Nursing the Respiratory Patient

Question 1

What are the common signs of respiratory disease?

Answer 1

Nasal Discharge
Sneezing
Stertor
Stridor
Cough
Dyspnoea
Tachypnoea

Question 2

What are typical lung sounds for a patient in respiratory distress?

Answer 2

Wheeze
Crackles
Stirdor - high pitch sounds
Stertor - low pitched sounds

Question 3

How would you assess respiratory patients?

Answer 3

RR, effort and noise:
- Observation
- Auscultation

Oxygenation:
- mm colour
- Pulse oximetry
- Arterial blood gases
- Capnography (CO2)
- Ultrasonography + Radiography – care not to cause further dyspnoea)

Question 4

Which patients are candidates for respiratory therapy? Choose 5.

Answer 4

Any patient with dyspnoea
Airway obstruction
Pleural space disease
Pulmonary oedema
Pulmonary contusions
Pneumonia
Feline asthma
Pulmonary thromboembolism
Diaphragmatic rupture
Severe anaemia
Cardiac patients
Shock cases

Question 5

What are the aims for respiratory therapy?

Answer 5

Increased oxygen saturation of the blood and tissues and decrease respiratory effort.

Question 6

What visual respiratory checks can be carried out?

Answer 6

Respiratory rate, effort, external audible noise.
Signs of trauma or abdominal distension.

Question 7

What oxygenation parameters should be carried out?

Answer 7

• MM colour for signs of cyanosis
• Pulse oximetry measures percentage of haemoglobin that is saturated with O2 - Normal >95%
• Capnography (CO2) measures carbon dioxide in expired gas and assesses partial pressure of CO2 in arterial blood. Assesses ventilation.
• Normal ETCO2 35-45mmHg
• Hypoventilation ETCO2 >45mmHg
• Arterial blood gases is the best assessment for ventilation & oxygenation (PaO2 = Partial pressure of oxygen in arterial blood
• Ultrasonography + Radiography

Question 8

What are nursing aims for respiratory therapy?

Answer 8

• Minimise stress and maintain optimum temperature
• Minimal handling
• Intravenous cannulisation
• Bed baths/suction to remove excess secretions
• Coupage and nebulization
• Oral/mm care

Question 9

What methods of oxygen can be given?

Answer 9

Flow-by oxygen
Mask
Nasal prongs
Nasal cannula
Oxygen cage
Oxygen tent
Incubator
Intubation +/- ventilator
(tracheotomy/transtracheal catheterisation)

Question 10

What are the potential complications of oxygen therapy?

Answer 10

Decrease of O2 saturation to vital tissues due to stress and handling

Increased dyspnoea – keep sternal/lateral recumbency, NOT dorsal

Drying of nasal mucosa – oxygenation longer than 2hrs, delivered directly into the respiratory tract or at rates of over 4L/min, requires a humidifier

Oxygen toxicity - >50% O2 for over 12hrs. Start 100% then reduce to lowest level that provides effect

Atelectasis – due to alveoli filling with fluid. Low intensity mobilisation, turning the patient, nebulisation and coupage, pain management

Question 11

What are the standards when evaluating a patient in respiratory distress?

Answer 11

• Maintain blood oxygen levels above 95%
• Maintain normal mucous membrane colour
• Decrease respiratory rate and effort, reduction of paradoxical breathing
• Monitor frequently to assess effect of interventions, review plan and identify complications