Respiratory Interventions – Stroke Nursing Care in Med-Surg

00:01 Now let's look at the respiratory system.

00:03 Now our goal here is to maintain adequate oxygenation for tissue perfusion.

00:08 So you need the heart to transport it around, but you need the respiratory system to make sure you have adequate oxygen in that blood supply.

00:15 So, remember, you're going to listen to lung sounds posterior and anteriorly.

00:19 That's going to tell us about the lungs, and remember in the cardiovascular, we talked about you're listening closely for signs of crackles, or fluid volume overload.

00:28 Monitor and assess the patient's oxygenation. You might do this with a simple pulse ox, or you can just watch for signs where the patient might be getting restless or agitated.

00:37 You want to do a pulse ox to check on that.

00:40 So if we need to, provide some supplemental O2 as required.

00:44 Remember, Mr. Johnson was on nasal cannula at 2 liters.

00:48 And encourage the patient to move and deep breathe.

00:51 People are usually resistant to this, right, because they're a little fearful, they're a little overwhelmed, and they're just flat tired.

00:58 So you're going to have to be very positive and not take "no" for an answer easily.

01:04 Encourage the patient to get up and to move and to be active because we want those -- deep breaths, and if we move them around, they are more likely to breathe, too.

01:13 But you can also do deep breathing with them while they're right in bed.

01:17 So you want to watch them for any signs of respiratory complications because what we're trying to avoid with the deep breaths is atelectasis.

01:26 That means lungs are kind of collapsed, and collapsed lungs do not exchange CO2 and O2.

01:32 So that's why we want all patients to cough and deep breathe, right? So, we want them to -- take a really deep breath and we can encourage coughing because that helps to open up those airways.

01:43 Now, the health care provider might even order an incentive spirometer.

01:47 That's just a little tool that you'll use a mouthpiece and the patient will breathe so that you can see how much volume they're actually able to pull.

01:56 So, we're looking for atelectasis.

01:59 We want these lungs all fully functioning.

02:02 We're also watching him closely for aspiration pneumonia.

02:06 Now, we worked with the speech therapist, right, to make sure he could swallow safely, and they made recommendation as to the type of diet that he would be eating.

02:14 So, we know if he can take thin liquids or needs those yucky thickening put into his normally thin liquids, we know what he needs, but we still want to watch him closely for any signs of choking or aspiration pneumonia.

02:29 The only protection you have is your epiglottis, and that's a little flap that protects either your airway when you're trying to eat food. So that's that slaps, it's a little leaf flap shape, it will close over your airway when you're swallowing food, so it doesn't go down the wrong pipe, like your grandmother probably used to call it.

02:48 So patients with a stroke sometimes had difficulty with chewing and with swallowing, and they're at an increased risk for aspirating something.

02:56 Now, that means they'll either take food or liquids down into their lungs.

03:01 They weren't protected. It went straight down into their lungs and it can develop an infection, which is what aspiration pneumonia is.

03:09 We're also watching for pulmonary edema. You already hit that, right? You know that you listen to the front and the back, and we expect we'll hear it first in the bases.

03:17 So, let's wrap this 1 part up.

03:20 The respiratory complications I'm taking a look at, I'm watching for is atelectasis, collapsed areas of the lungs where the lung sounds will be very diminished.

03:29 Aspiration pneumonia where they're going to sound real junkie, or pulmonary edema, which will be crackles.

03:38 So, let's practice with Mr. Johnson.

03:40 I want you to think through in your mind, as you're going through an assessment, a long assessment of Mr. Johnson, what are the sounds that would let you know that he's in trouble? Don't look at your notes. Just pause the video and think through what are the worst case scenarios you're on the alert for with Mr. Johnson because he's had a stroke?