Care of Patients with Respiratory System Disorders

OUTLINE I - Sputum collection and examination II - Use of MDI III - Nebulization therapy IV – Incentive spirometry

I - Collection of sputum Early morning, deep cough sample is preferred Samples should be immediately transported to laboratory The sputum sample is obtained by having the patient: Rinse the mouth with water to minimize contamination by normal oral flora Breathe deeply several times Cough deeply Expectorate the raised sputum into a sterile container.

invasive procedures used to collect specimens Sputum may be obtained by : Nasotracheal or orotracheal suctioning with a sputum trap or by fiberoptic bronchoscopy Bronchoscopy for patients with acute severe infection, patients with chronic or refractory infection, or immunocompromised patients when a diagnosis cannot be made from an expectorated or induced specimen.

II - metered-dose inhaler (MDI) A device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. The medication in a metered dose inhaler is most commonly a bronchodilator, corticosteroid or a combination of both for the treatment of asthma and COPD. INDICATION: It is the most commonly used delivery system for treating  asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases.  

II - metered-dose inhaler (MDI) A spacer (holding chamber) may also be used to enhance deposition of the medication in the lung and help the patient coordinate activation of the MDI with inspiration. Spacers come in several designs, but all are attached to the mdi and have a mouthpiece on the opposite end Once the canister is activated, the spacer holds the aerosol in the chamber until the patient inhales The patient should take a slow, 3- to 5-second inhalation immediately following activation of the MDI

II - metered-dose inhaler (MDI) correct steps in administering medication with an MDI: Remove the cap and hold the inhaler upright. Shake the inhaler. Tilt head back slightly and breathe out slowly. Position the inhaler approximately 1–2 inches away from the open mouth, or use a spacer/holding chamber. When using a medicine chamber, place the lips around the mouthpiece. Press down on the inhaler to release the medication as you start to breathe in slowly and deeply through the mouth. For (3–5 seconds. ) Continue breathing in as the medication is released (press the cartridge down).

II - metered-dose inhaler (MDI) correct steps in administering medication with an MDI: 6. Hold your breath for 8–10 seconds to allow the medication to reach down into your airways. 7. Repeat puffs as directed, allowing 1–2 minutes between puffs. 8. Apply the cap to the MDI for storage. 9. After inhalation, rinse mouth with water when using a corticosteroid-containing MDI.

Iii - Nebulization Therapy DEFINITION Is the process of medication administration via inhalation utilizing a nebulizer which transports medications to the lungs by means of mist inhalation. A nebulizer is a small device that can convert a drug from a solution into an aerosol form by means of a compressor/compressed gas source. Nebulization creates a mist of drug particles that can be inhaled via a face mask or mouthpiece soothing the inflamed airways Bronchodilators are the most common nebulized drugs but many others can be nebulized, including steroids and antibiotics.  

Nebulization Therapy Purpose To add moisture to oxygen delivery system To hyrdate thick sputum and prevent mucus plugging To administer various drugs to the airways MEDICATIONS ADMINISTERED via Nebulizer Bronchodilators (for example, salbutamol), Anticholinergics (for example, ipratropium bromide), Corticosteroids (for example, beclometasone) Normal saline.

Indication of Nebulization Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as: Bronchospasms Chest tightness Excessive and thick mucus secretions Respiratory congestions Pneumonia Atelectasis Asthma

Contraindications In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as: Patients with unstable and increased blood pressure Individuals with cardiac irritability (may result to dysrhythmias) Persons with increased pulses Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)

Equipment Nebulizer and nebulizer connecting tubes Compressor oxygen tank Mouthpiece/mask Respiratory medication to be administered Normal saline solution

Possible effects and reactions after nebulization therapy Palpitations Tremors Tachycardia Headache Nausea Bronchospasms (too much ventilation may result or exacerbate bronchospasms)

CAUTION Patients with COPD should have nebulizers driven by air Patients with acute asthma should have nebulizers driven by oxygen (usually 6-8l/min  If a patient with glaucoma is to receive an anticholinergic drug such as ipratropium bromide, a mouthpiece is preferred to reduce the leakage of nebulised solution into the eyes  Compressors should be serviced on a regular basis according to local policy.  Local infection control procedures should be followed to minimize the risk of cross infection.  

Nurse’s roles 1. Closely monitor all clients receiving bronchodilators for signs of increased heart rate, nervous agitation and restlessness 2. Patient teaching: Proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful Emphasize compliance to therapy Report untoward symptoms immediately for apposite intervention.

IV - INCENTIVE SPIROMETRY A method of deep breathing that provides visual feedback to help the patient inhale slowly and deeply the patient performs sustained maximal inspirations and can see the results of these efforts as they register on the spirometer. A target is established for each patient. The patient first exhales, then places the lips around the mouthpiece and slowly inhales, trying to drive the piston on the device to a marked goal. A common recommendation for use of the incentive spirometer is 10 deep breaths every hour while awake. IDEAL POSITION : the patient assumes a sitting or semi-fowler’s position to enhance diaphragmatic excursion

INCENTIVE SPIROMETRY Indications: Used after surgery, especially thoracic and abdominal surgery, To promote the expansion of the alveoli To prevent or treat atelectasis. As a preventive measure, incentive spirometry may be more effective than ippb because it maximizes the amount of air inhaled while maintaining relatively low airway pressures. advantages: It encourages the patient to participate actively in treatment It ensures that the maneuver is physiologically appropriate and is repeated It is a cost-effective way of preventing complications.

INCENTIVE SPIROMETRY two types of Incentive spirometers A - volume type - the tidal volume of the spirometer is set according to the manufacturer’s instructions. the purpose of the device is to ensure that the volume of air inhaled is increased gradually as the patient takes deeper and deeper breaths. B - A flow spirometer has the same purpose as a volume spirometer, but the volume is not preset. The spirometer contains a number of movable balls that are pushed up by the force of the breath and held suspended in the air while the patient inhales. the amount of air inhaled and the flow of the air are estimated by how long and how high the balls are suspended. volume type Triflow spirometer

Assisting the Patient to Perform Incentive Spirometry Explain the reason and objective for the therapy: the inspired air helps to inflate the lungs. The ball or weight in the spirometer will rise in response to the intensity of the intake of air. The higher the ball rises, the deeper the breath. Assess the patient’s level of pain and administer pain medication if prescribed. Position the patient in semi-fowler’s position or in an upright position (although any position is acceptable). Demonstrate how to use diaphragmatic breathing. Instruct the patient to place the mouthpiece of the spirometer firmly in the mouth, to breathe air in (inspire), and to hold the breath at the end of inspiration for about 3 seconds. The patient then exhales slowly.

Assisting the Patient to Perform Incentive Spirometry Encourage approximately 10 breaths per hour with the spirometer during waking hours. Set a reasonable volume and repetition goal (to provide encouragement and give the patient a sense of accomplishment). Encourage coughing during and after each session. Assist the patient to splint the incision when coughing postoperatively. Place the spirometer within easy reach of the patient. For the postoperative patient, begin the therapy immediately. (If the patient begins to hypoventilate, atelectasis can start to occur within an hour.) Record how effectively the patient performs the therapy and the number of breaths achieved with the spirometer every 2 hours.

References Kozier & erbs fundamentals of nursing. Eighth ed. Craven & hirnle. Fundamentals of nursing. Human health and function. Lippincott & Williams. Fourth ed. Nursing crib