Week No.

__ – Complete Date (Month/Day/Year) (Day of the Week)

PRIORITIZED NURSING PROBLEM FOR CROUP

Nursing Diagnosis Nursing Intervention Rationale
1. INEFFECTIVE Independent
AIRWAY
CLEARANCE Teach the patient the proper The most convenient way to
ways of coughing and remove most secretions is
breathing. (e.g., take a deep coughing. So it is necessary to
breath, hold for 2 seconds, and assist the patient during this
cough two or three times in activity. Deep breathing, on the
succession) other hand, promotes
Educate the patient in the oxygenation before
following: The proper sitting position and
- Optimal positioning (sitting splinting of the abdomen
position) promote effective coughing by
- Use of pillow or hand splints increasing abdominal pressure
when coughing and upward diaphragmatic
- Use of abdominal muscles for movement. Controlled coughing
more forceful cough methods help mobilize
- Use of quad and huff secretions from smaller airways
techniques to larger airways because the
- Use of incentive spirometry coughing is done at varying
- Importance of ambulation and times. Ambulation promotes
frequent position changes lung expansion, mobilizes
Position the patient upright if secretions, and lessens
tolerated. Regularly check the atelectasis.
patient’s position to prevent Upright position limits
sliding down in bed. abdominal contents from
Perform nasotracheal pushing upward and inhibiting
suctioning as necessary, lung expansion. This position
especially if cough is promotes better lung expansion
ineffective. and improved air exchange.
Explain procedure to patient Suctioning is needed when
Use well-lubricated soft patients are unable to cough out
catheters secretions properly due to
Use curved-tip catheters and weakness, thick mucus plugs, or
head positioning (if not excessive or tenacious mucus
contraindicated). production.
Instruct the patient to take This procedure can also
several deep breaths before and stimulate a cough. Frequency of
after nasotracheal suctioning suctioning should be based on
procedure and use patient’s present condition, not
supplemental oxygen, as on preset routine, such as every
appropriate. 2 hours. Over suctioning can
Stop suctioning and provide cause hypoxia and injury to
supplemental oxygen if the bronchial and lung tissue.
patient experiences Using well-lubricated catheters
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

bradycardia, an increase in reduces irritation and prevents

ventricular ectopy, and/or trauma to mucous membranes.
significant desaturation. These facilitates secretion
- Use universal precautions: removal; from a specific side of
gloves, goggles, and mask, as the lung (left or right).
appropriate. Hyperoxygenation before,
Maintain humidified oxygen as during, and after suctioning
prescribed. prevents hypoxia.
Encourage patient to increase Oxygen therapy is
fluid intake to 3 liters per day recommended to improve
within the limits of cardiac oxygen saturation and reduce
reserve and renal function. possible complications
Coordinate with a respiratory As protection against the blood-
therapist for chest related modes of transmission,
physiotherapy and nebulizer health care workers should use
management as indicated. universal precautions when
Provide postural drainage, coming in contact with the
percussion, and vibration as blood of all patients, or bodily
ordered. fluids containing blood.
Pace activities especially for Increasing humidity of inspired
patients with reduced energy. air will reduce thickness of
Maintain planned rest periods. secretions and aid their removal.
Promote energy-conservation Fluids help minimize mucosal
methods. drying and maximize ciliary
Educate patient on coughing, action to move secretions
deep breathing, and splinting a variety of medications are
techniques. prepared to manage specific
Provide patient understanding problems. Most promote
about the proper use of clearance of airway secretions
prescribed medications and and may reduce airway
inhalers. resistance.
Educate caregivers in hest physical therapy helps
suctioning techniques. Provide mobilize bronchial secretions; it
opportunity for return should be used only when
demonstration. Modify prescribed because it can cause
techniques for home setting. harm if patient has underlying
conditions such as cardiac
disease or increased intracranial
pressure.
Oral care freshens the mouth
after respiratory secretions have
been expectorated.
Patient will understand the
underlying principle and proper
techniques to keep the airway
clear of secretions.
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

Understanding prescriptions
promote safe and effective
medication administration.
HydrationAC facilitates easy
elimination of secretions.
This promotes safe and effective
removal of secretions from the
airway.

