1. Module 11

2.  Mr. Y. is first day post-op following open heart surgery. HCP’s orders: 1. Turn, cough, deep breath q2h 2. Incentive spirometer q2h while awake 3. O 2 per nasal cannula at 2 l/min 4. Pulse oximetry continuous. 5. Up to chair tomorrow a.m.

3.  How does performing breathing exercises support Mr. Y’s respiratory function?

4.  Because Mr. Y. has an incision in his chest, it is uncomfortable for him to breathe normally. He is hypoventilating.  Which type of breathing would be appropriate to teach Mr. Y? Explain how you would teach him.  Explain why you did not choose pursed-lip breathing ro abdominal breathing.

5.  Mr. Y’s doctor ordered him to turn q 2h.

6. What is the rationale for having a patient utilize voluntary coughing?

7.  Mr. Y is suppose to use an incentive spirometer q2h while awake.  What is the purpose of him using this device?

8.  Place mouthpiece in mouth with lips tightly around the mouthpiece  Inhale with slow deep breath to raise the flow rate indicator. Continue inhaling to try to raise the piston to the prescribed volume level. (Tell patient like sucking on straw)  Exhale completely through nose if possible or mouth.  Do this several times every 1-2 hours.

10. Inspiration Inhale like sucking on straw

11.  Which of the following patients would the nurse expect incentive spirometer to be used? Choose all that apply. a.First day post- operative abdominal surgery patient b.16 year old with fracture of leg in hospital for casting c.24 y/o woman in post partum unit who had vaginal delivery yesterday d.45 y/o woman on bedrest for past 4 days e.A 62 y/o diabetic patient admitted for wound care treatment of leg ulcers What did you base your decision making?

12.  Any of the patients who had possibility of stasis of secretions in the lungs is a candidate for use of an incentive spirometer.

16. Rationale: *gravity assists in lung expansion *reduces pressure from the abdomen on the diaphragm Semi-fowlersOrthopneic

18.  Activation of cough reflex  Reduce pain  Increase ventilatory compensation  Drainage of areas of the lungs  Maintaining a patent airway

20.  Stimulates respirations while walking  Upright position allows for lung expansion.

22.  Measures the flow of air inhaled through a mouthpiece.  Purpose: ◦ Encourages deep breathing by providing visual feedback about their inspiratory ability so they can improve their own breathing efforts.

23.  Place mouthpiece in mouth with lips tightly around the mouthpiece  Inhale with slow deep breath to raise the flow rate indicator. Continue inhaling to try to raise the piston to the prescribed volume level. (Tell patient like sucking on straw)  Exhale completely through nose if possible or mouth.  Do this several times every 1-2 hours.

25. Inspiration Inhale like sucking on straw

26.  Which of the following patients would the nurse expect incentive spirometer to be used? Choose all that apply. a.First day post- operative abdominal surgery patient b.16 year old with fracture of leg in hospital for casting c.24 y/o woman in post partum unit who had vaginal delivery yesterday d.45 y/o woman on bedrest for past 4 days e.A 62 y/o diabetic patient admitted for wound care treatment of leg ulcers What did you base your decision making?

27.  Any of the patients who had possibility of stasis of secretions in the lungs is a candidate for use of an incentive spirometer.

30. Postural DrainagePercussion Vibration

31.  Drainage of secretions by gravity from various segments of the lung

32.  Percussion- forceful striking of the skin with cupped hands to mechanically dislodge tenacious secretions from bronchi  Vibration is a technique in which the chest wall is set in motion by oscillating movements of the hands.

33. Indicated for patients who have hypoxemia or inadequate transport of oxygen

34.  Mental Confusion  Restlessness  Tachypnea  Tachycardia  Air Hunger  Sweating  Cyanosis

36.  Specific concentration  Method  Liter flow per minute

37.  Place “No Smoking Oxygen in Use” sign on the door, at head of bed, and on the oxygen equipment  Instruct patient / visitors about precautions  Make sure electrical devices are in good working order to prevent sparks  Avoid materials that generate static electricity  Ground equipment  Make known location / use fire extinguishers

38.  Low-flow  High-flow

39.  Low-flow Devices: 1.Nasal Cannula – tube that extends around the face with curved prongs that fit into the nostrils.  Comfortable  Allows patient to eat, drink, talk  Check skin – around ears and nostrils for irritation.  Need to clean nares and if drying occurs, add humidification.  Pad area over ears with gauze or cotton balls

40.  Low-flow devices 2. Face Mask Simple Partial rebreather mask  Nursing Care  Assess skin around ears and where the elastic or mask compress the skin  Can cause anxiety in patients and give feeling of confinement or claustrophobia.  Use of humidification may be needed to prevent drying.

41.  High-flow devices ◦ Venturi Mask - the device delivers oxygen at a precise oxygen concentration and can be set to meet specific needs of the patient.

42.  Humidification ◦ Necessary to prevent mucous membranes from drying and becoming irritated and loosen secretions for easier expectoration

43.  Flow Meter: ◦ Regulates the amount of oxygen being delivered ◦ Calibrated in liters per minute ◦ Can be regulated by nurses by turning knob to elevate ball within chamber

45.  Pulse oximetry is a non-invasive way of measuring oxygen saturation of hemoglobin in the blood  Normal saturation is 95% - 100%  Levels below indicate oxygenation problems.. A saturation below 70% is critical, life-threatening and requires immediate attention.

46.  A sensing device is clipped to an area with pulsating arterial blood such as a finger, toe or earlobe.  With this device, a photoelectrical detector records the amounts of light transmitted or reflected by deoxygenated versus oxygenated hemoglobin picking up light signals registered by the pulsations.

47.  Assess for best location  Prepare the site  Attach the sensor  Follow manufacturer’s directions for use.  Read values and document.  Notify doctor of low levels

48. The nurse assesses the pulse oximetry of a patient with known respiratory problems and obtains a reading of 88%. What would the nurse do?