Specific Methods of Respiratory Management

1. Specific Methods of Respiratory Management Respiratory Module

2. Deep Breathing & Coughing • Airway clearance • Nrs Dx • Ineffective airway clearance • h fluids

3. Breathing Exercises • Goal • i work of breathing • h efficiency • Diaphragmatic breathing • Pursed-lip breathing

4. Breathing Exercises • Diaphragmatic breathing • Gen info • Diaphragm – muscle • Practice • Procedure • Place 1 hand on abdomen and other on chest • Push out abd during I • Chest move very little

5. Breathing Exercises • Pursed-lip Breathing • Gen info • Used when SOB • Keep airway open during E  h CO2 excretion • With diaphragmatic breathing • Counting  i anxiety

6. Breathing Exercises • Pursed-lip Breathing • Procedure • I • slowly through nose • Count 2 • E • Through pursed lips • Count 4

7. Positioning • Conserve energy • Max lung expansion • Pt specific • Fowlers • Chair • leaning forward • Good lung down

8. Oxygen therapy • Goal • Provide adequate transport of O2 • i work • i stress to myocardium • Need for O2 based on • ABG’s • Clinical assessment

9. Oxygen therapy • Cautions on O2 tx • Med! • Except in emergency need MD Rx • Give O2 only to bring the pt back to baseline • ***COPD • WHY?

10. Oxygen therapy • COPD & O2 • Normal - CO2 indicator to breath • COPD – O2 indicator to breath • d/t h CO2 levels “burned” medulla sensor for CO2 • Medulla uses O2 to initiate breath

11. COPD & O2 • COPD + h O2  • i Resp  • h PaCO2  • Carbon dioxide narcosis & acidosis  • Deathmosis

12. Oxygen therapy • Precautions • Catalyst for combustion • “No smoking” sign • Tanks  missiles • No friction toys

13. Oxygen Side effects • O2  • Hyper or hypo ventilation? • Hypoventilation  • Atelectasis

14. Oxygen toxicity • O2 overdose • h O2 concentration > 48 hrs • “r/t the destruction and i of surfactant • “the formation of a hyaline membrane lining the lung • “and the development of pulmonary edema that is not cardiac in origin”

15. Oxygen Toxicity S&S • Sub-sternal distress • Chest pain • Dry cough • Paresthesia • Dyspnea • Progressive • Restlessness • * PaO2 > 100mmHg

16. Oxygen Toxicity Prevention • i FiO2 • P.E.E.P. • Positive, End, Expiratory, Pressure • C.P.A.P. • Continuous positive airway pressure

17. Method of O2 Administration Nasal Cannula • Flow rate • 1-6 L/min • FiO2 • 20-40% • Nrs • Talk & eat • Comfort • Nose breather

18. Method of O2 Administration Simple Mask • Flow rate • 6-10 L/min • FiO2 • 40-60% • Nrs • Higher flow rate

19. Method of O2 Administration Partial Re-breather Mask (Reservoir) • Flow rate • 6-10 L/min • FiO2 • 60-100% • Nrs • Uses reservoir to capture some exhaled gas for rebreathing • Vents allow room air to mix with O2

20. Method of O2 Administration Non-rebreather Mask • Flow rate • 6-10 L/min • FiO2 • 70-100%

21. Method of O2 Administration • Nrs • Side vents closed • Reservoir vent closed for I, open for E • Reservoir bag stores O2 for I but does not allow E air in • Reservoir never collapse to <½

22. Method of O2 Administration Venturi • Flow rate • 4-8 % • FiO2 • 20-40% • Nrs. • Precise % of O2 • i.e. COPD

23. Which one of the following conditions could lead to an inaccurate pulse oximetry reading if the sensor is attached to the clients ear? • Artificial nails • Vasodilation • Hypothermia • Movement of the head

24. Nebulizer Mist Treatment • Deliver Moisture OR medication directly into the lungs • Topical – i systemic S/E • Indications: • Must be able to deep breath

25. Nebulizer Mist Treatment Meds: • Bronchodilators • Albuteral (ventolin) • Corticosteroids • Mucolytic agents • Acetylcysteine • Antibiotics

