Now we're not talking about just affecting the assessment,
now we're talking about the signs of respiratory impairment.
This is really significant that you recognize these.
Because this means you've got abnormal assessment going on, you've got to respond.
So if your patient complains -- now, we always say that patient complains,
doesn't mean they're whining.
This means the patient is communicating to you that,
"I feel short of breath at rest or normal activity." This is significant.
If the patient has exerted themselves and they're short of breath,
we kind of expect that depending on how short of breath they are.
But if they're short of breath at rest just sitting there or with doing normal things
like walking normal household distances, something is wrong.
We need to do more investigation to figure out the cause.
Now if you start to notice a change in personality in the patient or the family member
tells you about the change in personality, listen to them
because those are the earliest signs of respiratory impairment.
The person will start acting differently, someone who knows the patient very well
is likely gonna be able to recognize that before you do if you're just getting to know the patient.
So changes in personality, increased restlessness or irritability
or confusion or decreased level of consciousness, LOC, yeah, those are classic symptoms.
So you definitely wanna put a star by that or whatever your system is for remembering that.
But when you see an exam question, the patient becomes more restless or irritable or agitated,
confusion, those are signals to you that they're probably pointing you toward respiratory impairment.
In real life, when you observe these things in your assessment of the patient,
you're gonna have to stop and ask yourself, what's the underlying cause?
What data do I need to collect? Do I need to pulse ox? Do I need to auscultate their lungs?
And the answer to both of those is probably yes, to start to figure out what's going on.
Now, if I look at a patient and they're visually labored or having a difficult time breathing,
you knew that was a problem before you ever started nursing school.
That's a really an obvious one. The ones we talked about were a little more subtle.
The changes in personality, increased restlessness, those are more subtle observations.
But seeing them visibly labored or difficult, that will be more obvious to you.
If you notice them using their accessory muscles that means their normal muscles of breathing
are not enough to provide adequate oxygen to their body,
so they're recruiting all these other muscles in their neck to try
and get enough oxygen into their blood.
Now, if they tell you they can't lay down and breathe well, that's orthopnea.
That is about time. Now, we see that a lot with congestive heart failure patients.
So, I always make it a practice to ask a congestive heart failure patient,
"Hey, how are things going? Hey, where do you normally sleep at night?"
If they tell me they can lay down in bed, I'll ask them,
"Do you find yourself needing to prop yourself up with pillows to sleep comfortably?"
If they say "yes," I'm gonna ask them more questions.
If I asked where they sleep at night and they say, "In my recliner," that's another red flag.
Because if a patient with congestive heart failure can't lay down
because they feel like they're being smothered, that's a sign of respiratory -- pulmonary edema.
They're having fluid volume overloaded in their lungs.
So if they lay down, they feel like they're smothering.
So that's one example of patients that have a difficult time laying down
and feeling like they can't breathe well enough, is a congestive heart failure patient
and pulmonary edema that's starting to get into some trouble respiratory -wise.
So these are some key questions you can ask to kinda get a feel for that.
If I hear abnormal breath sounds, I'm gonna have to dig deeper and find out what they are.
Some we expect, some we don't expect. So any abnormal breath sounds.
So unless it's clear and equal on both sides that would count as an abnormal breath sound.
They have increased sputum or if it's getting thicker or if it's frothy,
that's definitely a side of fluid volume overload. Or there's blood-tinged in the sputum.
Those are all causes for concern that means you need to ask some more questions and run some more tests.
Now last, I'm talking about paradoxical chest wall movement.
When I breathe in, my chest will shake them up and expand.
When I breathe out, it should go down and get smaller.
If I've got the opposite of that, something really crazy is going on. Okay. So these are examples.
If you observe any of these signs, you need to know that it's not okay to just walk away.
You gotta start asking more questions, doing more assessments, checking on oxygenation.
And if you determine it's severe enough, you need to contact the healthcare provider.
So healthcare providers have to closely watch for changes in respiratory status the healthcare team,
all of us work together to monitor and intervene with signs of respiratory impairment.
Remember, airway, breathing, it's always our top priority.
Just a smidge above circulation, but you need all three of those.