RESPIRATORY CARE MODALITIES

Positioning

1. High Fowlers PositionThe head of the bed is elevated to 90 degrees to promote oxygenation via maximum chest expansion.

2. Semi-Fowlers PositionThe head of the bed is elevated 30 to 45 degrees.

3. Orthopneic positionThe patient assumes an upright or semivertical position by using pillows to support the head and chest, or sits upright in a chair. (FOR CLIENTS W/ ASTHMA)

Compress the chest, give better expulsion of CO2Patient should lean forward to _

NSG RESPONSIBILITIES

pillows or splintsSupport patients body in correct alignment using_.

BREATHING EXERCISES

I. Pursed-Lip Breathing 2 seconds

4 seconds1. Breathe in through your nose for about _ seconds.2. Pucker your lips.3. Breathe out very slowly through the pursed-lip for about _ seconds.4. Repeat

II. Abdominal (Diaphragmatic Breathing)-PATIENTS W/ COPD

1. Place one hand on your belly just below the ribs and the other hand on your chest.2. Take a deep breath through your nose. As you inhale, let your belly push your hand out while keeping the chest still.3. Exhale.

5-10 min, 4x a day Deep breathing exercises

3-4 timesExhalation is _times longer than inhalation

COUGHING EXERSICES

I. Controlled coughing

Forward, 2-31. Sit on a chair or on the edge of your bed, with both feet on the floor. Lean slightly forward.2. Fold your arms across your abdomen and breathe in slowly through your nose.3. To exhale: lean _, pressing your arm against your abdomen. Cough _times through a slightly open mouth. 4. Breathe in again by sniffing slowly and gently through your nose.

II. Huff coughing technique

2 to 31. Sit on a chair with both feet on the floor. 2. Take a slow, deep breath through your nose and hold for two counts.3. To exhale, open your mouth and make a huff sound in your throat. 4. Huff _times as you exhale.

NEBULIZATIONThe process of medication administration via inhalation.

nebulizationDrug delivery device used to administer medication in the form of a mist inhaled into the lungs.

nebulizationUsed for the treatment of bronchospasms, chest tightness, excessive and thick mucus secretions, respiratory congestions, pneumonia, atelectasis, and asthma.

POSSIBLE SIDE EFFECTS AND INHALATION REACTIONS OF NEBULIZATION*Palpitations*Tremors*Tachycardia*Headache*Nausea*Bronchospasms

CTT

chest tubea tube inserted into the thoracic cavity for the purpose of removing air or fluid, or both.

*Pneumothorax (air)*Hemothorax ( Fluid)Chest Drainage can be used to treat:1. second or third interspace along midclavicular or anterior axilliary line.2. sixth or seventh lateral interspace interspace in the midaxillary line.

3Bottles #

2-3 cmImmersion of tube to water(cm)

2 inchesBottles are how many inches apart

10-2- cmMeasurement of water in bottles

2nd bottleBottle that acts as artificial lungs

Intermittent bubblingContinuous bubblingNo bubblingMonitor in CTT:NormalAbnormal/leakageabnormal

HeparinWhat we inject if theres blood clot in the tube to remove it

3rdBottle that may not be connected to the ventilator

*Clamp the tube*Immerse the tube with sterile waterNursing interventions if the bottles were broken:

Subcutaneous emphysemaComplication

Single bottle water seal system

1 inThe tube from the patient extends approximately _inch( 2.5 cm) below the level of the water in the container.

Single bottle water seal systemThe end of the drainage tube from the patient chest is covered by the layer of the water, which permits the drainage of the air and fluid from the pleural space.

2 bottle system

two bottle systemConsist of the same water-seal chamber, plus a fluid collection bottle.

3 bottle system

3 bottle systemIt is similar in all respect to the two way bottle system, except for the addition of a third bottle to control the amount of suction applied.

1st tube of bottleabove the water level comes from the water seal bottle

2nd tubeleads to the vacuum or suction motor, or to wall suction.

3rd tubelong tube that extends below the water level in the bottle and opens to the athmosphere outside the bottle.

seven and one half3rd tube regulate the amount of the vacuum in the system, depending on the depth to which the tube submerged- the usual depth is _inches (20 cm)

Heimleich maneuverUsed for removal of foreign bodies blocking the upper airway.

Stand or kneelIf the person can't breathe, cough, or make sounds, then: _behind the person and wrap your arms around his or her waist.

