Previous section | Next section

Ineffective breathing pattern

Related theory

Post‐operatively, respiratory function can be influenced by a number of factors:
  • increased bronchial secretions from inhalation anaesthesia
  • decreased respiratory effort from opiate medication
  • pain or anticipated pain from surgical wounds
  • surgical trauma to the phrenic nerve
  • pneumothorax as a result of surgical or anaesthetic procedures
  • co‐morbidity, for example asthma or chronic obstructive pulmonary disease.
All factors affecting adequate expansion of the lungs and the ejection of bronchial secretions will encourage the development of atelectasis and consolidation of the affected lung tissue (AAGBI [5]). To prevent this, deep breathing exercises (DBEs), coughing exercises and early mobilization may be undertaken post‐operatively. DBEs help to remove mucus, which can form and remain in the lungs due to the effects of general anaesthetic and analgesics (which depress the action of the cilia of the mucous membranes lining the respiratory tract and also depress the respiratory centre in the brain). DBEs prevent pneumonia by increasing lung expansion and preventing the accumulation of secretions. They also initiate the coughing reflex; voluntary coughing in conjunction with DBEs facilitates the expectoration of respiratory tract secretions. A physiotherapist will often provide pre‐operative and/or post‐operative advice and/or assessment for DBEs. Note that patients will require adequate analgesia and support for their wound to enable DBEs and mobilization.

Evidence‐based approaches

Principles of care

Respiratory rate and function is often the first vital sign to be affected if there is a change in cardiac or neurological state. It is therefore imperative that this observation is performed accurately; however, studies show that it is often omitted or poorly assessed (NHS England and NHSI [136]). Routine post‐operative respiratory observations will include:
  • airway
  • respiratory rate (regular and effortless), rhythm and depth (chest movements symmetrical)
  • respiratory depression: indicated by hypoventilation or bradypnoea; may be opiate induced or due to anaesthetic gases
  • listening for audible signs of stridor, wheeze or secretions
  • observing any changes in the patient's colour for signs of peripheral or central cyanosis
  • pulse oximetry: should be above 95% on air (unless the patient has lung disease) and maintained above 95% if oxygen therapy is prescribed to prevent hypoxia or hypoxaemia
  • use of oxygen therapy: flow and method of delivery
  • any chest drains (if applicable).
Oxygen is administered to enable the anaesthetic gases to be transported out of the body, and is prescribed when patients have an epidural, patient‐controlled analgesia or morphine infusion. Nurses should ensure and record the following:
  • Oxygen therapy is prescribed.
  • Oxygen is administered at the correct rate.
  • Continuous oxygen therapy is humidified to prevent mucous membranes from drying out.
  • The skin above the ears is protected from the elastic on the mask or nasal prongs.
Previous section | Next section