Respiratory Modalities 2014 Final-Ch 21

1
NURS 342
Respiratory Care
Modalities
mpbq spring 2014
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Oxygen Therapy
Administration
of oxygen at greater than 21% (the

concentration of oxygen in room air) to provide adequate
transport of oxygen in the blood, to decrease the work of
breathing, and to reduce stress on the myocardium, refer to
Chart 21-2
Assess
for signs and symptoms of hypoxia, arterial blood gas

results, and pulse oximetry, refer to Chart 21-1
Oxygen
delivery systems, refer to Figures 21-1 and 21-2 and

Table 21-1
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Oxygen Delivery by Mask
Figure 21-1
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Venturi Mask Nonrebreathing

Mask
Partial
Rebreathing
Mask
T-Piece and Tracheostomy Collar
Figure 21-2
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Question
Is the following statement true or false?
The primary oxygen administration method for a patient with

COPD is a nasal cannula.
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Answer
False
The primary oxygen administration method for a patient with

COPD is a Venturi mask, not a nasal cannula.
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Complications of Oxygen Therapy
Suppressed respiratory drive and low O2 tension
Fire
Oxygen
toxicity: O2 concentrations of greater than 50% for

extended periods of time (longer than 48 hours) can cause an
overproduction of free radicals, which can severely damage
cells
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Oxygen Toxicity
Symptoms include substernal discomfort, paresthesias,

dyspnea, restlessness, fatigue, malaise, progressive respiratory
difficulty, refractory hypoxemia, alveolar atelectasis, and
alveolar infiltrates on x-ray
Prevention:
Use lowest effective concentrations of oxygen

PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen
percentages to be used
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Question
A patient with hypoxemia will have an increase in the PaO2

level.
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10
Answer
False
A patient with hypoxemia will have a decrease in the PaO 2 level,

not an increase in the PaO2 level
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Incentive Spirometry
Two
11
types: volume or flow
Device
encourages patient to inhale slowly and deeply to

maximize lung inflation and alveoli expansion
Used
to prevent or treat atelectasis
Nursing
care
Positioning of patient, encourage use, set realistic goals, and record

outcomes.
Patient education, refer to Chart 21-3
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Question
The patient should be encouraged to use an incentive

spirometer approximately 10 breaths per hour between
treatments while awake
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12
Answer
True
The patient should be encouraged to use an incentive

spirometer approximately 10 breaths per hour between
treatments while awake
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13
Mini-Nebulizer Therapy
Handheld
apparatus that disperses a moisturizing agent or

medication into the lungs, make a visible mist
Nursing
care: Refer to Chart 21-4
Slow, deep breathes through mouth and hold a few seconds at the
end of inspiration
Coughing exercises to mobilize secretions
Assess
patent before treatment and evaluate patient response

after treatment
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14
15
Chest Physiotherapy
Includes
postural drainage, chest percussion and vibration,

breathing retraining, and effective coughing, refer to Chart 214
Goals:
remove secretions, improve ventilation, and increased

efficiency of respiratory muscles
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Postural Drainage: Lower Lobes,

Anterior Basal Segments
Figure 21-3
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16
Postural Drainage: Upper Lobes, Anterior 17

Segments
Figure 21-3
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Postural Drainage: Lower Lobes, Lateral

Basal Segments
Figure 21-3
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18
Postural Drainage: Upper Lobes, Apical

Segments
Figure 21-3
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19
Postural Drainage: Lower Lobes, Superior 20

Segments
Figure 21-3
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21
Postural Drainage: Upper Lobes, Posterior
Segments
Figure 21-3
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22
CPT: Postural Drainage, Percussion,

Vibration, and HFCWO
Figure
21-4
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23
Patient Teaching: Home Oxygen

Safety
Humidification
Flow
Ordering
rate and adjustment
Maintenance
equipment
Identification
malfunction
of
of
oxygen
Signs
Diet,
of supplies and
and symptoms
activity, travel
Electrical
outlets
Airway
obstruction, refer
to Chart 21-6
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24
Endotracheal Intubation
Provides
patent airway, access for mechanical ventilation,

facilitates removal of secretions
Care,
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refer to Chart 21-7
25
Endotracheal Tube
Figure 21-6
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Tracheostomy Tubes
Figure 21-7
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26
27
Tracheostomy
Prevention
of complications, refer to Chart 21-8
Guidelines
for patient care, refer to Chart 21-9
Guidelines
for tracheal suctioning, refer to Chart 21-10
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28
Nursing Diagnosis: Patients With