Postural Drainageone way to help treat breathing problems due to swelling and too much mucus in the airways of the lungs.

Postural DrainageTreat or prevent an infectionMake breathing easier

two to four, 3 to 15The exercise usually performed _times daily, before meals and at the bedtime. Each position is held for _minutes.

tachycardia, palpition, dsypnea or chest painthe procedure should be discontinued if _occur

ENDOTRACHEAL INTUBATION

endotracheal intubationMedical procedure in which a tube is placed into the windpipe (trachea) through the mouth or nose.

endotracheal intubationAn emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own.

General anesthesia, muscle relaxing_and a _medication are usually administered so that you do not feel anything

PROCEDURE:

80-100Prior to attempting the insertion of an ETT and as indicated by clinical condition, one should ventilate the infant with bag and mask using _% oxygen

sniffingInfant's head should be slightly extended (in the _position) with the body aligned straight.

1-2The ETT is held in the right hand and inserted between the vocal cords so that the tip is _cm below the vocal cords.

5-6Ensure endotracheal position by the use of a CO2 detector- this has become a standard of care. The detector should change color (purple to yellow) by _breaths.

1/4Secure ETT with two pieces of _inch adhesive tape placed on lip and securely around ETT.

chest x-rayVerify the position of the ETT by _

TRACHEOSTOMY

tracheostomySurgical incision in the trachea just below the larynx

tracheostomyFor clients who need a long term airway support

Bandage scissorsEquipment at bedside of the client

Hydrogen peroxideSolution used in providing tracheostomy

Semi fowlersPosition of conscious client

Side lyingPosition of unconscious client

2.5-4mmMeasurement of tube for infant:

6-9 mmMeasurement of tube for adult:

15-20cm H2O Cuff pressure

4 hrsCheck cuff pressure every _ hrs

Exerts much pressure, no blood supply leading to trabstracheal tissue necrosisAbove 20/25 cm H2O of cuff pressure indicates

8 hrsReposition client every _ hrs

Weaning offRemoving of tube in the ventilator

H. peroxide Half strengthKind of hydrogen peroxide that is given to client

To promote lung expansionWhy semi fowlers position to client

SUCTIONINGAspirating secretions through a catheter connected to a suction machine or wall suction outlet

OROPHARYNGEAL, NASOPHARYNGEAL, NASOTRACHEAL SUCTIONING

100-12095-11050-95Wall unitADULT: _mmHgCHILD: _mmHgINFANT: _ mmHg

10-155-102-5Portable unitADULT: _mmHgCHILD: _ mmHgINFANT: _mmHg

yankauerMoisten the tip of the _or suction catheter with sterile water or saline.

Yankauer deviceUsed for oral suctioning

10-15Advance the catheter about _ cm

FOR NASOPHARYNGEAL AND NASOTRACHEAL SUCTION

13Measure the distance between the tip of the clients nose and the earlobe, or about _cm (5 in.) in adults.

10-15A suction attempt should last only _ seconds

ENDOTRACHEAL SUCTIONING

semi-fowlersplace the client in a _position to promote deep breathing, maximum lung expansion, and productive coughing.

100-120, 50-95WALL UNIT- ADULT: _mmHg CHILDREN AND INFANTS: _mmHg.

12-15Using your non dominant hand, turn on the oxygen to _L/min.

3-5Compress the Ambu bag _x

3-5Remove ENT in the ventilator, give _doses in hyperoxygenating

2-3mlAdditional water if we suction thick secretions

Fr 8-12Pedia catheter size

Fr 14-16Adult catheter size

12.5Insert the catheter about _cm for adults

5-10Apply suction for _ secs.by placing the non dominant thumb over the thumb port.

3Give not more than _ blows in hyperoxygenating client

THORACENTESISInvasive procedure that involves insertion of needle into the pleural space for the removal of pleural fluid or air.

*Arm is elevated and stretched forward*Client leans forward over a pillowTWO POSITIONS COMMONLY USED:

*2nd & 3rd Upper anterior intercostal space/upper anterior chest*6th & 7th Lower posterior intercostal space/lower posterior chest2 sites of thoracentesis:

1000mlDont remove more than _ ml of fluid from pleural cavity within the first 30 minutes. (after proc.)

