Why work in respiratory nursing?

Working in the specialty of respiratory medicine and thoracic surgery offers an interesting, diverse, and wide-ranging choice of excellent opportunities for an appealing and fulfilling career. The specialty includes over 30 different medical conditions of which some are common and some relatively rare so there is ample opportunity to subspecialize as well as to take a more generalist pathway. Nurses in this specialty are often members of a multidisciplinary team working with other specialist nurses, consultants, general practitioners, physiotherapists, occupational therapists, pharmacists, and respiratory technicians. This chapter gives a brief overview of the nurse’s role in respiratory medicine and thoracic surgery and their position in a multidisciplinary team in acute settings or within the community. The desirable qualities for a respiratory nurse are outlined, and the relevant training courses and study days are covered.

The multidisciplinary team

Respiratory services should be delivered in an integrated way, taking into account the overlap in patient population and in the personnel providing care. The majority of patients with respiratory disease are cared for by a team of health professionals from both primary and secondary care. Respiratory nurses work as part of the multidisciplinary team. This team includes doctors, ward-based, and outpatient nurses, physiotherapists, occupational therapists, lung-function technicians, community pharmacists, social services and, of course, the patient, and their family and carers. This chapter outlines the responsibilities and contributions of each member of the multidisciplinary team in providing respiratory services.

Glossary

This chapter provides an alphabetical glossary of terms used in respiratory medicine, which are comprehensively covered in this second edition of the Oxford Handbook of Respiratory Nursing. These include subjects such as altitude and its effect of the lungs, to angina, antigens, anoxia, and apnoea; breathlessness, bronchiolitis, and bronchospasm; through to vasodilation, ventilation, and vesicular sounds. While the main text covers these subjects comprehensively with systematic description of the main respiratory diseases found in adults, this glossary is an at-a-glance guide to the terms a medical professional will need to know, particularly when discussing and meeting the needs of respiratory patients.

Pulmonary rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management, care, and treatment of patients with chronic lung disease, particularly with COPD and increasingly in ILD. Breathlessness is a symptom of the underlying lung disease, and can result in reduced patient activity, which in turn reduces fitness, leads to social isolation, and can exacerbate depression and anxiety. PR is a multidisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy. This chapter describes the rationale for PR, how to set up an effective rehabilitation regime through education and physical exercise, and how to provide follow-up care.

Tuberculosis (TB)

This chapter covers the key facts about tuberculosis (TB), then goes on to describe the epidemiology and pathophysiology of the disease. Risk factors, and signs and symptoms, and investigations are all covered. The treatment phase and standard drug therapies are shown, and directly observed therapy for the patient with an increased risk of poor adherence is described. Mono-resistant, multidrug-resistant, and extensively drug-resistant types are included in this chapter, as well as contact tracing in line with NICE clinical guidelines. Mycobacterium Tuberculosis (MTB) is part of a family of mycobacterium which includes Mycobacterium bovis. M. bovis is uncommon in humans, although it frequently affects cattle and badgers. MTB can affect any organ in the body; this chapter will concentrate on the diagnosis, treatment, and prevention of pulmonary MTB in adults in the UK.

Obstructive sleep apnoea

This chapter covers the causes, signs, and symptoms of obstructive sleep apnoea (OSA). It explains the process of diagnosis, from a history, medications, family, and psychosocial history, occupation, and diagnostic procedures. Differential diagnoses that should be excluded are listed. The prevalence of OSA is estimated to be around 4% of the population. It is quite a common disorder, although this figure may be an underestimate as many people may not seek treatment. Prevalence figures also vary according to the chosen threshold for defining a significant sleep abnormality and symptoms. Treatment options are also outlined, and the specific aspects of nursing care are listed.

Cystic fibrosis

Cystic fibrosis (CF) is the most common, life-threatening, and recessively inherited disease in the Western world. This chapter provides an overview of the condition, including its aetiology, pathology, and genetics. It then covers the clinical presentations and confirmation of diagnosis of CF, complications (respiratory, gastrointestinal, pancreatic, bowel, hepatic, reproductive, and diabetic). Anyone recognized as having high risk of having a baby with CF and in whom pregnancy is contemplated, or who has a newborn with CF, should be offered screening and early genetic advice. Care and management are described in detail, including nutrition, physiotherapy, infection control, antibiotics, the transition from paediatric to adult care, transplant, and end-of-life care.

Pulmonary embolism

A pulmonary embolism (PE) is a clinically significant obstruction occurring in part of or the entire pulmonary vascular tree. The most common cause is a thrombus from a distant site such as the leg. Most pulmonary emboli originate from detached portions of venous thrombi that have formed in the deep veins of the lower limbs. Other sites where they form include the right side of the heart and the pelvis. Non-thrombotic emboli, mainly fat, air, and amniotic fluid, may also occur but these are rarer. This chapter provides an overview of incidence and aetiology, and tabulates the risk factors for PE. The clinical features and assessment are covered, and six different investigations are explained. Management—anticoagulants, thrombolysis, and high-flow oxygen—are also included, along with nurse involvement at different points of PE.

Pharmacology

Pharmacology is the study of the actions, mechanisms, uses, and adverse effects of a drug. A drug is any natural or synthetic substance that changes the physiological state of a living organism. In respiratory medicine drugs are used for the prevention, diagnosis, and treatment of a disease. This chapter begins by outlining basic pharmacology and pharmacokinetics, absorption, distribution, metabolism, and excretion. It then covers pharmacodynamics and adverse drug reactions (ADRs). It then begins to look at β‎2 agonists for asthma and COPD, oral bronchodilators, anticholinergic bronchodilators, theophyllines, and corticosteroids. Combinations of different drug therapies for respiratory conditions are described. Monoclonal antibody therapies are described, including dosing regimens, administration, side effects, and interactions. Different inhaler devices are covered. Patient engagement and placebo devices are included.

Acute respiratory distress syndrome (ARDS)

The incidence of describing acute respiratory distress syndrome (ARDS) is approximately 23% in mechanically ventilated patients. The diagnosis of ARDS varies widely; studies report a variation in the population diagnosed with ARDS, from 10 to 86 cases per 100,000. Complications of mechanical ventilation are common and include ventilator-associated pneumonia (VAP), barotrauma from excessive airway pressures, and volutrauma from excessive tidal volumes which may both worsen ARDS. Pneumothorax occurs in some patients, necessitating the placement of chest drains. This chapter starts with describing ARDS and the Berlin Definition, and its incidence. It also covers aetiology and physiology, then goes on to its treatment and general management. This includes respiratory support, position changes, and other treatments. Situation-dependent prognoses are outlined. Specific nursing care is also described.