CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC DevelopmentNOT FOR SALE OR DISTRIBUTIONand ImplementationNOT FOR SALE OR DISTRIBUTION of Respiratory Care Plans © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DavidDISTRIBUTION C. Shelledy, Jay I.NOT Peters FOR SALE OR DISTRIBUTION © Toria/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE 11. Design a respiratory care plan to mobilize secretions. 12. Propose a respiratory care plan for the treatment and/or Overview © Jones & Bartlett Learning, LLC prevention of atelectasis and© pneumonia. Jones & Bartlett Learning, LLC Introduction to RespiratoryNOT Care Plans FOR SALE OR DISTRIBUTION13. Give examples of types of respiratoryNOT FOR care plans SALE used inOR the DISTRIBUTION Common Conditions Requiring Care Plan Development intensive care unit. Respiratory Care Plan Development 14. Explain the role of diagnostic testing in the development of a Maintain Adequate Tissue Oxygenation respiratory care plan. Treat and/or Prevent Bronchospasm and Mucosal Edema Assessment and Treatment of COPD KEY TERMS Mobilize© Jones and Remove & SecretionsBartlett Learning, LLC © Jones & Bartlett Learning, LLC ProvideNOT Lung FOR Expansion SALE Therapy OR DISTRIBUTION acute respiratoryNOT distress FOR SALEhistory OR DISTRIBUTION Critical Care and Mechanical Ventilation syndrome (ARDS) hypoxemia Diagnostic Testing acute respiratory incentive spirometry (IS) Respiratory Care Plan Format failure (ARF) inhaled corticosteroid acute ventilatory (ICS) CHAPTER OBJECTIVES failure (AVF) intermittent positive © Jones & Bartlett Learning, LLC © Jonesairway &clearance Bartlett Learning,pressure LLC breathing 1. Describe the purpose of a respiratory care plan. techniques (ACT) (IPPB) NOT FOR SALE2. Identify OR the DISTRIBUTION key elements of a respiratory care plan. NOTantiasthmatic FOR SALE medication OR DISTRIBUTIONlung expansion therapy 3. Describe common conditions that may require development anti-inflammatory agent mechanical ventilation of a respiratory care plan. asthma mucosal edema 4. Define respiratory failure, and give examples of several types atelectasis oxygen therapy of respiratory failure. bronchial hygiene physical 5. Define ventilatory ©failure Jones, and contrast & Bartlett acute ventilatory Learning, LLCbronchiectasis ©pneumonia Jones & Bartlett Learning, LLC failure and chronic ventilatory failure. bronchodilator therapy positive airway 6. Give examples of NOTappropriate FOR outcome SALE measures OR for DISTRIBUTION a bronchospasm NOTpressure FOR (PAP) SALE OR DISTRIBUTION respiratory care plan. chest physiotherapy (CPT) protocol 7. Outline the key steps in the development and implementation chronic bronchitis pulmonary edema of a respiratory care plan. chronic obstructive respiratory care plan 8. Develop a respiratory care plan to maintain adequate tissue pulmonary disease retained secretion oxygenation. (COPD) six-minute walk test (6MWT) 9.© JonesCreate a respiratory & Bartlett care plan Learning, for the treatment LLC and/or chronic ventilatory© Jones & BartlettSOAP note Learning, LLC NOTprevention FOR of SALE bronchospasm OR andDISTRIBUTION mucosal edema. failure (CVF)NOT FOR SALEtreatment OR DISTRIBUTION menu 10. Describe the care of patients with asthma and COPD. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 25 © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284217155_CH02_025_068.indd 25 28/11/20 5:25 PM 26 CHAPTER 2 Development and Implementation of Respiratory Care Plans © Jones &Overview Bartlett Learning, LLC © JonesO (Objective). & Bartlett Refers Learning, to what the LLC clinician observes or objective test results. This chapter provides a guide to the development, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION A (Assessment). Refers to the clinician’s assessment. implementation, and evaluation of respiratory care P (Plan). Refers to the plan of care. plans. The respiratory care plan provides a detailed description of the care to be provided based on the in- A modification known as SOAPIER adds care plan dividual needs of the patient. Care plans often include documentation of the following: assessment, diagnosis,© orJones problem & list;Bartlett goals and/or Learning, ob- LLC © Jones & Bartlett Learning, LLC I (Intervention). What was done. jectives; specific activitiesNOT FORor interventions SALE OR to be DISTRIBUTION taken; NOT FOR SALE OR DISTRIBUTION E (Evaluation). The clinician’s evaluation of the care outcomes of care provided; and evaluation. In order to provided. develop an appropriate respiratory