As a new nurse, I'm still learning things and getting familiar with patient conditions and things that I didn't learn in school or textbooks. I have had a few respiratory patients since I've started working in pediatrics that would recieve breathing treatments (ex: albuterol nebs) for their conditions. I can't seem to figure out (after a great deal of research) why most of my patients breath sounds worsen and o2 says drop right after receiving breathing treatment. Is this normal? I've been meaning to ask the RT person but I always seem to be occupied with my patients when he comes and never got to ask him. I have already searched the web which has taken ridiculously a lot of time to find an answer and still no answer.
Jun 13, '16
Breath sounds can worsen if there were mucus plugs and airway construction/bronchospams open up the bronchioles and now the mucus (likely thinned by the nebulized mist) are loose and noisy ready for expectoration. The O2 sat may briefly dip if the heart rate raises and the probe doesn't compensate or they hold their breath with the increased loose secretions as long as the drop in sat is not sustained....
Jun 13, '16
Thank you so much Justbeachynurse for taking the time to reply. I have noticed this as well as far as high heart rate and low o2 connection. I hate when parents ask me these type of questions and I don't quite understand the reason for it. It's very fustrating.
Jun 14, '16
I generally will wait 10 minutes after a treatment to re-assess. O2 sats and HR have stabilized at that point. Patient will often sound worse after a treatment for the exact reasons Just Beachy mentioned.
Jun 17, '16
Moving air makes noise. I would rather have noisy breath sounds over no breath sounds. You might hear the term "opened up". The inflammation and secretions may still be present but the bronchoconstriction has eased somewhat after a treatment to where there is air movement which might mean coarser breath sounds or louder wheezes. For assessment, you ask the patient how they feel, watch their retractions, note HR and RR. Monitor the SpO2 for signs of transient hypoxia.
The transient hypoxia is best explained by reviewing Ventilation/Perfusion Mismatch. The issue is that many of the newly reventilated airways are now carrying oxygen to areas of the lung that have a much decreased blood flow.
You also have to look at the diagnosis which clues you to the pathophysiology of that disease process. There are many different wheezes, crackles and rhonchi depending on the disease process. A few straight forward asthmatics might clear or wheeze less but that might also depend on the corticosteroids given and degree of the inflammatory response. Bronchiolitis can be a different process. PNA in an asthmatic is another situation which you might expect several different breath sounds.
Jun 17, '16
I was going to say everything Heinz57 said - spot on!
Jul 12, '16
You just got a bunch of excellent clinical advice.
I will suggest, though, that if you are working in Peds caring for these type of patients you need to pursue your knowledge base and skill set. Your education is not over and you must commit to reading about the diseases and complications that your patients are suffering.
You didn't say how long you have been in this position. Just keep in mind that everyone has a learning curve. The vast majority of nurses are nearly dangerous for the first 6 months on their first job. That can be true for experienced nurses who are changing specialty too. It takes about a year before you feel competent with most things that your daily job will throw at you and around 2-3 years before you are proficient.
Don't stop learning. This was a really good question.
May 8, '17
Albuterol for instance is a bronchodilator, which also helps with aiding in getting secretions that are trapped up. However patient needs to be able to perform effective cough to clear those secretions.
When you auscultate the patient what kind of sounds do you hear? wheezing, or ronchi? Do you ask the patient to cough to assess if sounds persist after cough or clear. Are they using their spirometer? You can also email to the RT staff or stop by their office.
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