Question

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6. Show how nurses implement nursing interventions to assist the patient and family to cope with the psychosocial impact caused by severe respiratory problems. Give three separate examples
7. How can nurses apply knowledge of anatomy and physiology to assess critically ill patients with respiratory problems affecting gas exchange or perfusion.
8. Give three examples of how to teach the patient and caregiver(s) about common drugs and other management strategies used for respiratory problems.
9. Show how a nurse can implement evidence-based nursing interventions to prevent complications of pulmonary embolism, mechanical ventilation, or any other critical respiratory problem.

Answer 1

Anxiety and depression are common and important comorbidities in patients with breathing difficulties. The presence of anxiety and/or depression in COPD or other severe respiratory problems ,patients is associated with increased mortality, exacerbation rates, length of hospital stay, and decreased quality of life and functional status. There is currently no consensus on the most appropriate approach to screening for anxiety and depression in COPD.

Additional high quality studies are urgently required to optimise screening and effective treatment of anxiety and depression in patients with respiratory disorders , to enhance complex chronic disease management for these patients.

Depression and anxiety, when coexisting with respiratory distress significantly impact quality of life and functional outcomes. In acknowledgement of the biopsychosocial impact of chronic ill health, the World Health Organization has stated that patients with chronic diseases such as COPD should receive integrated care programs which are centered on the patient rather than just the disease . Fortunately, interventions targeting these psychological comorbidities are well-established for the general population . However psychological care guidelines are less well developed for the specific patient population . Where psychological treatments have been used in COPD, these have typically been based on guidelines already in use for depression and anxiety in the wider population Treatments can be divided into psychological relaxation, cognitive behavioural therapy (CBT), self-management] and pharmacological interventions. Pulmonary rehabilitation, a specific treatment for COPD, also has beneficial effects on anxiety and depression.

Psychological therapies

For patients with a chronic health condition who are also experiencing clinical or sub-threshold depression, the UK’s National Institute for Health and Care Excellence (NICE) recommends use of low to high intensity psychosocial interventions depending on the severity of mood symptoms . Low intensity interventions may include individual or self-help programs, or online CBT, while high intensity interventions are typically individual or group CBT sessions. These recommendations are based on moderate quality randomized controlled trials and the experience and opinion of the Guideline Development Group. While the NICE guideline targets general chronic health presentations, good quality studies are somewhat lacking in COPD-specific populations. Existing studies show mixed results that are difficult to compare, because of factors such as small sample size, varied populations, lack of data on disease severity and differences in the screening tools used to assess these patients. A recent meta-analysis has described the benefits of the most common psychological interventions—relaxation therapy, CBT and self- management education programs

2.Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation with each other is important for understanding respiratory physiology. Ventilation to perfusion ratio alters with anaesthesia, body position and with one-lung anaesthesia. Hypoxic pulmonary vasoconstriction, an important safety mechanism, is inhibited by majority of the anaesthetic drugs. Ventilation perfusion mismatch leads to reduced arterial oxygen concentration mainly because of early closure of airway, thus leading to decreased ventilation and atelectasis during anaesthesia. Various anaesthetic drugs alter neuronal control of the breathing and bronchomotor tone.

Accurate knowledge of anatomy and physiology of the respiratory tract is important not only in the field of pulmonology but also in anaesthesiology and critical care. About 70–80% of the morbidity and mortality occurring in the perioperative period is associated with some form of respiratory dysfunction. General anaesthesia and paralysis are associated with alterations in the respiratory function. Dynamic anatomical changes and physiological alteration happening during anaesthesia make it imperative for an anaesthesiologist to have sound knowledge of the respiratory system and apply it for safe and smooth conduct of anaesthesia. Such knowledge has influence on clinical practice of airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and surgeries, optimising ventilator strategies in perioperative period and designing airway devices.

3.Most patients have families that are providing some level of care and support. In the case of older adults and people with chronic disabilities of all ages, this “informal care” can be substantial in scope, intensity, and duration. Family caregiving raises safety issues in two ways that should concern nurses in all settings. First, caregivers are sometimes referred to as “secondary patients,” who need and deserve protection and guidance. Research supporting this caregiver-as-client perspective focuses on ways to protect family caregivers’ health and safety, because their caregiving demands place them at high risk for injury and adverse events. Second, family caregivers are unpaid providers who often need help to learn how to become competent, safe volunteer workers who can better protect their family members (i.e., the care recipients) from harm.