Respiratory Assessment: Key Indicators

• Oxygen (O2) is a colorless, odorless, and tasteless gas that is essential for life
• Without oxygen, death can occur within minutes
• Oxygen enters the body through the airway, which includes the nose, mouth, breathing tube or tracheostomy

Supplemental Oxygen

• Support workers often assist clients who have difficulty breathing or absorbing oxygen
• These clients require supplemental oxygen supplied via nasal tube or face mask
• It is the support worker's responsibility to provide safe and effective care

Oxygen Therapy

• Oxygen therapy involves administering oxygen at concentrations greater than those in room air
• Only qualified healthcare providers, such as physicians or nurse practitioners, can prescribe oxygen therapy
• The prescription includes the amount of oxygen, the type of device, and the duration of therapy
• Respiratory therapists or nurses usually set up the oxygen device and provide respiratory therapies
• Respiratory therapists evaluate, treat, and maintain lung function to help clients keep breathing

Oxygen Needs

• Some clients need oxygen constantly, while others need it for symptom relief, such as chest pain or shortness of breath
• It is crucial to administer only the prescribed amount of oxygen
• Excessive oxygen can dangerously slow the client's respiratory rate

Task Considerations

Before assisting with any care, ensure that:

• The task is within your scope of practice according to your province or territory
• The task is part of your job description at your facility or agency
• You have received the necessary training
• You know how to use the equipment properly
• A nurse or respiratory technician provides supervision

Altered Respiratory Function

• Respiratory function involves three processes: air movement into and out of the lungs, O2 and CO2 exchange in the alveoli, and O2 transport to cells with CO2 removal
• Altered respiratory function occurs when any of these processes are affected
• Shortness of breath (SOB) or shortness of breath on exertion (SOBOE) indicates altered respiratory function
• Clients with breathing difficulties may panic, feel anxious, and struggle to breathe, often preferring to sit upright (orthopnea)
• Struggling to breathe is exhausting and dangerous, requiring prompt and accurate reporting to supervisors
• Never increase the oxygen level on an oxygen tank unless directed by the client's care plan, as it can be harmful

Signs and Symptoms of Altered Respiratory Function

• Hypoxia
• Abnormal breathing pattern
• Shortness of breath
• Cough (note frequency and time of day)
• Dry or hacking cough
• Harsh or barking cough
• Productive (sputum-producing) or nonproductive cough
• Sputum color (clear, white, yellow, green, brown, or red)
• Sputum odor (none or foul)
• Sputum consistency (thick, watery, or frothy)
• Hemoptysis (bloody sputum)
• Noisy respirations
• Wheezing
• Wet-sounding respirations
• Crowing sounds
• Chest pain location
• Constant or intermittent chest pain
• Description of chest pain (stabbing, knifelike, aching)
• Factors that worsen chest pain (movement, coughing, yawning, sneezing, sighing, deep breathing)
• Cyanosis (skin, mucous membranes, lips, nail beds)
• Changes in vital signs
• Body position (sitting upright, leaning forward or hunched over a table)

Abnormal Respiratory Patterns

• Normal respiration rate for adults is 12 to 20 per minute; infants and children have faster rates
• Normal respirations are quiet, effortless, and regular, with uniform chest rise and fall
• Eupnea is the medical term for normal respirations
• Tachypnea is rapid breathing (over 20 respirations per minute) caused by fever, exercise, pain, airway obstruction, or hypoxemia
• Bradypnea is slow breathing (fewer than 12 respirations per minute) caused by drug overdoses or nervous system disorders
• Apnea is the absence of breathing, occurring in cardiac or respiratory arrest
• Kussmaul respirations are deep and rapid, characteristic of diabetic acidosis
• Hypoventilation involves slow, shallow, and irregular respirations caused by lung disorders, obesity, airway obstruction, or drug effects
• Hyperventilation involves rapid and deeper-than-normal respirations caused by asthma, emphysema, infection, fever, nervous system disorders, hypoxia, anxiety, pain, or drugs
• Dyspnea is difficult, labored, or painful breathing caused by heart disease, exercise, or anxiety
• Cheyne-Stokes respirations gradually increase in rate and depth, then become shallow and slow, with possible apnea for 10 to 20 seconds; common near death
• Orthopnea is shortness of breath when lying flat, relieved by sitting or standing, caused by emphysema, asthma, pneumonia, angina pectoris, or heart disorders

Hypoxia

• Hypoxia is a deficiency of oxygen in the cells due to abnormal respiratory function, caused by illness, disease, injury, or surgery
• Hypoxia is life-threatening, leading to cell damage or death
• Restlessness
• Dizziness
• Disorientation
• Confusion
• Behavior and personality changes
• Difficulty concentrating and following directions
• Apprehension
• Anxiety
• Fatigue
• Agitation
• Increased pulse rate
• Increased rate and depth of respirations
• Sitting position, often leaning forward
• Cyanosis (bluish skin, mucous membranes, lips, nail beds)
• Dyspnea