Respiratory Therapy Notes

Patient Positioning and Assistance with Coughing

Patient Positioning

• Patients need to be in an optimal position for assessment and therapy; they can either sit up or have the bed raised.
• Assistance is provided for patients unable to sit independently.
  • Method: Grab the patient's elbow and arm to pull them up.

Cough Technique

• Importance of proper coughing technique emphasized.
• Encourage use of the diaphragm during coughing for effectiveness.
  • Key steps:
  1. Bear Down: Engage abdominal muscles.
  2. Inhale Deeply: To prepare for a forceful cough.
• Correct Definition of a Cough:
  • Should be a meaningful, forceful effort, distinct from a weak throat clearing.

Assessment during Coughing

• Process and importance explained for instructional purposes.
• JVD Assessment (Jugular Venous Distension):
  • Turn patient's head to the left while assessing to observe JVD during the cough.
  • This correlates with assessing for cardiovascular issues.

Implications for Lab Practical

• Students are expected to demonstrate strong coughs for grading.
• If a partner fails to perform as instructed, it reflects poorly, resulting in point deduction.
  • Criteria for assessment:
  • Report strength of cough: weak, fair, or strong.
  • Identify if cough is productive or nonproductive.
  • For productive coughs, evaluate secretions based on:
    • Amount
    • Color
    • Consistency
• Correct documentation is essential during practical assessments, and students must accurately report findings.

Assessing Jugular Venous Distension (JVD)

JVD Assessment

• Right side assessment preferred due to anatomical considerations.
• JVD can indicate underlying heart issues, highlighting systemic venous pressure.
  • Assessment Angle: Bed positioned at a 45-degree angle is crucial for accurate evaluation.
  • Importance of using proper angles in assessments emphasized to avoid false reporting.

Reporting JVD

• If JVD is not present, report as negative.
• Documentation must reflect true observations; report must be valid with no deceitful notes.

Pedal Edema Assessment

Understanding Pedal Edema

• Definition: Swelling in lower extremities due to fluid accumulation in interstitial spaces, often seen in congestive heart failure patients.
• Assessment Technique:
  • Pull socks off patient partially.
  • Apply pressure to the dorsal side of the foot for 3-5 seconds.
  • Observe for rebound response after pressure is released.

Scoring System for Pedal Edema

• Scoring from 1 to 4 based on the depth and duration of skin rebound:
  1. 1+: Immediate rebound, indention of 2 mm or less.
  2. 2+: Rebound after 15 seconds, indention of 4 mm.
  3. 3+: Rebound after 15-60 seconds, indention of 6 mm.
  4. 4+: Rebound after greater than 60 seconds, indention of 8 mm.
• Documentation necessity: Proper scoring and reporting based on observations.

Severe Cases

• Weeping edema may occur with severe fluid overload, leading to fluid leaks from extremities. Monitor for immediate healthcare intervention if identified.

Blood Pressure Measurement Techniques

Significance of Blood Pressure Measurement

• While not a lab practical component, understanding blood pressure is essential for all respiratory therapists.
• Manual measurement is a useful competency for various practice settings.

Technique for Manual Blood Pressure Measurement

• Equipment: Blood pressure cuff and stethoscope required.
• Process Overview:
  1. Place the cuff on the upper arm above the elbow at the brachial artery.
  2. Legs must be uncrossed for proper circulation during measurement.
• Measurement Process:
  1. Inflate cuff until pressure is around 160 mmHg.
  2. Slowly deflate while listening for Korotkoff sounds (first beat for systolic, last for diastolic).
  3. Example given: A reading of 150/70 mmHg noted.

Normal Values and Clinical Implications

• Recognize normal (120/80 mmHg), elevated, and hypertensive values.
• Essential for recognizing and reporting patient statuses accurately during assessments.

Oxygen Tank Operations and Calculations

Types of Oxygen Tanks

• Commonly used tanks: E tank and H tank.
• PSI values for tanks typically nominal: 2200 PSI when full.

Duration Calculation Formula for Oxygen Tanks

• Equation: Duration (in minutes) = \frac{Current PSI - 500}{Liter Flow Rate}
• Significance of calculation: To ensure adequate oxygen supply for patient transport without running out.

Example Calculation for E Tank Usage

• Full E Tank: 2200 PSI
  • Flow Rate Example: 4 liters/minute
  • Calculation: (rac{2200 - 500}{0.28}) ext{ for transport after deduction}
  • Result Interpretation: Approximately 34.72 minutes of usable oxygen available.

Consistent Monitoring During Patient Transport

• A variety of scenarios discussed for ensuring patient safety during transport based on calculated tank duration.
• Need for additional tanks if transport is longer than anticipated.

Safety Considerations and Tank Management

Safety in Handling Oxygen Tanks

• Importance of handling procedures including cracking the tank to clear debris before attaching regulators.
• Announcement protocols reinforced to avoid startling patients or personnel during this process.

Regulatory Compliance - PISS System

• Oxygen tanks and regulators must use a PIN-index safety system to prevent incorrect assembly.
  • Explanation of the PISS system including how it matches tanks to appropriate regulators based on pin configuration.

Use of Flow Meters

Understanding Flow Meters in Clinical Settings

• Importance of flow meters for accurate oxygen therapy delivery.
• Flow meters must be read at eye level to ensure accurate liter setting to avoid patient mismanagement.

Common Details in Hospitals

• Recognize the use and interpretation of Thorpe flow meters, which operate based on pressure from oxygen supply.
• Importance of labeling oxygen devices accurately and understanding their limits and capabilities.