92192 Adult Nursing: Respiratory

Subject level: Undergraduate

Handbook description

This subject contributes to overall course aims by continuing the development of students' knowledge and skills in adult nursing care. The subject provides the opportunity for students to continue to develop generic nursing skills using clinical exemplars from the respiratory system which reflect current epidemiological trends in health care. The theoretical basis incorporates skills development in patient assessment, data collection, and relevant psychomotor skills necessary for the provision of nursing care based on current best nursing practice. The development of the relationship between the nurse and the patient includes transitions through health and illness, respect for cultural identity, ethical considerations and resource availability. The concept of clinical judgment within acute care settings is developed in both the theory component and in clinical settings.

Subject objectives/outcomes

On successful completion of this subject students should be able to:

1. demonstrate beginning skills in nursing assessment, nursing diagnosis and nursing management for patients with alterations to respiratory function (ANMC competencies: 1.2; 5.1; 5.2; 5.3; 6.1; 6.2; 6.3; 7.1; 7.2; 7.3; 8.1; 8.2)
2. begin to understand the functional health patterns and how they relate to alterations in respiratory function (ANMC competencies: 5.1; 5.2; 5.3)
3. continue to develop data collection techniques which allow for effective surveillance of the health status of patients and the ability to recognise and report significant variations (ANMC competencies: 5.2; 5.3)
4. provide beginning levels of nursing care for patients based on the Australian Nursing and Midwifery Council (ANMC) National Competency Standards for the Registered Nurse all domains
5. develop a beginning awareness of the nurse's role in patient education and the promotion of patients' adherence to a specific therapeutic regimen (ANMC competencies: 7.1; 7.7)
6. demonstrate the essential elements of oxygen therapy at a beginning level (ANMC competencies: 9.5.)
7. demonstrate beginning skills in manual handling (ANMC competencies: 1.2; 7.1; 9.5)
8. understand the need to provide nursing care that is culturally safe and is consistent with the Code of Professional Conduct for Nurses in Australia (ANMC competencies: 2.1; 2.3; 9.5).

Content

Identify the underlying pathophysiological process/es: given the patient's medical diagnosis, what is the underlying pathophysiological process/es that disrupts the normal structure and function of the respiratory system to create respiratory dysfunction/respiratory problems?

• inflammation (asthma, Chronic Obstructive Pulmonary Disease (COPD)) and infection (pneumonia, COPD)
• airway narrowing and constriction: bronchoconstriction, bronchospasm (asthma, COPD)
• airway remodelling (asthma, COPD)
• destruction of lung tissue with loss of alveoli and loss of lung tissue elasticity and compliance (COPD)

Use the nursing process to identify, provide and evaluate nursing care

• Assess: Collect information (data) about the patient's respiratory status i.e. interview the patient using Gordon's Functional Health Patterns (2002) as a guide
• do a physical examination including observing respirations and examining the chest
• look at diagnostic test results e.g. sputum culture and sensitivity (C&S), chest x-ray, peak expiratory flow rate (PEFR), pulmonary function tests (PFTs), pulse oximetry, arterial blood gases (ABGs)

Identify nursing diagnose/s

• Analyse the data to identify if the patient is experiencing any problem with air entry, breathing (ventilation) and/or gas exchange i.e. ineffective airway clearance, ineffective breathing pattern, impaired gas exchange
• Remember that these respiratory problems may give rise to additional nursing diagnoses e.g. activity intolerance and self-care deficit, impaired tissue integrity: pressure sores, knowledge deficit and ineffective management of therapeutic regime
• Plan: identify appropriate goals of care. Use the following principles as a guide: clear the airway, mobilise pulmonary secretions, reduce the work of breathing, oxygenate the system, promote self care and self management
• Make the goals of care realistic and specific (i.e. observable and measurable) by setting expected outcomes. Identify what is of priority i.e. what goal should be achieved first. Identify nursing actions to achieve the goals of care.
• Implement: carry out the nursing actions to achieve the goals of care e.g. to clear the airway: encourage deep breathing and controlled coughing, forced exhalation (huffing), use of incentive spirometry; assess effect of medication, if ordered, to mobilise pulmonary secretions: increase fluid intake; assist physio with chest percussion, vibration and postural drainage if ordered; administer nebuliser, if ordered; assess effect of medication, if ordered, to reduce the effort of breathing: position in high fowler's, assist with activities of daily living including mobility assistance, bedbathing, mouth care, grooming, toileting/bedpan, to oxygenate the system: administer and monitor oxygen therapy, if ordered, to promote self care and compliance with therapeutic regime: provide explanation and health education
• Evaluate: evaluate the effect of this care by comparing the patient's current condition with the expected outcomes