FUNDS: respiratory care

Dyspnea interventions

• Treat the underlying cause 

• Positioning: high-fowler’s 

• O2 therapy 

• Medications - bronchodilators, mucolytics, inhaled steroids, anti-anxiety agents 

• Breathing exercises 

  • Deep breathing and cough (DB/C) 

  • Pursed-lips breathing 

  • Diaphragmatic breathing 

• Relaxation & meditation

respiratory arrest priorities

airway, breathing, circulation

Inhaled Medications for respiratory arrest

• Opens airways to liquefy or loosen thick secretion or to reduce inflammation in the airways 

• Administered by nebulizer, metered-dose inhaler (MDI), or dry powder inhaler (DPI)

Nebulizer: can be used for respiratory arrest

• Utilize the force of high-flow oxygen or compressed air through a fluid medication of disperse fine particles of liquid medication into the deeper passages of the respiratory tract, where absorption occurs 

MDI:

• Handheld inhaler that uses an aerosol spray or mist to deliver a controlled dose of medication

• Can use a chamber or a spacer 

• Makes administration easier and more dosage more accurate 

• Patient education is important

• Common mistakes when using MDI’s

• 1. Not shaking the inhaler

• 2. Holding the canister upside down 

• 3. Inhaling through the nose rather than the mouth

• 4. Inhaling too rapidly 

• 5. Stop inhaling when its felt in the throat 

• 6. Not holding their breath after inhalation 

• 7. Inhaling 2 sprays with one breath 

DPI:

• Handheld inhaler that uses dry powder form of medication 

• They are breath-activated 

• A quick breath activates the flow of medication

Order of suctioning –

Tracheal suctioning is always performed before oral suctioning;

what to do during respiratory distress

Immediately withdraw catheter and supply oxygen if respiratory distress (e.g., decreased HR, decreased SpO2) occurs during the procedure

Mobilization of pulmonary secretions

• Hydration - 1900-2900 mL 92-3 quarts daily, unless contraindicated by renal or cardiac status

• Humidication of O2 - necessary when flow rate >4 LPM; hoods & tents for pediatric pts 

• Nebulization - moisture or medications added to inhaled air; used for bronchodilators & mucolytics; enhance mucociliary clearance 

• DB/C techniques - at least q2h while awake

  • If large amts - q1h while awake & arouse at night q2h

  • Q2-4h for post-op & tach splitting to prevent hospital-acquired pneumonia 

oxygen therapy is indicated when

history of hypoxia, assessment notices hypoxia, lab data signifies hypoxia

target O2 sat

94-98%

target O2 sat for COPD pts

88-92%

O2 requires

doctors order

O2 flow rate measured in

L/min

rate depends on condition of pt & route of administration

Humidification is not necessary with low flow oxygen

(4L/min or less).

Humidification should be used when

O2 is delivered at high flow rates (greater than 35%), tracheostomy, or artificial airways and patients experiencing difficulty expectorating sputum.

O2 dries and dehydrates the

respiratory membranes.

• Low-flow devices 

• Devices: nasal cannula, simple mask, partial rebreather mask, and nonrebreather mask

• High-flow devices

Devices: venturi masks, high-flow nasal cannula

nonrebreather gives

pure oxygen

partial rebreather gives

half room air, half oxygen

The nurse is caring for a client experiencing acute dyspnea. What is the priority intervention?

B. Place the client in High-Fowler’s position

The nurse observes a client using a metered-dose inhaler (MDI). Which action indicates the client needs further teaching?

B. Tilts head back slightly

Which statement by a patient using a MDI indicates correct understanding?

B. “I will exhale fully before putting the inhaler in my mouth.”

The nurse is preparing to suction a tracheostomy. Which action requires immediate intervention?

C. Suctioning for 20 seconds

During tracheal suctioning, the client’s SpO₂ falls from 98% to 85% and HR decreases to 50 bpm. What is the priority nursing action?

C. Withdraw the catheter and provide oxygen

The nurse teaches a patient with thick secretions about hydration. Which statement shows understanding?

B. “I need 1900–2900 mL of water every day unless restricted.”

The nurse is caring for a patient receiving 6 L/min via nasal cannula. Which action is appropriate?

B. Add humidification to prevent mucosal dryness

A COPD patient has oxygen prescribed to maintain saturation between 88%–92%. Their SpO₂ is 96% on 2 L/min. What is the priority action?

C. Lower the oxygen flow

Which oxygen device delivers the MOST precise oxygen concentration?

C. Venturi mask

A client is using a dry powder inhaler (DPI). Which teaching should the nurse include?

C. “A fast, deep inhalation will activate the medication.”

A patient with pneumonia is ordered DB/C every 2 hours. What is the best rationale for this order?

C. Enhances mucociliary clearance and lung expansion