Sunday, March 7, 2010

Selected Areas of Care - Respiratory Management

Respiratory Management
  1. Complies with established guidelines
  2. Positions the patient to facilitate respiratory hygiene activity(ies)
  3. Provides a receptacle to receive secretions as needed
  4. Assesses the patient's respiratory status before initiating respiratory hygiene activity(ies) by:
    • instructing the patient specifically to breathe in and out as deeply as possible moving the stethoscope from side to side
    • observing breathing patterns
  5. Directs the patient in or performs one or more respiratory hygiene activity(ies):
    • Deep Breathing
      • instructs the patient specifically to breathe in and out as deeply as possible
      • repeats deepbreathing exercise as ordered or as indicated by the patient's condition
    • Coughing:
      • instructs the patient specifically to breath in and out deeply
      • instructs the patient specifically to cough forcefully on third or fourth expiration
      • provides for splinting, whiile the patient is coughing, if necessary
    • Mechanical deviceds, such as those used for inspiratory spirometry, etc.
      • instructs the patient specifically to use the device
      • repeats respiratory exercise as ordered or as indicated by the patient's condition
    • Chest Percussion
      • claps the designated area(s) of the chest wall vigorously with cupped hands, unless contraindicated
      • vibrates the designated area(s) of the chest wall vigorously, unless contraindicated
    • Suctioning
      • when suctioning by catheter is assigned
        • verifies patency of the catheter
        • sets the pressure on the suction machine as designated
        • inserts the catheter before suctioning
        • rotates the catheter continuously during suctioning
        • suctions for no more than 15 seconds at a time
        • repeats as necessary to remove secretions or
      • when suctioning with a bulb syringe is assigned:
        • deflates the bulb syringe prior to insertion
        • inserts the bulb syringe into the patient's mouth and/or nares before suctioning
        • aspirates secretions
        • repeats as necessay to remove secretions
  6. Reassesses respiratory status immediately after respiratory hygiene activities
  7. Records
    • bilateral breath sounds heard after treatment in comparison with those heard initially related to each of the above assessment findings
    • abnormal breathing patterns
    • respiratory hygiene activities implemented

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