{"id":3703,"date":"2018-11-12T19:57:08","date_gmt":"2018-11-13T00:57:08","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/?post_type=chapter&#038;p=3703"},"modified":"2019-09-30T12:59:33","modified_gmt":"2019-09-30T16:59:33","slug":"2-7-head-to-toe-assessment-chest-respiratory-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-7-head-to-toe-assessment-chest-respiratory-assessment\/","title":{"raw":"2.7 Head-to-Toe Assessment: Chest \/ Respiratory Assessment","rendered":"2.7 Head-to-Toe Assessment: Chest \/ Respiratory Assessment"},"content":{"raw":"Checklist 17 provides a guide for subjective and objective data collection in a respiratory assessment.\r\n<table style=\"border-collapse: collapse;border: 1px solid #000000\" border=\"0\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h3 style=\"text-align: center\"><a id=\"checklist17\"><\/a>Checklist 17: Chest \/ Respiratory Assessment<\/h3>\r\n[caption id=\"attachment_3686\" align=\"aligncenter\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration.png\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration-300x225.png\" alt=\"\" width=\"300\" height=\"225\" class=\"wp-image-3686 size-medium\" \/><\/a> Figure 2.9 Respiratory System[\/caption]\r\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policies and guidelines regarding this specific skill.<\/em><\/h5>\r\n<strong>\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr style=\"height: 10px\">\r\n<td style=\"width: 50%;text-align: center;height: 10px\" colspan=\"2\">\r\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #333333\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li style=\"text-align: left\">Document according to agency guidelines.<\/li>\r\n<\/ul>\r\n<strong>\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border-collapse: collapse;border: 1px solid #000000\" border=\"0\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h3 style=\"text-align: center\">Objective Data<\/h3>\r\n<h5 style=\"text-align: center\">The data that we can observe with our senses.<\/h5>\r\n<strong>\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000\">\r\n<h4 style=\"text-align: center\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Observe the <strong>work of breathing<\/strong> including use of accessory muscles.\r\n\r\n[caption id=\"attachment_4131\" align=\"aligncenter\" width=\"250\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-300x221.jpg\" alt=\"\" width=\"250\" class=\"wp-image-4131 size-medium\" \/><\/a> Figure 2.10 Observe for work of breathing[\/caption]<\/td>\r\n<td style=\"border: 1px solid #000000\">Increased work of breathing may be observed through a spectrum of responses including a small amount of nasal flaring through to use of all accessory muscles. Increased work of breathing is often associated with an increased respiratory rate.\r\n\r\nThe patient may appear distressed and\/or feel anxious. Likewise they may not appear distressed, depending on the severity and other comorbidities. Ability to speak may be affected.\r\n\r\nIncreased work of breathing may indicate respiratory compromise and impaired oxygenation caused by things like acute airway obstruction, pulmonary edema,\u00a0 atelectasis, and others.\r\n\r\nUnusual findings should be followed up with a focused respiratory assessment.\r\n\r\nMore resources:\r\n<ul>\r\n \t<li>Khan Academy. (2012). <em>Respiratory distress<\/em>. Retrieved from\u00a0<a href=\"https:\/\/www.youtube.com\/watch?v=vO63j9m5grE\">https:\/\/www.youtube.com\/watch?v=vO63j9m5grE<\/a>.<\/li>\r\n \t<li>Some agencies use the following for objectively assessing respiratory distress and work of breathing (see page 22):\r\n<ul>\r\n \t<li>The Canadian triage &amp; acuity scale. (2013). <em>CTAS \u2022 \u00c9TG<\/em>. Retrieved from\u00a0<a href=\"http:\/\/ctas-phctas.ca\/wp-content\/uploads\/2018\/05\/participant_manual_v2.5b_november_2013_0.pdf\">http:\/\/ctas-phctas.ca\/wp-content\/uploads\/2018\/05\/participant_\r\nmanual_v2.5b_november_2013_0.pdf<\/a>.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\"><strong>Expansion \/ Retraction of Chest Wall<\/strong><\/td>\r\n<td style=\"border: 1px solid #000000\">The chest wall should expand and contract symmetrically. If not, consider if this is a new or pre-existing condition.\r\n\r\nChest expansion may be asymmetrical with conditions such as atelectasis, pneumonia, fractured ribs, pneumothorax, or hemothorax.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Assess <strong>respiratory rate<\/strong> by inconspicuously observing breathing. One way to do this is to palpate radial pulse for a full minute but use some of that time to count respirations.