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d Herbal medicine.

5 What does the term ‘breakthrough pain’ mean, and what type of prescription would you expect for it?

a A patient who has adequately controlled pain relief with short-lived exacerbation of pain, with a prescription that has no regular time of administration of analgesia.

b Pain on movement which is short-lived, with a q.d.s. prescription, when necessary.

c Pain that is intense, unexpected, in a location that differs from that previously assessed, needing a review before a prescription is written.

d A patient who has adequately controlled pain relief with short-lived exacerbation of pain, with a prescription that has 4-hourly frequency of analgesia if necessary.

6 A patient has just returned from theatre following surgery on their left arm. They have a PCA infusion connected and from the admission, you remember that they have poor dexterity with their right hand. They are currently pain free. What actions would you take?

a Educate the patient’s family to push the button when the patient asks for it. Encourage them to tell the nursing staff when they leave the ward so that staff can take over.

b Routinely offer the patient a bolus and document this clearly.

c Contact the pain team/anaesthetist to discuss the situation and suggest that the means of delivery are changed.

d The patient has paracetamol q.d.s. written up, so this should be adequate pain relief.

7 In which of the following situations might nitrous oxide (Entonox) be considered?

a A wound dressing change for short-term pain relief or the removal of a chest drain for reduction of anxiety.

b Turning a patient who has bowel obstruction because there is an expectation that they may have pain from pathological fractures.

c For pain relief during the insertion of a chest drain for the treatment of a pneumothorax.

d For pain relief during a wound dressing for a patient who has had radical head and neck cancer that involved the jaw.

8 What are the key nursing observations needed for a patient receiving opioids frequently?

a Respiratory rate, bowel movement record and pain assessment and score.

b Checking the patent is not addicted by looking at their blood pressure.

c Lung function tests, oxygen saturations and addiction levels.

d Daily completion of a Bristol stool chart, urinalysis, and a record of the frequency with which the patient reports breakthrough pain.

These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.

Answers to the multiple choice questions can be found in Appendix 3.

Chapter 10

Respiratory Care

Overview

This chapter explains the nursing management and assessment of patients with respiratory problems. Administration of oxygen therapy, managing patients with chest drains and tracheostomies, counselling patients regarding smoking cessation and performing cardiopulmonary resuscitation (CPR) will be discussed.

Respiratory therapy

Definition

The principle of oxygen therapy is the application of pharmacological and non-pharmacological means to improve breathing and therefore improve gaseous exchange. This will include an assessment of the cause of the impaired breathing, reversal of causes where possible and therapies to optimize respiratory function (Shelledy and Mikles 2002).

Anatomy and physiology

See also Chapter 12.

The respiratory system is a complex system that is responsible for the efficient exchange of the respiratory gases, primarily oxygen and carbon dioxide. The respiratory system is responsible for ensuring a continuous optimum supply of oxygen to the tissues and the elimination of carbon dioxide during expiration. Four separate functions are necessary to achieve optimal respiration (Marieb et al. 2010).

1 Pulmonary ventilation: adequate breathing and movement of air in and out of the lungs, ensuring a fresh supply of oxygen to the alveoli.

2 External respiration: ensuring adequate gas exchange, oxygen uptake and carbon dioxide unloading between the blood and