I. Pneumonia Pneumonia is an inflammation of the terminal airways, alveoli and interstitial lung mass that can be caused by disease microorganisms, physicochemical factors, immune injury, allergies and drugs. Bacterial pneumonia is the most common form of pneumonia and one of the most common infectious diseases. It can occur in any population and the clinical presentation is mainly characterized by an acute onset, sudden chills, fever, chest pain, cough, sputum, and inflammatory infiltrative shadows visible on lung X-ray. Children, the elderly and infirm, and those with reduced body resistance are susceptible to this disease. Psychological guidance Patients with pneumonia often develop fever, chest pain, cough, sputum and other discomfort at the onset of the disease, resulting in fear of coughing due to pain, thus affecting the healing process. Therefore, patients should be actively encouraged and given help, and told that pneumonia can generally be completely cured after active treatment to reduce patient anxiety and obtain cooperation. Eat a high-calorie, high-protein, vitamin-rich, easy-to-digest diet, usually a semi-liquid diet, such as milk, egg custard, soft noodles, fish porridge, weak meat, etc. Eat and drink plenty of water. Avoid eating warm and phlegm-producing foods, such as snake meat, white fruit, tangerine, pepper, longan meat, and other contraindications as in chronic bronchitis and emphysema. Rest in bed during high fever to ensure sufficient sleep, after the fever subsides, you can move around indoors, and pay attention to prevent getting cold when you first get up. Medication guidance Common drugs include antibiotics such as penicillin and expectorants such as Mucosol, which should be taken under the guidance of a doctor or nurse. If skin itching or rash, diarrhea, stomach discomfort, or bloody sputum occurs during the course of medication administration, you should immediately tell your healthcare provider. Special instructions (1) Cooperate with the retention of sputum culture specimens. (2) If sputum is abundant and difficult to cough up, effective coughing of sputum can be performed every 1-2h, i.e., several times of random deep breathing (abdominal), holding the breath for a moment at the end of inhalation, and then coughing. You can also use the chest percussion method, with two fingers together and arching into a cup shape, relaxing the wrist, and percussing each lobe of the chest rapidly and regularly, repeatedly percussing each lobe for 1-3 min to loosen the sputum and make it easy to cough out. (3) In case of high fever, apply ice packs to the head, axillae and groin, warm water baths and alcohol baths, pay attention to keeping warm when reducing fever, and change wet clothes in time. If necessary, take antipyretic drugs as prescribed by the doctor, and closely observe whether sweating, fever reduction or deficiency symptoms appear. Observation Cooperate with the monitoring of vital signs and pay attention to the presence of chills, chest pain, cough and sputum. Discharge instructions (1) Although pneumonia can be cured, it is prone to recurrence if physical attention is not paid. (2) Therefore, after discharge, you should quit smoking, avoid getting wet and cold, avoid going to crowded public places as much as possible, treat upper respiratory tract infection in time, and return to the hospital for chest X-ray review after 1 month. (3) Eat reasonably and keep a happy mood. (4) If you have high fever, chills, chest pain, cough, coughing sputum, you should seek medical attention immediately. If necessary, receive influenza vaccine and pneumococcal vaccine. Second, spontaneous pneumothorax Spontaneous pneumothorax refers to the accumulation of gas in the pleural cavity caused by the rupture of lung parenchyma or dirty pleura without the influence of exogenous or interventional factors. Patients with a small amount of gas accumulation do not need special treatment and the gas accumulation in the pleural cavity can usually be absorbed on its own within 2 weeks. For large amount of pneumothorax, pleural puncture should be performed to extract the accumulated gas, or closed chest drainage should be performed to reduce the pressure of the accumulated gas on the lung and mediastinum and promote the early expansion of the lung, while antibiotics should be applied to prevent infection. Symptoms are: dyspnea, cough, pneumothorax, palpitations, retrosternal pain, chest tightness, chest pain 1 Dietary guidance: Strengthen nutrition, enter a high-protein, high-calorie, low-fat diet to enhance physical fitness. Enter coarse fiber food, keep the bowel movement smooth. 