Nursing Care Plan for Respiration



These emergencies are due to respiratory failure for various reasons, and the body is unable to oxygenate the blood. Immediate treatment is essential to avert death. The quicker this can take place the better. Getting professional help is recommended.

Symptoms of Respiratory Failure

  • Breathing has ceased.
  • In less serious cases, there may be gasping or noisy breathing. Fits may occur.

What to Do in the Case of Respiratory Failure

It is vital to get the respiratory system and circulatory apparatus operating as soon as possible. Unless the vital centers of the brain start to receive adequate oxygen as a matter of urgency, irreversible brain damage will result. Also, the heart will not operate unless it, too, is getting enough oxygen via the normal heart action.



The simplest and quickest way of achieving this is by resuscitation along the methods outlined in that section. Every first aider must have a complete knowledge of this vital emergency measure. It is essential.

There are other disorders that can similarly interfere with normal lung and heart action. The basic treatment is identical, but some points will be mentioned in each case.



Strangulation

This may occur accidentally or purposely when some form of constriction about the neck prevents normal respiration. Remove the obstruction at once. In children and babies it may be clothing or bedding, or things wrapped around the neck in play.

Check circulation and respiration at once, and commence resuscitation. Continue for as long as necessary (i.e. until both are operating normally). Transport to an emergency ward may be necessary.



Hanging

Free the neck as quickly as possible, often easiest done by grasping the lower limbs and lifting. Free the obstruction and start resuscitation at once if respiration and circulation have stopped. Continue until they are back to normal.

Choking

This may occur in all ages but is more common in small children under the age of four years. It is stressed that peanuts are a very frequent cause for this, and parents should be aware of the danger of letting small children have access to them. Many accidents have occurred, and some have ended disastrously. Spasm of the airway usually causes the main immediate problem.



Often there is a fit of coughing, and often violent attempts at inspiration are made. The face, lips, neck and fingers may turn blue as oxygenation is impeded. Consciousness may be lost and breathing failure may take place. Remove any obstruction if this is obvious and possible. Hold an infant by the legs and give three to four sharp smacks between the shoulders. Alternatively, lay an older child over the knees head down and strike similarly. With adults, a few sharp slaps between the shoulders may help.

Some time ago, a National Conference in America set out a procedure to be followed when treating a choking person. It differs somewhat from standard Australian teachings, but is widely used in America. It consists of:



  1. Body blows.
  2. Manual thrusts. (Well known as the Heimlich maneuver; first introduced into America in 1975, and widely used with a great deal of success ever since. Dr Henry J. Heimlich runs the Heimlich Institute in Cincinnati, Ohio).
  3. Finger sweeps. It is pointed out that many first aiders in Australia are unfamiliar with this method. But overseas experience indicates that it may be highly successful and, indeed, lifesaving.

Not long ago the New England Journal of Medicine reported that “the Heimlich maneuver is safe, effective, and easily mastered by the average person. It can be performed on standing or seated victims and on persons who have fallen to the floor. It can be performed on children and even on oneself.”

Body Blows

With the patient standing or sitting (and still conscious), the rescuer stands at the side and slightly behind the patient. With the heel of the hand, a sharp blow is delivered over the victim’s spine, between the shoulder blades. This should be attempted four times. The other hand should be placed on the breastbone to give support. Ideally the patient’s head is at a lower level than the chest to make use of gravity. An unconscious victim should be rolled toward and facing the rescuer, with the chest against the rescuer’s thigh. The same procedure follows.

Manual Thrusts

The abdominal thrust on a conscious patient is carried out with the rescuer standing behind the victim (who is standing or may be sitting).

The rescuer wraps both arms around the victim’s waist. Grasping one fist with the other hand, the thumb side of the fist is placed against the victim’s abdomen, between the waist and the rib cage. Then the fist is pressed four times into the victim’s abdomen with a quick inward and upward thrust. The idea is to force air out of the lungs, creating an artificial cough in the hope of dislodging the foreign body. Ideally it will happen without having to perform the action four times. It is important to place the hands just below the ribs to avoid fracturing them with the thrusts.



If the victim is unconscious, the rescuer should lay the person on the back, then while straddling, place the heel of one hand against the victim’s abdomen, between the waist and rib cage. The second hand is put on top of the first. The rescuer’s shoulders should be directly over the victim’s abdomen. Apply to the victim an inward and upward thrust. If the victim is alone, the maneuver can be performed by pressing a fist into the upper abdomen with a quick upper thrust.

Finger Sweeps

With the head up, open the victim’s mouth by grasping both tongue and lower jaw between the thumb and fingers, and lifting. This draws the tongue away from the back of the throat, and away from any foreign body that may be present there. This in itself may help to relieve obstruction.

Then insert the index finger of the other hand into the throat to the base of the tongue, and using a hooking action try to dislodge any foreign body that may be felt, and maneuver it into the mouth. Be careful not to push it down deeper. If the foreign body can be felt, it should be grasped and removed.

The Routine

The recommended American routine is as follows:



  1. Apply four blows to the back in rapid succession.
  2. Apply four manual thrusts.
  3. Try the finger sweep.
  4. Repeat four back blows and four manual thrusts until they are effective, or until the victim becomes unconscious. Call for help as a matter of urgency, or get the patient to hospital quickly. (This information is based on material in the Journal of the American Medical Association, 1980, 244, 460.)

Suffocation by Smoke Persons subjected to excessive smoke may suffer from burns, carbon monoxide poisoning or smoke irritation of the respiratory tract. Get the patient to fresh air urgently, give resuscitation if necessary, and seek medical aid to prevent complications.

Carbon Monoxide Poisoning

This gas is odorless, but is highly toxic and combines with the red cells to prevent adequate oxygenation of the body, more importantly of the brain. It may occur from inhaling the exhaust fumes from motor-car engines, or from domestic gas (in those places where coal gas is still used). Even small amounts of gas in the inspired air are dangerous. Asphyxia may result. Headaches, dizziness and drowsiness may occur. This may lead to confusion and coma. Often the lips are pink, and the patient looks quite well.

Plenty of fresh air is essential. Remove the patient to the outside of the house, garage or car. Artificial resuscitation is essential until respiration has become reestablished.

Other Disorders

Other respiratory disorders may occur, either from infections or from injuries. These must be treated along the general principles indicated.