Specific methods of respiratory management
Download
1 / 86

Specific Methods of Respiratory Management - PowerPoint PPT Presentation


  • 191 Views
  • Updated On :

Specific Methods of Respiratory Management. Respiratory Module. Deep Breathing & Coughing. Airway clearance Nrs Dx Ineffective airway clearance h fluids. Breathing Exercises. Goal i work of breathing h efficiency Diaphragmatic breathing Pursed-lip breathing. Breathing Exercises.

Related searches for Specific Methods of Respiratory Management

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Specific Methods of Respiratory Management' - ashton


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Deep breathing coughing l.jpg
Deep Breathing & Coughing

  • Airway clearance

    • Nrs Dx

      • Ineffective airway clearance

    • h fluids


Breathing exercises l.jpg
Breathing Exercises

  • Goal

    • i work of breathing

    • h efficiency

  • Diaphragmatic breathing

  • Pursed-lip breathing


Breathing exercises4 l.jpg
Breathing Exercises

  • Diaphragmatic breathing

    • Gen info

      • Diaphragm – muscle

      • Practice

    • Procedure

      • Place 1 hand on abdomen and other on chest

      • Push out abd during I

      • Chest move very little


Breathing exercises5 l.jpg
Breathing Exercises

  • Pursed-lip Breathing

    • Gen info

      • Used when SOB

      • Keep airway open during E  h CO2 excretion

      • With diaphragmatic breathing

      • Counting  i anxiety


Breathing exercises6 l.jpg
Breathing Exercises

  • Pursed-lip Breathing

    • Procedure

      • I

        • slowly through nose

        • Count 2

      • E

        • Through pursed lips

        • Count 4


Positioning l.jpg
Positioning

  • Conserve energy

  • Max lung expansion

  • Pt specific

    • Fowlers

    • Chair

    • leaning forward

  • Good lung down


Oxygen therapy l.jpg
Oxygen therapy

  • Goal

    • Provide adequate transport of O2

    • i work

    • i stress to myocardium

  • Need for O2 based on

    • ABG’s

    • Clinical assessment


Oxygen therapy9 l.jpg
Oxygen therapy

  • Cautions on O2 tx

    • Med!

      • Except in emergency need MD Rx

      • Give O2 only to bring the pt back to baseline

        • ***COPD

        • WHY?


Oxygen therapy10 l.jpg
Oxygen therapy

  • COPD & O2

    • Normal - CO2 indicator to breath

    • COPD – O2 indicator to breath

      • d/t h CO2 levels “burned” medulla sensor for CO2

    • Medulla uses O2 to initiate breath


Copd o2 l.jpg
COPD & O2

  • COPD + h O2 

  • i Resp 

  • h PaCO2 

  • Carbon dioxide narcosis & acidosis 

  • Deathmosis


Oxygen therapy12 l.jpg
Oxygen therapy

  • Precautions

    • Catalyst for combustion

    • “No smoking” sign

    • Tanks  missiles

    • No friction toys


Oxygen l.jpg
Oxygen

Side effects

  • O2 

  • Hyper or hypo ventilation?

    • Hypoventilation 

    • Atelectasis


Oxygen toxicity l.jpg
Oxygen toxicity

  • O2 overdose

  • h O2 concentration > 48 hrs

  • “r/t the destruction and i of surfactant

  • “the formation of a hyaline membrane lining the lung

  • “and the development of pulmonary edema that is not cardiac in origin”


Oxygen toxicity15 l.jpg
Oxygen Toxicity

S&S

  • Sub-sternal distress

  • Chest pain

  • Dry cough

  • Paresthesia

  • Dyspnea

    • Progressive

  • Restlessness

  • * PaO2 > 100mmHg


Oxygen toxicity16 l.jpg
Oxygen Toxicity

Prevention

  • i FiO2

  • P.E.E.P.

    • Positive, End, Expiratory, Pressure

  • C.P.A.P.