2 Guidance of rest and activity: Bed rest, oxygen absorption is beneficial to the absorption of gas. Take the affected side when the chest pain is painful, take the semi-recumbent position when the chest is tight, and move appropriately, but avoid strenuous exercise. 3 Guidance on closed chest drainage (1) Ensure that the closed chest drainage tube is airtight with the closed chest drainage device. (2)The drainage bottle should be placed below the patient’s chest where it is not easily touched, the fluid level should be 1500px below the drainage tube outlet plane, and the length of the drainage tube should be appropriate to facilitate patient turning and avoid folding and twisting. (3) Encourage the patient to take a deep breath once in 2h, coughing, blowing balloon or bottle exercises to promote lung expansion and accelerate the elimination of gas in the chest cavity. 4 Guidance on daily life (1) Avoid lifting heavy objects, violent coughing, breath-holding and straining to defecate, etc. (2) Pay attention to the combination of work and rest, and do not engage in strenuous exercise, such as playing ball, running, etc., within one month after the pneumothorax is healed. (3)Don’t do pulling action and chest enlargement within 3-6 months after pneumothorax discharge to prevent pneumothorax from being induced again. (4)Smokers should be advised to quit smoking. (5) Instruct patients to keep a happy mood and avoid mood swings. Bronchial asthma is a chronic inflammation of the airways involving a variety of cells and cellular components. Such inflammation is often accompanied by increased airway reactivity, resulting in recurrent episodes of wheezing, shortness of breath, chest tightness and/or coughing, mostly occurring at night and/or in the early morning. Symptoms are cyanosis, episodic cough, hyperinflation of the lungs, dyspnea, diminished breath sounds, jugular venous anger, coughing sputum, and odd pulse. Provide light, easily digestible food with sufficient calories, not easy to eat fish, shrimp, crab, eggs, milk and other allergy-prone foods. Avoid alcohol and too salty food. Eat more high-protein foods such as lean meat, soybeans, etc. Patients with indigestion should eat less and more meals. Eat foods containing vitamin A, C and calcium such as carrots, leeks, pumpkin, dates, tomatoes, green vegetables, etc. 2 Rest and activity guidance Go to semi-recumbent or sitting position during asthma attack, a small table can be placed on the bed so that patients can rest on the table to reduce fatigue. During the non-exacerbation period, you should actively exercise, such as swimming, brisk walking, jogging, etc., to improve lung function as much as possible, to maximize the recovery of labor force, and to prevent the disease from developing into irreversible airway obstruction and prevent the occurrence of sudden death. 3 Guidance on daily life Avoid triggers of asthma: factors that can trigger asthma include: respiratory viral infections, dust mites that breed indoors on beds, carpets, sofas, velvet products, animal fur, mood swings, mental trauma, exposure to cold air, strenuous exercise, and consumption of allergy-prone foods. Asthma patients should pay attention to find and avoid exposure to sensitive factors to avoid triggering asthma. Do not plant flowers or pets indoors, clean frequently, wash bedding, and leave the scene when cleaning. Avoid cold air, smoke and dust. Prohibit smoking and avoid exposure to smoke and irritating gases. Hydrate more. Drink plenty of water during acute attacks and eat semi-liquid food to facilitate the wetting and discharge of phlegm. Carry antiasthmatic medication with you and learn simple emergency self-treatment methods in case of an attack. Recognize the precursors of asthma attacks, such as sneezing and itchy nose. Bronchiectasis is characterized by irreversible anatomical abnormalities of local bronchial structures. It is caused by chronic purulent inflammation and fibrosis of bronchial and surrounding lung tissues, which destroys the muscles and elastic tissues of bronchial walls, resulting in bronchial deformation and persistent dilatation, with typical clinical symptoms: chronic cough, coughing up large amounts of pus sputum and repeated hemoptysis. Some of them have congenital genetic factors, and most patients have a history of childhood measles, whooping cough or bronchopneumonia. 