Published Mar 11, 2005
What are some parameters I should look for in a pts condition when deciding to request a PRN resp treatment??
generally, you should assess their respiratory status. breathing rate & quality, lung sounds, spo2, ect. ask yourself why you would give a patient an initial breathing treatment, the prn's are the same. like i said, that's a general answer. do you work a ward, ed, or i.c.u.?
Most patients who take respiratory treatments regularly will ask for one when they feel dyspneic. However different drugs have different indications.
The most common drug used in a neb is Albuterol. The main indicated is bronchospasm. The best way to identify bronchospasm is wheezing. So to answer your question Bronchiole wheezing would be your answer.
A lot of nurses will call for a PRN treatment when their patients lungs sound "junkie" Here is a quick run down of breath sound, what they are, and what they indicate.
Fine Crackles (or rales) may be fluid in the small airways. The treatment would be Lasix or some other diuretic
Expiratory Crackles may be atelectasis. The air sacs collapse upon expiration. The treatment for this would be Incentive Spirometry or IPPB
Medium Crackles may be fluid and secretions in the middle airways. The treatment for this is Chest Physiotherapy.
Rhonchi is low pitched loud crackly sound much like some one blowing bubbles in a glass of milk with a straw. This may be secretions in the large airways. The best treatment for this is deep breathing and coughing. If that does not clear the sound one may need to suction the patient.
Wheezes are sounds that are heard continuously during inspiration or expiration, or during both inspiration and expiration. They are described as a musical sound. They are caused by air moving through narrowed airways. They may be narrowed by constriction or swelling of airway or partial airway obstruction. In this case you would probably give a bronchodilator. Deep breathing and coughing may clear a partial obstruction.
Stridor refers to a high-pitched harsh sound heard during inspiration. Stridor is caused by obstruction of the UPPER airway, and is a sign of respiratory distress and thus requires immediate attention. Most of the time you can hear it when you walk into the room. It is best heard with a stethoscope on the neck. The drug of choice for this is racemic epinephrine. The most common cause of stridor is swelling of the airway and the racemic epi is a vasodilator. This will help relieve edema.
you are right. you should assess everything on the patient and know what interventions you need to take to correct the problem. a low spo2 needs oxygen not necessarily a respiratory treatment. the same goes for abnormal breath sounds. you need to know what the sound indicates. they may not need a drug neb treatment. as far as respiratory rate, it could be a respiratory issue or the respiratory system maybe compensating for a metabolic problem.
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