Comprehensive Oxygen Therapy, Airway Management, and Respiratory Physiotherapy

Oxygen Therapy

Administration of oxygen at a concentration greater than room air (21%) to prevent or treat hypoxemia, maintain adequate tissue oxygenation, decrease the work of breathing, and reduce myocardial workload.

Hypoxemia

A decrease in arterial oxygen (low PaO₂ or SaO₂). Signs include restlessness, anxiety, tachypnea, tachycardia, dyspnea, confusion, altered mental status, and late sign of central cyanosis.

Hypoxia

Insufficient oxygen at the tissue level despite or regardless of blood oxygen levels. May result from hypoxemia, anemia, decreased cardiac output, or impaired tissue oxygen use.

Fraction of Inspired Oxygen (FiO₂)

The concentration of oxygen inhaled by the patient. Room air contains 21% (0.21) oxygen.

Oxygen Toxicity

Lung injury caused by prolonged exposure to high oxygen concentrations (usually FiO₂ >50% for more than 48 hours) due to oxygen free radical formation. Manifestations include substernal chest pain, paresthesia, cough, dyspnea, and alveolar infiltrates.

Arterial Blood Gas (ABG)

A diagnostic test used to evaluate oxygenation, ventilation, and acid-base balance by measuring pH, PaO₂, PaCO₂, HCO₃⁻, and SaO₂.

Pulse Oximetry (SpO₂)

A noninvasive method of measuring arterial oxygen saturation using a pulse oximeter.

Reduction Gauge

Device that decreases the high pressure inside an oxygen cylinder to a safe working pressure.

Flow Meter

Device that regulates the oxygen flow delivered to the patient, measured in liters per minute (L/min).

Humidifier

Device that adds moisture to oxygen to prevent drying and irritation of the respiratory mucosa, especially during prolonged therapy or high-flow oxygen.

Low-Flow Oxygen Delivery System

Provides oxygen flow lower than the patient's inspiratory demand, resulting in a variable FiO₂ depending on the patient's breathing pattern.

High-Flow Oxygen Delivery System

Provides sufficient flow to meet the patient's inspiratory demand while delivering a fixed and accurate FiO₂.

Nasal Cannula

The most commonly used low-flow oxygen device. Delivers 24-44% FiO₂ at 1-6 L/min. Advantages include comfort, ease of use, and allowing the patient to eat and talk. Disadvantages include nasal dryness, irritation, and reduced effectiveness if the patient breathes through the mouth.

Oropharyngeal Catheter

A low-flow oxygen device inserted through the nose into the oropharynx. Delivers 23-42% FiO₂ at 1-6 L/min. Rarely used because it may cause discomfort and gagging.

Simple Face Mask

A low-flow oxygen mask delivering 40-60% FiO₂ at 6-8 L/min. Requires a minimum flow of 6 L/min to prevent carbon dioxide rebreathing. Must be removed during meals.

Partial Rebreather Mask

A reservoir mask delivering 50-75% FiO₂ at 8-11 L/min. The reservoir bag should remain partially inflated throughout inspiration.

Non-Rebreather Mask

Provides the highest oxygen concentration without intubation (80-100% FiO₂) at 10-15 L/min. Uses one-way valves to prevent rebreathing of exhaled air and entry of room air. The reservoir bag should never completely collapse during inspiration.

Venturi Mask

A high-flow oxygen device that delivers the most accurate and precise FiO₂ through interchangeable adapters. Commonly indicated for patients with COPD or anyone requiring controlled oxygen therapy.

Aerosol Mask

A high-flow device that delivers 30-100% FiO₂ with humidified oxygen at 8-10 L/min. Used when humidification is essential.

Tracheostomy Collar

A high-flow oxygen device placed over a tracheostomy tube. Delivers 30-100% FiO₂ at 8-10 L/min while providing humidified oxygen directly to the airway.

T-Piece

A T-shaped adapter attached to an endotracheal or tracheostomy tube to deliver humidified oxygen. Commonly used during ventilator weaning.

Face Tent

A loose-fitting oxygen device that delivers 30-100% FiO₂ at 8-10 L/min. Best for patients with facial trauma, burns, or claustrophobia who cannot tolerate a mask.

Transtracheal Catheter

A small catheter surgically inserted directly into the trachea. Delivers 60-100% FiO₂ at 0.25-4 L/min while using less oxygen than other devices. Requires regular catheter care.

Demand Oxygen Delivery System (DODS)

Also called a pulse-dose oxygen delivery system. Delivers oxygen only during inspiration, conserving 50-75% of oxygen and extending cylinder life.

Oxygen Safety Precautions

Oxygen supports combustion but is not flammable. Do not smoke or allow open flames near oxygen. Avoid petroleum-based products; use water-based lubricants. Secure oxygen cylinders properly and post 'No Smoking' signs.

