainly represented by obstructive emphysema. It usually includes the characteristics of chronic bronchitis and obstructive emphysema. : A lung disease characterized by airflow limitation that is not completely reversible and progressively develops into a trilogy of COPD: chronic bronchitis → obstructive emphysema → chronic cor pulmonale

Concept: Chronic bronchitis (referred to as diffuse bronchitis) refers to chronic non-specific inflammation of the trachea, bronchial mucosa and surrounding tissues Diagnosis☆: Chronic cough with cough and sputum for more than three months every year for more than two consecutive years, excluding other known causes

The main factor leading to the occurrence of chronic bronchitis: smoking Triggers: respiratory infections, air pollution, allergic reactions, nutritional status, climate Infectious factors are important factors in the occurrence and development of COPD (smoking is the most risk factor and the most important pathogenic factor of this disease)

Stages of COPD disease course ① Acute attack period (within one week) ② Chronic relapse period (>1 month) ③ Clinical remission period (>2 months)

Chronic bronchitis → emphysema ← vision, touch, touch, hearing (☆Symptoms: Chronic cough, expectoration , gasp) ↓ COPD← progressively worsening shortness of breath → hallmark symptom ↓ cor pulmonale

Vision: (Barrel-shaped chest) Severe cases may have shallow and rapid breathing with a pursed lip breathing lamp Touch: The tremor weakens or disappears Percussion: excessive voicelessness, heart dullness shrinks or disappears, and the lower boundary of the lungs moves downwards Listening: Reduced breath sounds, prolonged breathing, distant heart sounds

Pulmonary function test☆ The ratio of forced respiratory volume in the first second to forced vital capacity (FEV₁/FVC%) is <70%, FEV₁ is lower than 80% of the expected value, and the residual volume as a percentage of total lung capacity (RV/TLC) increases. If it exceeds 40%, it means that the lung capacity is Hyperinflation (pulmonary function measurement is the “gold standard” for diagnosing COPD)

Treatment of acute exacerbation ① Anti-infective treatment ② Expectorant, cough and asthma relief ③ Oxygen administration Stable phase treatment ① Bronchodilators ② Expectorants ③ Glucocorticoids ④ Long-term home oxygen therapy (LTOT): Long-term home oxygen therapy (LTOT) generally adopts low flow (1 to 2 liters per minute) and low concentration. (25%~29%) Continuously provide oxygen, and the daily oxygen inhalation time should not be less than 15 hours to increase the oxygen partial pressure (%=21 4×L/min)

Concept: Bronchial asthma, referred to as asthma, is a disease based on chronic inflammation of the airways involving inflammatory cells such as eosinophils, mast cells, and T lymphocytes, and characterized by airway hyperresponsiveness and reversible airway obstruction. . Clinical manifestations: Recurrent wheezing, shortness of breath, chest tightness or coughing and other symptoms, often occurring at night and/or early in the morning and worsening

Health history: Predisposing factors: ① Inhaled allergens: such as inhaled dust mites, pollen, fungus robes, animal wool, etc. ②Infection: Such as bacterial, viral, parasitic infection, etc. ③Food: Such as fish, shrimp, crab, eggs, milk, etc. ④Drugs: such as propranolol, aspirin (side effects: gastrointestinal dysfunction), etc. ⑤ Others: climate change, exercise, mental factors, pregnancy, etc.

Special manifestations of symptoms: 1. Cough variant asthma: chronic cough as the only symptom. 2. Exercise-induced asthma: Chest tightness and dyspnea occur during exercise, more common in teenagers.

Stages of bronchial asthma: 1. Acute attack stage: shortness of breath, cough, chest tightness, and difficulty breathing. 2. Chronic duration: wheezing, coughing, chest tightness. 3.Remission period

To control acute attacks: ⑴ β₂ receptor agonist: Salbutamol (SAMA) is commonly used, and aerosol inhalation is the preferred method of administration. ⑵Theophylline: Aminophylline is commonly taken orally, and can be given intravenously for severe and critical asthma. ⑶Anticholinergic drugs: ipratropium bromide (LAMA) is commonly used for aerosol inhalation. ⑷Adrenal glucocorticoids: currently the most effective drug for controlling asthma, used for moderate and severe asthma. Oral prednisone or prednisolone is commonly used, and intravenous hydrocortisone or dexamethasone can be used in severe or severe asthma attacks. ⑸ Cromoglycate disodium: most effective in preventing asthma induced by exercise or allergens.

