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Care of the Patient with Respiratory Conditions

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This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Medical Assistant (MA)
This course will be updated or discontinued on or before Tuesday, October 28, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


92% of participants will know how to care for patients with respiratory conditions.


Upon completion of this course, the participants will be able to:

  1. Describe 4 ways to care for patients with respiratory conditions.
  2. Identify how to stop infection.
  3. Identify how to care for a patient with a tracheostomy.
  4. Identify how to care for a patient with a ventilator.
  5. Discuss professional boundaries.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Care of the Patient with Respiratory Conditions
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Maryam Mamou (BSN, RN, CWOCN)

Respiratory Conditions

The respiratory system carries oxygen to the lungs. The lungs send oxygen all over the body through the blood. The lungs also clean toxins out of the blood and breathe them out. When the respiratory system does not work correctly, the entire body is affected. Common respiratory conditions include:

  • Asthma
  • Bronchitis
  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive Heart Failure
  • Croup
  • Cystic Fibrosis
  • Pneumonia
  • Tuberculosis (Zimlich, 2022)

Care of Patients with Respiratory Conditions

Patients with respiratory conditions not only have problems with breathing, but this affects everything else that they do. They become tired more easily and have less energy to do everyday things such as bathing, dressing, and even eating. They also have anxiety when they cannot get enough oxygen.

Patient Positioning

Check with the patient’s nurse to make sure that there are no special instructions about positioning the patient or any position that the patient cannot be placed in. Normally, the best positions for patients with respiratory conditions are the semi-fowler's or fowler's position because these positions make it easier for them to breathe. Semi-fowler's position is the patient is lying on their back with the head of the bed raised to between a 30-degree and 45-degree angle. The patient's legs can be bent or straight. Fowler’s position is the head of the bed is raised to between a 45-degree and 60-degree angle. The patient’s legs can be placed straight out or slightly bent. It is a higher position than semi-fowlers. Fowler's position makes chest expansion easier for the patient and improves breathing (STERIS, 2023).

For patients who cannot get out of bed, reposition them as often as possible, every 2 hours if allowed, to make breathing easier for them and stop secretions from pooling in their airways. Respiratory therapists teach patients breathing exercises, such as coughing and deep breathing movements. CNAs working with the patient should know what exercises the patient has been taught and encourage the patient to do them. If the patient is having problems doing breathing exercises or does not want to do them, the CNA should report this to the respiratory therapist or the nurse.

Watch for Changes

Watch the amount and type of sputum that the patient is bringing up. Changes in the amount, thickness, or color of the sputum can be a sign of an infection or other change in the patient’s condition and should be recorded and reported to the nurse. Notice the patient’s breathing pattern. Notify the respiratory therapist or nurse if there are changes in breathing, and if the patient is having difficulty breathing. A patient who is having difficulty with breathing should not be left alone, send someone to get help, turn on the call light, or open the patient’s door and call out that help is needed immediately.

Mouth Care

Keep the patient’s mouth moist and do regular mouth care. Never adjust the oxygen setting or stop the oxygen flow. If you have a concern about the patient’s oxygen setting, talk to the patient’s nurse or respiratory therapist. If the patient complains that they are not getting in enough oxygen, call the nurse to check on the settings and stay with the patient.


Regular exercise is important for a patient with respiratory conditions to strengthen their lungs and heart. In the hospital, the physical therapist will put together an exercise program for the patient and work with them on activities such as getting out of bed and walking short distances.

The CNA needs to talk to the nurse or therapists working with the patient to decide on the best time to plan activities such as bathing and dressing the patient so that they are ready to do other activities but are not worn out. Patients who are too tired to do their exercise program lose interest in it and are more inclined to give up. Occupational therapists teach patients energy-saving skills that make it possible for them to do self-care and stay as independent as possible. These skills should be on the care plan. The CNA should know the skills that the patient has been taught and help them to continue using them as needed throughout the day. The CNA needs to report back to the nurse or therapists how the patient is getting on with what they have learned and if the CNA sees any problems that they are having.