Nursing Responsibilities During Oxygen Therapy

Verify the prescription, assess respiratory status and SpO₂ before and during therapy, ensure the correct device and flow rate are used, check equipment function, provide humidification when indicated, monitor for oxygen toxicity and skin breakdown, and educate the patient not to adjust oxygen flow independently.

Incentive Spirometry

A lung expansion therapy that encourages slow, deep inhalation to prevent or treat atelectasis, improve alveolar ventilation, increase inspiratory capacity, and promote lung expansion. Commonly used after surgery and prolonged bed rest.

Indications for Incentive Spirometry

Postoperative patients, prolonged immobilization, atelectasis, shallow breathing, restrictive lung disorders, and patients at risk for pulmonary complications.

Contraindications for Incentive Spirometry

Unconscious patients, inability to follow instructions, severe respiratory distress, inability to generate adequate inspiratory effort, and severe pain preventing deep breathing.

Nursing Responsibilities for Incentive Spirometry

Position the patient in High Fowler's position, explain the procedure, encourage slow deep inhalation, hold the breath for 3-5 seconds at maximal inspiration, perform about 10 breaths every hour while awake, encourage coughing afterward, and monitor progress.

Benefits of Incentive Spirometry

Prevents atelectasis, improves lung expansion, mobilizes secretions, increases inspiratory capacity, and reduces postoperative pulmonary complications.

Mini-Nebulizer Therapy

Administration of aerosolized medication into the lower respiratory tract by converting liquid medication into a fine mist for inhalation.

Nebulizer

A device that converts liquid medication into aerosol particles for inhalation directly into the lungs.

Indications for Nebulizer Therapy

Asthma, COPD, bronchospasm, wheezing, retained secretions, and diseases requiring inhaled medications.

Contraindications for Nebulizer Therapy

Medication allergy, inability to tolerate aerosol therapy, medications unsuitable for nebulization, and severe respiratory instability unless specifically indicated.

Advantages of Nebulizer Therapy

Direct medication delivery to the lungs, rapid onset of action, fewer systemic side effects, effective secretion mobilization, and suitable for children and elderly patients.

Disadvantages of Nebulizer Therapy

Longer treatment time, equipment contamination if not cleaned properly, medication wastage, and dependence on a power source or compressed gas.

Nursing Responsibilities During Nebulizer Therapy

Assess breath sounds before and after treatment, verify medication and dosage, position the patient upright, instruct slow deep inhalation through the mouth, monitor for adverse effects, clean equipment after use, and document the patient's response.

Chest Physiotherapy (CPT)

A group of airway clearance techniques that mobilize pulmonary secretions, improve ventilation, and facilitate expectoration.

Goals of Chest Physiotherapy

Mobilize retained secretions, improve airway clearance, enhance gas exchange, prevent atelectasis, and decrease the work of breathing.

Postural Drainage

The use of gravity-assisted positioning to drain secretions from specific lung segments into larger airways for removal.

Percussion

Rhythmic clapping of the chest wall with cupped hands to loosen secretions attached to the bronchial walls.

Vibration

Rapid oscillatory movement of the hands over the chest wall during exhalation to move loosened secretions toward the larger airways.

Coughing

The body's natural airway-clearing mechanism that expels mucus, secretions, and foreign materials from the respiratory tract.

Huff Cough

A forced exhalation with an open glottis used to mobilize secretions while minimizing airway collapse.

Effective Cough

A deep inspiration followed by a strong, controlled cough that effectively clears secretions from the airway.

Indications for Chest Physiotherapy

Pneumonia, bronchiectasis, cystic fibrosis, chronic bronchitis, atelectasis, retained secretions, and neuromuscular disorders affecting cough.

Contraindications for Chest Physiotherapy

Untreated pneumothorax, pulmonary embolism, active hemoptysis, unstable chest trauma, increased intracranial pressure, severe osteoporosis, rib fractures, recent thoracic surgery unless prescribed, and severe cardiovascular instability.

Nursing Responsibilities During Chest Physiotherapy

Assess respiratory status before and after treatment, monitor oxygen saturation, perform therapy before meals or 1-2 hours after eating, encourage coughing after treatment, provide hydration when appropriate, and document patient response.

Benefits of Chest Physiotherapy

Improves ventilation, increases oxygenation, enhances secretion clearance, reduces airway obstruction, lowers infection risk, and improves overall respiratory function.

Complications of Chest Physiotherapy

Hypoxemia, bronchospasm, aspiration, vomiting, fatigue, pain, rib injury, transient dysrhythmias, and increased intracranial pressure in susceptible patients.