Medication and care: Tea for asthma (aminophylline), anti-inflammatory, sugar consumption (glucocorticoids), emergency brake (albuterol), prevention of perverts (sodium cromoglycate) ⑴β₂ receptor agonists: ①Cannot be used alone and regularly for a long time. ②Use an atomized inhaler. ③ When injecting salbutamol intravenously, attention should be paid to the drip rate (2 to 4 μg/min), and side effects such as heart palpitations and muscle tremors should be observed. ④Sustained-release tablets must be swallowed whole and cannot be chewed. ⑵Theophylline: Excessive dosage of aminophylline or too fast intravenous injection (drip) speed can cause nausea, vomiting, headache, insomnia, tachycardia, arrhythmia, and drop in blood pressure. During intravenous injection, the concentration should not be too high, the speed should not be too fast, and the injection time should be more than 10 minutes to prevent poisoning symptoms. Theophylline sustained-release tablets or theophylline controlled-release tablets cannot be chewed. ⑶ Glucocorticoids: After inhalation treatment, you should rinse your mouth and wash your face. When taking systemic medication, attention should be paid to side effects such as obesity, diabetes, hypertension, osteoporosis, and peptic ulcer. It should also be taken after meals.

Guiding the use of inhalers is the key to successful treatment ⑴ Metered dose inhaler ① Open the cap and shake well ② Take a deep breath ③ Hold the nozzle with double layers ④ Inhale through the mouth while pressing and spraying ⑤ Hold your breath for 5 to 10 seconds and exhale slowly

Symptoms: ① Systemic symptoms: low fever, night sweats, fatigue, loss of appetite and weight loss, etc. ② Respiratory symptoms: cough, hemoptysis, chest pain, dyspnea, etc. Clinical types: ⑴ primary pulmonary tuberculosis ⑵ hematogenous pulmonary tuberculosis ⑶ secondary pulmonary tuberculosis: including ① infiltrative pulmonary tuberculosis ② cavitary pulmonary tuberculosis ③ tuberculosis ④ caseous pneumonia ⑤ fibrocavitary tuberculosis ⑷ tuberculous pleurisy

(PPD) 0.1ml (5IU) is injected intradermally in the middle and upper 1/3 of the inner side of the left forearm. Result judgment: if the diameter of induration is less than 5mm, it is negative (-), if it is 5-9mm, it is weakly positive ( ), if it is 10-19mm, it is positive ( ), if it is not less than 20mm or if it is less than 20mm but there are local blisters or necrosis, it is strong positive ( )

Early, combined, appropriate, regular and full course of treatment are the principles of chemotherapy. Symptomatic treatment: ① Toxic symptoms: glucocorticoids ② Blood stuck: Pituitaryin 5~10U is added to 50% glucose 40ml and injected slowly intravenously, then 10U is added to 5% glucose solution 500ml for intravenous infusion General care ① Rest: bed rest ② Diet care: high calorie, high protein, high vitamin

☆Practice listening after one week (Page ₄₄ to benefit the liver and calm the stomach) ☆The primary measure to control the spread of tuberculosis is to isolate and effectively treat patients with excretion; the easiest and most effective way to dispose of sputum from tuberculosis patients is to incinerate

Concept: Pneumonia refers to inflammation of the terminal airways, alveoli and pulmonary interstitium, which can be caused by a variety of pathogens, physical and chemical factors, allergic factors, etc. It is a common disease of the respiratory system and a frequently-occurring disease. Bacterial pneumonia (most common): G-bacteria (Diplococcus pneumoniae, Staphylococcus aureus, hemolytic Streptococcus); aerobic G-bacteria (Klebsiella pneumoniae, Haemophilus influenzae, Enterobacter spp., etc.)

Concept: Community-acquired pneumonia (CAP): refers to infectious lung parenchymal inflammation suffered outside the hospital. The main pathogen is pneumococcus (40%) Hospital-acquired pneumonia (HAP): refers to pneumonia that does not exist when the patient is admitted and is not in the incubation period, but occurs in the hospital 48 hours after admission. The main causative bacteria of CAP: pneumococcal most common (40%) Gram-negative bacilli (20%) most common: Klebsiella pneumoniae Ventilator-associated pneumonia (VAP) is the most common form of HAP, and treatment and prevention are difficult. Among them, Klebsiella pneumoniae is the most common pathogenic bacteria.

