Management of Impaired Cardiopulmonary Functioning

Core Concepts

Surveillance: assessment and monitoring

The nurse collects a picture of the whole system, then watches it for change:

• Respiratory: rate, depth, and rhythm of breathing; effort and work of breathing (accessory muscle use, retractions, nasal flaring, tripod sitting); breath sounds; cough and sputum characteristics; and the patient's own report of dyspnea.
• Cardiovascular: heart rate and rhythm, blood pressure, pulse strength and equality, skin color and temperature, edema, and urine output as a marker of perfusion.
• Mental status: confusion, restlessness, or lethargy can be early signs of hypoxia — the brain is the most sensitive organ to oxygen shortage.
• Pulse oximetry gives a continuous estimate of blood oxygen saturation, but it has limits: it can be inaccurate with poor peripheral perfusion, cold hands, motion, or nail polish, and it does not measure ventilation (CO₂ removal). A trend over time matters more than a single number, and the device never replaces watching the patient.

Positioning: the first intervention

Position directly affects breathing. Upright positions — sitting upright, high Fowler's, or out of bed in a chair — allow the diaphragm to descend and the lungs to expand, and they reduce the work of breathing for many patients. Patients with orthopnea breathe best sitting up. Routine repositioning (about every two hours, per policy) prevents secretions from pooling in dependent lung regions and protects skin. When a patient cannot be upright, side-lying positions with the head of bed elevated are common compromises — individualized to the patient's condition and orders.

Airway clearance and lung expansion

• Coughing and deep breathing move air into collapsed or under-ventilated areas and help clear secretions. The nurse coaches the patient: slow deep breath, hold, then a controlled cough. Postoperative patients who splint their incisions are taught to support the incision so they can cough effectively.
• Incentive spirometry gives visual feedback that encourages a slow, sustained deep breath — used commonly after surgery to prevent atelectasis. It is a coaching tool: the nurse teaches the technique, observes the patient use it, and tracks whether the patient is doing it regularly.
• Chest physiotherapy principles (positioning to drain specific lung segments, percussion, vibration) and suctioning are performed per order and policy, often with respiratory therapy collaboration; suctioning is an invasive skill with specific scope and safety rules that vary by institution.

Breathing retraining

For patients with chronic conditions such as COPD, two techniques reduce the work of breathing:

• Pursed-lip breathing: inhale through the nose, then exhale slowly through pursed lips. The gentle back-pressure keeps airways open longer, so more air is expelled and the next breath is easier.
• Diaphragmatic breathing: the patient uses the diaphragm instead of neck and chest muscles, reducing fatigue and improving ventilation of the lower lungs.

These are learned skills — the nurse teaches, models, and coaches until the patient can perform them and knows when to use them (especially during activity or breathlessness).

Oxygen therapy: a prescribed drug

Oxygen is a medication: the device, flow rate, and target are ordered by the provider and must not be adjusted casually. Delivery devices differ in how much oxygen they add (nasal cannula, simple face mask, non-rebreather mask, and others), and the choice depends on the patient's needs and orders. Nursing responsibilities include verifying the order, setting up and checking the device and connections, humidifying when indicated per policy, monitoring the patient's response, and safety — no smoking or open flames around oxygen, and skin care where the device touches the face or ears. The nurse also watches for signs that ventilation is being suppressed — oxygen supports breathing but never replaces the assessment.

Activity, rest, and energy conservation

Impaired cardiopulmonary function makes activity cost more oxygen. The nurse balances activity (which strengthens muscles and prevents complications) with rest (which the patient needs). Practical tools: pace activities, schedule rest periods, cluster care to avoid repeated interruptions, and teach the patient to recognize their own activity tolerance — when to slow down or stop. Early progressive mobility per orders (sitting up, dangling, standing, walking) is both a preventive and a therapeutic intervention.

Medication support and evaluation

Nurses administer prescribed medications (bronchodilators, diuretics, and others relevant to the patient's condition), observing and documenting response and side effects, and teaching patients what each medication is for and what to report. Evaluation ties everything together: did the respiratory rate move toward the target? Are breath sounds clearer? Can the patient walk farther without distress? Outcome criteria are individualized and documented — assessment data, interventions, and response — which is both a legal record and the evidence base for the next cycle of care.

Common Confusions