The patient’s diet and eating habits can also be affected by their respiratory condition, and the type of food they eat can affect their breathing. For example, reducing the amount of carbohydrates in the diet can help make breathing easier. Carbohydrates are sugar, starchy vegetables like potatoes, bread, rice, and pasta. When the body turns carbohydrates into energy, it gives off more carbon dioxide for the amount of oxygen used. The patient then must exhale extra carbon dioxide. Sometimes, it can be hard for patients with respiratory conditions to eat enough calories each day. A special diet may be planned to help them stay at a healthy weight.

The patient should rest before eating. Assist the patient to sit upright for meals and make sure that they are in a comfortable position. Advise the patient to eat slowly and take small bites of food. Stop between bites and do some deep breathing exercises. It is best to eat 4-6 small meals a day. This makes it easier for the diaphragm to move and helps prevent problems with breathing. If taking drinks with meals makes the patient too full to finish eating, it can be better to drink fluids after meals.

Other things that can be done to make eating easier and more enjoyable for patients with respiratory conditions is to know the foods that they like and how they like them served. Can they prepare their meals at home, and what problems, if any, are they having with shopping for food and meal preparation? Helpful meal preparation advice includes cooking vegetables until they are soft. Use liquids such as broth, juice, or water to cook food until it is tender. Meats may be easier to chew if they are cut up into small pieces or minced. Dipping breads in liquid can make them easier to eat (American Lung Association, 2023).

Stop Infection

Before going into a patient’s room, a CNA should know if any special precautions need to be taken. Precautions are steps that healthcare workers take to stop the spread of infections. This information can be obtained from reports, care plans, and signs that are placed on the door of the patient’s room. Good handwashing before and after caring for the patient is standard. Personal Protective Equipment includes gowns, gloves, masks, and eye protection.

Droplet Precautions are steps taken to protect you against drops of moisture that come from an ill patient when they cough, or sneeze. Respiratory droplets can also be produced when certain procedures are being done with the patient, such as suctioning. Normally, the droplets can travel about 3 feet, and CNAs caring for these patients will need to wear a gown, gloves, face mask, and eye protection.

Airborne Precautions are used with a patient with certain infections that can be spread through the air. As well as the protective equipment listed above, CNAs caring for these patients will also need to wear an approved N95 respirator mask.

Following isolation precautions protects the CNA, the patient, other patients, and the members of the healthcare team(Douedi, 2022).


A tracheostomy is a surgical procedure that makes a small opening in the trachea to allow the patient to breathe. A tube is put into the tracheostomy opening, and this tube must always be kept in place and clear of secretions. These patients have blockage of their upper airway, and the only way they can get air into their lungs is through the tracheostomy tube. Never cover the opening of a tracheostomy with a blanket or anything else (Raimonde, 2023). Depending on the qualifications and training of the CNA, their work with a patient who has a tracheostomy may differ.

When bathing a patient with a tracheostomy, the CNA should be careful not to get water into the tracheostomy tube. Care should also be taken not to dislodge the tracheostomy tube. It is held in place with special tracheostomy ties that are attached to each side of the tracheostomy tube and tied around the patient's neck. All caregivers should check to see if the ties are wet or covered with mucus and let the nurse know.

Also, when caring for a patient with a tracheostomy, it is important to check that the tracheostomy ties are neither too tight nor too loose around the patient’s neck. For an adult patient, it should be possible to put a finger under the tracheostomy tie. For a child, it should only be possible to put a fingertip under the tie. If the tracheostomy tie is found to be too tight or to lose, this needs to be reported immediately to the nurse. Ties that are too tight can cause pressure on the patient’s skin, with redness and skin breakdown. A tie that is too loose puts the tracheostomy tube at risk of falling out (Emory, 2022).


