8.1. Respiratory Care Procedures

RESPIRATORY CARE
Oxygen Therapy
 is prescribed by the primary care provided, who specifies the concentration, method of
delivery and depending on the method, liter flow per minute.
 when administering oxygen is an emergency measure, the nurse may initiate the therapy
without a primary care provider’s order.
 For clients who have COPD, a low-flow oxygen system is essential
Oxygen Therapy
 Dry gases dehydrate the respiratory mucous membranes, humidifying devices that add
water vapor to inspired air an essential adjunct of oxygen therapy, particularly for over 2
lpm.
OXYGEN EQUIPMENT
 Flow Meter
Oxygen Therapy
 Oxygen passing through the water picks up water vapor before it reaches the client.
 The more bubbles created; the more water vapor is produced.
 The line for the prescribed flow rate should be in the middle of the ball of the flow meter.
 Humidifier
Oxygen Regulator
Low Flow Oxygen System
 Nasal Cannula
Nasal cannula (nasal prong)
 Is the most common and inexpensive device used to administer oxygen.
 Is easy to apply and does not interfere with the client’s ability to eat or talk.
 It is relatively comfortable , permits some movement and is well tolerated by the client.
 It delivers low concentration of oxygen ( 24-45% at flow rates of 2-6 LPM)
 It can be drying and irritating to mucous membrane.
Face masks
 Cover the client’s nose and mouth
 1. Simple face mask - delivers oxygen concentration from 40-50% at liter flows of 5-8 LPM
 2. Partial rebreathing mask- delivers oxygen concentration to 60-90% at liter of 6-10 LPM
Face masks
 The oxygen reservoir bag that is attached allows the client to rebreathe about the first
third of the exhaled air in conjunction with oxygen.
 Simple Mask (Rebreathing Mask)
High Flow Oxygen System

 Non-Rebreathing Mask
Face masks
 Nonbreathing mask- delivers the highest oxygen concentration possible 95-100%
 One-way valves on the mask and between the
reservoir bag and the mask prevent the room air and the client’s exhaled air from entering the
bag, so only the oxygen in the oxygen in the bag is inspired.
 Venturi Mask
Tracheostomy Mask
Transtracheal Oxygen Catheter
Oxygen Extension Tubing

Respiratory Care Procedures
 Used to prevent and treat respiratory complications
 May assist in inflating the alveoli and in removing secretions
Nursing Diagnoses
 Ineffective Airway Clearance
◦ For the person who has secretions in the airway that are not coughed up.
 Impaired Gas Exchange
◦ For a person who is unable to obtain the oxygen needed to expel the CO2.
 Ineffective Breathing Pattern
◦ For person taking shallow breaths.
 Risk for infection
◦ For a person with respiratory infection.
General Procedure: Assessment

 Obtain a baseline data about the patient’s respiratory status -RR
 Auscultate each lung and note areas with diminished breath sounds
 Assess the patient’s activity pattern
 Check the patient for factors that may limit respiratory effort
General Procedure: Planning
 Patient outcomes:
◦ The patient coughs out all secretions
◦ The lungs are clear to auscultation
◦ The RR is within normal
◦ The patient takes deep breaths at interval
◦ The patient is resting comfortably
General Procedure: Implementation

 Wash or disinfect hands
 Identify the patient using two identifiers
 Explain
 Carry out the planned pain relief measures
 Carry out the specific procedures
 Remove gloves if used, and wash or disinfect hands.
Deep Breathing
 To fully expand all alveoli and encourage the movement of secretions
Assist the patient with deep breathing:
 Instruct the patient both by explaining and demonstrating proper deep breathing
 Position the patient for maximum expansion of the lungs
 Have the patient inspire by counting to 2 slowly
 Have the patient exhale slowly while you count to 4
 Watch the patient for chest and abdominal expansion
 Correct the patient’s breathing technique as needed
 Repeat for a total of 10 deep breaths
Devices:
 Incentive spirometers
◦ Volume-Oriented Spirometer (electronic)
 a signal is activated when the patient achieves a prescribed inspiratory volume
 Emphasize on the long inspiratory effort
 Exhale normally, and then place mouth in the mouthpiece and inspire through the
machine
◦ Flow-Oriented Spirometer (mechanical)
 Has plastic chambers with movable balls
 Inhale through the nose, exhale through the mouth, then inhale through the
mouthpiece
 Repeat 10 times every 1 to 2 hours
Intermittent Positive Pressure Breathing (IPPD) Machine
◦ Uses positive pressure to increase inspiration and a nebulizer device to deliver

moisture deep into the lungs
◦ Used for the patient with respiratory disease who needs to have a medication
delivered to the lungs using pressure
◦ It is not a first-line choice for respiratory treatments

