Respiratory Therapist: Patient Assessment

Role of Respiratory Therapist in Patient Assessment

• Respiratory therapists assist physicians in diagnosis and management through patient assessment.
• Cognitive skills used when communicating with the patient.
• Appropriate assessment tests are selected.
• Assessment results are interpreted.
• Therapy solutions are formulated.
• Treatment plans are suggested and evaluated.
• Respiratory therapists help select and interpret tests to determine the patient's problem, and take action.
• In the Intensive Care Unit, respiratory therapists help to immediately solve problems at the bedside.
• On general floors, respiratory therapists address changes needed in medications, procedures, and oxygen devices.

Stages of Patient-Therapist Interaction

• A pre-interaction stage is when a review of the patient chart is done to make an initial assessment and clarify the respiratory therapist's role in patient care.
• During the introductory stage, the respiratory therapist introduces themself, states the purpose of their visit, checks the patient's armband with permission, and seeks to establish a positive rapport, while watching out for signs of resistance.
• The initial assessment stage involves determining the patient's illness, a brief physical assessment, checking pulse/respirations/breath sounds/SpO2, and comparing these findings to existing respiratory therapy or nursing notes.
• During the treatment and monitoring phase, begin treatment after gathering assessment data, reassess vital signs and breath sounds after a few minutes, record both positive and negative effects of treatment, and stop tx at any sign of adverse effects, monitor, document and inform the appropriate health care team.
• The follow-up stage involves performing actions after treatment completion such as reassuring vital signs, cleaning and replacing dirty items, return patient to a comfortable position, let patient know when you will return, and thanking the patient.

Documentation of Assessment Findings

• Documentation of your treatment should include the date and time.
• Documentation of your treatment should include the type of treatment/procedure.
• Documentation of your treatment should include drugs and dosages.
• Documentation of your treatment should include the patient's response including any adverse effects.
• Documentation of your treatment should include goals, objectives, or end-point criteria for treatment.
• Documentation of your treatment should include your signature and credentials.
• Double-checking documentation is very important.
• Example documentation: On 08/31/2023 at 09:00 a.m., "Patient received nebulizer treatment (tx) with a 1.25 mg dose."
• Example of pre treatment vital Signs: "Pulse 86/min, SpO2 92%, RR 25/min, Bp 110/70, Temp 36.5, breath sounds included expiratory bilateral wheezing throughout all lung fields."
• Example of post treatment vital Signs: "Pulse 120/min, SpO2 98%, RR 16/min, Bp 100/50, decrease in expiratory wheeze in bases, patient tolerated tx well, wearing nasal cannula at 2L/min."

Use of Space in Patient Assessment

• The social space between patient and therapist is 4-12 feet (edge of bed), begin introductions and develop an overall picture of the patient's breathing, position, and environment.
• The personal space is 18" to 4 feet (beside bed); this distance is used to conduct the patient interview by asking general questions, and developing a rapport with patient.
• The intimate space is up to 18", and movement into this area should be slow upon asking permission and performing the assessment.

Confidentiality

• Information gained from the patient, including medical records and interviews, is private.
• Many patient issues are sensitive.
• Discuss patient related subjects with health care team only
• Family members asking questions should be referred to the physician unless the question is specific to respiratory therapy.
• The administration of medications, treatments, oxygen, along with vitals and SpO2 readings should also be kept confidential.

Expressing Concern

• Face the patient and make appropriate eye contact.
• Maintain a relaxed and open stance.
• Appropriate use of touch involves only touching after developing rapport and use as necessary.
• Hand placements should be limited and sensitive.
• Be an active listener by encouraging the patient.
• Again make eye contact to show active listening.
• Nodding and verbal cues are good ways to respond and create a positive rapport.
• Ask for clarification as needed if directions are not clear.
• Taking notes is acceptable upon asking the patients permission.

Ten Rules for Clinical Etiquette

• Maintain a professional appearance at all times.
• Ensure all patients are aware of your identify and purpose.
• Call patient by Mrs, Mr, Miss, Ms, and not by first name
• Respect and preserve patient's modesty.
• Avoid foot from resting on bed, and do sit on bed
• Guard of patient's personal data confidential at all times
• Refrain from discussing patient's prognosis with others or in front of patient
• Avoid arguing with the patient and never raise your voice
• Never criticize the actions of other staff near the patient.
• Keep disagreements and criticisms out or near patient's chart

Respiratory therapists play a critical role in patient assessment, aiding in diagnosis and management. They utilize cognitive skills for effective communication, select appropriate tests, and interpret results to formulate therapy solutions. Respiratory therapists also suggest and evaluate treatment plans, ensuring optimal patient care in various settings.