Respiratory Complications: Nursing Care Plan

This paper provides a discussion about post-operative respiratory complications, focusing on the increased incidences in Canada and highlighting the past and current nursing practices in treating and managing respiratory complications. The paper also provides a nursing care plan to minimize the respiratory complications and achieve quality patient care with reduced patient outcomes.

Running head: RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
Respiratory Complications: Nursing Care Plan
Name of student:
Name of university:
Author Note:

1RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
Abstract
The following paper provides a discussion about post-operative respiratory complications,
focussing on the increased incidences in Canada and highlighting the past and current nursing
practices in treating and managing respiratory complications. The paper also provides a
nursing care plan to minimise the respiratory complications and achieve quality patient care
with reduced patient outcomes.
Keywords: respiratory complications, post-operative, post-surgery, nurses, patient
Introduction
Respiratory complications have been reported as common incidences in Canada;
research has shown that majority of respiratory complications occur due to post-operative
surgical procedures and during general anaesthesia in hospital settings. These often contribute
to acute respiratory failure in patients who have undergone surgical operations. Incidences of
respiratory complications have been commonly reported post-surgery, lung surgery being
most common. Atelectasis (complete lung collapse), acute respiratory failure and pneumonia
are common complications post-surgery. Respiratory complications may lead to deleterious
outcomes in patients, which as a result require improved nursing care and beneficial nursing
care plan to reduce respiratory fatalities.
Respiratory complications
Respiratory complications have been common post-surgery, atelectasis or complete
lung collapse being a common complication reported among Canadian patients with
estimates of 3.7 -7.9% (Brueckmann et al., 2013). Pulmonary oedema, pneumonia and re-
intubation are also commonly associated among patients post-surgery. These complications
lead to re-hospitalizations and often fatal outcomes for the patients. This is where the nursing

2RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
care and practice come into play to minimize the incidences of respiratory complications and
thereby promote an improved wellbeing of the patients and quality patient care.
Previous nursing practice
Past research evidences show that acute respiratory failure resulting post-surgical
procedures were treated and managed through non-invasive ventilation. Non-invasive
ventilation involved the delivery of mechanical ventilation preventing intubation
requirements. Non-invasive ventilation involves conventional tubing connected through a
face mask with disposable foam. The oxygen pressure support was increased in a regulated
manner to provide patient comfort. Standardized treatment through oxygen supplementation
used to be a method of treatment for acute respiratory failure (Scala & Pisani, 2018).
Endotracheal intubation was sometimes involved as an intervention for patients who did not
respond to standard oxygen supplementation or non-invasive ventilation. Endotracheal
intubation provided mechanical ventilation to protect the alveolar airways and managed to
remove the patient’s inability to undergo non-invasive ventilation. Conventional ventilation
involving intravenous administration of benzodiazepines was used alongside intubation
treatment.
These previous nursing practices have shown that the patients who have received
post-operative treatments to minimise the respiratory failure, have shown a chance of re-
hospitalizations due to lack of proper care post discharge. Many patients did not support non-
invasive ventilation due to their inability to tolerate the face mask associated with non-
invasive ventilation. Additional respiratory troubles have been encountered among patients
post-surgery. Ventilator induced injuries of the patients’ lungs are also observed (Ladha et
al., 2015). Over-inflation of lungs with decreased compliance have been observed among
patients receiving ventilator treatments.

3RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
Current nursing practice
Based on patients’ clinical outcomes, nursing practice has evolved through training
and education to focus on the roots of the respiratory complications and promote quality
patient care through designing and implementing various care plans in response to patients’
conditions. A simple and inexpensive strategic care plan in the name of ‘I COUGH’ program
has been developed and intervened in providing patient care in hospital settings This
incorporated lung expansion exercises, educating patients and their families about personal
hygiene (Ruscic et al., 2017). Relieving pain is also involved as a part of the strategic plan.
Post-operative pain management is also a necessity in mobilization goals.
Nursing officials play an extensive role in these practices. Collaborative efforts,
communication skill development, performing within multidisciplinary team, providing
individual patient care in response to their conditions are prime qualities of nurses which
determine the efficient implementation and beneficial outcomes of these practices.
Evidence-based nursing practice
With the increasing incidences of respiratory complications and its adversities among
patients post-surgical procedures, nurses have developed themselves with time through
education and training to enhance their knowledge and incorporate practice guidelines to
achieve quality patient care. The nurses have developed care plans based on past evidences
and have implemented these care plans and models to achieve an increased improvement in
patient care (Schmidt & Brown, 2014). The nurses involve in a multidisciplinary health care
team to devise a strategic care plan focussing on comprehensive patient and family education.
An ‘I COUGH’ nursing program has been designed and implemented as an evidence-based
nursing intervention to minimise incidences of respiratory complications (Cassidy et al.,
2013). The ‘I COUGH’ program puts its emphasis on incentive spirometry, both coughing

4RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
and deep breathing, oral care and understanding through education provided to patients and
their families, getting out of bed thrice on a daily routine and head-of-bed elevation (do
Nascimento Junior et al., 2014). Nurses and clinical physicians are provided with education
to put this ‘I COUGH’ intervention into practice.
Education as an important initiative
Major incorporation of the ‘I COUGH’ program involved providing education to
patients and their families, nursing officials and clinical physicians. Patients and their
families are provided detailed education regarding necessity of post-operative care to prevent
respiratory complications. A proper demonstration on the use of incentive spirometry is
provided to patients, nurses and clinical physicians in the preoperative setting. A brief
knowledge about I COUGH program elements is provided to the patients and their families.
A comprehensive nursing education formed a key initiative in the intervention procedure.
Attending clinical physicians and involved house staffs are similarly educated to promote
improvement in patient care (Veronovici et al., 2014). The nurses involved in clinical follow
up of patients are provided with necessary education and training, they collaborated with unit
nursing officials to clinically review the intervention outcomes and teach these unit nurses
about the principles of the ‘I COUGH’ intervention program.
Conclusion
Severity of respiratory complications in the post-operative stages occur due to gaps in
in nursing care. Efficient management of patient complications lead to reduced rates of
complications. Efficacy in treatment and management prior to operation leads to better
patient outcomes. The clinical improvement in respiratory complications cannot be fully
attributed to the nursing care; with newer levels of respiratory complications arising with
patient cases, the nursing care evolves through evidence-based research and enhanced

5RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
learning skills. Effective nursing care plan developed through evidence-based research lead to
a positive patient outcome through effective reduction of complication rates. Care models and
care plans are therefore better nursing interventions to reduce respiratory complicacies
through time to time modification.

6RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
References
Brueckmann, B., Villa-Uribe, J. L., Bateman, B. T., Grosse-Sundrup, M., Hess, D. R.,
Schlett, C. L., & Eikermann, M. (2013). Development and validation of a score for
prediction of postoperative respiratory complications. Anesthesiology: The Journal of
the American Society of Anesthesiologists, 118(6), 1276-1285.
doi:10.1097/ALN.0b013e318293065c
Cassidy, M. R., Rosenkranz, P., McCabe, K., Rosen, J. E., & McAneny, D. (2013). I
COUGH: reducing postoperative pulmonary complications with a multidisciplinary
patient care program. JAMA surgery, 148(8), 740-745.
doi:10.1001/jamasurg.2013.358
DiBardino, D. M., & Wunderink, R. G. (2015). Aspiration pneumonia: a review of modern
trends. Journal of critical care, 30(1), 40-48. doi.org/10.1016/j.jcrc.2014.07.011
do Nascimento Junior, P., Modolo, N. S., Andrade, S., Guimaraes, M. M., Braz, L. G., & El
Dib, R. (2014). Incentive spirometry for prevention of postoperative pulmonary
complications in upper abdominal surgery. The Cochrane Library. DOI:
10.1002/14651858.CD006058.pub3
Gattas, D. J., Dan, A., Myburgh, J., Billot, L., Lo, S., Finfer, S., & CHEST Management
Committee. (2013). Fluid resuscitation with 6% hydroxyethyl starch (130/0.4 and
130/0.42) in acutely ill patients: systematic review of effects on mortality and
treatment with renal replacement therapy. Intensive care medicine, 39(4), 558-568.
doi: 10.1007/s00134-013-2854-7.
Ladha, K., Melo, M. F. V., McLean, D. J., Wanderer, J. P., Grabitz, S. D., Kurth, T., &
Eikermann, M. (2015). Intraoperative protective mechanical ventilation and risk of

7RESPIRATORY COMPLICATIONS: NURSING CARE PLAN
postoperative respiratory complications: hospital based registry study. Bmj, 351,
h3646. doi.org/10.1136/bmj.h3646
Ruscic, K. J., Grabitz, S. D., Rudolph, M. I., & Eikermann, M. (2017). Prevention of
respiratory complications of the surgical patient: actionable plan for continued process
improvement. Current opinion in anaesthesiology, 30(3), 399.
Scala, R., & Pisani, L. (2018). Noninvasive ventilation in acute respiratory failure: which
recipe for success?. European Respiratory Review, 27(149), 180029.
DOI: 10.1183/16000617.0029-2018
Schmidt, N. A., & Brown, J. M. (2014). Evidence-based practice for nurses. Jones & Bartlett
Publishers.doi:10.1111/j.1365-2648.2011.05707.x
Semler, M. W., Janz, D. R., Lentz, R. J., Matthews, D. T., Norman, B. C., Assad, T. R., &
Kocurek, E. G. (2016). Randomized trial of apneic oxygenation during endotracheal
intubation of the critically ill. American journal of respiratory and critical care
medicine, 193(3), 273-280. doi.org/10.1164/rccm.201507-1294OC
Stéphan, F., Barrucand, B., Petit, P., Rézaiguia-Delclaux, S., Médard, A., Delannoy, B., &
Bérard, L. (2015). High-flow nasal oxygen vs noninvasive positive airway pressure in
hypoxemic patients after cardiothoracic surgery: a randomized clinical
trial. Jama, 313(23), 2331-2339. doi:10.1001/jama.2015.5213
Veronovici, N. R., Lasiuk, G. C., Rempel, G. R., & Norris, C. M. (2014). Discharge
education to promote self-management following cardiovascular surgery: An
integrative review. Canadian Journal of Cardiovascular Nursing, 13(1), 22-31.
doi.org/10.1177/1474515113504863

8RESPIRATORY COMPLICATIONS: NURSING CARE PLAN