Altered Respiratory Function PDF

Oxygen (O2) is a gas that is part of the air we breathe. At room temperature, it has no taste, odour, or colour. Oxygen is the most important basic need for life, and without it, death will occur within minutes. Oxygen enters the body as part of the air that we breathe and enters our body through an...

Oxygen (O2) is a gas that is part of the air we breathe. At room temperature, it has no taste, odour, or colour. Oxygen is the most important basic need for life, and without it, death will occur within minutes. Oxygen enters the body as part of the air that we breathe and enters our body through an airway. This is the pathway that air takes as it enters the body and goes into the lungs. An airway can be our nose, mouth, or through a breathing tube or tracheostomy. As a support worker, you will often work with clients who have difficulty breathing or absorbing enough oxygen into their bodies. To survive, these clients require supplemental oxygen, which is supplied to them through a nasal tube or face mask. It is your responsibility to know how to provide safe and effective care to these clients. Oxygen therapy is usually defined as the administration of oxygen to a client at concentrations greater than those found in room air. Oxygen is considered to be a medication in that there are very strict rules to follow when providing oxygen to a client, and only qualified health care providers can administer it. Only a physician or nurse practitioner can prescribe oxygen therapy to a client. The amount of oxygen the client is to receive, the type of device to use, and the times for therapy must also be prescribed. It is usually the role of the respiratory therapist (or nurse at some agencies) to set up the oxygen device and take the leadership role in providing respiratory therapies. A respiratory therapist is a regulated professional who evaluates, treats, and maintains heart and lung function and helps the client to keep breathing. Some clients may need oxygen constantly, whereas others may need it for relief of symptoms such as chest pain (in those with heart disease) or shortness of breath (in clients with respiratory diseases who may have enough oxygen while at rest but become short of breath with mild activity). It is important that the client receive only the amount of oxygen that is ordered; receiving too much oxygen can slow the client’s respiratory rate to a dangerous level. As with any task, before giving or assisting with any care described in this chapter, you should make sure of the following: Your province or territory allows you to perform the task. The task is in your job description at your facility or agency. You have the necessary training. You know how to use the equipment. You have reviewed the task with a nurse.  A nurse or respiratory technician will supervise you. Altered Respiratory Function The function of the respiratory system involves three processes that must work together. Respiratory function is altered if even one of these processes is affected: 1. Air moves into and out of the lungs. 2. O2 and CO2 are exchanged at the alveoli. 3. The blood transports O2 to the cells and removes CO2 from them. The client who is short of breath (SOB) or who is short of breath on exertion (SOBOE) has altered respiratory function—that is, something is preventing the person from breathing easily. Altered respiratory function may be an acute or chronic condition. When unable to breathe easily, a client may panic or feel anxious. The client becomes uncomfortable, is usually visibly struggling to breathe, and often wants to sit up in the bed or in a chair since it may be more difficult to breathe when lying flat (orthopnea) (BOX 39.2). Struggling to breathe is both exhausting and dangerous for the client, as usually more energy is used (and therefore more oxygen) in doing so. Report your observations to your supervisor promptly and accurately so that quick action may be taken to correct the problem and prevent it from getting worse. You should be aware, however, that if the client uses an oxygen tank, you should never turn up the oxygen level if the client’s care plan does not direct you to do so. In certain circumstances, turning up the oxygen could cause extreme harm to the client and can make the client even more short of breath! Signs and Symptoms of Altered Respiratory Function Signs and symptoms of hypoxia Any abnormal breathing pattern Complaints of shortness of breath or being “winded” or “short-winded” Cough (note frequency and time of day) Dry and hacking Harsh and barking Productive (produces sputum) or nonproductive  Sputum (see page 946) Colour—clear, white, yellow, green, brown, or red Odour—none or foul Consistency—thick, watery, or frothy (with bubbles or foam) Hemoptysis—bloody (hemo) sputum (ptysis, meaning “to spit”); note if the sputum is bright red, dark red, blood-tinged, or streaked with blood Noisy respirations Wheezing Wet-sounding respirations Crowing sounds Chest pain Location Constant or intermittent (comes and goes) Client’s description (stabbing, knifelike, aching) What makes it worse (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 The normal respiration rate for adults is 12 to 20 per minute. Infants and children have faster rates (see TABLE 24.3, on page 544). Normal respirations are quiet, effortless, and regular, and both sides of the chest should rise and fall in a uniform manner. The medical term for normal respirations is eupnea. Tachypnea—rapid (tachy) breathing (pnea). Respirations are 20 or more per minute. Fever, exercise, pain, airway obstruction, and hypoxemia are common causes. Bradypnea—slow (brady) breathing (pnea). Respirations are fewer than 12 per minute. Drug overdoses and nervous system disorders are common causes. Apnea—the lack or absence (a) of breathing (pnea). It occurs in cardiac arrest and respiratory arrest. Sleep apnea in adults and periodic apnea in newborns are other types of apnea. Kussmaul respirations—deep and rapid respirations characteristic of diabetic acidosis or other conditions causing acidosis. Hypoventilation—slow (hypo), shallow, and sometimes irregular respirations. Common causes include lung disorders (such as pneumonia) that affect the alveoli. Other causes include obesity, airway obstruction, adverse effects of drugs, and nervous system and musculoskeletal disorders affecting the respiratory muscles. Hyperventilation—rapid (hyper) and deeper-than-normal respirations. Its many causes include asthma, emphysema, infection, fever, nervous system disorders, hypoxia, anxiety, pain, and some drugs. Dyspnea—difficult, laboured, or painful (dys) breathing (pnea). Heart disease, exercise, and anxiety are common causes. Cheyne–Stokes—respirations that gradually increase in rate and depth and then become shallow and slow. Breathing may stop (apnea) for 10 to 20 seconds. Drug overdose, heart failure, renal failure, and brain disorders are common causes. Cheyne–Stokes respirations are common when death is near. Orthopnea—shortness of breath (dyspnea) when lying in a flat or supine position and ability to breathe comfortably (pnea) only when sitting or standing (ortho). Common causes include emphysema, asthma, pneumonia, angina pectoris, and other heart and respiratory disorders. Hypoxia Hypoxia—a deficiency (hypo) of oxygen in the cells (oxia)—is one of the results of abnormal respiratory functioning, and it is caused by any illness, disease, injury, or surgery that affects respiratory function. Hypoxia is a life-threatening condition because without enough oxygen to function, cells will be damaged or die. Signs and Symptoms of Hypoxia Restlessness Dizziness Disorientation Confusion Behaviour and personality changes Difficulty concentrating and difficulty following directions Apprehension Anxiety Fatigue Agitation Increased pulse rate Increased rate and depth of respirations Sitting position, often leaning forward Cyanosis (an abnormal condition evidenced in light-skinned clients by bluish colour in the skin, mucous membranes [lips, gums, and around the eyes], and nail beds; in darker-skinned clients, cyanosis may be easiest to see in the mucous membranes and nail beds) Dyspnea