Airway Management

A group of interventions performed to establish, maintain, and protect a patent airway to ensure adequate oxygenation and ventilation.

Artificial Airway

A device inserted into the airway to maintain airway patency and facilitate ventilation when the patient cannot maintain it independently.

Oropharyngeal Airway (OPA)

A curved airway inserted through the mouth to prevent the tongue from obstructing the airway. Used only in unconscious patients with no gag reflex.

Indications for Oropharyngeal Airway

Unconscious patient, absent gag reflex, airway obstruction caused by the tongue, and assistance during bag-valve-mask ventilation.

Contraindications for Oropharyngeal Airway

Conscious or semiconscious patients, intact gag reflex, oral trauma, and recent oral surgery.

Nasopharyngeal Airway (NPA)

A soft rubber or plastic tube inserted through the nostril into the nasopharynx to maintain airway patency. Can be used in conscious or semiconscious patients with an intact gag reflex.

Indications for Nasopharyngeal Airway

Patients with an intact gag reflex, oral trauma, trismus, seizures, or when an oropharyngeal airway cannot be inserted.

Contraindications for Nasopharyngeal Airway

Basilar skull fracture, severe facial trauma, nasal obstruction, nasal fracture, or active epistaxis.

Endotracheal Intubation

Insertion of an endotracheal tube through the mouth or nose into the trachea to maintain an airway, provide mechanical ventilation, and protect against aspiration.

Indications for Endotracheal Intubation

Respiratory failure, respiratory arrest, inability to protect the airway, airway obstruction, severe hypoxemia, general anesthesia, and mechanical ventilation.

Contraindications for Endotracheal Intubation

No absolute contraindications in emergencies. Relative contraindications include severe laryngeal trauma and upper airway abnormalities.

Endotracheal Tube (ET Tube)

A cuffed tube inserted into the trachea to maintain airway patency and allow oxygen delivery and mechanical ventilation.

Cuffed Endotracheal Tube

An ET tube with an inflatable cuff that seals the trachea to prevent air leakage and aspiration.

Cuff Pressure

Pressure within the ET tube cuff that should generally be maintained at 20-30 cm H₂O to prevent tracheal injury while maintaining an adequate seal.

Nursing Responsibilities During Endotracheal Intubation

Prepare equipment, monitor oxygen saturation, assist the physician, verify tube placement, secure the tube, monitor cuff pressure, provide oral care, and assess respiratory status.

Verification of Endotracheal Tube Placement

Confirmed by bilateral chest expansion, equal breath sounds, absence of gastric sounds, end-tidal CO₂ detection, chest X-ray, and improvement in oxygenation.

Complications of Endotracheal Intubation

Esophageal intubation, aspiration, hypoxemia, airway trauma, laryngeal edema, tracheal injury, infection, and accidental extubation.

Tracheostomy

A surgically created opening through the anterior neck into the trachea to establish a direct airway.

Tracheostomy Tube

A tube inserted into the tracheostomy stoma to maintain airway patency.

Indications for Tracheostomy

Prolonged mechanical ventilation, upper airway obstruction, excessive secretions, airway protection, head and neck cancer, and severe facial trauma.

Advantages of Tracheostomy

Improves patient comfort, decreases airway resistance, facilitates secretion removal, allows easier oral care, improves communication with speaking valves, and reduces dead space.

Complications of Tracheostomy

Hemorrhage, pneumothorax, subcutaneous emphysema, infection, accidental decannulation, tube obstruction, tracheal stenosis, and tracheoesophageal fistula.

Nursing Responsibilities for Tracheostomy Care

Maintain sterile technique, clean the stoma, replace dressings, suction as needed, maintain cuff pressure, assess for infection, secure the tube, and keep emergency equipment at the bedside.

Suctioning

Removal of airway secretions using negative pressure to maintain airway patency and improve ventilation.

Indications for Suctioning

Visible secretions, ineffective cough, coarse crackles, decreased oxygen saturation, respiratory distress, increased airway pressure, and suspected airway obstruction.

Contraindications for Suctioning

No absolute contraindications when the airway is obstructed. Use caution in patients with bleeding disorders, increased intracranial pressure, severe bronchospasm, or recent airway surgery.

Open Suctioning

A suctioning technique in which the patient is temporarily disconnected from the ventilator while a sterile suction catheter is inserted.

Closed Suctioning

A suctioning technique using an enclosed sterile catheter without disconnecting the patient from the ventilator, reducing infection risk and oxygen loss.

Nursing Responsibilities During Suctioning

Assess the need for suctioning, pre-oxygenate the patient, use sterile technique, limit suction time to 10-15 seconds, monitor oxygen saturation and heart rhythm, avoid routine saline instillation unless indicated, reassess breath sounds, and document the procedure.