    • Continuous positive airway pressure


Method of o2 administration l.jpg
Method of O2 Administration

Nasal Cannula

  • Flow rate

    • 1-6 L/min

  • FiO2

    • 20-40%

  • Nrs

    • Talk & eat

    • Comfort

    • Nose breather


Method of o2 administration18 l.jpg
Method of O2 Administration

Simple Mask

  • Flow rate

    • 6-10 L/min

  • FiO2

    • 40-60%

  • Nrs

    • Higher flow rate


Method of o2 administration19 l.jpg
Method of O2 Administration

Partial Re-breather Mask (Reservoir)

  • Flow rate

    • 6-10 L/min

  • FiO2

    • 60-100%

  • Nrs

    • Uses reservoir to capture some exhaled gas for rebreathing

    • Vents allow room air to mix with O2


Method of o2 administration20 l.jpg
Method of O2 Administration

Non-rebreather Mask

  • Flow rate

    • 6-10 L/min

  • FiO2

    • 70-100%


Method of o2 administration21 l.jpg
Method of O2 Administration

  • Nrs

    • Side vents closed

    • Reservoir vent closed for I, open for E

    • Reservoir bag stores O2 for I but does not allow E air in

    • Reservoir never collapse to <½


Method of o2 administration22 l.jpg
Method of O2 Administration

Venturi

  • Flow rate

    • 4-8 %

  • FiO2

    • 20-40%

  • Nrs.

    • Precise % of O2

    • i.e. COPD


Slide23 l.jpg


Nebulizer mist treatment l.jpg
Nebulizer Mist Treatment inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Deliver Moisture OR medication directly into the lungs

  • Topical – i systemic S/E

  • Indications:

    • Must be able to deep breath


Nebulizer mist treatment25 l.jpg
Nebulizer Mist Treatment inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Meds:

  • Bronchodilators

    • Albuteral (ventolin)

  • Corticosteroids

  • Mucolytic agents

    • Acetylcysteine

  • Antibiotics


Metered dose inhaler l.jpg
Metered Dose Inhaler inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Admin. Topical meds directly into the lungs

  • i systemic S/E

  • Meds:

    • Corticosteroids

    • Bronchodilators

    • Mast cell inhibitors


Metered dose inhaler27 l.jpg
Metered Dose Inhaler inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Procedure

  • Canister into unit correctly

  • Shake gently

  • Hold inhaler – breath out slowly (not into inhaler)


Metered dose inhaler28 l.jpg
Metered Dose Inhaler inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Place mouthpiece into your mouth

  • Close lips around it

  • Tilt head back

  • Keep tongue out of way

  • Press top of the canister firmly & breath in through your mouth


Metered dose inhaler29 l.jpg
Metered Dose Inhaler inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Remove inhaler from mouth

  • Hold breath for several seconds

  • Breath out slowly


Metered dose inhaler30 l.jpg
Metered Dose Inhaler inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Rinse your mouth afterward to help reduce unwanted side effects


Incentive spirometry l.jpg
Incentive Spirometry inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Device enc. Deep breath

  • Prevent & tx Atelectasis

  • Procedure

    • Inhale!


Chest physiotherapy l.jpg
Chest physiotherapy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Goal

    • Remove bronchial secretions

    • h ventilation

    • h efficiency of respiration


Chest physiotherapy33 l.jpg
Chest physiotherapy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Postural drainage

  • Help move secretion deep w/in lungs

  • Used when pt has weak or ineffective cough (& retaining secretions)

  • Client is placed in various positions to drain lungs

    • 15 min each position


Chest physiotherapy34 l.jpg
Chest physiotherapy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Nrs. Management

  • Auscultate /a & /p

  • Pt comfort

  • Assess for:

    • h pain

    • SOB

    • Weakness

    • Lightheadedness

    • Hemoptysis


Chest physiotherapy35 l.jpg
Chest physiotherapy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Percussion

  • Cupped hands strike the chest repeatedly

  •  sound waves loosen secretions

    Vibration

  • Vibrations using hands or vibratos to loosen secretions


Chest physiotherapy36 l.jpg
Chest physiotherapy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Percussion& vibration

  • X after meals

  • X over:

    • Chest tubes

    • Sternum

    • Spine

    • Kidneys

    • Spleen

    • Breasts

  • Caution with elderly


Chest drainage tubes l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Continuous chest drainage

  • Insertion of one or more chest tube by MD

  • Into the pleural space

  • Drain fluid or air


Chest drainage tubes38 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Indications

  • Air in pleural space

  • Pneumothorax

  • Pleural effusion

  • Penetrating chest injury

  • Chest surgery


Chest drainage tubes39 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Upper, anterior chest (2nd & 4th intercostal space)

    • Remove air

  • Lower lateral chest (8th or 9th intercostal space)

    • Remove fluid


Chest drainage tubes40 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • MD inserts

  • Nrs connects system and secures all connections

  • Vaseline gauze and sterile occlusive dressing at insertion site to prevent leakage


Chest drainage tubes41 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • 2 padded clamps at bedside

  • Clamps only used if:

    • Chest system accidentally disconnected

    • Changing drainage system

    • Trial period before removal


Chest drainage tubes42 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Tubes never clamped for more than few min 