2. IMPAIRED Place patient with proper body A sitting position permits

BREATHING alignment for maximum maximum lung excursion and
PATTEERN breathing pattern. chest expansion.
Encourage sustained deep These techniques promotes deep
breaths by: inspiration, which increases
- Using demonstration: oxygenation and prevents
highlighting slow inhalation, atelectasis. Controlled breathing
holding end inspiration for a methods may also aid slow
few seconds, and passive respirations in patients who are
exhalation tachypneic. Prolonged
- Utilizing incentive spirometer expiration prevents air trapping
- Requiring the patient to yawn This method relaxes muscles
Encourage diaphragmatic and increases the patient’s
breathing for patients with oxygen level.
chronic disease. This training improves
Evaluate the appropriateness of conscious control of respiratory
inspiratory muscle training. muscles and inspiratory muscle
Provide respiratory strength.
medications and oxygen, per Beta-adrenergic agonist
doctor’s orders. medications relax airway
Avoid high concentration of smooth muscles and cause
oxygen in patients with COPD. bronchodilation to open air
Maintain a clear airway by passages
encouraging patient to mobilize Hypoxia triggers the drive to
own secretions with successful breathe in the chronic CO2
coughing. retainer patient. When
Suction secretions, as administering oxygen, close
necessary. monitoring is very important to
Stay with the patient during avoid uncertain risings in the
acute episodes of respiratory patient’s PaO2, which could
distress. lead to apnea.
Ambulate patient as tolerated This facilitates adequate
with doctor’s order three times clearance of secretions.
daily This is to clear blockage in
Encourage frequent rest airway.
periods and teach patient to This will reduce the patient’s
pace activity. anxiety, thereby reducing
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Consult dietitian for dietary oxygen demand.

modifications. Ambulation can further break up
Encourage small frequent and move secretions that block
meals. the airways.
Help patient with ADLs, as Extra activity can worsen
necessary. shortness of breath. Ensure the
Avail a fan in the room. patient rests between strenuous
Encourage social interactions activities.
with others that have medical COPD may cause malnutrition
diagnoses of ineffective which can affect breathing
breathing pattern. pattern. Good nutrition can
Educate patient or significant strengthen the functionality of
other proper breathing, respiratory muscles.
coughing, and splinting This prevents crowding of the
methods diaphragm.
Educate patient about This conserves energy and
medications: indications, avoids overexertion and fatigue.
dosage, frequency, and Moving air can decrease
possible side effects. feelings of air hunger.
Incorporate review of metered- Talking to others with similar
dose inhaler and nebulizer conditions can help to ease
treatments, as needed. anxiety and increase coping
Teach patient about: skills.
- pursed-lip breathing These allow sufficient
- abdominal breathing mobilization of secretions.
- performing relaxation This information promotes safe
techniques and effective medication
- performing relaxation administration.
techniques These measures allow patient to
- taking prescribed medications participate in maintaining health
(ensuring accuracy of dose and status and improve ventilation.
frequency and monitoring Exercise promotes conditioning
adverse effects) of respiratory muscles and
- scheduling activities to avoid patient’s sense of well-being.
fatigue and provide for rest
periods
Refer patient for evaluation of
exercise potential and
development of individualized
exercise program.

Teach the patient the proper The most convenient way to

ways of coughing and remove most secretions is
breathing. (e.g., take a deep coughing. So it is necessary to
breath, hold for 2 seconds, and assist the patient during this
cough two or three times in activity. Deep breathing, on the
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

succession) other hand, promotes

Educate the patient in the oxygenation before
following: The proper sitting position and
- Optimal positioning (sitting splinting of the abdomen
position) promote effective coughing by
- Use of pillow or hand splints increasing abdominal pressure
when coughing and upward diaphragmatic
- Use of abdominal muscles for movement. Controlled coughing
more forceful cough methods help mobilize
- Use of quad and huff secretions from smaller airways
techniques to larger airways because the
- Use of incentive spirometry coughing is done at varying
- Importance of ambulation and times. Ambulation promotes
frequent position changes lung expansion, mobilizes
secretions, and lessens
atelectasis.
Upright position limits
abdominal contents from
pushing upward and inhibiting
lung expansion. This position
promotes better lung expansion
and improved air exchange.

