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Disorder of respiratory system — Clinical Guidelines

Overview

Respiratory disorders encompass a wide range of conditions affecting the respiratory system, impacting oxygenation, ventilation, and overall patient comfort, particularly in palliative and hospice care settings. Effective management focuses on symptom control, quality of life, and interdisciplinary collaboration.

Diagnosis

Clinical Assessment: Includes history, physical examination, and observation of respiratory patterns 8 16.

Pulse Oximetry: Non-invasive monitoring of arterial oxygenation levels 8.

Respiratory Tests: Utilization of specific tests by specialists like orthodontists for identifying mouth breathers 7.

Specialized Evaluations: Speech and language therapists may conduct assessments for patients with ventilatory needs or tracheostomies 3.

Management

Symptom Control: Focus on managing pain and respiratory distress, with attention to racial and ethnic disparities in pain management 9.

Non-Invasive Ventilation (NIV): Considered for high-risk patients during procedures like upper endoscopies to prevent respiratory complications 10.

Interdisciplinary Care: Implementation of critical pathways to ensure coordinated and quality hospice care 13.

Technology Utilization: TeleHospice models enhance rural hospice care accessibility and quality 5.

Special Populations

Pediatrics: Concurrent hospice care models impact cost structures in pediatric populations 2.

Elderly: Health literacy significantly influences hospice care knowledge, attitudes, and decisions among seniors 6.

Comorbidities: Management strategies must consider comorbidities and the need for advanced clinical skills in specialized areas like SLTs 3.

Key Recommendations

Utilize pulse oximetry for continuous monitoring of oxygenation in all respiratory care settings (Evidence: Strong 8).

Implement interdisciplinary critical pathways to standardize and enhance hospice care quality (Evidence: Moderate 13).

Address health literacy to improve understanding and satisfaction with hospice care among elderly patients (Evidence: Moderate 6).

Consider non-invasive ventilation strategies for high-risk patients undergoing procedures to mitigate respiratory complications (Evidence: Moderate 10).

Promote culturally sensitive care practices to address disparities in patient satisfaction and outcomes (Evidence: Moderate 11).

References

1 Brecher DB, Romero MS. A Request for Gender-Affirming Treatment in End-of-Life Care: A Case Study From an Inpatient VA Hospice Program. The American journal of hospice & palliative care 2024. link 2 Cozad MJ, Svynarenko R, Hinds PS, Mack JW, Keim-Malpass J, Lindley LC. Pediatric Concurrent Hospice Care: Cost Implications of a Hybrid Payment Model. The American journal of hospice & palliative care 2022. link 3 Sella Weiss O, Gvion A, Mcrae J. Speech and language therapists' management of ventilated patients and patients with tracheostomy in Israel. International journal of language & communication disorders 2021. link 4 Miller AG, Gentile MA, Coyle JP. Respiratory Therapist Endotracheal Intubation Practices. Respiratory care 2020. link 5 Doolittle GC, Nelson EL, Spaulding AO, Lomenick AF, Krebill HM, Adams NJ et al.. TeleHospice: A Community-Engaged Model for Utilizing Mobile Tablets to Enhance Rural Hospice Care. The American journal of hospice & palliative care 2019. link 6 Huang HY, Kuo KM, Lu IC, Wu H, Lin CW, Hsieh MT et al.. The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors. Health & social care in the community 2019. link 7 Costa JG, Costa GS, Costa C, Vilella OV, Mattos CT, Cury-Saramago AA. Clinical recognition of mouth breathers by orthodontists: A preliminary study. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2017. link 8 Pretto JJ, Roebuck T, Beckert L, Hamilton G. Clinical use of pulse oximetry: official guidelines from the Thoracic Society of Australia and New Zealand. Respirology (Carlton, Vic.) 2014. link 9 Laguna J, Goldstein R, Braun W, Enguídanos S. Racial and ethnic variation in pain following inpatient palliative care consultations. Journal of the American Geriatrics Society 2014. link 10 Cabrini L, Nobile L, Cama E, Borghi G, Pieri M, Bocchino S et al.. Non-invasive ventilation during upper endoscopies in adult patients. A systematic review. Minerva anestesiologica 2013. link 11 Campbell CL, Baernholdt M, Yan G, Hinton ID, Lewis E. Racial/ethnic perspectives on the quality of hospice care. The American journal of hospice & palliative care 2013. link 12 Primiano FP, Chatburn RL. Zen and the art of nomenclature maintenance: a revised approach to respiratory symbols and terminology. Respiratory care 2006. link 13 Wright PM. A critical pathway for interdisciplinary hospice care. The American journal of hospice & palliative care 2001. link 14 Watson J. Becoming aware: knowing yourself to care for others. Home healthcare nurse 1999. link 15 Mak JM, Clinton M. Promoting a good death: an agenda for outcomes research--a review of the literature. Nursing ethics 1999. link 16 Banner MJ, Hurd TE, Boysen PG. A mechanical model of spontaneous ventilation. Critical care medicine 1984. link

Disorder of respiratory system