Prepared by: Ali Refak lazeem
Supervised by: Dr. Tahseen
Assessment of respiratory status in
acutely or critically ill
Often, a patient is intubated and receiving mechanical ventilation
1. physical assessment , monitoring techniques and
knowledgeable about possible ventilator-associated events.
2. The nurse analyzes findings from the health history and
assessment while considering laboratory and diagnostic test
3.The nurse must assess for patient–ventilator synchrony and
for agitation, restlessness, and other signs of respiratory distress
(nasal flaring) . After checking the ventilator settings and that
alarms are always in the “on” position
4. The nurse note changes in the patient’s vital signs and
evidence of hemodynamic instability and report them to the
5.The patient’s position must be assessed to ensure that
the head of the bed is elevated to prevent aspiration
6.The patient’s mental status should be assessed and
compared to previous status. Lethargy and somnolence
may be signs of increasing carbon dioxide levels
7.Chest auscultation, percussion, and palpation are essential
and routine parts of the evaluation of the critically ill patient
with or without mechanical ventilation.
8.Tests of the patient’s respiratory status are easily performed
at the bedside by measuring the respiratory rate, tidal volume,
minute ventilation, vital capacity, inspiratory force
Indications For Tidal Volume, Minute
Ventilation, Vital Capacity, Inspiratory Force
1- Risk for pulmonary complications, including those who
have undergone chest or abdominal surgery
3- Preexisting pulmonary disease
These tests are also used routinely for mechanically
A collection of fluid in the pleural space,
rarely a primary disease process;
usually secondary to other diseases.
The pleural space contains a small amount of fluid (5 to 15 ml),
which acts as a lubricant that allows the pleural surfaces to move
without friction .
The effusion relatively clear fluid or bloody or purulent.
An effusion of clear fluid may be A transudate or an exudate.
A transudate (filtrate of plasma that moves across intact capillary
walls) occurs when factors influencing the formation and
reabsorption of pleural fluid are altered, usually by imbalances in
hydrostatic or oncotic pressures.
Most common from heart failure.
An exudate (extravasation of fluid into tissues or a cavity)
results from inflammation by bacterial products or tumors
involving the pleural surfaces
Usually, the clinical manifestations are caused by the underlying
➢ Pneumonia causes fever, chills, and pleuritic chest pain,
➢ A malignant effusion may result in dyspnea, difficulty lying flat,
➢ A large pleural effusion causes dyspnea (shortness of breath).
➢ A small-to- moderate pleural effusion causes minimal or no
Assessment of the area of the pleural
1- decreased or absent breath sounds
2- decreased fremitus and a dull, flat sound on percussion.
3-Tracheal deviation away from the affected side may also be apparent.
* In the an extremely large pleural effusion, the assessment reveals a
patient in acute respiratory distress.
2-Computed tomography (CT) scan of the chest
3-Ultrasound of the chest
4-Thoracentesis (a needle is inserted between the ribs to
remove a biopsy, or sample of fluid)
5-Pleural fluid analysis (an examination of the fluid
removed from the pleura space)
6- Cytologic analysis for malignant cells
The objectives of treatment
1-discover the underlying cause of the pleural effusion
2- prevent re-accumulation of fluid
3-relieve discomfort, dyspnea, and respiratory compromise.
Specific treatment is directed at the underlying cause (e.g.,
heart failure, pneumonia, and cirrhosis)
Diuretics and other heart failure medications are used to
treat pleural effusion caused by congestive heart failure.
A malignant effusion may also require treatment with
chemotherapy, radiation therapy or a medication infusion
within the chest.
Procedures for treating pleural effusions include:
Tube thoracostomy (chest tube).
if the underlying cause is a malignancy result
re-accumulation of fluid,Repeated thoracenteses
result in pain, depletion of protein and electrolytes,
A chemical pleurodesis performed to obliterate the
pleural space and prevent re-accumulation of fluid .
using thoracoscopic approach or chest tube.
A chemically irritating agent (e.g., talc or another) is instilled or
aerosolized into the pleural space.
after instilled, the chest tube is clamped for 60 to 90 minutes and
the patient is assisted to assume various positions to promote
uniform distribution of the agent and to maximize its contact with
the pleural surfaces
The tube is unclamped and chest drainage continued several days
longer to prevent re-accumulation of fluid and to promote the
formation of adhesions between the visceral and parietal pleurae
Hinkle, J. L., & Cheever, K. H. (2018).
Brunner and Suddarth’s textbook of medical-
surgical nursing. Wolters kluwer india Pvt Ltd.