1. Chapter 25 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. 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.

7. 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

8. Endotracheal Tube

9. 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.

10. Tracheostomy Tubes

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

12. 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

13. 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)

14. Ventilator Modes

15. 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

16. 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

17. Collaborative Problems
Alterations in cardiac function
Barotrauma
Pulmonary infection
Sepsis

18. 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.

19. 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.

20. 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

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

22. 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

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

24. 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

25. Chest Tube Drainage System
Refer to fig

26. 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