7B - Respiratory Care

What are early signs of hypoxia?

Change in respiratory status + change in mental status.

What vital sign change appears early in hypoxia?

Increased blood pressure.

What cardiac signs may indicate hypoxia?

Tachycardia, dysrhythmias, chest pain, MI.

When should you consider giving oxygen in trauma or anemia?

Immediately — oxygen demand exceeds supply.

What is hypoxemic hypoxia?

Low oxygen in the blood due to lung problems.

What is circulatory hypoxia?

Poor perfusion or decreased blood flow to tissues.

What is anemic hypoxia?

Low hemoglobin → decreased oxygen-carrying capacity.

What is histotoxic hypoxia?

Cells cannot use oxygen (ex: cyanide poisoning).

What is required to administer oxygen?

A provider order (except in emergencies). O₂ is a medication.

Why must oxygen tanks be handled and stored with caution?

They are highly pressurized and oxygen supports combustion.

What is oxygen toxicity?

Lung damage from prolonged high-concentration O₂. S/S: chest pain, cough, dyspnea, restlessness.

What is combustion in oxygen therapy?

Oxygen itself is not flammable but intensifies fire — increases burning speed and heat.

What is the concern with oxygen use in COPD patients?

Too much O₂ can suppress hypoxic drive → CO₂ retention → respiratory depression.

What oxygen flow is typical for COPD patients?

Low-flow oxygen (1–2 L/min).

What should be avoided around oxygen therapy?

Smoking, candles, open flames, sparks, oil-based lotions, and unsecured oxygen tanks.

What is a sign oxygen toxicity may be developing?

Substernal chest pain or new/worsening dyspnea.

When can a nurse start oxygen without an order?

Emergency situations requiring immediate support.

What is the safest way to store oxygen tanks?

Upright, secured, in cool/dry areas, away from heat sources.

What is the flow range and FiO₂ for a nasal cannula?

1–6 L/min, 24–44% FiO₂. >4 L dries mucosa; ineffective for mouth breathers.

When is a simple face mask used?

Short-term moderate O₂ needs (40–60%). Must be fitted; risk for skin breakdown.

What is the key nursing point for a partial rebreather mask?

Reservoir bag must remain partially inflated during inspiration/expiration.

What oxygen system provides the highest FiO₂ without intubation?

Nonrebreather mask (NRB) → 80–95% FiO₂.

What do the one-way valves on an NRB mask do?

Prevent room air entry and prevent exhaled air from re-entering the bag.

Which oxygen device is best for COPD patients?

Venturi mask — delivers precise FiO₂.

What determines FiO₂ in a Venturi mask?

The color-coded valve (barrel) attached.

When is a face tent used?

For patients who cannot tolerate masks (burns, facial trauma). Provides humidification

What is the purpose of a transtracheal catheter?

Long-term low-flow O₂ directly to trachea; less visible and more comfortable.

When is hyperbaric oxygen therapy used?

CO poisoning, gas gangrene, decompression sickness, wound healing.

What is the difference between low-flow oxygen and high-flow oxygen?

Low-flow oxygen cannot be a specific amount, while high flow is a very specific amount.

What is the purpose of an incentive spirometer?

Prevents atelectasis by promoting deep inhalation and lung expansion.

Does the patient inhale or exhale into the incentive spirometer?

Inhale.

How often should a patient use the incentive spirometer?

10 times per hour while awake.

What type of breathing pattern is needed for the incentive spirometer?

Slow, deep inhalation.

hat happens if a patient uses the spirometer too quickly?

They won’t achieve full lung expansion.

What does a small-volume nebulizer do?

Converts liquid medication into a mist for inhalation.

Who benefits most from nebulizers?

Patients who cannot use inhalers effectively (young, elderly, SOB).

What medications are commonly given via nebulizer?

Bronchodilators (like albuterol), steroids, mucolytics.

How long does a nebulizer treatment usually take?

10–15 minutes.

What should the nurse monitor during a nebulizer treatment?

RR, heart rate (tachycardia from albuterol), breath sounds.

What is the purpose of chest physiotherapy (CPT)?

To loosen and mobilize secretions so they can be coughed or suctioned out.

What are the 4 components of CPT?

Postural drainage, percussion, vibration, breathing retraining.

What is postural drainage?

Using gravity to drain mucus from specific lung segments.

When should postural drainage be performed?

Before meals or 1–2 hours after meals.

How long is each postural drainage position held?

5–15 minutes.

What should follow postural drainage?

Effective coughing or suctioning to remove loosened secretions.

What does chest percussion do?

Uses cupped-hand clapping to loosen secretions.

What does chest vibration do?

Gentle shaking during exhalation to move mucus toward larger airways.

When is CPT contraindicated?

Rib fractures, spinal surgery, hemoptysis, unstable BP, severe respiratory distress.

Why is breathing retraining used in CPT?

To improve ventilation, reduce work of breathing, and enhance mucus clearance.

What does the flutter valve do?

Creates oscillating pressure during exhalation to loosen and mobilize mucus.

Who benefits from a flutter valve?

Patients with thick secretions: COPD, pneumonia, cystic fibrosis, bronchiectasis.

Goal of diaphragmatic breathing?

