1. RESPIRATORY CARE. ASSESSMENT OF BREATHING & PATIENT POSITIONING.

2. ASSESSMET OF BREATHING.

3. PREPARATION. Giving consideration to the sub headings below what interventions would you as the nurses need to perform to ensure total patient care. Giving consideration to the sub headings below what interventions would you as the nurses need to perform to ensure total patient care. THE PATIENT. THE PATIENT. EQUIPMENT/ENVIRONMENT. EQUIPMENT/ENVIRONMENT. NURSE. NURSE. PROCEDURE. PROCEDURE. POST PROCEDURE. POST PROCEDURE.

4. PATIENT The patient should be relaxed and resting, recent activity should be noted. The patient should be relaxed and resting, recent activity should be noted. Do not inform the patient when you will be assessing breathing Do not inform the patient when you will be assessing breathing Why? Why?

5. EQUIPMENT/ENVIRONMENT Watch with a second hand. The nurses hands should be clean. How long do we check the rate and why?

6. PROCEDURE Observe the movement of the chest wall. Observe the movement of the chest wall. Observe the rhythm of the respiration. Observe the rhythm of the respiration. Observe the patients colour for signs of cyanosis. Observe the patients colour for signs of cyanosis. Observe the symmetry of chest movement whether the accessory muscles are being used. Observe the symmetry of chest movement whether the accessory muscles are being used.

7. OBSERVE FOR THE FOLLOWING. Difficulty in breathing. Difficulty in breathing. Pain on breathing and its location. Pain on breathing and its location. Noisy respiration – whether there is a wheeze or stridor. Noisy respiration – whether there is a wheeze or stridor. Cough – whether dry or productive. Cough – whether dry or productive. Sputum – amount, colour and consistency. Sputum – amount, colour and consistency.

8. POST PROCEDURE Ensure the patient is comfortable. A patient with breathing difficulties may be most comfortable sitting upright. Ensure the patient is comfortable. A patient with breathing difficulties may be most comfortable sitting upright. Record respiratory observations and report abnormalities. Record respiratory observations and report abnormalities. Adjust the frequency of observations as necessary. Adjust the frequency of observations as necessary.

9. POINTS FOR PRACTICE. A more accurate observation is obtained if the patient is unaware of the procedure. A more accurate observation is obtained if the patient is unaware of the procedure. Many nurses achieve this by pretending to be feeling the radial pulse. Many nurses achieve this by pretending to be feeling the radial pulse. Cyanosis can be seen around the lips, ear lobes, mouth and finger tips. Cyanosis can be seen around the lips, ear lobes, mouth and finger tips. In darker skin patients signs of poor perfusion may be detected in the area around the lips or nail beds. If breathing is very shallow and difficult to observe, lightly rest your hand on the patients chest or abdomen to feel for movement.

10. POSITIONING OF THE BREATHLESS PATIENT.

11. PREPARATION. Giving consideration to the sub headings below what interventions would you as the nurses need to perform to ensure total patient care. Giving consideration to the sub headings below what interventions would you as the nurses need to perform to ensure total patient care. THE PATIENT. THE PATIENT. EQUIPMENT/ENVIRONMENT. EQUIPMENT/ENVIRONMENT. NURSE. NURSE. PROCEDURE. PROCEDURE. POST PROCEDURE. POST PROCEDURE.

12. THE PATIENT Explain the procedure to gain consent and full co operation. Explain the procedure to gain consent and full co operation. The patient may be anxious because of the difficulty in breathing. The patient may be anxious because of the difficulty in breathing.

13. EQUIPMENT/ENVIRONMENT Bed with adjustable back rest/profiling bed. Bed with adjustable back rest/profiling bed. Pillows - four to five if possible. Pillows - four to five if possible. Bed table. Bed table. Firm supporting armchair. Firm supporting armchair. Hoist may be needed if the patient is unable to move unaided. Hoist may be needed if the patient is unable to move unaided.

14. NURSE. Two nurse may be needed. The movement may require more nurses. Check the patients risk assessment first. Two nurse may be needed. The movement may require more nurses. Check the patients risk assessment first. Clean hands and apron to be worn and changed after each intervention. Clean hands and apron to be worn and changed after each intervention.

15. PROCEDURE Explain to the patient exactly what is to be done to reduce excess movement. Explain to the patient exactly what is to be done to reduce excess movement. Assist the patient to sit forward. A second nurse may be needed to help with the back rest/pillows. Assist the patient to sit forward. A second nurse may be needed to help with the back rest/pillows. If the foot of the bed can be raised slightly this prevents the patient slipping back down. If the foot of the bed can be raised slightly this prevents the patient slipping back down.

16. Cont.. For short periods the patient may get relief by leaning forward with the forearms resting on the bed table. This may be more comfortable sitting on the side of the bed with the feet supported or in a chair. For short periods the patient may get relief by leaning forward with the forearms resting on the bed table. This may be more comfortable sitting on the side of the bed with the feet supported or in a chair. If able to get put of bed, the breathless patient is often most comfortable sitting in an armchair and may prefer to sleep in this position. If able to get put of bed, the breathless patient is often most comfortable sitting in an armchair and may prefer to sleep in this position.

17. POST PROCEDURE. Observe the patient for any changes in pattern, colour, cough etc. Observe the patient for any changes in pattern, colour, cough etc. Ensure drinks, tissues, call bell etc are close to hand. Ensure drinks, tissues, call bell etc are close to hand. If sitting for long periods, a pressure relieving mattress or cushion may be needed to prevent pressure sores developing. If sitting for long periods, a pressure relieving mattress or cushion may be needed to prevent pressure sores developing. Document the care given and report any changes. Document the care given and report any changes.

18. POINTS FOR PRACTICE. When positioning the breathless patient, the aim is to maximise respiratory function while reducing physical effort, therefore the patient must be comfortable and well supported. When positioning the breathless patient, the aim is to maximise respiratory function while reducing physical effort, therefore the patient must be comfortable and well supported. Ensure pillows are supporting the small of the back so that the patient does not sink into them and restrict chest movement. Ensure pillows are supporting the small of the back so that the patient does not sink into them and restrict chest movement. Regular repositioning/turning etc to prevent pressure sores etc. Regular repositioning/turning etc to prevent pressure sores etc.