A patient receiving oxygen therapy via nasal cannula suddenly exhibits signs of increased respiratory distress, how do you assess the situation and what specific actions would you take?
When a patient receiving oxygen therapy via nasal cannula suddenly exhibits signs of increased respiratory distress, a rapid and thorough assessment is crucial, followed by immediate, appropriate actions to stabilize the patient. This situation requires a combination of observation, critical thinking, and prompt intervention to ensure adequate oxygenation and prevent further complications.
First, immediately assess the patient's overall appearance and level of consciousness. Observe if they appear anxious, restless, confused, or lethargic, as these can indicate worsening hypoxemia (low blood oxygen). Assess their mental status by asking simple questions such as their name, location, and the current day. Changes in consciousness can be a sign of severe respiratory distress. For example, a patient who was previously alert and oriented who now appears confused or drowsy is experiencing a decline in their condition, which needs to be immediately addressed.
Next, assess the patient’s breathing pattern. Observe the rate, depth, and effort of their respirations. Count the number of breaths per minute, and note if their breathing is rapid (tachypnea) or slow (bradypnea). Observe if they are using accessory muscles of the neck and chest, flaring their nostrils, or exhibiting labored breathing. Check if their breathing is shallow or deep. Note if they are having difficulty inhaling or exhaling, and if their chest wall is moving symmetrically. For example, if the patient's breathing rate has increased significantly, and they appear to be using their neck muscles to breathe, this indicates their body is working harder to obtain enough oxygen. Also, listen to the patient's breathing, and note any wheezing, stridor, or crackling sounds.
Evaluate the patient's skin color, particularly around the mouth, lips, and nail beds, for signs of cyanosis (bluish discoloration), which indicates a significant lack of oxygen in the blood. Note also any pallor or diaphoresis (sweating). For example, a patient who has bluish discoloration around their lips and nail beds and also appears sweaty is showing signs of severe hypoxia.
Check the patient's pulse oximetry reading (SpO2) if a pulse oximeter is available. Compare the current reading to the patient’s baseline and prescribed range. Note if the reading is below the acceptable range for the patient. However, even if a reading is within the acceptable range, a patient showing signs of respiratory distress still needs to be assessed and treated. For example, if the patient’s oxygen saturation was previously 95% and it is now 88%, that is a sign of hypoxemia. Even if it’s still at 90%, but the patient shows difficulty breathing, the situation still requires intervention.
Assess the patient’s nasal cannula to ensure it is positioned properly and is delivering oxygen effectively. Check for any kinks or obstructions in the tubing and ensure the oxygen flow rate is set to the prescribed level. Check that the prongs of the cannula are properly inserted into the patient's nostrils and are not dislodged or loose. Also check that the nasal cannula is well-fitting so that there are no leaks around the nostrils that would interfere with proper oxygen delivery. For example, if you find the tubing is kinked, the flow meter is not on, or the nasal cannula is dislodged, these should be corrected immediately.
If the patient’s condition seems severe, immediately activate the emergency response system as per facility protocols. If another staff member is nearby, ask them to notify the nurse or call for help, while you remain with the patient. For example, if the patient is experiencing severe shortness of breath, loss of consciousness, or severe cyanosis, an immediate emergency response is critical.
While waiting for additional assistance, assist the patient to a comfortable position. Most often, sitting upright or in a semi-fowler's position facilitates better lung expansion. If the patient is feeling anxious, encourage them to take slow, deep breaths to help calm down and improve oxygenation. Ensure the patient is not lying flat as this can interfere with breathing. For example, help the patient sit upright, and offer them slow and calm breathing techniques.
If the patient has a portable oxygen tank, be sure that the tank is not empty. Check the gauge to ensure that there is enough oxygen supply in the tank. If the tank is almost empty, replace it with a full tank. If the oxygen is not portable, check that the oxygen tank is still full and there are no interruptions in the system.
Check for any other factors that may be contributing to the increased respiratory distress such as pain or anxiety. Attempt to minimize any known triggers, and make the patient as comfortable as possible. Sometimes, if a patient is feeling pain or anxiety, that can increase their breathing difficulties. For example, if the patient states they have pain, attempt to treat that pain. If anxiety is an issue, try calming the patient by using deep breathing, calming techniques and reassurance.
After addressing the immediate issues, document all of your findings, including your assessment of the patient’s level of consciousness, breathing pattern, skin color, pulse oximetry reading, the oxygen equipment check, and all interventions you provided. It is important to be clear and concise, and objective in your documentation. For example, record the time of onset of respiratory distress, the interventions taken, and how the patient responded to each intervention.
Report the patient’s condition and the interventions that you took to the nurse or the healthcare provider immediately. Be clear and concise in your report, and report the findings of your assessment, the interventions you took and the patient's response to the interventions. It is essential that the nurse is aware of the situation and they should be kept abreast of any new developments. For example, report all your findings to the nurse as well as any changes in the patients condition.
In summary, when a patient on oxygen therapy suddenly shows signs of respiratory distress, a CNA should assess the patient’s overall condition, evaluate their breathing pattern, assess for cyanosis, check their pulse oximetry, ensure the oxygen equipment is properly functioning, initiate the emergency response if required, position the patient for optimal breathing, report all findings to the nurse, and document everything thoroughly. This comprehensive approach is crucial to provide immediate and appropriate care and prevent further complications.