During normal respiration, eating, drinking and speaking in full sentences are effortless. The first stage of a respiratory assessment is to observe the patient for the following:

A thorough patient history and physical assessment will help to determine what the underlying cause of the respiratory concern may be. Additional investigations such as a chest X‐ray, arterial blood gas analysis, and a computed tomography (CT) scan or ventilation/perfusion (V/Q) scan may also be necessary to aid diagnosis.

Having made a comprehensive assessment, the immediate cause of respiratory insufficiency should be corrected where possible. The cause may be directly related to respiratory function or a secondary effect of another process. For example, the patient may be in severe pain and good pain management may allow them to breathe deeply and cough more effectively, improving respiratory function. Conversely, an opioid overdose may result in decreased or absent respiration, and treatment will include supporting respiration and administering the antidote to the opioid. Regardless of the cause, respiratory function needs to be supported while the underlying condition is being treated (O'Driscoll et al. [209]).

Respiratory therapy therefore includes a variety of interventions, such as:

Surgery may be indicated to repair a ruptured diaphragm or to manage trauma of the thoracic cavity. Some patients may require insertion of a tracheostomy tube or chest drain, or a stent or shunt for superior vena cava obstruction (for example). Finally, positioning (see Chapter c07: Moving and positioning) and physiotherapy play a major role in improving respiratory function (English [72]). Any person who is unable to maintain tissue oxygenation requires supplemental oxygen until they are able to manage again on room air.