\r\n\r\nLikewise, placing your hand on the patient's chest and counting the rise \/ fall cycles\r\n\r\n[caption id=\"attachment_315\" align=\"aligncenter\" width=\"250\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-300x199.jpg\" alt=\"\" width=\"250\" class=\"wp-image-315 size-medium\" \/><\/a> Assessing respiratory rate.[\/caption]<\/td>\r\n<td style=\"width: 50%;height: 311px\">Normal respiratory rate (interpreted as respirations per minute):\r\n<ul>\r\n \t<li>Newborn: 30\u201360<\/li>\r\n \t<li><span style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">Infant (6 months): 30\u201350\u00a0<\/span><\/li>\r\n \t<li>Toddler (2 years): 25\u201332<\/li>\r\n \t<li>Children (3\u201312 years): 20\u201330<\/li>\r\n \t<li>Adolescents (13\u201318 years): 12-20<\/li>\r\n \t<li>Adults: 12\u201320<\/li>\r\n<\/ul>\r\nIf a patient's respiratory status is stable, it may be appropriate to count respirations for 30 seconds and multiply by two to determine respiratory rate.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\"><strong>Pulse Oximetry<\/strong>: Consists of a probe\u00a0with a light-emitting diode (LED) attached to the\u00a0patient's\u00a0finger,\u00a0forehead, or ear.\u00a0Beams of red and infrared light are emitted from the LED, and the light wavelengths\u00a0are absorbed differently by the oxygenated and the deoxygenated hemoglobin (Hgb) molecules.\u00a0The receiving sensor measures the amount of light absorbed by the oxygenated and deoxygenated Hgb in the arterial (pulsatile) blood. (Perry et al., 2018).\r\n\r\n[caption id=\"attachment_317\" align=\"aligncenter\" width=\"250\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-300x199.jpg\" alt=\"\" width=\"250\" class=\"wp-image-317 size-medium\" \/><\/a> Pulse oximetry[\/caption]<\/td>\r\n<td style=\"width: 50%;height: 342px\">The more Hgb that is saturated with oxygen, the higher the SpO<sub>2<\/sub>, which should normally measure above 95% oxygen saturation (SpO<sub>2<\/sub>) (Perry et al., 2018).\r\n\r\nSee <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/5-3-pulse-oximetry\/\">Chapter 5.3 Pulse oximetry<\/a>.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Use a stethoscope to auscultate <strong>breath sounds<\/strong> anterior and posterior for quality of air entry and any adventitious sounds. Assess bilaterally comparing one side with the other in a systematic fashion.\r\n\r\n<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-322 alignright\" \/><\/a> <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1.jpg\" rel=\"noopener\" target=\"_blank\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-323 alignleft\" \/><\/a><\/td>\r\n<td style=\"border: 1px solid #000000\">Diminished air entry may indicate atelectasis, pneumonia, hemothorax, pneumothorax, or collapsed lung.\r\n\r\nThe presence of crackles or wheezing must be further assessed, documented, and reported. If such things are affecting the patient negatively, intervention is needed.\r\n\r\nCrackles may indicated mucous related to asthma or chronic obstructive pulmonary disease (COPD), or fluid related to pulmonary edema.\r\n\r\nWheezing may indicate bronchoconstriction related to asthma, bronchitis, or emphysema.\r\n\r\nFriction rub (creaking) may indicate inflammation related to pleurisy.\r\n\r\nThe nurse should always consider what interventions they can implement independently and what interventions have been ordered by the authorized prescriber\u00a0to relieve impaired oxygenation.\r\n\r\nMore resources:\r\n<ul>\r\n \t<li>Cable, C. (1997).\u00a0<em>The auscultation assistant<\/em>. Retrieved from\u00a0<a href=\"https:\/\/www.med.ucla.edu\/wilkes\/intro.html\">https:\/\/www.med.ucla.edu\/wilkes\/intro.html<\/a>.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\"><strong>Cough &amp; Sputum<\/strong><\/td>\r\n<td style=\"border: 1px solid #000000\">The nurse might observe coughing and expectorated sputum.\r\n\r\nReasons for coughing might include bacterial or viral infection, aspiration, or presence of sputum. Observe and ask if the cough is a concern for the patient.\r\n\r\nIf sputum is present, observe or inquire about amount, colour, and consistency. Ask if sputum is normal for the patient.