It is suggested by Henderson (1998) that breathlessness in the UK today is a common and complex subjective set of symptoms. A vast range of medical and lifestyle choices cause and exacerbate breathlessness, which can be a frightening and sometimes a painful experience for the patient. A nurses interaction with a patient can help alleviate and reduce these episodes and make a substantial difference to patients both in the community and hospital setting.
For many people, becoming breathless after normal exertion is nothing to be concerned about as commented on by Madge and Esmond (2001) and is the expected physiological response to increased activity. However for those who become breathless after minimal exercise or simple daily activities such as walking, going up and down stairs or shopping this can have a significant impact on quality of life for both the person and their family.
This assignment will identify some of the impacts, interventions and outcomes in relation to patient’s quality of life measured against activities of living from Roper, Logan and Tierney.
Whilst looking at the impact that breathlessness can have on patient the author will look at the physical, psychological and social health implications and how this can affect the overall (holistic) quality of life for these patients. Often these three areas overlap and the physical implications of breathlessness can have a direct effect on the patient’s social health, financial ability to provide for themselves and others, which in turn affects the person physiological well-being or vice versa.
The author will also discuss the nursing care required in each area (physical, psychological and social health) and some of the evidence that has supported this in relat...
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The respiratory system undeniably serves a very important function in the body. Anyone who has had any event where they couldn’t breathe normally, or maybe not at all, recognizes the importance and mental peace that comes with being able to breathe stress free.
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes an acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used; a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiratory pressure.
However, this approach not only lacks objectivity, but it also fails to acknowledge the abnormal physiology that precedes this breakdown in self-care. For instance, it has been reported that 70% of patients preceding cardio-pulmonary arrest had a physiological decline in respiratory or mental function (Schein et al 1990). Observing deterioration in activities of daily living alone does not accurately mirror underlying physiological deterioration occurring in patients.
One of the pivotal roles of a nurse is the ability to recognise patient deterioration. The skill of identifying crucial elements of deterioration and acting appropriately is fundamental for positive patient outcome. A vital skill performed primarily by nurses is the act of respiratory rate measurement. This skill is performed in addition to five other physiological parameters, which form a basis for a scoring system. The scoring systems commonly used are known as NEWS (National Early Warning Score) and EWS (Early Warning Score). As many adverse events are preceded by a period of time where by the patient exhibits physiological dysfunction, there is often time to correct abnormalities. This has significance for nurses, as they are responsible
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
The surface area for gas exchange decline and lung mass decrease, residual volume increases as the alveoli enlarge. In addition, the speed of breathing out with maximal effort gradually diminishes, and coughing becomes less effective which also increase the risk of pulmonary illness (Bickley &Szilagyi, 2016). There is a decrease in arterial pO2, but the O2 saturation normally remains above 90% (Bickley &Szilagyi, 2016). When the patient has COPD - a disease state characterized by the presence pf airway obstruction that is not fully reversible , with chronic inflammation found in the airways, lung parenchyma, and blood vessels- as they age the disease becomes more progressive due to the natural changes of aging to the pulmonary system (Lewis, 2007). The defining features of COPD are irreversible airflow limitation during forced echalation caused by loss of elastic recoil and airflow obstruction caused by mucus hypersecretion, mucosal edema, and brochospasm (Lewis, 2007). Gas exchange abnormalitites result in hypoxemia and hypercarbia (Lewis, 2007). Air trapping worsen and alveoli are destroyed (Lewis, 2007).There is a siginificant ventilation/perfusion mismatch and hypoxemia resutlts (Lewis, 2007). Pulmonary hypertension may occur late in the course of COPD leading to hypertrophy of the right ventricle
There are many models available including Roper Logan Tierney (RLT) (1996).The RLT model, which my portfolio is based, offers a framework for nurses to be able to ensure that individuality is taken into account when undertaking nursing care. In order to ensure that all aspects of an individual's life are integrated into an effective plan of care, Roper at al (1996) uses a problem solving approach and the nursing process in conjunction with their model for nursing.
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I am writing this reflection because of an incident that happened during activity time. When a resident became upset saying she has chest pain and cant breath. The resident was able to take herself to her
The sensation of breathlessness, frequent suctioning, inability to talk, vagueness regarding their surroundings or ailment, discomfort, isolation from others, and fear contribute to high levels of anxiety. These high levels of anxiety are thought to be high contributing factors in patients having difficulty weaning off of ventilator support. “Patients who are unable to wean from the ventilator are often transferred from surgical, medical, and cardio-thoracic intensive care units to pulmonary step-down units for the weaning process (Hunter, Bryan C., et al 2015 pg 200).” Researcher have decided to take a different approach to easing the stress and anxiety related to ventilated patients by the using soothing music instead of pharmaceutical
There are 2 types of breathing, costal and diaphragmatic breathing (Berman, 2015). Costal refers to the intercostal and accessory muscles while diaphragmatic refers to breathing using your diaphragm (Berman, 2015).It is important to understand the two different types of breathing because it is vital in the assessment of the patient. For example, if a patient is suing their accessory muscles to aid in breathing then we can safely assume that they are having breathing problems and use a focused assessment of their respiration. Assessing respiration is fairly straightforward. The patient’s respiration rate can be affected by anxiety so a useful to avoid this is to check pulse first and after you have finished that, while still holding their pulse point, check their respiration rate. Inconspicuous assessment avoids the patient changing their breathing because they know they are being assessed which patients can sometimes do subconsciously. Through textbooks and practical classes I have learned what to be aware of while assessing a patient’s respiratory rate. For example; their normal breathing pattern, if and how their health problems are affecting their breathing, any medications that could affect their respiratory rate and also the rate, depth, rhythm and quality of their breathing (Berman, 2015). The only problem I found while assessing respiration rate was I thought it seemed a bit invasive looking at the
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.