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Respiratory Care Modalities

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Presentation on theme: "Respiratory Care Modalities"— Presentation transcript:

1 Respiratory Care Modalities

2 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. Assess for signs and symptoms of hypoxia, arterial blood gas results, and pulse oximetry. Oxygen administration systems

3 Venturi Mask, Nonrebreathing Mask, Partial Rebreathing Mask

4 T-Piece and Tracheostomy Collar

5 Complications of Oxygen Therapy
Oxygen toxicity Reduction of respiratory drive in patients with chronic low oxygen tension Fire

6 Oxygen Toxicity Oxygen 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. 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.

7 Incentive Spirometer Types: volume and flow
Device insures that a volume of air is inhaled and the patient takes deep breathes. Used to prevent or treat atelectasis. Nursing care Positioning of patient, teach and encourage use, set realistic goals for the patient, and record the results.

8 Intermittent Positive-Pressure Breathing
Indicated for patients who need to increase lung expansion. Rarely used. Monitor for side effects, which may include pneumothorax, increased intracranial pressure, hemoptysis, gastric distention, psychological dependency, hyperventilation, excessive oxygen administration, and cardiovascular problems.

9 Mini-Nebulizer Therapy
A hand-held apparatus that disperses a moisturizing agent or medication such as a bronchodilator into the lungs. The device must make a visible mist. Nursing care: instruct patient in use. Patient is to breathe with slow, deep breathes through mouth and hold a few seconds at the end of inspiration. Coughing exercises may be encouraged to mobilize secretions after a treatment. Assess patent before treatment and evaluate patient response after treatment.

10 Chest Physiotherapy Includes postural drainage, chest percussion and vibration, and breathing retraining. Effective coughing is also an important component. Goals are removal of bronchial secretions, improved ventilation, and increased efficiency of respiratory muscles. Postural drainage uses specific positions to use gravity to assist in the removal of secretions. Vibration loosens thick secretions by percussion or vibration. Breathing exercises and breathing retraining improve ventilation and control of breathing and decrease the work of breathing

11 Postural Drainage- Lower Lobes, Anterior Basal Segment

12 Postural Drainage- Upper Lobes, Anterior Segments

13 Postural Drainage- Lower Lobes, Lateral basal segments

14 Postural Drainage- Upper Lobes, Apical Segments

15 Postural Drainage- Lower Lobes, Superior Segments

16 Postural Drainage- Upper Lobes, Posterior Segments

17 Percussion and Vibration

18 Patient Teaching: Home Oxygen-
Safety considerations Flow rate and flow adjustment Maintenance of equipment Identification of malfunction Humidification Ordering of supplies and oxygen Signs and symptoms to report Diet and activity, travel Electrical outlets

19 Endotracheal Intubation:
Placement of a tube to provide a patent airway for mechanical ventilation and for removal of secretions Purpose and complications related to the tube cuff Assessment of cuff pressure Patient assessment Risk for injury/airway compromise related to tube removal Patient and family teaching

20 Endotracheal Tube

21 Tracheostomy Bypasses the upper airway to bypass an obstruction, allow removal of secretions, permit long-term mechanical ventilation, prevent aspirations of secretions, or to replace an endotracheal tube. Complications include bleeding, pneumothorax, aspiration, subcutaneous or mediastinal emphysema, laryngeal nerve damage, posterior tracheal wall penetration. Long-term complications include airway obstruction, infection, rupture of the innominate artery, dysphagia, fistula formation, tracheal dilatation, and tracheal ischemia and necrosis.

22 Tracheostomy Tubes

23 Nursing Diagnoses: Patients with Endotracheal Intubation or Tracheostomy
Communication Anxiety Knowledge deficit Ineffective airway clearance Potential for infection

24 Mechanical Ventilation
Positive or negative pressure breathing device to maintain ventilation or oxygenation. Indications Negative-pressure “Iron lung”, chest cuirass Positive-pressure Pressure-cycled Timed-cycled Volume-cycled

25 Noninvasive Positive–Pressure Ventilation
Use of mask or other device to maintain a seal and permit ventilation. Indications Continuous Positive Airway Pressure (CPAP) Bi-level Positive Airway Pressure (bi-PAP)

26 Positive Pressure Ventilator
Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.

27 Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.

28 Nursing Process: The Care of Patients who are Mechanically Ventilated Infections- Assessment
Assessment of the patient Systematic assessment include all body systems In-depth respiratory assessment including all indicators of oxygenation status Comfort Coping, emotional needs Communication Assessment of the equipment

29 Nursing Process- The Care of Patients who are Mechanically Ventilated Infections- Diagnoses
Impaired gas exchange Ineffective airway clearance Risk for trauma Impaired physical mobility Impaired verbal communication Defensive coping Powerlessness

30 Collaborative Problems
Alterations in cardiac function Barotrauma Pulmonary infection Sepsis

31 Nursing Process: The Care of Patients who are Mechanically Ventilated Infections- Planning
Goals include achievement of optimal gas exchange, maintenance of patent airway, attainment of optimal mobility, absence of trauma or infection, adjustment to nonverbal methods communication, acquisition of successful coping measures, and the absence of complications.

32 Enhancing Gas Exchange
Monitor ABGs and other indicators of hypoxia. Note trends. Auscultate lung sounds frequently Judicious use of analgesics Monitor fluid balance A complex diagnosis that requires a collaborative approach.

33 Promoting Effective Airway Clearance
Assess lung sounds at least every 2-4 hours. Measures to clear airway: suctioning, CPT, position changes, promote mobility Humidification Medications

34 Preventing Trauma and Infection
Infection control measures Tube care Cuff management Oral care Elevation of HOB

35 Other Interventions ROM and mobility; get out of bed
Communication methods Stress reduction techniques Interventions to promote coping Include in care: family teaching, and the emotional and coping support of the family. Home ventilator care

36 Weaning Process of withdrawal of dependence upon the ventilator
Successful weaning is a collaborative process Criteria for weaning Patient preparation Methods of weaning

37 Patients Undergoing Thoracic Surgery
Preoperative assessment Preoperative preparation Patient teaching Reduction of anxiety Postoperative expectations Strategies to reduce postoperative complications: atelectasis and infection

38 Chest Drainage Used to treat spontaneous and traumatic pneumothorax
Used postoperatively to reexpand the lung and remove excess air, fluid, and blood. Types of drainage systems Traditional water seal Dry suction water seal Dry suction Management Prevention of cardiopulmonary complications

39 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

40 Technique for Supporting Incision While a Patient Coughs


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