1 Dietary guidance Eat a high protein, high calorie, high vitamin and nutrient-rich diet. Such as eggs, fish, meat, fresh vegetables, fruits and so on. In case of hemoptysis, give warm and cool, easily digestible semi-liquid, and fast in case of hemoptysis. Avoid drinking strong tea, coffee and other stimulating drinks. 2 Rest and activity guidance Rest should be paid attention to during the acute period, and respiratory exercises and appropriate whole-body exercises can be performed during the remission period. In case of co-infection with fever, cough and hemoptysis, bed rest should be taken. Absolute bed rest in case of hemoptysis. Adhere to appropriate physical exercise, such as running, walking, playing Tai Chi, etc., is conducive to the prevention of the onset of the disease. 3 Daily life guidance (1) Avoid strain and emotional fluctuations, keep a happy mood. (2) Cold weather should be timely increase and decrease clothing, so as to keep warm and avoid colds. (3) Pay attention to oral hygiene and change toothbrush regularly. (4) Quit smoking and avoid exposure to smoke and irritating gases. (5) Postural drainage, which can promote the elimination of sputum. In case of hemoptysis, blood should be gently coughed out, and do not hold the cough to avoid suffocation. V. Upper respiratory tract infection Upper respiratory tract infection is a general term for acute inflammation from the nasal cavity to the larynx, and is the most common infectious disease. About 90% are caused by viruses, and bacterial infections are often secondary to viral infections. The disease can develop in all seasons and at any age, and is spread by droplets or droplets containing the virus, or by contaminated utensils. When the body’s resistance is lowered, such as by cold, exertion, or rain, viruses or/and bacteria already present or invaded from outside grow and multiply rapidly, leading to infection. The disease has a good prognosis and is self-limiting, usually healing in 5-7 days. It is often followed by bronchitis, pneumonia, paranasal sinusitis, and in a few cases, acute myocarditis, nephritis, rheumatic fever, etc. Symptoms:sneezing, nasal congestion, sore throat, loss of taste, cough, low fever. Care measures 1. Keep indoor air fresh, ventilate twice a day for 15-30 min each time. 2. Ensure proper rest for the patient, and bed rest for the more ill or elderly. 3. Drink more water, depending on the patient’s body temperature, sweating and climate. Give a light, easily digestible, vitamin-rich, high-calorie, high-protein diet. 4. Give physical cooling for body temperature over 38.5 degrees Celsius. In case of high fever, use antipyretic and analgesic tablets as prescribed by the doctor. Observe the effect after cooling. Change clothes in time for patients who sweat a lot, and take good care of oral and skin cleaning. 5. Pay attention to keep warm when chills are present. 6. Use medication as prescribed by the doctor. Health guidance 1. Pay attention to respiratory isolation and prevent cross-infection. 2. Maintain adequate nutrition, rest and exercise to increase the body’s resistance. 3. Avoid smoking. 4. Insist on cold water washing to improve the body’s ability to adapt to cold. Acute bronchitis is an inflammation of the bronchial mucosa caused by pathogens such as viruses or bacteria. It is a common and frequent disease in infancy and childhood, often secondary to upper respiratory tract infections, and is often an early manifestation of pneumonia. The disease mostly involves both trachea and bronchus, so the correct name should be acute tracheobronchitis. It is characterized clinically by a cough with (or without) increased bronchial secretions. Key points of care 1. Quiet living environment, fresh air, open windows and doors for ventilation 2-3 times a day, pay attention to respiratory isolation to reduce the chance of secondary infection. 2, appropriate rest, fever bed rest, should often change position to facilitate the discharge of respiratory secretions. 3, drink more water, food nutritious, do not digest the diet, the body temperature exceeds 39 ℃ can be given cooling treatment. How to prevent: 1, regular disinfection of living rooms 2, prevention of upper respiratory tract infections 3, with upper respiratory tract infections should be promptly consulted to avoid the spread of the upper sense from the bottom to bronchitis. 