1. Chapter 14 Respiratory Procedures

2. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Patients at Risk for Poor Oxygenation Hypoxemia –Insufficient oxygen in the blood Patients at risk –Immobile –Cardiac or pulmonary disease

3. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Risk Factors for Poor Oxygenation Postoperative Sleep apnea Morbidly obese Neuromuscular disease Decreased consciousness Kyphoscoliosis

4. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Capillary Refill Indication of the peripheral circulation Cyanosis (problem with oxygen delivery) –Skin –Nailbeds –Mucous membranes –Lips

5. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Capillary Refill Capillary refill varies with age, but will return to normal within 2 to 3 seconds. Check capillary refill on all four extremities

6. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Pulse Oximeter Measures oxygen saturation of hemoglobin –95% to 100% - normal –Below 90% - complications –Below 85% - probable hypoxemia –70% or below - life-threatening emergency

7. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Pulse Oximeter Monitor the patient! Many variables interfere with accurate values!

8. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Oxygen Therapy Pressure gauge shows the amount of oxygen in the cylinder Never modify a gauge or part to make it fit! Humidification is not necessary in liter flows below 5 Chain tank to a carrier or base

9. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Oxygen Therapy Avoid sparks, post oxygen signs Remove smoking materials Follow all safety precautions

10. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Keeping the Airway Open Measure oral airway from tip of ear to corner of mouth If the patient gags or tries to remove the airway, leave it out Nasal airway may be used in responsive patients

11. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Keeping the Airway Open Do not use on patients with the following disorders: –Nasal deformity –Bleeding disorders –Sepsis –Receiving anticoagulants

12. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Suction Patient cannot breathe during suctioning –Do not exceed 10 seconds for suctioning, insertion, and removal A Yankauer (tonsil tip) is used for mouth and throat Flexible catheter is used for the nose, mouth, and throat

13. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Small Volume Nebulizer A nebulizer converts liquid medicine into a mist –Loosens and lubricates secretions It may be large, small, ultrasonic, or placed inside ventilator tubing

14. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Continuous Positive Airway Pressure CPAP maintains positive pressure during the respiratory cycle Pressure opens partially or fully closed alveoli –Provides more surface area for gas exchange Improves oxygenation and prevents premature airway closure

15. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Bilevel Positive Airway Pressure BiPAP is similar to CPAP Maintains positive airway pressure during inspiration and expiration Higher pressure during inhalation Reduces pressure during exhalation BiPAP reduces effort of breathing

16. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Postural Drainage Drains secretions from lungs For patients with cystic fibrosis or certain types of pneumonia –Can be used to treat other conditions PCT assists with positioning patient