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Caring for theBreathless Patient
Chris Hill
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Learning outcomes
Critically appraise the history and assessment
process when a patient presents withbreathlessness;
Critically evaluate the role of the interdisciplinary
team when caring for the breathless patient; Critically examine the management strategies
and nursing interventions for breathless patients.
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Anatomy and physiology Functions of the lung
Get oxygen into the body
Get carbon dioxide out
Alveoli are where gas exchange takes place
150 million alveoli in each lung
Conducting airways take gas to the alveoli
Blood flow also needed to each alveolus
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Assessment Inspection
AIRWAY (eg ability to speak) Position
Distress, facial expression, sweating
Audible noises, stridor, wheezing Respiratory rate / pattern
Symmetry of chest movement
Accessory muscles, movement of chest vs. abdomen
Palpation, percussion, auscultation
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Pulse oximetry 5th vital sign
Shines a red light and infrared light through(typically) a finger, measures absorption at these
wavelengths
Measures the percentage of haemoglobinsaturated with oxygen in arterial blood
Needs a good signal ie good pulse, not good if
cold / peripherally shut down
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History Chronic respiratory problems? drug history,
home oxygen, smoking (family, friends) Current respiratory drugs
Secretions
Amount
Character
Colour
Consistency Blood stained
Normal for patient?
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Useful images:
http://meded.ucsd.edu/clinicalmed/lung.htm
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Clubbing(http://commons.wikimedia.org/wiki/File:Acopaquia.jpg)
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Respiratory support AIRWAY
Treat cause of the problem Positioning
Oxygen therapy (wont stop people feeling breathless if
SpO2 is normal) + humidification of inspired gas Drugs / inhalers / nebulisers
Physiotherapy
Non-Invasive Ventilation (NIV) Invasive ventilation
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Positioning
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Oxygen
Oxygen should be regarded as a drug. It isprescribed for hypoxaemic patients
(my emphasis)
(British National Formulary 61, March 2011)
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Oxygen Flow MeterFlow = 2 L/min
1
5
1
5
(BTS guidelines)
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Nasal Cannulae
2-6 L/min gives approx
24-50% FIO2 Variable performance
(percentage oxygen
breathed by the patientwill depend on respiratory
rate / pattern)
Comfortable and easilytolerated
http://www.novapex.com.tw
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Simple face mask Can deliver 35% - 60%
Oxygen with flow 5-10 L/min
Variable performance(percentage oxygenbreathed by the patient will
depend on respiratory rate /pattern)
BTS recommendation is thatflow should be at least 5
L/min
http://www.novapex.com.tw
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Delivers 60 90%oxygen
Should not be used longterm
Critical illness / Trauma
patients
Post-cardiac orrespiratory arrest.
15 L/min oxygen flowneeded
Non re-breathing Reservoir Mask
http://www.novapex.com.tw
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Venturi Masks Delivers prescribed O2 (fixed) concentrations
irrespective of respiratory pattern. Various models available
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(QWUDLQHGDLU
'LOXWHGR[\JHQ'LOXWHGR[\JHQ'LOXWHGR[\JHQ'LOXWHGR[\JHQ
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Peak inspiratory flow
Start End
Flow
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Variable performance device
O2%=?
O24L/m
in
Air
Air
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O24L/m
in
Air
Air28% O2at 45L/min
28%O
2
Fixed performance device
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In use
When recording oxygen saturation, the
delivered oxygen must be recorded Delivery devices and/or flow rates should
be adjusted to keep oxygen saturation inprescribed range
If a patients oxygen needs increase this
should be reported
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Humidification Why?
Types
Advantages and disadvantages
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Key points
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References and recommended reading
Currie GP, Douglas JG (2006) ABC of chronic
obstructive pulmonary disease: Oxygen andinhalers BMJ 333:34-36
Harris S (2007) COPD and coping with
breathlessness at home: a review of theliterature British Journal of Community Nursing
12(9): 411 - 415
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References and recommended reading
ODriscoll BR, Howard LS, Davison AG (on
behalf of the British Thoracic Society EmergencyOxygen Guideline Development Group) (2008)
Guideline for emergency oxygen use in adult
patients Thorax63:Supp. VI Simpson H. (2006) Respiratory assessment.
British Journal of Nursing, 15(9):484-8.
Walsh M, Crumbie A (2007) Watsons Clinicalnursing and related sciences, 7th ed. Ballire
Tindall, London.