Respiratory-Assessment-OHT-Branding-edits.pptx

The presentation shows how to conduct a respiratory assessment which is critical in the management of respiratory conditions

1. Respiratory Assessment Nurse Practitioner Led Outreach Team (NLOT) – 2022 William Osler Health System | Ontario Health Team

2. Breathing is usually the first vital sign to alter in a deteriorating patient Purpose of assessment to determine the adequacy of gas exchange (O 2 & CO 2 ) Ventilation (air movement)  Diffusion (gas exchange between lung and RBC)  Perfusion (delivery to RBC) Respiratory rate and depth are controlled by the respiratory center in the brain stem Respiratory Assessment

3. Hypoxia Anaemic: Reduced Hgb or Carbon Monoxide poisoning Hypoxic: Reduced gas exchange in the lungs Circulatory: Reduced blood supply Histotoxic: Inability of tissues to use oxygen

4. Indicated: Initial assessment, changes from baseline, fluids, response to medications or treatments, patients with respiratory conditions Vitals with oxygen saturation History, baseline respiratory status Medications (treat symptoms, induce symptoms) Is there pain Are there other system changes Ex. Neurological, abdominal, etc. Blood Sugar Look, feel and listen Respiratory Assessment

5. Uses probe to transmit light through tissue Pulse oximetry can be unreliable when: Peripheral vasoconstriction (shock) Excessive movement Artificial nails or nail polish Carbon monoxide poisoning (will register as 100% SpO 2 ) Pulse Oximetry

6. Depth of breathing (shallow, normal, deep) Respiratory rate Pattern (regular vs laboured) Movement (symmetrical vs asymmetrical) Abnormal Pursed lips, nasal flaring, accessory muscle use, cyanosis, clubbed fingers Is there a cough? Sputum (note quantity, colour) Level of consciousness (alert vs depressed) Confusion Tracheal deviation Look

7. Chest movement (symmetrical vs asymmetrical) Lightly place hands on each side of the chest wall, thumbs together at midline. Thumbs should move apart on inspiration and fall back together on expiration. Feel

8. Distinguish between normal and abnormal Breathing should be quiet Listen with diaphragm of the stethoscope from side to side, top to bottom https://www.nursingtimes.net/clinical-archive/assessment-skills/how-to-perform-chest-auscultation-and-interpret-the-findings-06-01-2020/ Listen

9. https://www.nursingtimes.net/clinical-archive/assessment-skills/how-to-perform-chest-auscultation-and-interpret-the-findings-06-01-2020/ Normal Auscultation

10. Abnormal Sounds Include: crackles/rales, wheezes and rhonchi Caused by: Consolidation of secretions, compression or airway (mass), pleural effusion, collapsed lung Absent, diminished or adventitious breath sounds

11. Crackles/Rales Due to atelectasis or fluid in the small airways Heard on inspiration – possible pulmonary edema or pneumonia More significant if not cleared with coughing Can be fine or coarse

12. Wheezing High pitched whistling Can occur with inspiration or expiration, but usually more pronounced on expiration Occurs with airway narrowing

13. Rhonchi Resembling a snoring or gurgling sound Suggests secretions in large airways

14. Also important to perform a cardiac assessment including: Blood pressure and heart rate Heart rate: regular vs irregular Peripheral edema Cardiac Assessment

15. Humidify oxygen when greater than 4L/min or if into a tracheostomy tube CAUTION with COPD Excessive supplemental O2 removes a COPD’s residents hypoxic respiratory drive  hypoventilation  ↑ carbon dioxide levels, apnea (pauses in breathing)  ultimately respiratory failure CO 2 retention = hypercapnia Oxygen

16. Turns liquid medication into a mist Use saline to dilute NOT water RINSE mouth after antibiotics/steroids to avoid oral candidiasis Used when: Residents who have difficulty controlling and coordinating the use of inhalers (acutely ill, dementia) Inhalers are found to be ineffective in managing chronic lung disease or respiratory symptoms Nebulizers

17. Short acting beta2-adrenorecptors agonists: Salbutamol (Ventolin) Long Acting beta2 agonists: Salmeterol ( Serevent ) Inhaled Steroids: Flovent Anticholinergics: Strovent , Spiriva If using more than one, short acting bronchodilator should be administered first Spacing devices, masks, or nebulisation if trouble with administration Inhalers

18. Used to help clear airways Used in residents who are too weak to expectorate sputum, unconscious or semi-conscious Can be done through tracheal, oral or nasal pharyngeal Suctioning

19. Used for suspected pneumonia, pleural effusion and/or cardiac disease https://www.kaggle.com/datasets/paultimothymooney/chest-xray-pneumonia Chest X-Ray

20. Cardinal Symptoms: Increased dyspnea Increased sputum volume Increased sputum purulence Please note: Presentation with only one of the cardinal symptoms may not require antibiotics COPD Exacerbation

21. Infection and associated inflammation of the lungs Viral vs bacterial vs aspiration vs retention of lung secretions PEARLS: Always rule out aspiration in the setting of repetitive pneumonia Pneumonia

22. Considerations in choosing agent and dose selection: Antibiotics used in the past 3 months Updated Creatinine Clearance Is the resident on Coumadin Are there any allergies? Antibiotics

23. Case Study #1 85 year-old female PMHx of Diabetes Type II, Hypertension, Osteoporosis Vitals signs: RR 24bpm, B/P 110/70, HR 97bpm, T 37.5, SpO 2 91% on R/A Non-productive cough No shortness of breath Chest sounds:

24. Case Study #2 78 year-old male PMHx of Benign Prostatic Hyperplasia, Hypertension, Hypothyroidism, COPD, Anemia, Arthritis Vitals signs: RR 28bpm, B/P 125/77, HR 105bpm, T 37.0, SpO 2 88% on R/A Cough and shortness of breath present Chest sounds:

25. References Bennett, C. (2003). Nursing the breathless patient. Nursing Standard, 17(1): 45-51. Bickley, L., & Szilagyi , P. (2003). Bates’ Guide to Physical Examination and History Taking. Lipincott Williams & Wilkins , Philadelphia. Bradley, R. (2007). Improving Respiratory Assessment Skills . The Journal for Nurse Practitioners , 4: 276-277. Endacottt , R., & Jenks, C. (1997). Respiratory Assessment in A&E . Emergency Nurse, 5(4): 31-38. Ferns, T. (2007). Respiratory Auscultation: How to use a Stethoscope. Nursing Times, 103(24): 28-29. Hunter, J., & Rawlings-Anderson, K. (2008). Respiratory Assessment. Nursing Standard, 22(41): 41-43. Owen, A. (1998). Respiratory Assessment Revisited. Nursing , 4: 48-49.