Concept: Pneumococcal pneumonia is inflammation of the lung parenchyma caused by pneumococci, with acute inflammatory consolidation of lung segments or lung fluid. Pneumococcal bacteria live in the oropharynx and invade the lower respiratory tract under certain incentives to cause disease. Pathogenesis: bacterial capsular polysaccharide acts on tissues: causing alveolar wall congestion and edema, rapid exudation of white blood cells and red blood cells Symptoms: Systemic symptoms: The onset is sudden and sudden, with chills first, followed by high fever. The body temperature can reach as high as 39-41°C within a few hours, showing a persistent fever type. Typical patients cough up rust-colored sputum during the red liver-like degeneration stage (about 2 to 3 days after onset). Signs: Inspection, decreased respiratory movement, palpation, increased tremor, dullness, auscultation, decreased breath sounds or rales Complications: septic shock

⑴ Congestive phase: 1 to 2 days after the illness ⑵ Red liver transformation phase: 3 to 4 days after the illness, the sputum is rust-colored ⑶ Gray liver-like sputum: 5 to 6 days after the illness, the sputum is gray-white ⑷ Dissipation phase: the illness After about a week, the lung tissue can completely return to normal. Chest x-ray examination is an important basis for diagnosing pneumonia Anti-infection: The preferred course of treatment with penicillin (G) is usually 14 days, or the drug can be stopped 3 days after the fever subsides or the intravenous medication can be changed to oral administration and maintained for several days. ☆☆Observe for early symptoms of shock: rapid pulse, decreased blood pressure, pale complexion, cold limbs, and decreased urine output. Shock nursing measures: mid-recessed position, head and chest elevated 10 to 20° → facilitate breathing, lower limbs elevated 20 to 30° → reduce blood return volume Ethanol scrub → collapse to prevent and care for septic shock (blood volume replenishment and volume expansion are the most basic measures against shock.) Sodium bicarbonate solution: appropriate amount of acid correction and alkali replenishment, 5% sodium bicarbonate → alkalizes urine (hemolysis reaction)

Concept: Bronchiectasis is the expansion and deformation of the bronchial lumen due to chronic inflammation of the segmental or subsegmental bronchus and its surrounding tissue that damages the wall, causing serious pathological damage to the bronchial tissue structure. ☆Broncho-pulmonary tissue infection and bronchial obstruction The most common bronchial-pulmonary tissue infections in infants and young children: (whooping cough, measles, bronchopneumonia, tuberculosis) Symptoms ☆ ① Chronic cough with a large amount of thick sputum: foam layer, purulent mucus layer, turbid mucus layer, necrotic tissue sedimentation layer ② Repeated hemoptysis ③ Recurrent lung infection ④ Symptoms of chronic infection and poisoning Signs (persistent localized crackles) (typical signs of bronchiectasis) clubbing of fingers (toes) in some patients Imaging examination: Typical X-ray findings are orbit sign and curly hair-like shadow, and fluid level appears in the shadow during infection (honeycomb-like translucent shadow). Key points of treatment: ⑴ Anti-infection ⑵ Drainage sputum and keep the respiratory tract open ☆ ① Expectorants ② Bronchodilators ③ Nebulized inhalation ④ Postural drainage ⑤ Fiberoptic bronchoscope to suction sputum

Concept: Primary bronchial lung cancer (lung cancer for short): Tumor cells originate from bronchial mucosa or glands and is one of the most common malignant tumors. Mechanism: ⑴ Smoking is a very important risk factor for the occurrence of lung cancer ⑵Carcinogenic effects of chemical and radioactive substances ⑶In vivo factors ⑷Biological factors

Concept: Superior lung sulcus cancer at the apex of the lung often compresses the cervical sympathetic nerve, causing ipsilateral miosis, ptosis, enophthalmos, and forehead retardation, which is called Horner syndrome. Chest x-ray examination is one of the most important ways to detect lung cancer. Chemotherapy is the main method for treating small cell lung cancer. Commonly used chemical drugs include etoposide (VP-16), cisplatin (ODP), carboplatin (CBP), cyclophosphamide (CTX), and vincristine (VCR). ), teniposide (VMM26), methotrexate (MIX), ifosfamide (IFO) ☆Pulmonary encephalopathy is the leading cause of death from cor pulmonale

Respiratory failure can be diagnosed when the partial pressure of arterial oxygen (PaO₂) is <60mmHg, with or without partial pressure of carbon dioxide (PaCO₂) >50mmHg. In addition to the symptoms and signs of the primary disease causing respiratory failure, it is mainly the manifestation of multi-organ dysfunction caused by hypoxia and CO₂ retention. When severe hypercapnia (PaCO₂>80mmHg) occurs and CO₂ anesthesia occurs, the respiratory center can be suppressed, resulting in shallow and slow breathing or moist breathing. Concept: When carbon dioxide retention worsens, inhibitory symptoms appear, such as apathy, muscle tremors, indirect convulsions, drowsiness, and even coma, which is called pulmonary encephalopathy. ☆Dyspnea is the earliest and most prominent symptom of respiratory failure, and cyanosis is a typical manifestation of hypoxia. Patients with respiratory failure who develop neurological or psychiatric symptoms such as excitement should be considered to have pulmonary encephalopathy. Chronic respiratory failure is mostly type II respiratory failure, and low concentration (25% to 29%) and low flow (1 to 2L/min) continuous oxygen inhalation should be adopted.