Mechanical ventilators are machines that are used with patients who cannot breathe by themselves. The ventilator pushes air in and out of the patient’s lungs. These patients are very ill and usually need more one-on-one care than other patients. Ventilators have alarms that will sound if there is a problem. If an alarm sounds, the CNA should immediately call the nurse (Emory, 2022).

Patients on ventilators may be kept paralyzed by medication. Even if they are awake, they cannot talk and can have a hard time making their needs known. The CNA needs to keep this in mind and try to have good communication with the patient. This will help the patient to be less anxious and less afraid. Some ways to communicate with the patient include writing if this is possible for the patient. If this is too much for the patient to do, the CNA should use simple questions that need a ‘yes’ or ‘no’ answer, and the patient can use slight head, eye, or finger movements to answer. Here are some things that can be done to make communication with a ventilator-dependent patient easier:

  • Say the patient’s name and touch them gently on their shoulder or arm to let them know that you are there
  • Make eye contact with the patient and smile
  • Make sure that you are both using the same signal to communicate ‘yes’ and ‘no’
  • Speak to the patient in simple, short phrases and stop between thoughts
  • Give the patient the time they need to think and respond. If the patient does not seem to have understood your question, repeat it, and try to use more familiar words
  • Use visual cues when talking to the patient. For example, gesture or point to objects. To find out if the patient has any needs or has any symptoms, such as pain, use a communication board that has clearly printed symbols
  • Tell the patient what you are going to do before you start, for example, “I’m going to change the top sheet that is over you”
  • Before you leave the room, let the patient know that you are leaving and let them know when you will be back to check on them (Alberta Health Service, 2020).

Never make changes to ventilator settings, turn off alarms, or remove a patient from a ventilator. If you find that a ventilator alarm is sounding or the patient is looking distressed or restless, immediately call the patient’s nurse and stay with the patient (Emory, 2022).

Professional Boundaries

A CNA needs to communicate well with patients, their families, nurses, doctors, and therapists. Sometimes, it's easy to think, ‘Maybe I’m wrong, I should not say anything.’ It is wise to keep in mind that everyone is wrong from time to time, including doctors, nurses, and therapists, and in the interests of the patient, it is better to speak up and voice your concerns.

Having empathy is important for all caregivers. Empathy is being able to value and share the feelings of other people. It helps the CNA to connect with the patients they are looking after and their families. Empathy makes it easier to talk with patients and those close to them and to be able to offer comfort and support.

Providing comfort and support does not mean that the CNA forgets about professional boundaries. A professional boundary is a safe space between the patient and the CNA. In the relationship between the patient and CNA, the patient is, to some degree, helpless and needs care, while the CNA has a certain amount of power because they can give the care that the patient needs. Some examples of crossing professional boundaries include:

  • Sharing personal information with the patient
  • Keeping secrets with or for a patient
  • Acting as if you are the only one who knows how to care for the patient
  • Showing favoritism by spending more time with one particular patient
  • Complaining or making jokes about your employer or other team members to a patient
  • Sharing on social media information about a patient or the time you spend with them (Nyhus, 2021)

To prevent crossing professional boundaries, the CNA should:

  • Treat all the patients you are caring for with the same dignity and respect
  • Always speak and act professionally
  • Keep patient information confidential and only talk about patients with coworkers when it is needed
  • Ask for information about a patient on a need-to-know basis
  • Nothing about the patient, or even hints about the patient's care should be posted on social media (Nyhus, 2021)

A CNA must have all the information they need to know to provide safe and complete care to a patient. But if some facts do not have anything to do with patient care, the CNA should not ask about them. CNAs also need to be good at organizing and keeping track of patient information such as patient vital signs, special needs of a patient, and supplies needed.

Case Study

Callie is helping to train a new CNA who is coming to work on the cardiac unit. They are doing a room check to make sure that it has everything that is needed for the patient. Callie points out to Brian, the new CNA, that first, they look to see if the correct signs are on the patient’s room door. This patient is on oxygen and is on contact precautions, and both signs are on the door. They then use the hand sanitizer, which is immediately outside the room door, to clean their hands before entering the room.