◦ Is performed by a respiratory therapist, lasts 5 to minutes
Cough
 Always combined with deep breathing, but deep breathing may be done without
coughing.
Teach the patient to cough productively:

 Explain
 Assist the patient to a sitting position
 Splint as necessary
 Provide the patient with tissues if needed for expectorating sputum
 Have the patient deep breathe
 After the third breath, have the patient inspire and hold the breath 3 seconds
 Have the patient expire forcefully against the closed glottis, and then release the air
abruptly while flexing forward
 Repeat for 3 deep cough until the patient expectorate the mucus
 Auscultate the lungs and offer oral hygiene
 Repeat DBCE hourly as needed
Postural Drainage
 For large volume of secretions in the lungs
 Involves positioning the patient so that the force of gravity helps drain the lung secretions
 Each positions is generally held from 3 to 15 minutes
 Best done between meals, at least 2 hours after the patient has eaten
Assessment:
 Check the physician’s order
 Identify specific segments of the lung to be drained
◦ Lower lobes are drained most often
 The complete postural drainage or CPT is tiring can be done with rest periods between
positions
Planning
 Plan how you will place the patient in the various positions
 Obtain pillows and a sputum cup and tissues. Obtain clean gloves if the patient cannot
manage his or her own secretions.
Implementation:
 Explain the purpose and method of postural drainage
 Position the patient
Drain the upper lobes:
 Have the patient sit up if possible (sitting in a straight chair is ideal) or raise the head of
the bed to its maximum height.
◦ Have the patient lean to the right side (45-degree) for 5 minutes (left upper lobe)
◦ Then have the patient lean to the left side (45-degree) for 5 minutes (right upper
lobe)
◦ Have the patient lean forward at 30-to-45-degree angle for 5 minutes (posterior
segments of the upper lobes)
 Have the patient lean backward at 30-to-45-degree angle for 5 minutes (anterior
segments)
 Have the patient lie on the abdomen, back, and both sides while horizontal (remaining
segments of the upper lobes)
Drain the lower lobes:

 Have the patient lie on the left side, with the shoulders perpendicular to the bed (lateral
segment of the right lower lobe)
 Turn the patient halfway onto the back, so the shoulders are at a 45-degree angle to the
bed (right middle lobe)
 Turn the patient to the supine position, flat on the back (anterior segments of the right
and left lower lobes)
 Turn the patient halfway to the right side, so the shoulders are at 45-degree angle to the
bed (left lower lobe)
 Turn the patient completely onto the right side, so the shoulders are again at a 90-degree
angle to the bed (lateral segment of the left lower lobe)
 Have the patient turn unto the abdomen, with the head turned to the side (posterior
segments the lower lobes)

 Have the patient cough forcefully (lying on the abdomen)
 Return the patient to a comfortable position, offer mouth care, and allow for a rest
periods
Percussion
 Manual application of light blows to the chest wall
 Done over areas that need to be drained
 Percuss over the patient’s gown to decrease friction
Assessment:
 Check the physician’s order
 Identify specific segments of the lung to be drained
Planning:
 Plan how you will place the patient in the various positions
 Obtain pillows and a sputum cup and tissues. Obtain clean gloves if the patient cannot
manage his or her own secretions.
 Plan for assistance you may need
Implementation:
 Wash or disinfect hands
 Identify the patient using two identifiers
 Place the patient in the appropriate postural drainage position
 Cup your hands
 Clap cupped hands over the chest wall
 Wash or disinfect your hands
Vibration
 Same purpose as percussion
 Ask the patient to exhale after a deep inspiration and during exhalation, perform vibration
 NOTE! Using flat hands, place your hands firmly against the chest wall, one over the other.
◦ Keep your arms and shoulders straight, vibrate your hands back and forth rapidly
while the patient exhales

8.1. Respiratory Care Procedures

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RESPIRATORY CARE

High Flow Oxygen System

Oxygen Extension Tubing

General Procedure: Assessment

General Procedure: Implementation

◦ Uses positive pressure to increase inspiration and a nebulizer device to deliver

◦ It is not a first-line choice for respiratory treatments

Teach the patient to cough productively:

Drain the lower lobes:

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