respi care mod ali ties

8/3/2019 Respi Care Mod Ali Ties

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Respiratory CareModalitiesRachel Joy R. Rosale, RN, RM, MAN


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Oxygen Therapy

Indicated for clients with hypoxemia

O2 concentration is more important than L/min

Observe safety precautions and complications

Medical intervention prescribed by the physician

Nurse may initiate therapy


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Complications

O2-induced hypoventilation

RR Supply of O2 sensed by the brain

RR O2

Hypoventilation

CO2 retention

Respiratory acidosis

O2 toxicity

Prolonged O2 admin, client might develop toxicity thenbecome blind

Retrolental fibroplasia

Absorption atelectasis

Drying of mucus membrane

Infection


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Oxygen Delivery System

Low-Flow Delivery Systems

Gas delivered via small bore tubing at a rate shown on theflowmeter

Room air is inhaled with O2

Used for clients with RR below 25 and a regular andconsistent rate

Contraindicated to clients who require carefully monitoredconcentrations of oxygen

Ex: Nasal cannula, simple face mask, partial rebreather mask


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Oxygen Delivery System

High-Flow Delivery Systems

Supply all of the gas required during ventilation in preciseamounts regardless of the clients respiratory status

The ratio of room air to oxygen is regulated and does notvary with the clients respiration

Precise and consistent in O2 delivered

Ex: Venturi mask, face tent, T-tube/T-piece, transtrachealdelivery and tracheostomy collar


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Transtracheal Oxygen

Delivery


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Incentive Spirometry


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Endotracheal Intubation Use of an endotracheal tube through the mouth or nose into

the trachea with the use of laryngoscope

Once inserted, cuff is inflated

Maintain cuff pressure between 15-20 mmHg

High: Bleeding, ischemia, necrosis

Low: Risk of aspiration pneumonia


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Tracheostomy Tracheotomy is an opening made into the trachea;

Indications:

Bypass an obstruction

Removal of secretions

Permit long term use of mechanical ventilator

Prevent aspiration of oral/gastric secretions in anunconscious

Replace ET tube

Incision is made between 2nd and 3rd tracheal ring


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Mini-Nebulizer Therapy Hand-held apparatus used to administer

moisturizing agent or medication, such asbronchodilator or mucolytic agent, intomicroscopic particles into the lungs as thepatient inhales

Clears secretions; often used by COPD patientsat home on a long term basis

Instruct the client to breathe slowly through themouth, then hold breath for a few seconds


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Intermittent Positive-Pressure

Breathing Also called IPPV

Compressed gas is delivered under positive pressure into a

persons airways until a preset pressure is reached. Passiveexhalation is allowed through a valve, and the cycle beginsagain as the flow of gas is triggered by inhalation

Exhaled tidal volume goal of 10-15 mL/kg of body weight


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Chest Physiotherapy Percussion and vibration over the thorax to

loosen secretions in the affected area of thelungs

Consists of postural drainage, chest percussion,and vibration and breathing retraining

Aims to remove bronchial secretions, improve

ventilation and increase respiratory musclesefficiency

C/I: Rib fracture, chest incisions


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Chest Physiotherapy:Postural Drainage

Uses gravity to drain secretionsfrom segments of the lungs

Combined with CPT

Best time: 1 hr before meals,

2-3 hrs after meals


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Mechanical Ventilation Classification

Negative pressure ventilations

Positive pressure ventilations

Modes

Assist-control

Intermittent-Mandatory Ventilation

Synchronized


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Mechanical Ventilation Interventions: Assess client first, then, ventilator

Assess VS, lung sounds, respiratory status, and breathing patterns

Monitor skin color

Monitor chest for bilateral lung expansion

Obtain SpO2 Monitor ABG

Assess the need for suctioning and record

Assess ventilator settings

Assess level of water in humidifier and temperature of humidificationsystem

Ensure that the alarms are set

If a cause for alarm is undetermined, BAG the patient

Empty the tubing when moisture is present

Turn the client q 2hours, prevent immobility complications

Have resuscitation equipment @ bedside


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Mechanical Ventilation Causes of Alarms:

High Pressure

Increased secretions in the airway Wheezing or bronchospasm

Endotracheal tube is displaced

ET is obstructed as a result of kinks

Client coughs, gags, or bites ET

Low Pressure

Disconnection or lea

Client stops spontaneous breathing


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Mechanical Ventilation

Ventilation Control and Settings

Tidal Volumevol. of air client receives with each breath

Ratenumber of vent. Breath delivered/minute

Fraction of inspired O2 (FiO2)O2 conc. delivered to the client

Sighsvol. of air 1.5-2x the set tidal volume, deliverd 6-10x/hour Peak Airway Inspiratory Pressurepressure needed by the vent. To

deliver a set tidal volume at a given compliance

Continuous Positive Airway Pressureapplication of positive airwaypressure throughout the cycle for spontaneous breathing clients; forweaning

Positive End Expiratory Pressure (PEEP)exerted during expiration

Pressure Supportapplication of positive pressure on inspiration;used in combi with PEEP for weaning


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Mechanical Ventilation Weaningthe process of going from

ventilator dependence to spontaneousbreathing

SIMV T piece

Pressure support


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The Patient Undergoing

Thoracic Surgery PRE-OPERATIVE:

Lobectomy - w/ tubes in place; Unaffected

Pneumonectomyw/o tubes; Affected Segmentectomy

Wedge resection

Decorticationstripping off lung lining

Thoracoplastyribs

***Chest Tube to allow expansion of affected lung


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The Patient Undergoing

Thoracic Surgery POST-OPERATIVE:

VS

O2 Positioning

Meds

Coughing, splinting


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Closed Chest DrainagePurposes:

Remove fluid and/or air from pleural space

Re-establish normal negative pressure in thepleural space

Promote re-expansion of the lung

Prevent reflux of air/fluid into the pleural spaceform the drainage apparatus


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Closed Chest Drainage One Bottle System

Water seal and drainage in same bottle

Observe for intermittent bubblingand fluctuationof fluid with each respiration

IND: emphysema


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Closed Chest Drainage Two Bottle System

Water seal and drainage insame bottle

Observe for intermittentbubblingand fluctuation of fluidwith each respiration

IND: emphysema


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Closed Chest Drainage Three Bottle System


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Closed Chest Drainage Be sure CXR is done to assess placement.

Check for bubbling/fluctuation that is constant,continuous and gentle

TTS; ask the client to cough, deep breathe

Mark the amount of drainage at the beginningof each shift

Note character of drainage

Be sure the tubing is without kinks, coiled on bed

Keep bottles below level of the heart (2-3 feet)

DONT CLAMP NOR MILK the tubing

Maintain dry, occlusive dressing


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Closed Chest Drainage Removal of Chest Tubes: done by MD

Equipment: suture removal kit, sterile gauze,petroleum gauze, adhesive tape.

Semi-Fowlers or high-Fowlers position

Removal of tubes during expiration or at theend of full inspiration and do VALSALVAMANEUVER

Apply occlusive dressing CXR

Assess complications: subcutaneousemphysema, respiratory distress.

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