3. ANXIETY Recognize awareness of the Since a cause of anxiety cannot

patient’s anxiety. always be identified, the patient
Use presence, touch (with may feel as though the feelings
permission), verbalization, and being experienced are
demeanor to remind patients counterfeit. Acknowledgment of
that they are not alone and to the patient’s feelings validates
encourage expression or the feelings and communicates
clarification of needs, acceptance of those feelings.
concerns, unknowns, and Being supportive and
questions. approachable promotes
Familiarize patient with the communication.
environment and new Awareness of the environment
experiences or people as promotes comfort and may
needed. decrease anxiety experienced by
Interact with patient in a the patient. Anxiety may
peaceful manner. intensify to a panic level if
Accept patient’s defenses; do patient feels threatened and
not dare, argue, or debate. unable to control environmental
Converse using a simple stimuli.
language and brief statements. The nurse or health care
Reinforce patient’s personal provider can transmit his or her
reaction to or expression of own anxiety to the
pain, discomfort, or threats to hypersensitive patient. The
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well-being (e.g., talking, patient’s feeling of stability

crying, walking, other physical increases in a calm and non-
or nonverbal expressions). threatening environment.
Lessen sensory stimuli by If defenses are not threatened,
keeping a quiet and peaceful the patient may feel secure and
environment; keep protected enough to look at
“threatening” equipment out of behavior.
sight. When experiencing moderate to
Allow patient to talk about severe anxiety, patients may be
anxious feelings and examine unable to understand anything
anxiety-provoking situations if more than simple, clear, and
they are identifiable. brief instruction.
if the situational response is Talking or otherwise expressing
rational, use empathy to feelings sometimes reduces
encourage patient to interpret anxiety.
the anxiety symptoms as Anxiety may intensify to a panic
normal state with excessive
Recommend patient to keep a conversation, noise, and
log of episodes of anxiety. equipment around the patient.
Instruct the patient to describe increasing anxiety may become
what is experienced and the frightening to the patient and
events leading up to and others.
surrounding the event. The Obtaining insight allows the
patient should note how the patient to reevaluate the threat
anxiety dissipates. or identify new ways to deal
Consider the patient’s use of with i
coping strategies that the Talking about anxiety-
patient has found effective in producing situations and
the past anxious feeling can help the
Assist the patient in developing patient perceive the situation
new anxiety-reducing skills realistically and recognize
(e.g., relaxation, deep factors leading to the anxious
breathing, positive feelings.
visualization, and reassuring Anxiety is a normal response to
self-statements). actual or perceived danger.
Assist the patient in Recognition and exploration of
strengthening problem-solving factors leading to or reducing
abilities. Highlight the logical anxious feelings are important
strategies that the patient can steps in developing alternative
use when experiencing anxious responses. The patient may be
feelings unaware of the relationship
Explain all activities, between emotional concerns and
procedures, and issues that anxiety. If the patient is
involve the patient; use comfortable with the idea, the
nonmedical terms and calm, log may be shared with the
slow speech. Do this in health care provider, who may
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

advance of procedures when help the patient develop more

possible, and validate patient’s effective coping strategies.
understanding. Symptoms often provide the
Instruct the patient in the health care provider with
appropriate use of antianxiety information regarding the
medications. degree of anxiety being
Teach use of appropriate experienced.
community resources in Cognitive therapies focus on
emergency situations (e.g., changing behaviors and feelings
suicidal thoughts), such as by changing thoughts.
hotlines, emergency rooms, Replacing negative self-
law enforcement, and judicial statements with positive self-
systems. statements aids to reduce
anxiety.
This enhances the patient’s
sense of personal mastery and
confidence.
Reassurance is not helpful for
the anxious individual.
Discovering new coping
methods provides the patient
with a variety of ways to
manage anxiety
Anxiety is a normal response to
actual or perceived danger; if
the threat is eliminated, the
response will stop.
Learning to identify a problem
and to evaluate the alternatives
to resolve that problem helps the
patient cope.
With preadmission patient
education, patients experience
less anxiety and emotional
distress and have increased
coping skills because they know
what to expect. Uncertainty and
lack of predictability contribute
to anxiety.

Short-term use of antianxiety

medications can enhance patient
coping and reduce physiological
manifestations of anxiety.
This aids in reduction in
anxiety.
Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)

If patient and family can

identify anxious responses, they
can intervene earlier than
otherwise.
Use of guided imagery has been
useful for reducing anxiety.
the method of suicide
prevention found to be most
effective is a systematic, direct-
screening procedure that has a
high potential for
institutionalization.

References: