The ease of breathing is a subconscious action that is a fundamental part of life. A professional manner is the foundation on which an assessment and quality patient care is built. It is vital that nurses have sound knowledge of the anatomy and physiology of the respiratory system to be able to carry out a respiratory assessment. It is essential that nurses are able to recognise and assess symptoms of respiratory dysfunction to provide early, effective and appropriate interventions to improve patient outcomes.
It is necessary for a nurse to have a comprehensive knowledge base of the anatomy and physiological process of a healthy functioning pulmonary system, in order to carry out a respiratory assessment (Jenkins, 2003, p124, Kennedy, 2007, p42 & Crisp and Taylor, 2005, p639). The respiratory system consists of the upper airway, including the nasal passages, sinuses, pharynx and larynx and the lower airway includes the trachea, bronchi, lung, bronchioles and alveoli. The main purpose of the respiratory system is to provide oxygen to all the cells in the body and to remove the by-product of carbon dioxide. This is why respiratory assessment should be carried out by a competent nurse that can easily identify potential respiratory defects in patients (Moore, 2007, p56).
The skills the nurse must use to gather relevant information during a breathing assessment include interviewing skills, observation skills and listening skills (Crisp and Taylor, 2005, p634). Jenkins (2003, p138) states that there are three phrases involved in assessment. These include a collection of data, interpretation of the data to assess the degree of alteration in breathing and identifying the individual’s actual and potential problems relating to breathing.
A respiratory assessment should begin with a patient’s history, as it is a vital element and provides clues to the cause of respiratory difficulty or failure. If properly recorded it provides the nurse with an organised, unbiased, detailed and chronologic report of the development of symptoms that has caused the patient to seek health care (Wilkins, et al, 2003, p12). When proficiently obtained, the history provides enough sufficient information for an accurate diagnosis and care plan. Finesilver (2003, p42, cited in Kennedy, 2007) claims that ‘the physical examination only serves to reinforce the information derived from the history and allows the nurse to assess the patient’s mental state and whether he or she is orientated to time or place’. When conducting a respiratory assessment a quiet and calm atmosphere is ideal, although in reality, complications can occur (Kennedy, 2007, p43). The appropriate use of eye contact is one of the most significant and prevailing techniques for indicating true concern about a patient. Eye contact should be established often enough and long enough to be encouraging but should not be persistent that it makes the patient feel uncomfortable (Wilkins et al, 2000, p8).
Jenkins (2003, pp138-142) and Kennedy (2007, pp42-43) state that a nurse should consider the following when gaining history information. The assessment should include a medical, surgical, social, family, and smoking history. Closed questions should be used appropriately to minimise any suffering if the patient is intensely breathless. Explain terms and issues in simple terms and check for understanding within the individual so there is no confusion. Using silence allows for the person to rest or think and gives the nurse to write down detailed information. The nurse should prioritise questions so the most vital questions are asked first. Alternative sources for gathering a patient’s history is to involve; relatives, friends, work associates, previous physicians and past medical records, as they can provide a more accurate picture of the history and progression of symptoms (Wilkins, 2000, p14). History taking maybe limited depending on the severity of the breathing disfigurement and...
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