  • Prevents air from escaping 

  • Buildup of air in pleural space 

  • Pneumothorax


Chest drainage tubes43 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • 3-bottle system

  • Water seal bottle

  • Suction bottle

  • Drainage bottle


Chest drainage tubes44 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Water seal

  • When pt E 

  • Air trapped in the pleural space travels through chest tube to the water seal bottle 

  • Bubble up and out of the bottle


Chest drainage tubes45 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Water seal

  • Water acts as a seal – allows air to escape, prevents air from getting back in

  • Bubbles with E

    • Normal

  • Constant bubbling

    • Abnormal – leak

    • Check for leaks


Chest drainage tubes46 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Water Seal

  • Water level fluctuates

    • h I

    • i E

  • Tidaling

    • Normal

  • When lung is reinflated 

    • Tidaling stops

  • If tidaling stops:

    • Lung reinflated

    • Tubing kinked

    • Tubing occluded


Chest drainage tubes47 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Suction Bottle

  • Suction sometimes used to speed up lung reinflation

  • Amt of suction is dependent of the level of H2O in the bottle, not the amt of suction set on the machine


Chest drainage tubes48 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Suction Bottle

  • Suction level order by MD

    • -20cm Water

  • Turn suction machine on enough to cause gentle bubbling

    • Normal


Chest drainage tubes49 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Suction bottle

  • Vigorous bubbling 

  • water evaporation 

  • change amt of suction

    • Turn down suction

  • No bubbling

    • Kink in system

    • Suction disconnected


Chest drainage tubes50 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Drainage bottle

  • Collect fluid from pleural space

  • Fluid d/t

    • Pleural effusion

    • Chest trauma

    • Surgery


Chest drainage tubes51 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Drainage bottle

  • Fluid is not emptied to measure

    • Mark line q shift

      • Date

      • Time

      • Amt.

    • Add to I&O

  • Sudden h in fluid, or very bloody 

    • Notify MD


Chest drainage tubes52 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Nrs. Care

  • Must always be kept upright

  • Always below level of chest

  • Notify MD if:

    • h Dyspnea

    • Drainage chamber full


Chest drainage tubes53 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Transporting

  • Transport w/ pt

  • Ask MD if suction Ok to be off while transporting

    • Leave open to air

  • Do not clamp to transport


Chest drainage tubes54 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Nrs management

  • P rate, effort, SOB, symmetry, pain

  • Auscultate lung sounds

    • Absent/decreased  normal as inflate

  • P Drsg intact, drainage

  • Palpate insertion site for crepitus

  • P tubing for kinks, connections


Chest drainage tubes55 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • No depended loops

  • System below level of chest

  • P system for cracks or leaks

  • P water seal for

    • H2O level

    • Tidaling

    • Bubbling w/ E


Chest drainage tubes56 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • P suction control bottle

    • Gentle bubbling

    • H2O level

  • P and mark amount of drainage


Chest drainage tubes57 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Stripping

  • Slide fingers down the tube

    Milking

  • Gently squeezing tube w/out sliding

  • MD order only!


Chest drainage tubes58 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Accidental removal

  • Drainage tube disconnected from system:

    • Clamp immediately

    • Reconnect system

    • Unclamp

  • Drainage tube pulled out of patient:

    • Cover site with Vaseline gauze/ occlusive drsg

    • Notify MD


Chest drainage tubes59 l.jpg
Chest Drainage Tubes inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Removal of tube

  • MD removes

  • Place Vaseline gauze & sterile occlusive dressing over site

  • Assess:

    • Crepitus

    • Resp status

    • Dressing site


Question l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • You notice that the water seal on a pt chest tube rises and falls with each breath. What does this mean?

  • There is a leak in the system

  • Tubing is kinked

  • Too much suction

  • Too little suction

  • Lung reinflated

  • Normal occurrence


Question61 l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • You notice constant bubbling in the water seal bottle of a chest tube drainage system. What does this mean?

  • There is a leak in the system

  • Tubing is kinked

  • Too much suction

  • Too little suction

  • Lung reinflated

  • Normal occurrence


Question62 l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • You notice vigorous bubbling in the suction bottle of a chest tube drainage system. What does this mean?

  • There is a leak in the system

  • Tubing is kinked

  • Too much suction

  • Too little suction

  • Lung reinflated

  • Normal occurrence


Question63 l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • You notice constant bubbling in the suction bottle of a chest tube drainage system. What does this mean?

  • There is a leak in the system

  • Tubing is kinked

  • Too much suction

  • Too little suction

  • Lung reinflated

  • Normal occurrence


Question64 l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • You notice no bubbling in the suction bottle of a chest tube drainage system. What does this mean?

