Supporting Respiratory Function

1. Supporting Respiratory Function

2. Meet Mr. Y. • Mr. Y. is first day post-op following open heart surgery. HCP’s orders: • Turn, cough, deep breath q2h • Incentive spirometer q2h while awake • O2 per nasal cannula at 2 l/min • Pulse oximetry continuous. • Up to chair tomorrow a.m.

3. Supporting Respiratory Function • How does performing breathing exercises support Mr. Y’s respiratory function?

4. Breathing Exercises • Because Mr. Y. has an incision in his chest, it is uncomfortable for him to breathe normally. He is hypoventilating. • Which type of breathing would be appropriate to teach Mr. Y? Explain how you would teach him. • Explain why you did not choose pursed-lip breathing or abdominal breathing.

5. Turning • Mr. Y’s doctor ordered him to turn q 2h. Why

6. Voluntary Coughing What is the rationale for having Mr. Y utilize voluntary coughing?

7. Incentive Spirometry • Mr. Y is suppose to use an incentive spirometer q2h while awake. • What is the purpose of him using this device?

8. What is the key point when instructing a patient in the use of an incentive spirometer ?

9. Critical Thinking • Which of the following patients would the nurse expect incentive spirometer to be used? Choose all that apply. • First day post- operative abdominal surgery patient • 16 year old with fracture of leg in hospital for casting • 24 y/o woman in post partum unit who had vaginal delivery yesterday • 45 y/o woman on bedrest for past 4 days • A 62 y/o diabetic patient admitted for wound care treatment of leg ulcers What did you base your decision making?

10. Mr. Y becomes short of breath when he lies down. What is the best position to assist with breathing? Orthopneic Semi-fowlers

11. Chest PhysiotherapyPostural Drainage • Drainage of secretions by gravity from various segments of the lung

12. Percussion and Vibration • Percussion- forceful striking of the skin with cupped hands to mechanically dislodge tenacious secretions from bronchi • Vibration is a technique in which the chest wall is set in motion by oscillating movements of the hands.

13. Oxygen Therapy Why might Mr. Y. be a candidate for oxygen therapy? With hypoventilation, he could have inadequate transport of oxygen and develop hypoxemia.

14. Try This! Mr. Y becomes confused and restless, what could be the possible cause? What is the most significant data you collect to establish possible causes?

15. Mr. Y’s health care provider ordered him to have Oxygen per nasal cannula at 2 liters /min. • Why is a doctor’s order needed to give oxygen? • Items usually included in the order are: • Method/ Oxygen delivery system • Rate of oxygen administration in liters/minute

16. How is the nurse going to regulate the flow rate to 2 liters/min? What is the purpose of humidification?

17. Safety Precautions • Avoid open flames in the room • Place “No Smoking Oxygen in Use” sign on the door, at head of bed, and on the oxygen equipment • Instruct patient / visitors about precautions • Make sure electrical devices are in good working order to prevent sparks • Avoid materials that generate static electricity • Avoid using oils in the area • Ground equipment • Make known location and use of fire extinguishers

18. Oxygen Delivery Systems Mr. Y. has an order for the use of a nasal cannula. 1. What are the advantages of this system? 2. What is the nursing care related to the patient with a nasal cannula? What is the nurse doing? Why?

19. Oxygen Delivery Systems • If Mr. Y would have a face mask ordered, what care might be different?

20. Pulse Oximetry • Mr. Y has a pulse oximeter attached to his finger. What is the purpose of this device? What reading would be within normal range?

21. Try This The nurse assesses the pulse oximetry of a patient with known respiratory problems and obtains a reading of 88%. What would the nurse do?

22. Ambulation • Mr. Y has an order to get up out of bed and ambulate. What is the purpose of ambulation?