Chapter 14 Respiratory Procedures

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Patients at Risk for Poor Oxygenation Hypoxemia –Insufficient oxygen in the blood –Not a disease, can happen to anyone Patients at risk –Immobile –Cardiac or pulmonary disease S&S of decreased oxygenation –Decreased responsiveness –In a dark-skinned person? Cyanotic nail bed.

Is carbon dioxide a waste product? Is excess carbon dioxide and acid in the body harmful? Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3

4 Risk Factors for Poor Oxygenation Postoperative Sleep apnea Morbidly obese Neuromuscular disease Decreased consciousness Kyphoscoliosis

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Capillary Refill Indication of the peripheral circulation Cyanosis (problem with oxygen delivery) –Skin –Nailbeds –Mucous membranes –Lips

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Capillary Refill Capillary refill varies with age, but will return to normal within 2 to 3 seconds. Check capillary refill on all four extremities Indicates how well tissues are being nourished with oxygen.

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Pulse Oximeter Measures oxygen saturation of hemoglobin –95% to 100% - normal –Below 90% - complications –Below 85% - probable hypoxemia –70% or below - life-threatening emergency

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Pulse Oximeter Monitor the patient! –Move spring clip every 2 hrs to prevent skin breakdown. Many variables interfere with accurate values! –Nail polish –Temperature –Raynaud’s

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Oxygen Therapy Pressure gauge shows the amount of oxygen in the cylinder Never modify a gauge or part to make it fit! Humidification is not necessary in liter flows below 5 (sterile distilled water) Chain tank to a carrier or base Needs a physicians order!

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Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Oxygen Therapy Avoid sparks, post oxygen signs Remove smoking materials Follow all safety precautions

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Keeping the Airway Open Measure oral airway from tip of ear to corner of mouth If the patient gags or tries to remove the airway, leave it out Nasal airway may be used in responsive patients

OPA (oropharyngeal airway) Used to maintain a clear airway during resuscitation. Patient must be unconscious. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13

(NPA) Nasopharyngeal Airway Used for semiconscious/unconscious. Does not induce a gag reflex. Should be slightly smaller than nostril. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Keeping the Airway Open Do not use an NPA on patients with the following disorders: –Nasal deformity –Bleeding disorders –Sepsis –Receiving anticoagulants

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Suction Patient cannot breathe during suctioning –Do not exceed 10 seconds for suctioning, insertion, and removal A Yankauer (tonsil tip) is used for mouth and throat Flexible catheter is used for the nose, mouth, and throat

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Small Volume Nebulizer A nebulizer converts liquid medicine into a mist –Loosens and lubricates secretions It may be large, small, ultrasonic, or placed inside ventilator tubing

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Continuous Positive Airway Pressure CPAP maintains positive pressure during the respiratory cycle Pressure opens partially or fully closed alveoli –Provides more surface area for gas exchange Improves oxygenation and prevents premature airway closure

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Bilevel Positive Airway Pressure BiPAP is similar to CPAP Maintains positive airway pressure during inspiration and expiration Higher pressure during inhalation Reduces pressure during exhalation BiPAP reduces effort of breathing

The CPAP delivers air pressure at a single level. The air pressure cannot be altered. The BiPAP has two levels of airway pressure - high, when the patient inhales, and low when the patient exhales. The air pressure in the BiPAP can be altered. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.20

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.21 Postural Drainage Drains secretions from lungs For patients with cystic fibrosis or certain types of pneumonia –Can be used to treat other conditions PCT assists with positioning patient (use percussion)

Tips: –Wash hair at night to reduce effects of allergies. –Avoid exposing COPD patients to aerosols. –Cardinal sign of sleep apnea is daytime sleepiness Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.22