4, strengthen nutrition to increase the body’s resistance. Chronic bronchitis Disease summary: Chronic bronchitis refers to chronic inflammation of the trachea, bronchial mucosa and surrounding tissues. The main clinical symptom is coughing, coughing or recurrent wheezing, which is prone to attack in winter and can be complicated by chronic obstructive pulmonary emphysema or even pulmonary heart disease in severe cases. It is more common in middle-aged and elderly people, and is more common in men than in women. Health education prescription: 1. You should eat more easily digestible food, more fresh fruits and vegetables, and regular rationing to avoid affecting respiratory function due to body obesity. Drink more boiled water to dilute the sputum and open the respiratory tract. 2, absolute requirement to quit smoking. Avoid inhaling soot, oil smoke and other irritating gases. 3, combined with general whole body exercise, special abdominal breathing exercises, the purpose is to make the phlegm easy to cough up and promote the dissipation of inflammation. Abdominal breathing exercises: take a sitting position at the beginning of the practice, relax the shoulders and back, first exhale and then inhale. Exhale through the mouth, exhale gently tuck the abdomen; inhale through the nose, inhalation, chest, abdomen relaxation, so that the abdomen naturally rises. Be easy and comfortable, do not hold your breath. At the beginning of each exercise 3-5 minutes, practice several times a day. After proficiency can be carried out in the standing position and bed, but also in walking, and gradually develop the habit of abdominal breathing. 4, prevention of colds. Cold season should pay attention to cold and warmth, go out with a mask, try to avoid going to public places. Once infected, should be timely treatment. 5.According to the principle of “winter disease and summer treatment” in Chinese medicine, before the onset of the season, take some drugs to enhance the immune function of the body, such as the Chinese medicine “Yu Ping Feng San”, “Tonic Zhong Yi Qi Tang “or injection of BCG vaccine, etc. Eight, the concept of pleural effusion between the dirty layer, wall layer pleura is a potential pleural cavity, pleural cavity, containing a trace of lubricating fluid, its production and absorption is often in dynamic balance. When the hydrostatic pressure of blood increases, plasma osmolarity decreases, capillary permeability increases, and lymphatic vessels are blocked, it can accelerate the production of pleural fluid or reduce the absorption of pleural fluid, which can lead to pleural effusion. Psychological guidance Patients with long duration of illness, breathing difficulties and pain, especially cancerous pleural effusion, will suffer from pain and pressure both physically and mentally. Therefore, they often have anxiety and impatience, so they should communicate and talk with patients more often to increase trust, encourage patients to enhance confidence, eliminate bad psychology, and actively match Taiwan treatment. Dietary guidance: Repeated pleural effusion, the body consumption is too large, a lot of protein loss, should strengthen nutrition, into high protein, high vitamin, high calorie, nutrient-rich food, due to anti-TB drugs caused by liver function damage or chemotherapy drugs toxic side effects, the diet should be light and easy to digest. 2. Rest and activity guidance During the acute and hyperthermic periods, bed rest should be taken, with the affected side in the chest pain position and the semi-sitting position in case of difficulty. After the symptoms are relieved, you can move appropriately and avoid straining or getting cold. 3. Guidance on daily life Ensure sufficient sleep, avoid exertion, avoid emotional excitement, increase and decrease clothes with the change of temperature to prevent the occurrence of colds. Quit smoking and drinking, and ensure nutritional supplements. Pay attention to personal hygiene, forbid spitting, cover your nose and mouth with a tissue when coughing or sneezing, and wear a mask when going out. The room should be bright, dry and ventilated, and in winter, it should be ventilated twice a day for 30 minutes each time. Anti-tuberculosis drugs must be taken in full, adequate and regular doses. Do not stop taking or miss taking drugs at will, and medical staff should remind patients to take the drugs. It is normal to have red urine when taking rifampicin. Regular review of liver and kidney function. Chronic obstructive pulmonary disease (COPD) is a devastating lung disease characterized by incomplete and reversible airflow limitation, which usually develops progressively and is associated with an abnormal inflammatory response of the lung to harmful particles or gases. It is a chronic airway inflammatory disease that can be prevented and treated. Although it is a disease of the airway, the systemic impact on the whole body cannot be ignored. 