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becoming bradypnoea as it worsens), dyspnoea, tachycardia, hypertension, headaches, vasodilation, drowsiness, sweating and a red colouration (Shelledy 2009). Patients with hypercapnia will require urgent medical attention and close monitoring as hypercapnia will cause a respiratory acidosis (Beachy 2009). Patients with chronic hypercapnia have, at least partially, adapted to the chronically high levels of carbon dioxide, such as those who have COPD; in these patients oxygen therapy needs to be administered with caution (Marieb and Hoehn 2010).

Hypoxia is defined as a low level of oxygen delivery to the tissues and the signs of it include tachypnoea, dyspnoea, tachycardia, restlessness and confusion, headache, mild hypertension and pallor (Shelledy 2009). However, in its severe stages the symptoms will worsen leading to slow, irregular breathing, cyanosis, hypotension, altered level of consciousness, blurred vision and eventual respiratory arrest (Shelledy 2009). Hypoxia can have various causes.

Anaemic hypoxia: low red blood cell counts or red blood cells which do not contain enough haemoglobin cannot transport adequate amounts of oxygen.

Ischaemic hypoxia: this is where blood flow to a specific area is inadequate to supply enough oxygen, which can occur as a result of embolism or thrombosis.

Histotoxic hypoxia: there is adequate oxygenation but the cells cannot use the oxygen; this can occur as a result of poisons such as cyanide.

Hypoxaemic hypoxia: there is reduced arterial oxygen as a result of abnormal ventilation or perfusion to the lungs, or breathing air with inadequate amounts of oxygen. Carbon monoxide poisoning can also cause this.

(Marieb and Hoehn 2010)

Evidencebased approaches

Rationale

A thorough respiratory assessment is vital to:

identify patients who are at risk of deterioration

commence treatment that may stabilize and improve the patient’s condition and outcomes

help prevent unnecessary admission to critical care or intensive care units.

(Higginson and Jones 2009)

An alteration in the respiratory observations can indicate a severe derangement in a range of body systems, not simply the respiratory system, so it is a vital indicator of morbidity (Cretikos et al. 2008). Indeed, respiratory observations are often the first sign to alter in a deteriorating patient so timely, accurate observations, leading to escalation of treatment, could prevent critical events occurring (Goldhill et al. 1999, Hunter and RawlingsAnderson 2008).

Indications

All patients who are in hospital should have observations taken at the time of their admission or their initial assessment (NICE 2007b).

When a patient is transferred to a ward setting for intensive or highdependency care (NICE 2007b).

At least once every 12 hours while in hospital (NICE 2007b).

If there is any change or deterioration in the patient’s condition (NICE 2007b).

If the patient is acutely ill or at risk of respiratory deterioration then they will require continuous pulse oximetry and frequent respiratory assessment (Booker 2009, Levine 2007).

If the patient is receiving oxygen therapy then they will need to be closely monitored to ensure its efficacy (Higginson and Jones 2009).

Following medical situations including surgery, trauma or infections (Booker 2009, Hunter and RawlingsAnderson 2008).

To monitor the patient who is receiving blood or blood product transfusions or intravenous fluids (Hunter and RawlingsAnderson 2008).

Any patient who has, or is at risk of, chronic hypercapnia should have close monitoring of their respiratory function (O’Driscoll et al. 2008).

To monitor the patient’s response to medications, including opiates and bronchodilators (Hunter and RawlingAnderson 2008).

Methods of assessing respiration

Airway assessment

It is important to assess whether there is any obstruction to the patient’s airway from vomit, foreign bodies or the patient’s tongue (Higginson and Jones 2009). In the conscious patient, a way to check for a patent airway is to ask them a question; if they are able to answer normally then their