1. 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. Oxygen Toxicity
Oxygen concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals which can severely damage cells.
Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on X-ray.
Prevention:
Use lowest effective concentrations of oxygen.
PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used.

7. Incentive Spirometer Types: volume and flow
Device insures that a volume of air is inhaled and the patient takes deep breathes.
Used to prevent or treat atelectasis.
Nursing care
Positioning of patient, teach and encourage use, set realistic goals for the patient, and record the results.

8. 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.

9. Mini-Nebulizer Therapy
A hand-held apparatus that disperses a moisturizing agent or medication such as a bronchodilator into the lungs. The device must make a visible mist.
Nursing care: instruct patient in use.
Patient is to breathe with slow, deep breathes through mouth and hold a few seconds at the end of inspiration.
Coughing exercises may be encouraged to mobilize secretions after a treatment.
Assess patent before treatment and evaluate patient response after treatment.

10. Chest Physiotherapy
Includes postural drainage, chest percussion and vibration, and breathing retraining. Effective coughing is also an important component.
Goals are removal of bronchial secretions, improved ventilation, and increased efficiency of respiratory muscles.
Postural drainage uses specific positions to use gravity to assist in the removal of secretions.
Vibration loosens thick secretions by percussion or vibration.
Breathing exercises and breathing retraining improve ventilation and control of breathing and decrease the work of breathing

11. Postural Drainage- Lower Lobes, Anterior Basal Segment

12. Postural Drainage- Upper Lobes, Anterior Segments

13. Postural Drainage- Lower Lobes, Lateral basal segments

14. Postural Drainage- Upper Lobes, Apical Segments

15. Postural Drainage- Lower Lobes, Superior Segments

16. Postural Drainage- Upper Lobes, Posterior Segments

17. Percussion and Vibration

18. Patient Teaching: Home Oxygen-
Safety considerations
Flow rate and flow adjustment
Maintenance of equipment
Identification of malfunction
Humidification
Ordering of supplies and oxygen
Signs and symptoms to report
Diet and activity, travel
Electrical outlets

19. 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

20. Endotracheal Tube

21. 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.

22. Tracheostomy Tubes

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

24. 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

25. 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)

26. Positive Pressure Ventilator
Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.

27. Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.

28. 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

29. 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

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

31. 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.

32. 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.

33. 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

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

35. 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

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

37. Patients Undergoing Thoracic Surgery
Preoperative assessment
Preoperative preparation
Patient teaching
Reduction of anxiety
Postoperative expectations
Strategies to reduce postoperative complications: atelectasis and infection

38. 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

39. 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

40. Technique for Supporting Incision While a Patient Coughs