So if I'm watching a patient for signs of
respiratory problems, what should I look for?
Well if the patient tells you they're
short of breath, wow all hands on deck
let's start paying attention in assessing
further to know what's going on.
Watch their respiratory rate.
Sometimes the patient's respiratory
rate can be faster because they're anxious.
That may not be a sign of respiratory failure,
but a lot of times an elevated respiratory rate
is because things are not
going well internally in their lungs
until the brain is telling them to breathe
faster, breathe faster, breathe faster.
Eventually, they're gonna tire out if it's
elevated high enough and long enough.
Now if they look like they're really restless, has labored
breathing and they look like they just cannot catch their breath,
that's what air hunger looks like, there's a
really key sign that your patient's in trouble.
Restlessness or agitation, hey pay
attention to that "restlessness" word,
that tends to show up in nursing questions a lot.
So when you see restless,
always think about oxygenation.
When a patient just can't seem to get settled,
always try and check how well they're oxygenating.
And if they start to have some changes, mental status
changes or little bit confused or they're always sleepy,
that could be another red
flag you want to watch for.
So as a nurse, this slide has a lot of really good information
for you, these are the things you don't want to miss.
You want to catch them when they happen early.
So the patient tells you they're
short of breath or you observe.
Hey, their respiratory rate is really high,
it's even higher than when they came in.
They don't look like they're very comfortable,
looks like it's hard for them to catch their breath.
They seem to be getting more restless and fidgety in the
bed, they're agitated and now they seem somewhat confused.
Those are huge red alerts that your patient
is heading into respiratory problems.
Now what are the common tests that we do?
Well the most common thing's we
already talked about in ABG, right?
That's drawing an arterial blood gas sample from an
artery, different than most lab work is drawn from a vein.
Now an arterial blood stick is a little trickier.
You have to have special training for that,
so it will usually be done by a phlebotomist
but nurses in critical care areas and
ER are often trained to draw ABGs.
A CBC is a complete blood count.
I may be looking for things on that, maybe there's
a sign of infection in their white cell count,
Maybe you're looking for someone who has a chronic disease
problem, you might see polycythemia or an elevated red cell.
Now look at a chemistry panel - renal
function, liver function, electrolytes,
cardiac labs, see if maybe their hearts
has taken a hit, so we look at CKs or troponin.
So those are some of the most common tests.
You're gonna work with the healthcare provider.
Take your assessment information,
what you're seeing in the patient,
what you hear about their history and
their meds and their current symptoms
and decide what are the most
appropriate test that will be drawn.
In addition to that, they'll
look at the chest x-ray.
So on the chest x-ray, they can see probable pneumonia or
pulmonary edema - very common causes of respiratory problems
Also put the patient on a continuous
pulse ox and cardiac monitoring.
Now continuous pulse ox in a hospital setting is,
you just put a plastic clip that has a top and bottom,
you squeeze it here, it opens
up, put it on the patient's finger
with the sensor on the top and
there's our sensor on the bottom,
it shoots a red light through
your patients nail bed
and that will let us know what they're
hemoglobin saturation is or their pulse ox is.
That'll be a number that we're
looking at, 100% would be perfect
but obviously most people aren't at
100%, even if you're young and healthy,
probably around about 99%,
that would be really good.
But as a patient is in respiratory distress, you'll
see that number get lower and lower and lower.
We want to keep a sat usually 94% and above, but your
healthcare provider may adjust that for specific patients.
So I've got them on a pulse ox and a cardiac monitor.
That means they have these little foam stickies
on and you connect the monitor leads to that
and we can see what's going on with
the electrical conduction of their heart.
Use of the leads that are better just five, that's different
than a 12-lead EKG that's done for more specific diagnostics.
Okay, so what's the prognosis for
somebody who's in respiratory failure?
That's a pretty ominous diagnosis, right?
But this is what you're going to look at, the end outcome or
the prognosis for respiratory failure depends on these things:
the severity of the underlying
cause - what got us into this trouble,
how quickly treatment begins
and the patients overall health.
Well as a nurse where I can intervene is beginning
treatment quickly because I've assessed the patient,
I've recognized the signs and I've
intervened and advocated for the patient
but it depends on how severe the
causes of the respiratory problems,
how quickly we could start treatment
and the patients overall health.
We've got something with the minor thing, they're
young in their 20's, they're healthy and they're fit,
we can just intervene,
they've got a much better shot.
But if I'm dealing with an 87-year old
patient who has multiple comorbidities, right?
They have long histories of heart disease, lung disease
and a liver disease and kidney disease, and diabetes.
They're gonna have a much more difficult prognosis
and difficulty coming back from respiratory failure.