INCENTIVE SPIROMETRYAlso called Sustained Maximal Inspiration Devices (SMIs)

Incentive spirometryMeasures the flow of air inhaled through the mouthpiece

Incentive spirometerImprove pulmonary ventilation, counteract the effects of anesthesia or hypoventilation, Loosen respiratory secretions.

4 or 5Repeat the procedure several times and then _times hourly.

semi-fowlersPlace the patient in a comfortable sitting of _position

500Set the incentive spirometer VT indicator at the desired goal the patient is to reach of exceed. (_mL is often used to start.)

100-250mlIncrease gradually by _ml each try

*Flow oriented*Vol orientedTypes of spirometers:

CHESTPHYSIOTHERAPYset of techniques that include percussion, vibration, and postural drainage.

CPTto loosen respiratory secretions and move them into the central airways where they can be removed by coughing or suctioning

1. PERCUSSIONCLAPPING

PERCUSSIONForceful striking of the skin with cupped hands.

PERCUSSIONWhen the hands are used, the fingers and thumb are held together and flexed slightly to form a cup.

1 2Percuss each affected lung segment for _minutes.

Wills tumor1 danger of percussion

2. VIBRATIONseries of vigorous quiverings produced by hands that are placed flat against the clients chest wall.

fiveVibrate during _exhalations over one affected lung segment

StridingPosition for vibration

PERCUSSION (CLAPPING) & VIBRATION

*The lower ribs to shoulders in the back.*The lower ribs to top of chest in the frontPercuss with cupped hands over the chest wall for 1 2 minutes. Work from:

OXYGEN THERAPYrequired by patients who have difficulty ventilating all areas of their lungs, whose gas exchange is impaired, or people with heart failure to prevent hypoxia.

O2 promotes combustionNo Smoking because _

NASAL PRONGS (CANNULA)Most inexpensive device used to administer oxygen

2 6, 24% - 45%Delivers flow rates of _ LPM. _O2 concentration

27-29%2L

30-33%3L

33-37%4L

36-41%5L

39-45%6L

FACE MASKCovers the clients nose and mouth.

FACE MASKExhalation ports on the sides of the mask allow exhaled carbon dioxide to escape

2nd & 3rd tracheal cartilageInsert transtracheal catheter at _ tracheal cartilage

1. SIMPLE FACE MASK40%-60%Delivers _% - _% O2 concentration

5 8 LPM

2. PARTIAL REBREATHER MASK

60% - 90%O2 concentration

6 10Liter flows: _LPM

PARTIAL REBREATHER MASKThere is an O2 reservoir bag that is attached which allows the client to rebreathe the first third of the exhaled air in conjunction with Oxygen.

3. NONREBREATHER MASKDelivers the highest O2 concentration possible

95% - 100%O2 concentration

10 15Liter flows at _LPM

NONREBREATHER MASKOne way valves on the mask and between the reservoir bag and mask prevent room air and the clients exhaled air from entering the bag so only O2 in the bag is inspired.

4. VENTURI MASKDelivers O2 concentrations varying from 24% - 40% or 50%

4 10Liter flows of _ LPM

VENTURI MASKHas wide-bore tubing and color-coded jet adapters that correspond to a precise O2 concentration and liter flow

ADMINISTERING OXYGEN BY CANNULA & FACE MASK

CANNULAdeliver a relatively low concentration of oxygen when only minimal O2 support is required.

FACE MASK

- To provide moderate O2 support and a higher concentration of oxygen and/or humidity than is provided by the cannula.

30Check the liter flow and the level of water in the humidifier in _minutes and whenever providing care to the client

Intermittent positive pressure building (IPPB)Therapeutic application of inspiratory positive pressure to the airway.

CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)Provides for positive airway pressure during all parts of a respiratory cycle, but refers to spontaneous ventilation rather than mechanical ventilation.

POSITIVE END-EXPIRATORY PRESSUREManeuver by pressure during mechanical ventilation is maintained above atmospheric at end of exhalation, resulting in increased functional residual capacity.

Positive end-expiratory pressurePurpose: Increase functional residual capacity

Low flow O2Use simple face mask, cannula woth O2 conc of 24-48%

High conc.Higher than 30%

1. Check the patency and integrity2. The inner lining to be coated with waterPuposes of suctioning NSS:

WithdrawalApply suctioning upon _

Hyperoxygenate and hyperinflate the lungsNsg intervention in all suctionings

Terminates bifurcation of bronchiDanger of endotracheal intubation