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<table style=\"border: 1px solid #000000\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\r\n<h3 style=\"text-align: center\">Subjective Data<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">\r\n<ul>\r\n \t<li>If you don\u2019t already know, ask about respiratory diseases (COPD, asthma, cystic fibrosis). Presence of these may provide insight into explaining other respiratory assessment findings.<\/li>\r\n \t<li>Ask about use of respiratory medications. People with chronic respiratory disease often use one or more inhaled medications.<\/li>\r\n \t<li>Ask about breathing. Does the person experience trouble with breathing or shortness of breath?<\/li>\r\n \t<li>Do they have a cough?<\/li>\r\n \t<li>Is sputum present? If so what is the amount, colour, and consistency? Is this normal?<\/li>\r\n \t<li>Do they smoke? If so, what and how much?<\/li>\r\n \t<li>Ask about environmental exposures that may affect breathing. Some environmental allergies (airborne nut allergy, perfumes, cleaners) trigger respiratory difficulty.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">\r\n<h4 style=\"text-align: left\">Focused respiratory assessment may also include:<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">If a chest tube is present, ensure the tube is intact and secure and that the drainage system is functioning. Auscultate chest sounds, perform a respiratory assessment including palpating for evidence of subcutaneous emphysema at and near the chest tube insertion site. See\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-6-chest-tube-drainage-systems\/\">10.6 Chest Tube Drainage Systems<\/a><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"border: 1px solid #000000\">Arterial blood gasses (ordered by prescriber or as per agency protocol)<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Potential respiratory related nursing diagnoses:\r\n<ul>\r\n \t<li>Impaired oxygenation as evidenced by increased respiratory rate and use of accessory muscles to breathe.<\/li>\r\n \t<li>Risk of respiratory infection related to mucous production\u00a0 associated with COPD.<\/li>\r\n \t<li>Readiness to stop smoking.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000\">Sources: Assessment Skill Checklist, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Perry, Potter, &amp; Ostendorf, 2018; Potter et al, 2019; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>A client is experiencing mild respiratory distress. Identify two important strategies to address this.<\/li>\r\n \t<li>What potential respiratory issues might the nurse anticipate for the post op patient? Identify an important nursing intervention for each.<\/li>\r\n \t<li>Identify two strategies the nurse might implement for the immobile client whose chest sounds reveal decreased air entry to the bases.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<h2>Attributions:<\/h2>\r\nFigure 2.9\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Respiratory_System_(Illustration).png\">An Illustration Depicting the Respiratory System<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">Creative Commons Attribution-Share Alike 4.0 International license.<\/a>\r\n\r\nFigure 2.10\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Thoracic_landmarks_anterior_view.svg\">Chest Landmarks, for Radiography and Other Chest Imaging Techniques<\/a> by P. Lynch is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.5\/\">Creative Commons Attribution 2.5 license<\/a>.","rendered":"<p>Checklist 17 provides a guide for subjective and objective data collection in a respiratory assessment.<\/p>\n<table style=\"border-collapse: collapse;border: 1px solid #000000\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h3 style=\"text-align: center\"><a id=\"checklist17\"><\/a>Checklist 17: Chest \/ Respiratory Assessment<\/h3>\n<figure id=\"attachment_3686\" aria-describedby=\"caption-attachment-3686\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration.png\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration-300x225.png\" alt=\"\" width=\"300\" height=\"225\" class=\"wp-image-3686 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration-300x225.png 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration-65x49.png 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration-225x169.png 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/11\/Respiratory_System_Illustration.png 320w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-3686\" class=\"wp-caption-text\">Figure 2.9 Respiratory System<\/figcaption><\/figure>\n<h5 style=\"text-align: center\"><em>Disclaimer: Always review and follow your agency policies and guidelines regarding this specific skill.