funds 29 Respirations and Oxygen Delivery

clearing airway secretions

effective cough

most effective position: sitting

two deep breaths then inhale deeply. breath rapidly & forcibly rapidly w mouth open

postural drainage

in position 5-15 min, 2-4 times a day

in morning. never after a meal, >1h

done before

• bronchodialater 

• rhythmic clapping percussion w cupped hands over thoracic area, avoiding spine & sternum

assess pulse ox & lung sounds a&p. mouth care p

sputum specimen

best p nebulizer or wake up

rinse mouth w water. place lid upside down

deep breaths & cough to obtain 1/2tsp sputum

mouth care

patients w copd may do what to effectively breathe?

can oxygen be dry/irritating to the respiratory track?

yes, can cause epistaxis

humidifier beneficial

oxygen therapy equipment

oxygen source on wall always green

flowmeter

humidifer

tubing

in the order for oxygen, this information is included 

route (eg. nasal)

flow rate (eg. 1 L, 2L)

frequency (eg. prn, q2h)

safety measures pt on oxygen

sign on door

never frayed wires

no smoking

avoid flammable clothes

no oils, alchohol

inspired air is _% oxygen?

21%

oxygen administration

delivered via nasal cannula, mask, tent, croupette, catheter

requires humidification, flow rate orderd

common rates: 4-6L/min

COPD patients given 2-3L/min to avoid arrest (avoid breaking the drive to breathe)

oxygen administration via cannula

plastic tube w short, curved prongs. extend into nostril ¼ - ½ in

ensue prongs in properly, downward

skin breakdown risk

>3L requires humidifications

oxygen administration via masks

venturi mask: precise amount of oxygen. doesn’t change based on their respirations. good for humidity.

nonrebreather mask/ high con

highest concentration of oxygen. acute, breathing but distress

cannot b used w humidity 

bag inflated & mask snug.

one way expiratory valve 

artificial airways purposes

relieve an obstruction

protect the airway

facilitate suctioning

provide artificial ventilation

artificial airways

nasopharyngeal & oropharyngeal airways

keep the gone from falling back into the throat

artificial airways

endotracheal tubes

maintain an airway in the unconscious/ unable to ventilate on their own

• eg cardiac rest. short-term. leads to tracheostomy if needed for extended period

goes through larynx. cant talk. must provide alternate communication

tracheostomy

surgical opening into trachea to insert cuffed tracheostomy tube

cuff is inflated to remain in place & prevent aspiration

• pt cant talk

• maintains airway, facilitates suctioning & mechanical ventilation

• may be temporary or permeant

• a 2nd tracheostomy should be at bedside & inner cannula. different sizes too

parts of tracheostomy

valve used for cuff inflation & deflation & pressure measurement

face plate where ties are inserted to go round neck.

obturator guides inner cannula into the trachea

another pic tracheastomy

skin breakdown risk !!!!

stoma must be cleaned.

nasopharyngeal suctioning / oral suctioning

oral is attempted first. put in liquid first to ensure functioning. yankauer. 14-16 Fr

suction then clear out w water

av pressure between 80-120

should b replaced daily

• nasopharyngeal is sterile, oral clean

should be monitoring breathing and pulse ox while suctioning

tracheobronchial suctioning

deep suctioning to remove secretions. intubated pt or tracheostomy

sterile technique

should be pre-oxygenated prior bc trachea gets irritated & youre suctioning oxygen too

• never press on suction when going in, only out

• no longer than 10-15 seconds at a time, w oxygenation in between

should be monitoring breathing and pulse ox while suctioning

adventitious lung sounds

bag valve mask

cpr

chest drainage tubes

restore negative pressure in pleural space

used to remove air, fluid, blood from pleural space

connected to drainage device. may require suction/ use gravity

hemothorax

blood in pleural space.

lung has collapsed

pneumonthorax

partial/ complete collapse of lung due to accumulation of air in pleural space

chest suctioning device

should only be gentle bubbling in chamber.

aggressive bubbling can mean leak/

chest suctioning operations

subcut emphysema can happen. feels like rice-krispy. touch neck and assess

if greater than 100mL per hour, doc should b called

atelectasis

alveoli collapse

incentive spirometer prevents this