The purpose of this evidence-based nursing practice paper is to discuss the effectiveness of deep-breathing exercises in the care of a patient who is recently postoperative a coronary artery bypass graft surgery (CABG). It will also critique two professional research studies on this topic, and will answer three essential questions about each study. What are the results of the study? Are the results of the study valid? How are the findings clinically relevant to this patient?
The patient, who will be referred to as Mr. Doe throughout this paper, is a 58 year old male with coronary artery disease. His medical history includes angina, shortness of breath, diabetes type II, as well as hypercholesterolemia. He was scheduled for a CABG surgery, and it was performed on February 4 of this year (Mr. Doe, personal communication).
Two days postoperative, Mr. Doe had regular complaints of pain and nausea, for which he was medicated for by a patient-controlled analgesia (PCA) pump and with intravenous medication. He had diminished breath sounds in his right and left upper lobes, and his O2 saturations were steady at 94%. He was reluctant to ambulate in the early morning, stating that the nausea was too severe, and that the medications “made him too dizzy,” (Mr. Doe, personal communication). It was also difficult to get Mr. Doe to perform deep-breathing exercises every hour because of the nausea, but he did perform them when prompted to by the nurse and being reminded how important these exercises are in preventing complications.
Deep breathing exercises are very important after any surgery. Current research states that “postoperative hypoventilation can be a problem after abdominal or thoracic surgery if pain prevents the patient from ...
... middle of paper ...
...patients.
Works Cited
Pruitt, B. (2006). Help your patient combat postoperative atelectasis. Nursing 2006, 36(5), Retrieved from February 17, 2010, from CINAHL with Full Text database.
Stiller, K., Montarello, J., Wallace, M., Daff, M., Grant, R., Jenkins, S., Hall, B., & Yates, H. (1994). Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. American College of Chest Physicians, 105(3), 741-747. Retrieved from http://chestjournal.chestpubs.org/content/105/3/741.
Westerdahl, E., Lindmark, B., Eriksson, T., Friberg, O., Hedenstierna, G., & Tenling, A. (2005). Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. American College of Chest Physicians, 128(5). Retrieved from http://chestjournal.chestpubs.org/content/128/5/3482.full.html.
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes an acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used; a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiratory pressure.
It is not uncommon for a patient to experience pain and anxiety before or after a major procedure or breathing treatment. Imagining the myriad of complications that might occur during an operation can send one into multiple panic attacks. Coping with the loss of mobility and independence joined by the pain that accompanies recovery are only a few examples of the complex and traumatic experiences awaiting pre/post-operation patients. Fortunately, a medication was synthesized by Armin Walser and Rodney I. Fryer in 1975 to aid patients by easing anxiety and promoting sleepiness before an operation. An added benefit was that the events experienced during the operation were also forgotten while the medication was still in effect.
Shortness of breath, less physical activity, due to not being able to breath while e`
Patients with atelectasis will vary in their manifestations, depending on the degree of area affected. Typically, breath sounds will be reduced or diminished on the side of the alveolar collapse and oxygen saturation will be decreased because air is unable to fill the alveolar sacs where the process of ventilation-perfusion is supposed to take place (Lewis et al., 2014). According to Porth (2015), the patient may also exhibit tachypnea, diminished chest expansion, intercostal retractions, dyspnea, and tachycardia. These symptoms demonstrate how the body reacts and its attempt to compensate for the lack of oxygen. This lack of oxygenation to tissues results in cyanosis (Porth, 2015). An individual undergoing such difficulty to breath will present distressed and anxious. A thorough assessment of the patient and presence of some of these manifestations contribute to the diagnosis of atelectasis, which would be supplemented by a chest radiograph for confirmation (Porth, 2015). Most post-operative patients who fall victim to atelectasis and present with the signs and symptoms described, usually have risk factors that increase their probability of acquiring the
If the patient is in severe respiratory distress it may be hard for her to perform self-care due to hypoxemia and dyspnea. Rest is important part of patient diagnosis. Exercise program can help the patient with increasing endurance and strength without causing severe dyspnea and can improve sense of
Whilst looking at the impact that breathlessness can have on patient the author will look at the physical, psychological and social health implications and how this can affect the overall (holistic) quality of life for these patients. Often these three areas overlap and the physical implications of breathlessness can have a direct effect on the patient’s social health, financial ability to provide for themselves and others, which in turn affects the person physiological well-being or vice versa.
Describe how the client was monitored by the anesthesiologist or nurse anesthetist during the procedure. Include what type of anesthesia the client received and how the airway was maintained and monitored.
...respiratory distress syndrome after pulmonary resection. General Thoracic and Cardiovascular Surgery, 61(9), 504-512. Doi: 10.1007/s11748-013-0276-7
Patient care for the RN requires a holistic view of the patient. Although Mr Brown is admitted for knee replacement surgery, the nursing care will also take into consideration, Mr Brown’s co-morbidites and the impact of these on his recovery following surgery. Elderly patient’s with COPD have a higher mortality rate, this can be related to the medications used in anesthetics and the effect on the pulmonary system (Gruber & Tschernko., 2015). Medications used through the surgery may impact on the lungs by altering how the patient breathes and what muscles they are using to breath. If the patient is on a mechanical breathing device, there is a high chance of altered gas exchange through the alveoli and a risk of a collapsed lung or partial collapse
These protocols include performing preoperative and postoperative lung expansion exercises, assessing breathing patterns and most importantly performing a thorough preoperative evaluation. Lung expansion exercises such as incentive spirometry, coughing and deep breathing, chest physiotherapy and the use of CPAP mask are all important exercises that should be performed postoperatively and even in some cases preoperatively. Assessing breathing patterns can be an early indicator of imminent respiratory failure. Furthermore, performing a good preoperative evaluation can help the healthcare team become aware of any risks the patient may have and know how to prevent them or treat them (V. Horowitz, personal communication, September
...o those patients with chest pain, in order to maintain oxygen saturations as close to 100%, unknowingly realizing that the patient is being exposed to significant periods of hyperoxia (Moradkham & Sinoway, 2010 ). It has been suggested that this is due to poor monitoring skills by health professionals. (Moradkham & Sinoway, 2010 ). From reading this essay it is clear that there is a high demand and need of further clinical research into the effectiveness of oxygen in the client with chest pain. More research also has to be conducted in order for the health professionals to fully understand what oxygen does to the body. Through completing and implementing more updated and reviewed evidence and research on the effect of oxygen on the client with chest pain, a better practice can be put in place to ensure the patient is receiving the best care to save their life.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
...., & Jr, L. H. (1992). Release of vasoactive substances during cardiopulmonary bypass. Annals of Thoracic Surgery. doi:10.1016/0003-4975(92)90113-I-6