<\/em><\/h5>\n<p><strong>\u00a0<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 10px\">\n<td style=\"width: 50%;text-align: center;height: 10px\" colspan=\"2\">\n<h5><span style=\"color: #000000\">Safety considerations:<\/span><\/h5>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Perform hand hygiene.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Introduce yourself to patient.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Explain process to patient.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Be organized and systematic in your assessment.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Use appropriate listening and questioning skills.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Listen and attend to patient cues.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #333333\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li style=\"text-align: left\">Document according to agency guidelines.<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse;border: 1px solid #000000\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h3 style=\"text-align: center\">Objective Data<\/h3>\n<h5 style=\"text-align: center\">The data that we can observe with our senses.<\/h5>\n<p><strong>\u00a0<\/strong><\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000\">\n<h4 style=\"text-align: center\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Observe the <strong>work of breathing<\/strong> including use of accessory muscles.<\/p>\n<figure id=\"attachment_4131\" aria-describedby=\"caption-attachment-4131\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-300x221.jpg\" alt=\"\" width=\"250\" class=\"wp-image-4131 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-300x221.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-65x48.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-225x166.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x-350x258.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2019\/02\/489px-Thoracic_landmarks_anterior_view.svg-550-x.jpg 550w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-4131\" class=\"wp-caption-text\">Figure 2.10 Observe for work of breathing<\/figcaption><\/figure>\n<\/td>\n<td style=\"border: 1px solid #000000\">Increased work of breathing may be observed through a spectrum of responses including a small amount of nasal flaring through to use of all accessory muscles. Increased work of breathing is often associated with an increased respiratory rate.<\/p>\n<p>The patient may appear distressed and\/or feel anxious. Likewise they may not appear distressed, depending on the severity and other comorbidities. Ability to speak may be affected.<\/p>\n<p>Increased work of breathing may indicate respiratory compromise and impaired oxygenation caused by things like acute airway obstruction, pulmonary edema,\u00a0 atelectasis, and others.<\/p>\n<p>Unusual findings should be followed up with a focused respiratory assessment.<\/p>\n<p>More resources:<\/p>\n<ul>\n<li>Khan Academy. (2012). <em>Respiratory distress<\/em>. Retrieved from\u00a0<a href=\"https:\/\/www.youtube.com\/watch?v=vO63j9m5grE\">https:\/\/www.youtube.com\/watch?v=vO63j9m5grE<\/a>.<\/li>\n<li>Some agencies use the following for objectively assessing respiratory distress and work of breathing (see page 22):\n<ul>\n<li>The Canadian triage &amp; acuity scale. (2013). <em>CTAS \u2022 \u00c9TG<\/em>. Retrieved from\u00a0<a href=\"http:\/\/ctas-phctas.ca\/wp-content\/uploads\/2018\/05\/participant_manual_v2.5b_november_2013_0.pdf\">http:\/\/ctas-phctas.ca\/wp-content\/uploads\/2018\/05\/participant_<br \/>\nmanual_v2.5b_november_2013_0.pdf<\/a>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\"><strong>Expansion \/ Retraction of Chest Wall<\/strong><\/td>\n<td style=\"border: 1px solid #000000\">The chest wall should expand and contract symmetrically. If not, consider if this is a new or pre-existing condition.<\/p>\n<p>Chest expansion may be asymmetrical with conditions such as atelectasis, pneumonia, fractured ribs, pneumothorax, or hemothorax.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Assess <strong>respiratory rate<\/strong> by inconspicuously observing breathing. One way to do this is to palpate radial pulse for a full minute but use some of that time to count respirations.<\/p>\n<p>Likewise, placing your hand on the patient&#8217;s chest and counting the rise \/ fall cycles<\/p>\n<figure id=\"attachment_315\" aria-describedby=\"caption-attachment-315\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-300x199.jpg\" alt=\"\" width=\"250\" class=\"wp-image-315 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2220-1-350x232.jpg 350w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-315\" class=\"wp-caption-text\">Assessing respiratory rate.