1.Psychological guidance The patient’s condition is prone to recurrence, so that patients often have psychological problems of anxiety, fear and depression. Nursing staff should use communication skills to communicate effectively with patients, help them face the disease correctly, and eliminate their unnecessary fear and anxiety. 2.Dietary guidance Eat high-calorie, high-protein, high-vitamin, light, easy-to-digest food, such as lean meat, tofu, eggs, fish, fresh vegetables, fruits, etc. 3, rest and exercise guidance Reasonable rest, strengthen physical exercise, strengthen the body resistance. During the acute attack period, you should rest in bed; after the acute period, you can do proper exercise and exercise. According to the patient’s physical strength, he can participate in some appropriate activities. For example, jogging is one of the most complete whole-body coordinated exercises, which can increase lung capacity and endurance, and maintaining even breathing while jogging can make enough oxygen enter the body. Tai chi, soft exercises, walking, etc. can improve physical health. 4, medication guidance (1) cough syrup on the respiratory tract mucosa by the soothing effect, should not drink water after taking, so as not to dilute the drug, reducing the efficacy of taking a variety of drugs at the same time, then the last cough syrup should be taken. (2) Severe pulmonary insufficiency, sedative drugs should be used with caution, because they inhibit breathing; morphine, codeine and other drugs are prohibited. (3) Instruct patients to use quantitative inhalation aerosols correctly. 5, disease guidance Assist patients to develop respiratory exercise in the training program, and instruct patients on respiratory function exercise methods, such as lip reduction and abdominal breathing, respiratory gymnastics training, etc., to improve respiratory function. Encourage patients to breathe effectively and cough and cough up sputum. Instruct patients to excrete sputum by nebulized inhalation or assist in sputum excretion by chest percussion. Encourage patients to drink more water according to their condition, which can dilute the sputum and make it easy to be expelled. 6.Discharge health guidance Keep the air inside the residence fresh, ventilate more, avoid storing by irritating gas, such as pesticide items, etc., and go outdoors to breathe fresh air more often. Assist patients to quit smoking and make a plan to quit smoking. Because smoking can change the squamous epithelium of bronchial columnar cilia, cilia movement is impaired, and phagocytosis is reduced, which induces increased sputum and causes cough. Avoid triggers such as exposure to cold, rain, and excessive fatigue. Keep allergic individuals away from allergens and avoid allergen stimulation of the organism. Exercise daily in a planned manner, such as walking and jogging, so as not to feel fatigued. Strengthen cold tolerance training, wash face with cold water, etc. to enhance the body resistance. Instruct the patient to exercise the function of respiratory muscles. Instruct patients to cough effectively. Instruct patients to receive home oxygen therapy correctly, use oxygen therapy devices correctly, explain the necessity and benefits of long-term home oxygen therapy to patients and their families, and obtain active cooperation from patients. The purpose of long-term oxygen therapy is to correct hypoxemia, and it is beneficial to increase the survival rate of patients, improve the quality of life and neuropsychiatric status, reduce erythrocytosis, prevent nocturnal hypoxemia and improve sleep quality. Long-term oxygen therapy can prolong the survival of patients and reduce the death rate. Patients are advised to take oxygen for at least 15 hours a day, and low-flow oxygenation is generally advocated.