learning Objectives - Demonstrate skills in the nursing management of client with impaired respiratory function and gaseous exchange
Hours - 15
Teaching and Learning Activities - Lecture cum discussion Demonstration of various artificial respiratory devices Simulation Case discussion Videos and Films
Assessment Methods - Short answer Objective type Essay type Return demonstration
Content of the chapter
a) Assessment of respiratory function
– History
– Physical examination
– Diagnostic evaluation
b) Care of patient in respiratory intensive care
and ventilator care and respiratory function
c) Management of Patient with disorders of
upper respiratory airway.
– Obstruction of upper airway
– Epistaxis
– Sinusitis
– Pharyngitis
– Tonsillitis
– Laryngitis
– Deviated nasal septum
d) Management of patient with disorders of the
chest and lower respiratory tract
e) Management of patient with impaired • Lung
abscess
– Empyema
– Bronchial asthma
– COPD
– Pneumothorax
– Pneumonia
– Bronchitis
– Bronchiectasis
– Trauma
– Pulmonary Tuberculosis/DOTS
– Pulmonary embolism
– Pulmonary edema
– Lung tumors
– Disorders of pleura and pleural space
– Lung surgery
– Respiratory failure
– Acute respiratory distress syndrome,
– SARS
f) Alternate therapies
g) Drugs used in treatment of disorder of
respiratory system
Nursing Management of Patient with Impaired Respiratory Function and Gaseous Exchange
Impaired respiratory function affects oxygenation and carbon dioxide removal, leading to tissue hypoxia. Nursing care focuses on early assessment, maintaining airway patency, improving ventilation, and preventing complications.
a) Assessment of Respiratory Function
1. History
- Chief complaints:
- Dyspnea, cough, sputum, chest pain
- Duration and severity of symptoms
- History of:
- Smoking
- Occupational exposure (dust, chemicals)
- Allergies
- Previous respiratory illness (asthma, TB, COPD)
- Drug history (bronchodilators, steroids)
- Family history of respiratory diseases
2. Physical Examination
- Inspection
- Respiratory rate, rhythm, depth
- Use of accessory muscles
- Cyanosis, clubbing
- Palpation
- Chest expansion
- Tactile fremitus
- Percussion
- Dullness (consolidation, effusion)
- Hyper-resonance (pneumothorax)
- Auscultation
- Breath sounds
- Adventitious sounds: wheeze, crackles, rhonchi
3. Diagnostic Evaluation
- Chest X-ray
- Pulmonary function tests (PFT)
- Arterial blood gas (ABG)
- Pulse oximetry
- Sputum examination
- CT scan / Bronchoscopy (if indicated)
b) Care of Patient in Respiratory Intensive Care & Ventilator Care
Respiratory ICU Care
- Continuous monitoring of:
- Vital signs
- Oxygen saturation
- ABG values
- Maintain airway patency
- Oxygen therapy
- Chest physiotherapy
- Suctioning (as needed)
Ventilator Care
- Ensure correct ventilator settings
- Maintain humidification
- Prevent ventilator-associated pneumonia:
- Head elevation (30–45°)
- Oral hygiene
- Aseptic suctioning
- Monitor for:
- Tube displacement
- Barotrauma
- Psychological support and sedation as prescribed
c) Management of Patient with Disorders of Upper Respiratory Airway
1. Upper Airway Obstruction
- Maintain airway patency
- Oxygen therapy
- Suctioning
- Emergency tracheostomy if required
2. Epistaxis
- Position patient upright, head forward
- Apply nasal pressure
- Cold compress
- Nasal packing if severe
3. Sinusitis
- Steam inhalation
- Antibiotics and analgesics
- Encourage fluids
4. Pharyngitis / Tonsillitis
- Warm saline gargles
- Antibiotics (if bacterial)
- Soft diet
5. Laryngitis
- Voice rest
- Humidified air
- Avoid smoking
6. Deviated Nasal Septum
- Symptomatic care
- Pre- and post-operative nursing care if surgery indicated
d) Management of Patient with Disorders of Chest and Lower Respiratory Tract
- Maintain effective breathing pattern
- Positioning (semi-Fowler’s)
- Oxygen therapy
- Chest physiotherapy
- Encourage coughing and deep breathing
- Adequate hydration
- Monitor sputum and breath sounds
e) Management of Patient with Impaired Respiratory Conditions
Lung Abscess & Empyema
- Antibiotic therapy
- Chest drainage
- Postural drainage
Bronchial Asthma
- Bronchodilators
- Corticosteroids
- Avoid triggers
- Breathing exercises
COPD
- Oxygen (low flow)
- Bronchodilators
- Smoking cessation
- Pulmonary rehabilitation
Pneumothorax
- Oxygen therapy
- Chest tube care
- Monitor respiratory status
Pneumonia / Bronchitis
- Antibiotics
- Hydration
- Incentive spirometry
Bronchiectasis
- Chest physiotherapy
- Antibiotics
- Postural drainage
Pulmonary Tuberculosis (DOTS)
- Anti-TB drugs under DOTS
- Nutrition support
- Infection control measures
Pulmonary Embolism
- Oxygen therapy
- Anticoagulants
- Bed rest initially
Pulmonary Edema
- Oxygen
- Diuretics
- Upright positioning
Lung Tumors
- Pain management
- Chemotherapy / radiotherapy care
- Psychological support
Pleural Disorders
- Thoracentesis care
- Chest tube management
Lung Surgery
- Pre- and post-operative respiratory care
- Breathing exercises
- Pain control
Respiratory Failure / ARDS / SARS
- Mechanical ventilation
- Strict monitoring
- Infection control
- Supportive care
f) Alternate Therapies
- Breathing exercises (pursed-lip breathing)
- Yoga and pranayama
- Steam inhalation
- Chest physiotherapy
- Pulmonary rehabilitation programs
g) Drugs Used in Respiratory Disorders
- Bronchodilators: Salbutamol, Ipratropium
- Corticosteroids: Prednisolone, Budesonide
- Antibiotics: Penicillins, Macrolides
- Mucolytics: Acetylcysteine
- Antitussives: Dextromethorphan
- Antihistamines: Cetirizine
- Diuretics: Furosemide (pulmonary edema)
- Anti-TB drugs: Isoniazid, Rifampicin, Ethambutol
Conclusion
Nursing management of respiratory disorders focuses on early assessment, airway maintenance, oxygenation, prevention of complications, and patient education. Skilled nursing care significantly improves outcomes in patients with impaired respiratory function.