Wednesday, January 11, 2006

Respiratory Assessment and Respiratory Management

Respiratory Management and Assessment differ by only two steps.To avoid redundancy I will lump them together. Respiratory management and Respiratory Assessment WILL NOT be assigned in the same PCS. Bold
This is probably the most simple Mnumonic I have:PAR for Assessment and PAIR for Management.
As always the compliance with established guidelines is in place.

P- Position the Pt to facilitate respiratory assessment/ hygeine activities. This is usually high fowlers. Invoke CDM if another Italicposition is used and cite your reasoning.

A- Assess- breathing pattern, symmetry of chest expansion,nasal flaring or any cough.Auscultate lung sounds,while INSTRUCTING THE PT TO BREATHE AS DEEPLY AS POSSIBLE.You must MOVE THE STETHOSCOPE RIGHT TO LEFT , SIDE TO SIDE when assessing. Listening to one lung then another is NOT acceptable. I would ask for two complete breaths at each location. You must assess upper and lower lungs, but there is nothing to say that you cannot listen in more than 4 places. You should listen near shoulder level( reach with your right hand to the left part of the back as far as you can reach and it ought to be the correct spot) and immediately below the scapula ( imagine the bra line).Do not get specifac when describing lung sounds. normal/abnormal is all you need to know.

I.-Intervene. this is the Respiratory Management distinction. DO NOT start the intervention before the first assessment is complete. That would be a fail.The intervention will be designated. Provide a receptacle for any secretions. If it is a used emesis basis, wear gloves when handing it to the pt and for sure when emptying it!!Usually deep breathing and coughing or incentive spirometry will be assigned. Provide a splint for a pt with recent abdominal surgery. Instruct the pt to take three DEEP breathes and forcefully cough. that counts as one cycle. The CE will write on your assignment Kardex the number of cycles. Inspiromety is a little device that encourages the client to expand their lungs and prevent pneumonia. Chest percussion ,trach care and suctioning may be assigned. If assigned oxygen sat, do not omit!

R-Reassess and record immediately after respiratory hygeine is done and compare to initial documentation.Document pt response to activity.As you assessed bilaterally be sure you chart bilaterally

There is nothing to say you cannot listen to the pt while they are lying on their side or anteriorly but I would be nervous not to at least verbalize a reason for doing anything but posterior.

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