Interventional Pulmonary Hygiene

pulmonary hygiene basics

goal is to improve oxygenation, mobilize secretions, and prevent complications

coughing and deep breathing technique

semi-fowler's, complete exhale with lips pursed, inhale through nose, hold 305 seconds, repeat x3 and cough on third exhalation. every 1-2 hours

what is the purpose of pursed lip breathing

decreased dyspnea and panic, prevents small airway collapse, improves air exchange, helps control breathing during activity in patients with COPD

how to do pursed lip breathing

inhale through nose for 3 counts, exhale through pursed lips for 7. when walking, inhale for 2 steps and exhale for 4 steps

what is the purpose of diaphragmatic breathing?

decreased respiratory rate, increase alveolar ventilation, improve expiration

how to do diaphragmatic breathing

inhale through nose letting the abdomen fill as far as it will go. breath out through pursed lips and contract abdominal muscles with one hand pressing inward and upward on the abdomen

what are the purposes of an incentive spirometer

maximizes lung inflation, prevent atelectasis, improve gas exchange/secretion clearance.

how to use an incentive spirometer?

sit upright, exhale normally, seal lips, inhale slow and deep, hold 2-5 seconds, exhale. do 5-10 breaths an hour while awake. splint incisions, medicate pain and rest if dizzy or lightheaded

nasal cannula

1-6 L/min

24-44%

Patient can eat talk and move, can dry mucosa

simple mask

5-8L/minute. 40-55%. Minimum 5l needed to prevent CO2 rebreathing.

Venturi mask

3-8 L/minute, 24-55%. Most precise Fi02, useful in COPD. expensive and noisy

Partial rebreather mask

6-15 L/min. 60-90%. Resorvoir bag collects oxygen and some exhaled air. Never allow bag to completely collapse during inspiration

nonrebreather mask

10-15 L/min. 60-100%. Highest O2 concentration possible (besides intubation). One-way valves, bag 2/3 full

documentation surrounding oxygen delivery

document before O2, at initiation, and 15 to 30 mins after

takeaways surrounding oxygen therapy

requires order. room air =21%. indications are hypoxemia, increased work of breathing, increased myocardial work, pulmonary HTN. O2 doesn't correct underlying cause. Must be humidified if >4 L/minute.

positive airway pressure

forced air delivered through a mask or a nasal interface to keep airways open

CPAP (continuous positive airway pressure)

delivers one continuous pressure to keep airways open. treatment of mild to moderate sleep apnea.

BiPAP (bilevel positive airway pressure)

delivers two pressures, one for inhalation and one for exhalation. treatment of sleep apnea and additional respiratory support for pts with CHF, CAD, or pulmonary/neurological disorders

barriers to CPAP/BiPAP

dry nares, skin irritation, claustrophobia, difficulty breathing against pressure, and machine noise.

Chest physiotherapy (CPT)

includes postural drainage, coughing, deep breathing, and incentive spirometry to promote cardiopulmonary function

acapella/flutter valve

handheld device combining positive expiratory pressure (PEP) and airway vibrations to clear mucus

green acapella valve

high flow device for patients who can exhale at least 15 L/min for 3 seconds or longer

Blue Acapella Valve

low flow device for patients with lower expiratory flow/lung volume

smoking cessation

first step, patients must desire to stop smoking.

home oxygen safety

requires provider order and patient teaching on proper use/storage, no-smoking signs, and safe tubing placement.