1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Advanced Respiratory Care Skills

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Respiratory and Cardiovascular System See Figure 6-1. Ventilation-process of inhalation and exhalation Gas Exchange-o2 and co2 exchange Oxygen Transport-to tissue and cells and back to the lungs Anything that affects this process affects the persons ability to meet the need for oxygen.

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Respiratory System Neuromuscular disorders Neurologic disorders Trauma –causing blockage of the airway or collapse of the lung Disorders that result in blocking of the airway –cancer

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Respiratory System (cont) Disorders that cause the alveoli to fill with fluid –pneumonia Disorders that cause the alveoli to collapse –atelectasis (a common complication after surgery) –emphysema Disorders that prevent blood from entering the lungs to receive oxygen –such as pulmonary embolism

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders Affecting Ability to Transport Oxygen A low red blood cell count (anemia) Blood circulation through the body –heart failure Inability of oxygen to get to the cells –carbon monoxide poisoning

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Monitoring Blood Oxygen Levels Pulse oximetry: –Measures the amount of oxygen in the blood –Use of pulse oximeter –applied finger, toe, earlobe, nose, or forehead (or to the toe or foot in babies) Normal=95%=-100%

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors affecting accuracy of pulse oximetry Dark fingernail polish Using the same arm for blood pressure Poor circulation

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse Oximetry

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Arterial Blood Gases More accurate than pulse oximetry Much more invasive Requires a sample of arterial blood, usually from the radial artery in the wrist –Done by respiratory therapist, RN, or MD –Complications Bleeding or swelling c/o numbnessor tingling Pale or blue color Cold to touch

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Devices Delivering Supplemental Oxygen Nasal cannula Simple facemask Non-rebreather mask Continuous positive airway pressure Mechanical ventilator

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nasal Cannula

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Facemask

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for a Patient With Supplemental Oxygen Provide good oral care Check water in humidity bottles Check person for pressure sores from tubing on face and behind ears Check person for nose bleeds

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of airways Oropharyngeal or nasopharyngeal airway –Inserted through the nostril or mouth –Short term use Endotracheal intubation –Flexible plastic –Inserted through the mouth or nostril Extends to the trachea Balloon hold it in place

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Endotracheal Tube

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nasopharyngeal/Oropharyngeal Airway

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of airways Tracheostomy –Surgically created opening in the neck into the trachea –Can be cuffed or cuffless –Used when upper airway is blocked –Can be permanent or temporary (less than 3 weeks Care and Suctioning the tracheostomy –May or may not be allowed by the PCT

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tracheostomy

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tracheostomy Care

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Suctioning Done by RN or Respiratory therapist Dangers of suctioning –Puts person at risk for hypoxia (low oxygen in the blood –Stimulates the vagal nerve (can lower heart rate)

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins A Person May Need Suctioning if: The person cannot stop coughing The person is having trouble breathing The person asks to be suctioned The pulse oximetry reading is less than 90% and his or her heart rate is increased

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins APPLICATION Trach care Oral suctioning Tracheal suctioning

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanical Ventilation Ventilator breathes for a person who cannot breathe on his own Ventilator forces air into a person’s lungs –endotracheal or tracheostomy tube Refer to Figure 6-12

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Reasons for Mechanical Ventilation surgery pain medication because of severe injuries head injury Stroke drug overdose A spinal cord injury neurologic disorder An acute disorder –respiratory infection or heart attack

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chest Tube System

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Conditions Requiring Chest Tubes Pneumothorax: the build-up of air in the space between the lungs and the chest wall Hemothorax: the build-up of blood in the space between the lungs and the chest wall Severe lung infection: can cause the build-up of pus and fluid around the lung, making insertion of a chest tube necessary

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring For a Person With a Chest Tube Place the chest tube drainage system where it cannot be knocked over Make sure that the chest tube drainage system is below chest level Never disconnect the chest tube from the chest tube drainage system

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring For a Person With a Chest Tube (cont) If suction is used, never disconnect the chest tube drainage system from the suction without a doctor’s order Make sure tubing that connects the chest tube to the chest tube drainage system is not coiled or kinked or pulled out When positioning a person with a chest tube in the lateral position, use pillows to provide for comfort and to prevent the person from lying directly on the tubing

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What disorder affects the ability to carry oxygen to the body? A.Anemia B.Paralysis C.Cancer D.Pulmonary embolism

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Anemia The body’s ability to transport oxygen can be affected by a low red blood cell count.

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which is a normal pulse oximetry reading? A.60% – 80% B.70% – 90% C.95% – 100% D.40% – 60%

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. 95% – 100% The amount of light that reaches the sensor is translated into a measurement of how much oxygen the arterial blood is carrying.

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. A person with sleep apnea may also use a CPAP. A.True B.False

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. True People with sleep apnea may also use a CPAP mask. Sleep apnea is a disorder that causes the person to stop breathing for varying periods of time while he or she is asleep.

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A person with a chest tube should maintain which of the following? A. Not be allowed to eat B. Never get out of bed C. Have the drainage system opened and drainage measured at the end of each shift D. Never raise the drainage system above chest level

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Never raise the drainage system above chest level. Raising the drainage system above chest level may cause drainage to flow back into the chest cavity.