1. Respiratory Disorders
Therapeutic Services
By: Cindy Quisenberry

2. Anatomy & Physiology of the Respiratory System
Components of the respiratory system:
Upper air passages.
The lungs.
The bloodstream.
Muscles that cause inhaling and exhaling.
The job of the respiratory system:
To bring oxygen into the body.
To expel carbon dioxide.

3. Anatomy & Physiology of the Respiratory System
The airways consist of:
Nasal passages.
Oral cavity (the mouth).
Throat or pharynx.
Voice box or larynx.
Windpipe.
Bronchi (main airways in the lungs).
Bronchioles (airways off the bronchi).

4. Oxygen Therapy
Common lung diseases can lower the level of oxygen in the blood, causing the need for supplemental oxygen.
Oxygen is considered a drug and must be ordered by a physician.
Reasons for Oxygen Therapy
Low levels of oxygen in the blood (hypoxemia)
Work demands of breathing
Work of the heart

5. Oxygen Therapy Oxygen Delivery Devices Monitoring Oxygen Therapy
Nasal cannula
Simple mask
Monitoring Oxygen Therapy
Improvements expected with oxygen therapy:
Patient’s thinking ability should improve.
Shortness of breath (SOB) should decrease.
Vital signs should become closer to normal.
PaO2 should rise to an acceptable level.
Pulse oximetry values should improve.

6. Oxygen Therapy Nasal Cannula Simpler than a mask.
The fraction of the inspired oxygen (FiO2) varies depending on the flow of oxygen in L/min and the rate and depth of the patient’s breathing.
Delivers concentrations of 24-38% with flow rates from L/min; 30-35% with flow rates from 3 – 4 L/min; 38-44% with flow rates from 5 – 6 L/min.

7. Oxygen Therapy Simple Oxygen Mask
Requires a fairly high O2 flow to prevent rebreathing of CO2.
Minimum oxygen flow of 6 L/min. should be used
Delivers 40-60% oxygen with flow rate of L/min.

8. Oxygen Therapy Nonrebreather Oxygen Mask
Reservoir bag allows a high FiO2 to administered.
At rates slower than 6 L/min, the risk of rebreathing CO2 increases.
A valve closes during expiration so that exhaled air does not enter the reservoir bag and is not rebreathed.
Delivers 60-95% oxygen with flow rate of L/min.

9. Oxygen Therapy Venturi Oxygen Mask
Uses different size adaptors to deliver a fixed or predicted FiO2.
Used for patients who have COPD when an accurate FiO2 is essential and CO2 buildup must be kept to a minimum.
Delivers 24-60% with flow rates from 4-12 L/min.

10. Oxygen Therapy Open-Face Mask (Face Tent)
Fits loosely around the patient’s face.
Convenient for providing humidification and oxygenation.
Oxygen concentration cannot be controlled (depends on the rate and depth of the patient’s respirations).
Delivers concentrations of % with flow rates from 8 – 12 L/min.

11. Oxygen Therapy Hazards of Oxygen Therapy
Oxygen toxicity – too much oxygen for too long a time.
Retinopathy of prematurity (ROP) – high oxygen levels in infants.
Atelectasis – lung collapse.

12. Arterial Blood Gases
Measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

13. Medicated Aerosol Therapy
Causes airways to open up, or bronchodilate.
Has minimal side effects, since the medication travels directly into the lungs.

14. Medicated Aerosol Therapy
The Advantages of Aerosolized Medications
Can use smaller doses.
Act very quickly.
Side effects are minimal.
Convenient, easy, and painless to use.
Can be used at home.

15. Medicated Aerosol Therapy
The Disadvantages of Aerosolized Medications
Difficult to administer the correct dosage each time.
Difficult to teach the patient how to use.
Healthcare providers may not know how to instruct the patient on the proper techniques.

16. Medicated Aerosol Therapy
Types of Drugs Given by Aerosol
Nasal decongestants – Contain vasoconstrictors, drugs that decrease the blood flow to nose vessels causing nasal passages to open.
Bronchodilators – Drugs that increase the diameter of lung airways.
Corticosteroids – Drugs that may be inhaled and are used for anti-inflammatory maintenance.
Mucolytics – Drugs used to break down secretions within the lungs.
Antimicrobials – Used to treat a number of bacterial and fungal pulmonary infections.

17. Medicated Aerosol Therapy
Aerosol Drug Delivery System
The Metered Dose Inhaler (MDI)
The most commonly used aerosol drug delivery system.
A small portable pressurized device that delivers medication to the lungs.
Consists of a canister that contains a pressurized gas propellant and medication.

18. Medicated Aerosol Therapy
Metered Dose Inhaler Accessories
Add-on devices include: spacer, holding chamber, and extension device.
Advantages of using accessories are:
Medication enters through the patient’s mouth and does not hit the face.
Particle size is kept consistent.
Patient is able to inhale particles more deeply into lungs.

19. Medicated Aerosol Therapy
Evaluating Aerosol Therapy
Listen to the breath sounds before and after the treatment and note any improvement.
Ask the patient if he or she feels better after the treatment.
Use a test of pulmonary function before and after treatment.

20. Incentive Spirometry
Patients can see when the desired volume or flows have been reached.
An incentive spirometer is used to prevent or treat existing atelectasis or prevent atelectasis
Patients who may be prone to atelectasis include those who:
have had upper abdominal surgery.
have had thoracic (chest) surgery.
have chronic obstructive pulmonary disease (COPD).
are undergoing or have undergone surgery.
have been bedridden for extended periods of time.
are heavy smokers and are undergoing or have undergone surgery.

21. Mechanical Ventilation
Reasons to use:
To keep moving enough oxygen into the bloodstream and removing enough carbon dioxide from the lungs when other respiratory procedures fail.
When the patient has gone into respiratory arrest (stopped breathing).