Lung and respiratory assessment

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Working in a long-term care psychiatric hospital with forensic patients is a very exciting and rewarding experience. Completing head-to-toe assessments is of critical importance. Concise and accurate documentation is vital so that changes over time can be noted.

One of the areas of assessment that seems to have more attention than other systems is that of the lungs and the respiratory system. This is in part due to three primary factors:
1. smoking, 2. respiratory infections, and 3. chronic illness.

Smoking is probably the most troublesome with respiratory infections coming in a close second. Smoking cessation used to be a program component until repeated budget cuts in the state system disallowed provider resources to continue this important program. The majority of the patients (80%) are able to smoke only four (4) times per day, but the remaining 20% of the patients can actually smoke most times of the day. Nursing staff must continually assess cough, sputum production, and auscultate the anterior/posterior chest for abnormal sounds.

Respiratory infections, in a cloistered living area, are always of major concern. Assessing for an infection must be swift and accurate. Emphasis on standard precautions with continuous education on droplet control and hand washing is imperative. The nurse must be able to differentiate adventitious sounds and report their findings promptly to the attending. I believe this is one of the most challenging areas in nursing practice; when there is no means to isolate patients, numerous patients have poor hygienic habits, and so containing influenza and respiratory infections is very difficult in an institutional setting.

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