atients and the Nursing and Midwifery Council (NMC) (2018) expect nurses to use their knowledge and skills, to identify when their patients are unwell and to act on the information received. Respiratory rate is part of the holistic assessment of a patient, and careful monitoring should be used if the respiratory rate changes put it outside the patient's normal range (Kelly, 2018). Respiratory rate is a non-invasive and useful assessment tool and abnormalities in respiratory rate have been shown to indicate patient deterioration and should be managed accordingly (Cooper et al, 2014). However, evidence suggests that nurses may fail to take an accurate respiratory rate (McGain, 2008; Semler et al, 2013; Flenady et al, 2017). Changes and anomalies in respiratory rate are not simply associated with respiratory conditions-they are a good indicator that a patient is struggling to maintain homeostatic control (the body's internal environment). Respiratory rate is an early, extremely good indicator of physiological conditions such as hypoxia (low levels of oxygen in the cells), hypercapnia (high levels of carbon dioxide in the bloodstream), metabolic and respiratory acidosis. Cretikos et al (2008) showed that respiratory rate is a strong and explicit forecaster of events such as cardiac arrest and unexpected intensive care admissions. Dougherty and Lister (2015) discussed how respiratory rate can help identify patient deterioration, assess response to treatment, and help identify when a patient requires an escalation in care. Actions taken when indicators suggest that a patient is deteriorating improve
Noninvasive ventilation is becoming a more commonly used long-term treatment for various conditions in which the patient experiences chronic hypercapnic respiratory failure (type 2 respiratory failure). This article aims to discuss why patients require long-term noninvasive positive pressure ventilation (NPPV), and to describe some of the care considerations required for this patient group, in addition to challenges that nurses in the home care environment face when supporting these patients at home. The article provides a brief pathophysiological overview, while also discussing the use of NPPV as symptom support for patients with severe disease in the later stages of their lives. The term ‘noninvasive positive pressure ventilation’ is used to cover a number of different noninvasive systems, although the study primarily focuses on bi-level ventilation systems.
The assessment, care and management of patients requiring oxygen therapy are key aspects of a nurse's role. Although oxygen therapy is an important treatment for many clinical conditions, it carries risks and complications; therefore, nurses and other health professionals have a responsibility to ensure safe and effective practice along with maintaining and developing their knowledge and skills in this therapy. The relevant aspects of physiology and pathophysiology were explored and discussed in part one of this article ( Rolfe and Paul, 2018 ). The aims of the second part are to discuss: (1) the indications for oxygen therapy; (2) the principles of assessment, care and management of adult patients requiring oxygen therapy; and (3) recommendations for the safe and effective use of oxygen devices, along with the potential complications.
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