<\/figcaption><\/figure>\n<\/td>\n<td style=\"width: 50%;height: 311px\">Normal respiratory rate (interpreted as respirations per minute):<\/p>\n<ul>\n<li>Newborn: 30\u201360<\/li>\n<li><span style=\"font-size: 1.05rem;text-indent: 1em;font-family: inherit\">Infant (6 months): 30\u201350\u00a0<\/span><\/li>\n<li>Toddler (2 years): 25\u201332<\/li>\n<li>Children (3\u201312 years): 20\u201330<\/li>\n<li>Adolescents (13\u201318 years): 12-20<\/li>\n<li>Adults: 12\u201320<\/li>\n<\/ul>\n<p>If a patient&#8217;s respiratory status is stable, it may be appropriate to count respirations for 30 seconds and multiply by two to determine respiratory rate.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\"><strong>Pulse Oximetry<\/strong>: Consists of a probe\u00a0with a light-emitting diode (LED) attached to the\u00a0patient&#8217;s\u00a0finger,\u00a0forehead, or ear.\u00a0Beams of red and infrared light are emitted from the LED, and the light wavelengths\u00a0are absorbed differently by the oxygenated and the deoxygenated hemoglobin (Hgb) molecules.\u00a0The receiving sensor measures the amount of light absorbed by the oxygenated and deoxygenated Hgb in the arterial (pulsatile) blood. (Perry et al., 2018).<\/p>\n<figure id=\"attachment_317\" aria-describedby=\"caption-attachment-317\" style=\"width: 250px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1.jpg\" rel=\"noopener\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-300x199.jpg\" alt=\"\" width=\"250\" class=\"wp-image-317 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2214-1-350x232.jpg 350w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-317\" class=\"wp-caption-text\">Pulse oximetry<\/figcaption><\/figure>\n<\/td>\n<td style=\"width: 50%;height: 342px\">The more Hgb that is saturated with oxygen, the higher the SpO<sub>2<\/sub>, which should normally measure above 95% oxygen saturation (SpO<sub>2<\/sub>) (Perry et al., 2018).<\/p>\n<p>See <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/5-3-pulse-oximetry\/\">Chapter 5.3 Pulse oximetry<\/a>.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Use a stethoscope to auscultate <strong>breath sounds<\/strong> anterior and posterior for quality of air entry and any adventitious sounds. Assess bilaterally comparing one side with the other in a systematic fashion.<\/p>\n<p><a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1.jpg\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-322 alignright\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2317-1-350x232.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a> <a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1.jpg\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"size-medium wp-image-323 alignleft\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-768x509.jpg 768w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-1024x678.jpg 1024w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-225x149.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/06\/DSC_2323-1-350x232.jpg 350w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/td>\n<td style=\"border: 1px solid #000000\">Diminished air entry may indicate atelectasis, pneumonia, hemothorax, pneumothorax, or collapsed lung.<\/p>\n<p>The presence of crackles or wheezing must be further assessed, documented, and reported. If such things are affecting the patient negatively, intervention is needed.<\/p>\n<p>Crackles may indicated mucous related to asthma or chronic obstructive pulmonary disease (COPD), or fluid related to pulmonary edema.<\/p>\n<p>Wheezing may indicate bronchoconstriction related to asthma, bronchitis, or emphysema.<\/p>\n<p>Friction rub (creaking) may indicate inflammation related to pleurisy.<\/p>\n<p>The nurse should always consider what interventions they can implement independently and what interventions have been ordered by the authorized prescriber\u00a0to relieve impaired oxygenation.<\/p>\n<p>More resources:<\/p>\n<ul>\n<li>Cable, C. (1997).\u00a0<em>The auscultation assistant<\/em>. Retrieved from\u00a0<a href=\"https:\/\/www.med.ucla.edu\/wilkes\/intro.html\">https:\/\/www.med.ucla.edu\/wilkes\/intro.html<\/a>.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\"><strong>Cough &amp; Sputum<\/strong><\/td>\n<td style=\"border: 1px solid #000000\">The nurse might observe coughing and expectorated sputum.