Respiratory Distress, Tracheostomy Care and Chest Tubes

Recognizing Respiratory Distress and Hypoxia

Prompt identification of oxygenation problems is essential to safe nursing care. Early signs of hypoxia include restlessness, anxiety, irritability, tachycardia, and tachypnea. When oxygen levels drop, the brain and heart react first to compensate for the shortage. If hypoxia progresses without effective intervention, late signs of severe hypoxia emerge, including cyanosis, bradycardia, marked lethargy, and a decreased level of consciousness. The practical nurse immediately alerts the RN and activates the emergency response system for sudden respiratory depression, cyanosis, or tracheal deviation.

Increased work of breathing indicates that a client is struggling to move air. Key visual signs include retractions, nasal flaring, and the active use of sternocleidomastoid accessory muscles. Clients may also experience orthopnea, which is difficulty breathing while lying supine that is relieved by sitting upright. An ominous data finding is paradoxical abdominal breathing, where the abdomen pulls inward during inhalation rather than expanding outward; this indicates diaphragmatic fatigue and impending respiratory failure.

The practical nurse collects focused respiratory data, including rate, rhythm, depth, oxygen saturation, and lung sounds. An oxygen saturation below 90% generally indicates hypoxemia, although some clients have a prescribed target of 88% to 92%. The practical nurse promptly reports a new low reading or one below the prescribed range to the RN. When caring for a client in acute respiratory distress, the practical nurse helps the client sit upright in a position that eases breathing, such as high-Fowler or tripod position, and promptly alerts the RN.