26. Metered Dose Inhaler • Admin. Topical meds directly into the lungs • i systemic S/E • Meds: • Corticosteroids • Bronchodilators • Mast cell inhibitors

27. Metered Dose Inhaler Procedure • Canister into unit correctly • Shake gently • Hold inhaler – breath out slowly (not into inhaler)

28. Metered Dose Inhaler • Place mouthpiece into your mouth • Close lips around it • Tilt head back • Keep tongue out of way • Press top of the canister firmly & breath in through your mouth

29. Metered Dose Inhaler • Remove inhaler from mouth • Hold breath for several seconds • Breath out slowly

30. Metered Dose Inhaler Rinse your mouth afterward to help reduce unwanted side effects

31. Incentive Spirometry • Device enc. Deep breath • Prevent & tx Atelectasis • Procedure • Inhale!

32. Chest physiotherapy • Goal • Remove bronchial secretions • h ventilation • h efficiency of respiration

33. Chest physiotherapy Postural drainage • Help move secretion deep w/in lungs • Used when pt has weak or ineffective cough (& retaining secretions) • Client is placed in various positions to drain lungs • 15 min each position

34. Chest physiotherapy Nrs. Management • Auscultate /a & /p • Pt comfort • Assess for: • h pain • SOB • Weakness • Lightheadedness • Hemoptysis

35. Chest physiotherapy Percussion • Cupped hands strike the chest repeatedly •  sound waves loosen secretions Vibration • Vibrations using hands or vibratos to loosen secretions

36. Chest physiotherapy Percussion& vibration • X after meals • X over: • Chest tubes • Sternum • Spine • Kidneys • Spleen • Breasts • Caution with elderly

37. Chest Drainage Tubes • Continuous chest drainage • Insertion of one or more chest tube by MD • Into the pleural space • Drain fluid or air

38. Chest Drainage Tubes Indications • Air in pleural space • Pneumothorax • Pleural effusion • Penetrating chest injury • Chest surgery

39. Chest Drainage Tubes • Upper, anterior chest (2nd & 4th intercostal space) • Remove air • Lower lateral chest (8th or 9th intercostal space) • Remove fluid

40. Chest Drainage Tubes • MD inserts • Nrs connects system and secures all connections • Vaseline gauze and sterile occlusive dressing at insertion site to prevent leakage

41. Chest Drainage Tubes • 2 padded clamps at bedside • Clamps only used if: • Chest system accidentally disconnected • Changing drainage system • Trial period before removal

42. Chest Drainage Tubes • Tubes never clamped for more than few min  • Prevents air from escaping  • Buildup of air in pleural space  • Pneumothorax

43. Chest Drainage Tubes • 3-bottle system • Water seal bottle • Suction bottle • Drainage bottle

44. Chest Drainage Tubes Water seal • When pt E  • Air trapped in the pleural space travels through chest tube to the water seal bottle  • Bubble up and out of the bottle

45. Chest Drainage Tubes Water seal • Water acts as a seal – allows air to escape, prevents air from getting back in • Bubbles with E • Normal • Constant bubbling • Abnormal – leak • Check for leaks

46. Chest Drainage Tubes Water Seal • Water level fluctuates • h I • i E • Tidaling • Normal • When lung is reinflated  • Tidaling stops • If tidaling stops: • Lung reinflated • Tubing kinked • Tubing occluded

47. Chest Drainage Tubes Suction Bottle • Suction sometimes used to speed up lung reinflation • Amt of suction is dependent of the level of H2O in the bottle, not the amt of suction set on the machine

48. Chest Drainage Tubes Suction Bottle • Suction level order by MD • -20cm Water • Turn suction machine on enough to cause gentle bubbling • Normal

49. Chest Drainage Tubes Suction bottle • Vigorous bubbling  • water evaporation  • change amt of suction • Turn down suction • No bubbling • Kink in system • Suction disconnected

50. Chest Drainage Tubes Drainage bottle • Collect fluid from pleural space • Fluid d/t • Pleural effusion • Chest trauma • Surgery