care plan, the clini- R (Revision). Any changes in care provided based on cian must first perform a thorough patient assessment, the clinician’s evaluation. including a review of the patient’s existing medical re- cord,© aJones patient interview,& Bartlett and Learning, a physical assessment. LLC The Further details© Jones of SOAPIER & Bartlett can be Learning, found in LLC bedsideNOT measurement FOR SALE of clinicalOR DISTRIBUTION parameters related to Chapter 3. TheNOT respiratory FOR SALE care planOR mayDISTRIBUTION also include oxygenation, ventilation, and pulmonary function may a statement of how the intensity and/or duration of be performed. Pulse oximetry (Spo2) is routinely used therapy will be adjusted and when the therapy will be to assess oxygenation status. Arterial blood gases should discontinued. Assessment of the outcomes of therapy be obtained if there is concern regarding the patient’s may also be included, as well as measurable objectives © Jones & ventilatoryBartlett status,Learning, acid–base LLC balance, or the reliability of© Jonesof the &care Bartlett delivered. Learning, LLC NOT FOR SALESpo2 values. OR Laboratory,DISTRIBUTION imaging, and other diagnostic NOT FOR SALE OR DISTRIBUTION studies may be needed to further define and clarify the RC Insight patient’s problem and diagnosis. Following establish- ment and clarification of the patient’s diagnosis and/or The respiratory care plan provides a written de- problem list (see Chapter 1), a respiratory care plan is scription of the care the patient is to receive, based developed, implemented,© Jones and evaluated. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONon a thorough assessmentNOT and determination FOR SALE of OR DISTRIBUTION Introduction to Respiratory the care needed. Care Plans In summary, the respiratory care plan provides the Therespiratory care plan provides a written descrip- © Jones & Bartlett Learning, LLC written plan© of Jones treatment & thatBartlett the patient Learning, will receive. LLC tion of the care the patient is to receive. The plan is based The plan may include goals, objectives, rationale, sig- on NOTa careful FOR patient SALE interview OR and DISTRIBUTION physical assessment, nificance, andNOT a description FOR SALE of how OR care DISTRIBUTION will be assessed. review of diagnostic test results, and consideration of Following a careful patient assessment, the respiratory the treatment modalities available, sometimes known care plan is developed, implemented, and evaluated. A treatment menu as the . The respiratory care plan may take summary of the types of care often included in the res- the form of physician’s orders, a detailed progress note piratory care plan is provided in Table 2-1. © Jones & in theBartlett medical Learning, record, an established LLC protocol, completion© Jones & Bartlett Learning, LLC NOT FOR SALEof a standardized OR DISTRIBUTION respiratory care consultation and treat- NOTCommon FOR SALE Conditions OR DISTRIBUTION Requiring ment plan template, or the use of problem-oriented medi- cal records (e.g., SOAP notes). The respiratory care plan Respiratory Care Plan can be viewed as an individualized protocol for the patient. Development A basic respiratory care plan often includes the fol- Problems that affect oxygenation and/or ventila- lowing elements: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tion often require the development of a respiratory ■ Goals of therapyNOT FOR SALE OR DISTRIBUTIONcare plan. Other common respiratoryNOT FOR problems SALE in- OR DISTRIBUTION ■ Device or procedure to be used or medications to clude bronchospasm and mucosal edema, retained be given secretions, airway plugging, infection, consolidation, ■ Method or appliance to be used inadequate lung expansion, atelectasis, and pulmonary ■ Gas source or oxygen concentration edema. Common disease states or conditions en- © ■ Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTDevice FOR pressure, SALE volume, OR DISTRIBUTION and/or flow countered inNOT the physician’s FOR SALE office, OR clinic, DISTRIBUTION or acute ■ Frequency of administration and duration of care setting that may require respiratory care include therapy upper respiratory tract infection, pneumonia, acute bronchitis, asthma, chronic obstructive pulmonary SOAP notes are sometimes used to document patient disease (COPD) (including emphysema and chronic care plans: bronchitis © Jones & Bartlett Learning, LLC © Jones & Bartlett), pulmonary Learning, hypertension, LLC heart failure, lung NOT FOR SALES (Subjective). OR