Admission to a critical care unit is a stressful occurrence in an individual's life. The surroundings are not like anything most people have ever seen and subject them to situations they are ill equipped to handle. The addi- tion of respiratory compromise further insults their sen- sibilities and promises to introduce them to a level of fear and stress most people have never imagined. Accord- ing to Perrin, s critically ill patients consider the greatest sources of stress to be discomfort, decreased communica tion, increased anxiety, and sleeplessness. In recognizing these, the nurse can work to create an environment in which patients can be as comfortable as possible as they heal. Discomfort for a patient with PCP can come from several areas. The most life-threatening issue is the res- piratory compromise. The critical care nurse should begin with a thorough respiratory assessment including the pa- tient's opinion regarding his/her level of breathing dif ficulty 16 A graphic rating scale that rates difficulty on a scale of 1 to 5, with one being no difficulty and 5 being extreme difficulty, is one method, and a visual analog that allows the patient to chart the difficulty on a