6 Respiratory Nursing Priorities
Learn to recognize respiratory deterioration, prioritize airway and breathing, use oxygen and airway interventions safely, and evaluate whether a patient is improving.
Recognize respiratory deterioration
When breathing worsens, assess the patient rather than relying only on monitor readings. may impair oxygenation, carbon dioxide removal, or both. Increasing work of breathing, altered , and cyanosis are concerning signs.
A rising respiratory rate, accessory muscle use, restlessness, or slow answers can indicate deterioration. For example, a patient with pneumonia whose respiratory rate rises from to , begins using accessory muscles, and answers questions slowly needs prompt assessment and escalation—not routine observation or documentation alone.
Prioritize airway and breathing
In an acute change, stay with the patient, rapidly assess airway and breathing, and check oxygenation and vital signs. Provide immediate support within the prescribed plan and call for urgent clinical help, using the appropriate rapid-response or emergency pathway when indicated. Do not delay escalation for routine documentation or assume restlessness is only anxiety.
Prioritize airway and ventilation assessment when a patient becomes drowsy after an opioid. Oxygen alone does not correct inadequate ventilation. Do not wait for an result before responding to a patient who needs oxygen, and do not give a sedative simply to reduce anxiety when breathing is deteriorating.
Use oxygen and reassess the response
Treat with prescribed oxygen and titrate it toward the patient's . Do not withhold oxygen solely because a patient has COPD. The recommended saturation range is for patients with COPD and for most other hospitalized adults.
Reassess the patient's SpO₂, work of breathing, and after applying or adjusting oxygen. The monitor reading is only part of the assessment; consider whether the patient's overall clinical condition is improving. Do not increase oxygen simply to reach and then stop monitoring.
Interpret blood gases in context
Interpret an alongside the patient's clinical condition. A patient who becomes increasingly drowsy after receiving an opioid has an ABG with pH , PaCO₂ , and HCO₃⁻ . The low pH and elevated PaCO₂ indicate ; the near-normal bicarbonate suggests little metabolic compensation. Drowsiness in this situation raises concern for hypoventilation and deterioration.
Assess airway, ventilation, and level of consciousness, support breathing, and urgently notify the clinical team. Do not mistake this pattern for metabolic acidosis or assume that no action is needed because the condition is compensated.
Respond to ventilator alarms
A may signal a patient emergency. If a mechanically ventilated patient is visibly distressed and SpO₂ is falling, immediately assess the patient, airway, breathing, oxygenation, and circuit while calling for help. Do not silence the alarm and leave, assume a monitor malfunction, or change ventilator settings without an order.
If the patient is unstable or the ventilator or circuit is not providing ventilation, use the emergency manual-ventilation process required by local protocol while the cause is addressed. Do not rely on the alarm number alone.
Manage emergencies
Sudden respiratory distress in a patient with a , reduced air movement through the tube, and visible thick secretions may indicate an obstructed airway. Call for immediate help, assess airway patency and oxygenation, and follow the emergency and suctioning protocol. Provide oxygen, suctioning, or other emergency measures as trained and directed by protocol.
Do not delay action for routine care, offer fluids and wait, or remove the tube without assistance. emergencies require appropriate equipment and staff trained to manage the airway.
Evaluate improvement and escalate
After an intervention, reassess whether oxygenation, respiratory effort, and are improving. A patient receiving high-flow nasal oxygen is not adequately stabilized if SpO₂ remains below the prescribed target while respiratory effort and confusion worsen. Persistent combined with worsening effort or calls for prompt escalation and preparation for further respiratory support as directed.
A patient's report that a cannula feels unfamiliar does not, by itself, show that treatment is failing; reaching the prescribed target while respiratory effort decreases supports improvement. A higher level of oxygen delivery should not delay reassessment or escalation when the patient is worsening.