Respiratory- Case study

QUESTION

Respiratory

Signs of respiratory distress/deterioration in an adult

Why and when to do a respiratory assessment

3 assessments of a person with respiratory deterioration (rate, depth, effort is counted as 1

assessment

Recognise acute deterioration, prioritise and escalate care, implement the escalation process

and report to appropriate personnel

Track and trigger/EWS chart

Identify and implement enrolled nurse’s role and responsibilities in an emergency response

Cardiac

Pain management after thoracotomy

Purpose of an intercostal catheter

Safety management of UWSD system

Bedside safety equipment of UWSD

Education of person with UWSD

Renal

Types of acute kidney injuries

Management of an acute kidney injury

Nursing assessment and interventions of acute kidney injury

Suprapubic catheter

GIT and Stoma

GIT conditions that may require stoma

Purpose of a stoma

Assessment of a stoma

Discharge planning for person with a stoma

Psychological care of person with a stoma

ANSWER

Respiratory

Signs of respiratory distress/deterioration in an adult

Recognizing the signs of respiratory distress or deterioration in adults is crucial for timely intervention and appropriate care. Some common signs to watch for include:

Increased respiratory rate: A rapid respiratory rate, above the normal range (typically more than 20 breaths per minute), can indicate respiratory distress.

Shallow or labored breathing: Difficulty in taking deep breaths or visible effort in breathing, such as using accessory muscles or retractions, suggests respiratory compromise.

Decreased oxygen saturation: Monitoring oxygen saturation levels using pulse oximetry can help identify declining oxygen levels, which is a key indicator of respiratory deterioration.

Cyanosis: Bluish discoloration of the lips, nail beds, or skin indicates a lack of oxygen and requires immediate attention.

Altered mental status: Confusion, restlessness, or decreased level of consciousness may occur as a result of inadequate oxygenation.

Why and when to do a respiratory assessment

Respiratory assessments are performed to evaluate a person’s breathing status and detect any abnormalities or changes that may indicate respiratory distress or deterioration. These assessments are essential in various healthcare settings, including hospitals, clinics, and home care. Common reasons to conduct a respiratory assessment include:

Routine monitoring: Regular assessments are done to ensure baseline respiratory function and detect early signs of deterioration.

Suspected respiratory conditions: If a patient presents with symptoms such as cough, shortness of breath, or chest pain, a respiratory assessment is necessary to identify the underlying cause.

Post-surgical or post-procedural care: After surgical procedures or interventions, respiratory assessments help monitor for potential complications, such as respiratory distress or pneumonia.

3 assessments of a person with respiratory deterioration

Respiratory rate: Counting the number of breaths per minute provides vital information about the person’s breathing pattern. An increased or decreased respiratory rate may indicate respiratory distress.

Oxygen saturation: Using a pulse oximeter, measure the person’s oxygen saturation level to assess the adequacy of oxygenation. Decreased oxygen saturation suggests respiratory compromise.

Auscultation of breath sounds: Listen to breath sounds using a stethoscope to assess for abnormalities such as wheezing, crackles, or diminished breath sounds. These findings can indicate underlying respiratory conditions or complications.

Recognize acute deterioration, prioritize and escalate care, implement the escalation process, and report to appropriate personnel

In the event of acute respiratory deterioration, prompt recognition and appropriate action are crucial. Healthcare providers should follow these steps

Recognize signs of acute deterioration: Stay vigilant and identify any signs or symptoms of worsening respiratory distress.

Prioritize care: Ensure immediate attention and prioritize the patient’s respiratory needs, providing interventions such as administering oxygen or initiating non-invasive ventilation if necessary.

Escalate care: If the person’s condition continues to deteriorate or requires advanced interventions, promptly escalate care by involving the appropriate healthcare team, such as respiratory therapists, doctors, or critical care specialists.

Implement the escalation process: Follow the established protocols and guidelines for escalating care based on the severity of the respiratory deterioration.

Report to appropriate personnel: Communicate the situation and relevant information to the healthcare team, including documenting the interventions taken and the response of the patient.

Track and trigger/EWS chart

Track and trigger systems, also known as Early Warning Systems (EWS), are used to identify and respond to deteriorating patients promptly. EWS charts are structured tools that assign scores based on various physiological parameters such as respiratory rate, heart rate, blood pressure, and oxygen saturation. These scores help determine the level of clinical concern and guide appropriate interventions. Regular monitoring of the EWS chart enables healthcare providers to identify and respond to respiratory deterioration in a timely manner, ensuring the best possible outcomes for patients.

Identify and implement the enrolled nurse’s role and responsibilities in an emergency response

Enrolled nurses play a vital role in emergency responses involving respiratory distress. Their responsibilities may include:

Recognizing signs of respiratory distress: Enrolled nurses should be trained to identify early signs of respiratory deterioration or distress and report their observations promptly to the appropriate healthcare team members.

Assisting with interventions: Enrolled nurses may be involved in providing immediate interventions, such as administering oxygen, assisting with non-invasive ventilation, or positioning the patient for optimal respiratory function.

Monitoring and documenting: Enrolled nurses should closely monitor the patient’s respiratory status, document their findings accurately, and report any changes or concerns to the registered nurse or other healthcare professionals.

Collaborating in the care team: Enrolled nurses work collaboratively with other members of the healthcare team, such as registered nurses, doctors, and respiratory therapists, to ensure a coordinated and effective response to respiratory emergencies.

In summary, recognizing the signs of respiratory distress, conducting timely respiratory assessments, and implementing appropriate interventions are crucial for identifying and addressing respiratory deterioration. Enrolled nurses have a vital role in emergency responses, including recognizing signs, assisting with interventions, monitoring, and collaborating with the care team to ensure optimal patient care and outcomes. Regular tracking and escalation of care using EWS charts help in identifying deteriorating patients promptly. By fulfilling their role and responsibilities, enrolled nurses contribute to the effective management of respiratory emergencies and the well-being of patients.