<\/p>\n<p>Reasons for coughing might include bacterial or viral infection, aspiration, or presence of sputum. Observe and ask if the cough is a concern for the patient.<\/p>\n<p>If sputum is present, observe or inquire about amount, colour, and consistency. Ask if sputum is normal for the patient.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border: 1px solid #000000\">\n<tbody>\n<tr>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">\n<h3 style=\"text-align: center\">Subjective Data<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">\n<ul>\n<li>If you don\u2019t already know, ask about respiratory diseases (COPD, asthma, cystic fibrosis). Presence of these may provide insight into explaining other respiratory assessment findings.<\/li>\n<li>Ask about use of respiratory medications. People with chronic respiratory disease often use one or more inhaled medications.<\/li>\n<li>Ask about breathing. Does the person experience trouble with breathing or shortness of breath?<\/li>\n<li>Do they have a cough?<\/li>\n<li>Is sputum present? If so what is the amount, colour, and consistency? Is this normal?<\/li>\n<li>Do they smoke? If so, what and how much?<\/li>\n<li>Ask about environmental exposures that may affect breathing. Some environmental allergies (airborne nut allergy, perfumes, cleaners) trigger respiratory difficulty.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">\n<h4 style=\"text-align: left\">Focused respiratory assessment may also include:<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">If a chest tube is present, ensure the tube is intact and secure and that the drainage system is functioning. Auscultate chest sounds, perform a respiratory assessment including palpating for evidence of subcutaneous emphysema at and near the chest tube insertion site. See\u00a0<a href=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/10-6-chest-tube-drainage-systems\/\">10.6 Chest Tube Drainage Systems<\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #000000\">Arterial blood gasses (ordered by prescriber or as per agency protocol)<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Potential respiratory related nursing diagnoses:<\/p>\n<ul>\n<li>Impaired oxygenation as evidenced by increased respiratory rate and use of accessory muscles to breathe.<\/li>\n<li>Risk of respiratory infection related to mucous production\u00a0 associated with COPD.<\/li>\n<li>Readiness to stop smoking.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000\">Sources: Assessment Skill Checklist, 2014; Jarvis, Browne, MacDonald-Jenkins, &amp; Luctkar-Flude, 2014; Perry, Potter, &amp; Ostendorf, 2018; Potter et al, 2019; Stephen, Skillen, Day, &amp; Jensen, 2012; Wilson &amp; Giddens, 2013<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>A client is experiencing mild respiratory distress. Identify two important strategies to address this.<\/li>\n<li>What potential respiratory issues might the nurse anticipate for the post op patient? Identify an important nursing intervention for each.<\/li>\n<li>Identify two strategies the nurse might implement for the immobile client whose chest sounds reveal decreased air entry to the bases.<\/li>\n<\/ol>\n<\/div>\n<h2>Attributions:<\/h2>\n<p>Figure 2.9\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Respiratory_System_(Illustration).png\">An Illustration Depicting the Respiratory System<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\">Creative Commons Attribution-Share Alike 4.0 International license.<\/a><\/p>\n<p>Figure 2.10\u00a0<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Thoracic_landmarks_anterior_view.svg\">Chest Landmarks, for Radiography and Other Chest Imaging Techniques<\/a> by P. Lynch is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.5\/\">Creative Commons Attribution 2.5 license<\/a>.<\/p>\n","protected":false},"author":397,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3703","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3703","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3703\/revisions"}],"predecessor-version":[{"id":5113,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3703\/revisions\/5113"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/3703\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=3703"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=3703"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=3703"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=3703"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}