Strengthen the diaphragm and improve breathing efficiency by encouraging abdominal breathing.

How to perform diaphragmatic breathing?

Hand on abdomen/chest → inhale through nose → belly rises → exhale through pursed lips while tightening abdomen.

Purpose of pursed-lip breathing?

To prolong exhalation, reduce air trapping, and decrease airway resistance.

When is pursed-lip breathing especially useful?

COPD, dyspnea, anxiety, air trapping.

What is the HFCWO vest used for?

High-frequency chest vibrations to mobilize deep lung secretions.

What are some conditions treated with the HFCWO vest.

Cystic fibrosis, bronchiectasis, COPD with retained secretions.

Nursing considerations for HFCWO vest.

Encourage coughing after treatment; monitor for pain or hemoptysis; avoid during active bleeding or unstable fractures.

What is the purpose of an endotracheal tube (ETT)?

To maintain airway patency, allow mechanical ventilation, and protect airway from aspiration.

Where is the ETT placed?

Through the mouth → past vocal cords → into trachea.

Can a patient talk with an ETT?

No — the tube passes through the vocal cords.

Why is the ETT cuff important?

Seals airway so air doesn’t leak and prevents aspiration.

Normal cuff pressure range?

20–25 mmHg.

Risks of low cuff pressure?

Aspiration pneumonia due to inadequate seal.

Risks of high cuff pressure?

Tracheal ischemia, necrosis, bleeding.

How often should cuff pressure be checked?

Every 6–8 hours.

What position reduces aspiration risk with ETT?

HOB 30–45° (semi-Fowler’s).

Why perform oral care with chlorhexidine?

Prevents ventilator-associated pneumonia (VAP).

Why pre-oxygenate before suctioning?

Prevents hypoxia—suctioning temporarily removes oxygen.

What must always be monitored during mechanical ventilation?

Breath sounds, chest rise symmetry, oxygen saturation.

What should you do every 2 hours with an intubated patient?

Reposition to prevent skin breakdown and improve ventilation.

What is a major safety concern with an ETT?

Accidental extubation — tube must be secured.

What communication considerations exist for intubated patients?

Provide alternative communication methods (writing board, gestures).

What is the purpose of a cuffed tracheostomy tube?

Allows mechanical ventilation and prevents aspiration by sealing the airway.

What is the most dangerous early tracheostomy complication?

Tube dislodgement (loss of airway).

What does subcutaneous emphysema feel like?

“Rice Krispies” or crackling under the skin due to trapped air.

What is the correct cuff pressure range?

20–25 mmHg.

Why is humidified oxygen used with tracheostomies?

Prevents thick, dry secretions that can cause airway obstruction.

What patient position reduces aspiration risk in trach patients?

Semi-Fowler’s, HOB 30–45°.

What should the nurse do if a trach tube becomes dislodged?

Call for help, use a bag-valve mask over the stoma or face, and try to reinsert if trained.

What nursing intervention prevents infection?

Sterile suctioning + sterile tracheostomy care + oral hygiene.

What is a sign of airway obstruction in tracheostomy patients?

No airflow, high-pitched sounds, difficulty breathing, thick mucus.

Why must trach ties be secure?

To prevent accidental tube dislodgement or decannulation.

What is the primary reason for mechanical ventilation?

To support oxygenation and ventilation when the patient cannot maintain adequate gas exchange.

What ABG findings indicate need for ventilation?

PaO₂ < 55 mmHg OR PaCO₂ > 50 mmHg with pH < 7.32.

Why does altered mental status require mechanical ventilation?

Patient cannot maintain or protect their airway → high aspiration risk.

What clinical sign indicates immediate need for ventilation?

Apnea or severely decreased respiratory rate.

Why do neuromuscular disorders require ventilation?

Respiratory muscles weaken → cannot generate adequate breaths.

Why is mechanical ventilation used during major surgeries?

To control respirations under anesthesia and ensure oxygenation.

What respiratory condition indicates increased work of breathing?

Respiratory distress not relieved by other interventions (O₂, suctioning, bronchodilators).

Name two conditions where airway is compromised and ventilation is needed.

Facial trauma, inhalation burns, swelling, or obstruction.

Why would shock require mechanical ventilation?

Low perfusion → respiratory fatigue and failure.

What is the purpose of mechanical ventilation?

Support or replace breathing, improve oxygenation, remove CO₂, and relieve respiratory muscle workload.

What is the difference between CPAP and BiPAP?

CPAP = one continuous pressure; BiPAP = two pressures (IPAP/EPAP).

What does the A/C mode do?

Gives a full preset breath with every patient or machine-triggered breath.

What does PEEP do?

Keeps alveoli open at end of exhalation to improve oxygenation.

What causes a low pressure alarm?

Disconnected tubing, cuff leak, ventilator leak.

What causes a high pressure alarm?

Secretions, biting tube, kinked tube, bronchospasm, decreased lung compliance.

What are patient complications from ventilation?

Barotrauma, pneumothorax, cardiovascular drop from high PEEP, infection (VAP).

Required nursing intervention to prevent VAP?

Oral care q2–4 hrs, HOB 30–45°, suction as needed, maintain sterile technique.