Callie approaches the patient’s bed, says the patient’s name in a soft voice, “Ms. Brown,” and gently touches her arm. Callie asks the patient if she needs anything, and Ms. Brown raises her right index finger. Callie tells Brian that this means ‘no.’ Callie explains to Brian that since Ms. Brown has a tracheostomy and still uses a ventilator for part of the day, her healthcare team uses different gestures to make it easier for Ms. Brown and her caregivers to communicate with each other. Callie points to a picture chart on the wall next to the patient’s bed that has different gestures that are used with Ms. Brown and what each one means. Callie says that this also helps the patient’s family members communicate with the patient, family and healthcare team members know the exact meaning of each gesture, so there is no confusion.

After introducing Brian to Ms. Brown, Callie explained to the patient that they were checking to make sure nothing was missing from her room. First, Callie notes the bag-valve-mask on the wall next to the ventilator. Callie tells Brian that this must always be there. It is used to help the patient to breathe in an emergency. If it is ever found missing from any patient’s room who is on a ventilator, the nurse or respiratory therapist must be informed immediately.

Callie points to the sealed tracheostomy kit on the bedside table and tells Brian that it must always be there in case the tube in the patient’s airway falls out. The nurse and respiratory therapist check this every shift. However, if the CNA ever finds that this kit is missing or it has been opened and not replaced, they need to inform the nurse immediately. Callie also tells Brian never to remove any piece of equipment from a patient’s room, even if it looks like it has already been opened. Let the nurse know.

Brian asks what he should do if he finds the ventilator alarm sounding. Should he call the nurse and turn it off? Callie tells him to call the nurse immediately but not to turn off the alarm. Stay with the patient, stay calm, and let them know that their nurse is on the way.

When checking the other supplies in the room, Callie finds that there are no small-size gloves in the glove container. Brian wants to know if it's okay for someone with small hands to use the medium size gloves. Callie says that this is not a good practice. Every CNA should have properly fitting gloves so they can easily do care activities. Wearing the wrong size gloves could be uncomfortable for the CNA and the patient and make doing care harder. Callie reminds Brian that it is the CNA’s responsibility to make sure that all the supplies needed for patient care, such as gowns, gloves, and masks, are available. 

Callie makes eye contact with Ms. Brown, tells her that they are leaving, and asks if there is anything she needs. Ms. Brown indicates that she wants the lights lowered. Callie does this and tells her the time when she will be back to check on her. Ms. Brown looks at the clock on the opposite wall. Callie explains to Brian that it is important to let the patient know that they are not alone and when they can expect to see their CNA again. This helps the patient to be less anxious. If, for some reason, the CNA cannot get back at that time, they should ask someone else, such as the nurse, to check on the patient or to find someone to check on them.


Caring for someone with a respiratory condition can be hard work. The CNA needs to know about the patient's respiratory problems and other health conditions that the patient has. It is important not to divide the patient into separate conditions. Look at the patient as a whole person and realize that the patient is affected by everything that is going on with them.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


  • Alberta Health Service (2020). Quick Tips for communicating with a patient on a ventilator. Visit Source.
  • American Lung Cancer Society (2023). Visit Source.
  • Douedi, S, Douedi, H, (2022). Precautions, Bloodborne, Contact, and Droplet. National Library of Medicine. StatPearls. Visit Source.
  • Emory (2022). CNA Study Guide. Emory Test Prep, Published Monroe IL 2022.
  • Nyhus, J, (2021). What new nurses should know about Professional Boundaries. Visit Source.
  • Raimonde, A, Westhoven, N, Winters, R, (2023). Tracheostomy. National Library of Medicine. StatPearls. Visit Source.
  • Zimlich, Rachael, (2022) The 8 Most Common Types of Respiratory Diseases. Very Well Health. Visit Source.