Endotracheal Intubation or
Tracheostomy
Communication
Anxiety
Knowledge
deficit
Ineffective
airway clearance
Potential
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for infection
29
Mechanical Ventilation
Positive
or negative pressure device to maintain ventilation and

oxygenation
Indications,
Initial
settings, refer to Chart 21-12
Prevention
AVEA
of VAP, refer to Chart 21-13
and Puritan Bennett 840, refer to Figure 21-8
Patient
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refer to Chart 21-11
perspective, refer to Chart 21-14
Noninvasive Positive-Pressure
Ventilation
Use
of mask or other device to maintain a seal and permit

ventilation
Indications
Continuous
Bilevel
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positive airway pressure (CPAP)
positive airway pressure (BiPAP)
30
Ventilator Modes
Figure
21-9
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31
Nursing Process: Assessment

Systematic
assessment of all body systems
In-depth respiratory assessment including all indicators of

oxygenation status
Comfort, rest
Coping, emotional needs
Communication needs
Assessment
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of the equipment and settings, refer to Table 21-2
32
Nursing Diagnoses
Impaired
gas exchange
Ineffective
Risk
airway clearance
for trauma
Impaired
physical mobility
Impaired
verbal communication
Defensive
coping
Powerlessness
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33
Collaborative Problems
Alterations
in cardiac function
Barotrauma
Pulmonary
infection
Sepsis
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34
35
Nursing Process: Planning

Goals
include: maintenance of patent airway
Optimal
Absence
gas exchange
of trauma, infection, or complication
Adjustment
Successful
Optimal
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to nonverbal methods communication
coping measures
mobility
36
Enhancing Gas Exchange:

Interventions
Monitor
ABGs and other indicators of hypoxia. Note trends
Auscultate
Judicious
Monitor
A
lung sounds frequently
use of analgesics
fluid balance
complex diagnosis that requires a collaborative approach
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37
Effective Airway Clearance:

Intervention
Assess
lung sounds at least every 2 to 4 hours.
Measures
to clear airway: suctioning, CPT, position changes,

promote mobility
Humidification
Medications
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38
Trauma and Infection: Interventions

Infection
Tube
control measures
care
Cuff
management
Oral
care
Elevation
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of HOB
39
Other Interventions
ROM
and Immobility
Communication
Stress
methods
reduction techniques
Interventions
to promote coping
Include
in care: family teaching, and the emotional and coping

support of the family
Home
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care, refer to Charts 21-16 and 21-17

40
Weaning
Process
of withdrawal of dependence upon the ventilator
Successful
weaning is a collaborative process
Criteria
for weaning
Patient
preparation
Methods
Refer
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of weaning
to Chart 21-17
Thoracic Surgery
Surgeries
and
procedures,
refer to Chart 21-18
Related
risks, refer to
Chart 21-19
Complications,
Chart 21-21
Nursing
refer to
care plan, refer

to Chart 21-22
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Suctioning,
refer to
Chart 21-23
Arm/shoulder
exercise,
refer to Chart 21-24 and
Figure 21-24.1
Home
care, refer to
Chart 21-25
Support
incision, refer to
Figure 21-12
41
Chest Tube Drainage System:

Compare
Atrium Ocean and Oasis, refer to Figure 21-10
Set-up and management, refer to Chart 21-20
Disposable system
Compare water seal to dry suction, refer to Table 21-3
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42
Heimlich Valve
Figure 21-11
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43
Patient Teaching and Home Care

Considerations
Breathing and coughing techniques
Positioning
Addressing pain and discomfort
Promoting mobility and arm and shoulder exercises
Diet
Prevention of infection
Signs and symptoms to report
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44
Technique for Supporting Incision

While a Patient Coughs
Figure
21-12
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45

Respiratory Modalities 2014 Final-Ch 21

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1

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

of oxygen at greater than 21% (the

for signs and symptoms of hypoxia, arterial blood gas

delivery systems, refer to Figures 21-1 and 21-2 and

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Delivery by Mask

Venturi Mask Nonrebreathing

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

T-Piece and Tracheostomy Collar

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

The primary oxygen administration method for a patient with

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

The primary oxygen administration method for a patient with

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Complications of Oxygen Therapy

Suppressed respiratory drive and low O2 tension

toxicity: O2 concentrations of greater than 50% for

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Symptoms include substernal discomfort, paresthesias,

Use lowest effective concentrations of oxygen

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

A patient with hypoxemia will have an increase in the PaO2

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

A patient with hypoxemia will have a decrease in the PaO 2 level,

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

types: volume or flow

encourages patient to inhale slowly and deeply to

to prevent or treat atelectasis

Positioning of patient, encourage use, set realistic goals, and record

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

The patient should be encouraged to use an incentive

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

The patient should be encouraged to use an incentive

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

apparatus that disperses a moisturizing agent or

care: Refer to Chart 21-4

Coughing exercises to mobilize secretions

patent before treatment and evaluate patient response

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

postural drainage, chest percussion and vibration,

remove secretions, improve ventilation, and increased

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Postural Drainage: Lower Lobes,

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Postural Drainage: Upper Lobes, Anterior 17

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Postural Drainage: Lower Lobes, Lateral

mpbq spring 2014

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Postural Drainage: Upper Lobes, Apical