Chapter 25 Respiratory Care Modalities

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

Venturi Mask, Nonrebreathing Mask, Partial Rebreathing Mask

T-Piece and Tracheostomy Collar

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

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.

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

Endotracheal Tube

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.

Tracheostomy Tubes

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

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

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)

Ventilator Modes

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

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

Collaborative Problems Alterations in cardiac function Barotrauma Pulmonary infection Sepsis

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.

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.

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

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

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

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

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

Chest Tube Drainage System Refer to fig. 25-10

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