Timby's MedSurg 14e

298

UNIT 5 Caring for Clients With Respiratory Disorders

NURSING GUIDELINES 20-1

General Care for an Adult and Child: Choking (Guidelines From the American Red Cross) ( Note: Hands crossed at the neck is the universal sign of choking.) 1. Stand to the side and slightly behind the choking person. For a small child, kneel behind them rather than stand. 2. Perform five back blows using the heel of the hand to strike between shoulder blades. 3. Stand the person up straight if there is the person is continuing to choke. 4. Stand behind the person, and with knees bent slightly, perform five abdominal thrusts, pulling inward and upward. 5. Alternate performing five back blows and five abdominal thrusts until the person can cough, cry, speak, or becomes unresponsive. 6. If the person becomes unresponsive, lower them to a firm, flat sur face and begin cardiopulmonary resuscitation (CPR) (starting with compressions). 7. After each set of compressions and before attempting breathe, open the person’s mouth to look for an object. If an object is seen, remove with finger. Finger sweeps should not be performed unless an object is visible.

Abdominal thrusts on a conscious patient.

Clinical Scenario A client was seen in a clinic for a diagnostic procedure that required contrast. During the procedure, the client begins to complain of difficulty breathing and a feeling of fullness in the throat. What actions by the nurse are essential to this client’s care? See the following Nursing Process section.

NURSING PROCESS FOR THE CLIENT WITH LARYNGEAL OBSTRUCTION

Assessment Assess for air movement within the upper respiratory tract. Listen to lung sounds, monitor respiratory patterns, and look for

signs of increased nasal swelling and bleeding and symptoms of laryngeal edema.

Diagnosis, Planning, and Intervention Partial or total obstruction of the upper airway requires immediate recognition and intervention. When edema is the cause of partial upper airway obstruction, oxygen can be given until a primary provider is available to treat the client. Most likely procedures and pro tocols are in place to treat this emergency. Emergency drugs and a tracheostomy tray are available for immediate use. Other measures are as follows: Altered Breathing Pattern: Related to partial obstruction of the upper airway secondary to edema Expected Outcomes: (1) Client will maintain a patent airway. (2) Client will demonstrate improved breath sounds.

• Assess vital signs and monitor for changes frequently or un til the client demonstrates signs of improvement. Increased work of breathing will increase respiratory rate and heart rate. • Monitor arterial blood gases (ABGs). Increasing PaCO 2 and decreasing partial pressure of oxygen (PaO 2 ) indicate impending respiratory failure. • Position client in the semi-Fowler position. This posi tion promotes maximum lung expansion and improved air exchange.

• Assess airway patency frequently until treatment is initiated. Maintaining the airway is the highest priority. • Auscultate lungs for wheezing or decreased or absent breath sounds frequently until treatment is initiated and then as needed to assess client. Wheezing may indicate increased airway resis tance. Decreased or absent breath sounds indicate obstruction. • Discontinue administration of contrast agent. Removing the potential cause of the airway obstruction reduces the client’s reaction to the allergen and improves the client’s response to treatment.

Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. • Initiate CPR and prepare for possible airway intubation/ tracheostomy if airway is completely obstructed. Preparation for potential emergency assists to maintain the airway. • Administer subcutaneous epinephrine and a corticosteroid per orders and/or protocols. These medications reduce the edema and relieve the obstruction.

• Assess respiratory effort, including respiratory rate, depth, nasal flaring, and use of accessory muscles. Increased respi ratory effort indicates respiratory difficulties.