[Breathing-related nursing care problems--a descriptive study]

Research into nursing problems related to breathing that can occur by pulmonary patients and their relationship with literature on Nursing Diagnoses (further referred to as diagnoses) on this subject has been done on two nursing wards. Interviews have been held with eleven nurses working in direct patient care. From the acquired data twelve problems with their signs and symptoms as well as the possible etiology were found, each showing one or more similarities with diagnoses from the North American Nursing Diagnosis Association (NANDA). Similarities and differences between the NANDA diagnoses and the acquired data have been analysed.

Pediatric emergencies

The care of acutely ill children presents a unique challenge for health care professionals. Nurses often are required to make a quick assessment of the child's condition, even when the child is frightened or uncommunicative. This article addresses the most common of a multitude of illnesses seen in children and organizes them according to organ systems and common final pathways within a system.

The new alternatives to intubation

Noninvasive positive-pressure ventilation devices are brightening prospects for a diverse group of patients--and placing new demands on nurses. Here's how to work with them.

Interventions related to respiratory care

Nursing interventions provide the link between nursing diagnosis and patient outcomes. The validation of nursing interventions is the starting point for a standardized nursing language. This study adapted a method for the validation process for nursing interventions and identified interventions that nursing experts believe are vital to the care of respiratory patients. The study served as the pilot for further surveys by the Iowa classification project. Based on the results of this study, the group made modifications in the survey process. Specifically, national samples of nurses were used, definitions were included in the surveys, and standard deviations were calculated for each activity. The subsequent articles in this issue demonstrate these changes.

Pulmonary complications from enteral nutrition

Complications of enteral nutrition may compromise respiratory function by direct mechanical injury by feeding tubes, aspiration of formula, or alterations in metabolism. Although much of the data reviewed in this paper were published more than 10 years ago, these studies still comprise most of the literature on pulmonary complications of enteral nutrition. Many of the products that are described in these older studies no longer exist or are not widely used. Additional research is needed to determine whether the enteral formulas and delivery devices that have recently been developed are associated with a similar incidence of misplacement, aspiration, or displacement as that previously reported.

A functional classification of respiratory compromise in spinal cord injury

Spinal cord injury (SCI) patients have unique care needs, particularly related to the respiratory system. Respiratory problems now comprise a major cause of death in the acute and chronic phases of SCI, especially among quadriplegics. Previous literature has analyzed respiratory muscle dysfunction in SCI according to neurologic levels of injury (Alvarez, Peterson & Lunsford, 1981; McMichan, Michel & Westbrook, 1980). In general, the higher the level of injury, the greater the respiratory compromise and need for ventilatory assistance. Although level of injury is significant, it cannot be used as the sole determinant of respiratory compromise. For example, a 25 year old C4 quadriplegic with an intact diaphragm might have less respiratory impairment than a 60 year old C6 quadriplegic with CHF and a history of COPD. A new classification of SCI patients according to amount of respiratory compromise was developed by our team at the Spinal Cord Injury Unit at the Palo Alto VA Medical Center. The patient is scored in three categories: 1) level of injury; 2) completeness of injury; and 3) associating factors, i.e. age, preinjury chronic lung disease. The purpose of this grouping is to better predict the amount of ventilatory impairment in SCI patients. Used during the initial assessment, patients at high risk for impairment could be determined and optimal respiratory care initiated. This classification can also be used as a clinical nursing tool. Using this scoring system, the nurse could anticipate the patient's respiratory needs, i.e. suctioning, chest physiotherapy, oxygen, hydration, nutritional support and teaching of patient and family in order to comprehensively plan and implement care.(ABSTRACT TRUNCATED AT 250 WORDS)

Postoperative pulmonary complications

This discussion presented the most common causes of postoperative pulmonary complications. The categories of obstruction, hypoxemia, and hypoventilation were used for structure, with the most common causes of each identified. Problems and patients at risk for these problems have been identified along with treatment priorities. The reader is reminded that the categories of obstruction, hypoxemia, and hypoventilation cannot be taken as absolute. The existence of one usually suggests the presence of another.

Pulmonary problems

Prevention of pulmonary complications continues to be a major goal of therapy in the care of patients in the postoperative period. Numerous factors, including anesthesia and surgery-induced diaphragmatic dysfunction, reductions in lung volumes and capacities, and release of mediators that damage the endothelium, set the stage for the development of complications such as atelectasis, pneumonia, and ARDS. Nursing assessment focuses on the early identification and evaluation of respiratory distress and degree of oxygen supply/demand imbalance. Intervention focuses on restoration of appropriate ventilation/perfusion matching and provision of adequate oxygen to meet tissue metabolic demands.

Pulmonary considerations in the critical care phase

Spinal cord injuries create alterations in ventilatory mechanics that range from complete ventilator dependence in high cervical injuries to the need for an assisted cough to clear secretions in low thoracic injuries. The initial nursing assessment should include the degree of respiratory muscle impairment, the effectiveness of the patient's inspiratory efforts, and the ability to cough. Once the mechanisms responsible for respiratory difficulty have been determined, nursing interventions can be planned to compensate for impaired function. This may involve assisted coughing, frequent chest physiotherapy and suctioning, monitoring vital capacity and ABGs, and use of kinetic beds. Perhaps the greatest challenge for both the nurse and the patient is weaning from mechanical ventilation. Weaning requires a coordinated plan, based on trust between patient and nurse, in order to achieve maximum independence from ventilatory support.