  • There is a leak in the system

  • Tubing is kinked

  • Too much suction

  • Too little suction

  • Lung reinflated

  • Normal occurrence


Question65 l.jpg
Question? inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • While tuning a patient, the chest tube accidentally is pulled out of the patients chest. What should you do first?

  • Clamp the tube

  • Open the site with stoma openers

  • Cover the site with occlusive dressing

  • Re insert the tube

  • Call the MD


Tracheostomy l.jpg
Tracheostomy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Tracheotomy:

    • Surgical opening through the base of the neck into the trachea

  • Tracheostomy:

    • Permanent and has a tube inserted into the opening to maintain patency


Tracheostomy67 l.jpg
Tracheostomy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Reasons for Trach

    • Laryngeal CA

    • Airway obstruction

    • Trauma

    • Tumor

    • Difficulty clearing airway

    • Prolonged mechanical Ventilation


Tracheostomy68 l.jpg
Tracheostomy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Pt breaths through this opening, bypassing the upper airways

  • Semi-fowler position post-op

  • Cuff management

    • Usually 20-25mmHg


Tracheostomy69 l.jpg
Tracheostomy inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • If trach pulled out

    • Tracheal dilator to keep stoma open until MD arrives and reinsert tube


Suctioning l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

General Info:

  • Frightening & uncomfortable

  • Leads to Hypoxia

  • Leads to Vagal stim 

    • Bradycardia 

    • Cardiac arrest 


Suctioning71 l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Not do PRN

  • Enc cough

  • Hold own breath


Suctioning72 l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Oropharyngeal (clean) or nasopharyngeal (sterile) suctioning procedure

  • Gather equipment

  • Explain

  • Connect cath to suction tubing, keep cath. inside sterile sleeve

  • Turn on suction to level specified by facility (80-120 mmHg)


Suctioning73 l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Pour saline into sterile container

  • Put on sterile gloves

  • Suction small amt of saline into catheter to rinse and test suction

  • Have pt take several breaths


Suctioning74 l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • With thumb control uncovered, insert cath. through mouth/nose into pharynx until resistance is met or pt coughs

  • Slowly withdraw cath, suction intermittently while rotating

  • < 15 sec


Suctioning75 l.jpg
Suctioning inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Allow pt to rest

  • Repeat 2 more time if needed

  • If trach – DO NOT instill sterile saline into trach

  • If trach – hyperventilate before suctioning


Intubation l.jpg
Intubation inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Endotracheal tube (ET)

    • Mouth - trachea

  • Most also mech ventilated

  • Damages vocal cords & surrounding tissue

    • Only short term

  • Long term 

    • Tracheostomy


Mechanical ventilators l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

General Info

  • Provide ventilation to pt unable to breath effectively on own

  • Use + pressure to push O2 air in via ET or Trach tube


Mechanical ventilators78 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Indication for use

  • Cont. i in PaO2

  • Cont. h PaCo2

  • Persistent Acidosis


Mechanical ventilators79 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Nrs Management

  • Advance directives

  • Assess/monitor pt

  • Setting per order

  • Respond to alarms

  • Tubing free of water

  • Airway clear

  • Manual resuscitation bag at bedside


Mechanical ventilators80 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

Ventilator modes

  • FiO2

    • Fraction of inspired oxygen

    • Concentration of O2

  • Tidal Volume

    • Amt of air delivered with ea. Breath


Mechanical ventilators81 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Rate

    • Frequency of breaths

  • I:E

    • Inspiration to expiration ratio

    • 1:3

      • I-1 sec

      • E-3 sec


Mechanical ventilators82 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • AC

    • Assist control mode

    • Delivers breath ea time pt begins to inhale

    • If pt X breath, delivers preset minimum # of breaths


Mechanical ventilators83 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • SIMV

    • Synchronized Intermittent mandatory ventilation

    • Pt breaths on own, but delivers minimum # breaths


Mechanical ventilators84 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Pressure support (PS)

    • Provided + pressure on I to i work of breathing


Mechanical ventilators85 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Continuous positive airway pressure (CPAP)

    • + pressure on I & E to i work of breathing in spontaneously breathing pt


Mechanical ventilators86 l.jpg
Mechanical Ventilators inaccurate pulse oximetry reading if the sensor is attached to the clients ear?

  • Positive End Expiratory Pressure (PEEP)

    • Provides + pressure on E to keep small airways open

    • Prevent Atelectasis

    • If too high 

      • pneumothorax


ad