ONRUBIA, MARIA ANA BSN3A1 – 5S

MEDSURG RLE COURSE TASK

SUBMITTED TO: SIR NOEL ELISES & DR. JOEL JOHN DELA MERCED

1. Should you checking your own oxygen levels if you have coronavirus symptoms?
Explain. Give further details about this timely issue. Please input your answer on
the discussion board in Canvas, you may refer to the next post in the given
discussion. Expound your answer.

Coronavirus disease (COVID19) is an infectious disease caused by the SARSCoV2 virus.

Most people infected with the virus will have mild to moderate respiratory illness and clear up on
their own without special treatment. However, some will become very ill and require medical
attention. Older adults and those with underlying medical conditions such as cardiovascular
disease, diabetes, chronic respiratory disease, or cancer are more likely to develop serious illness.
Anyone can get sick from COVID19 and become seriously ill or die at any age. When you have a
severe case of COVID19, your oxygen levels can drop. So, to keep the oxygen in your body at a
normal level, we need to give medical oxygen. Now when your oxygen level is low due to a disease
like COVID19, the cells in the body don't have enough oxygen to perform their normal function
in every cell in the body that needs oxygen to function properly. So, if the oxygen levels are low,
if they're low for a long time, if they're not treated, the cells themselves stop working well. Then
they stop working completely and the cells can actually die. So, what you can see is the starting
organs, your organs for a while, your organs, you know, your brain, your heart, your lungs, your
kidneys all need oxygen. As a result, they will begin to misbehave in extremely severe cases which
can lead to death. So again, the life-saving treatment here is medical oxygen. So medical oxygen
takes oxygen from the air and compresses it so that the oxygen that you take in, say, from a
cylinder, is now almost, you know, you're breathing pure oxygen. And this is what we give our
patients to keep the oxygen levels at a normal level in the body.

Usually, low blood oxygen causes symptoms such as fatigue or shortness of breath. But
with COVID19, you can't have symptoms of hypoxia. Your doctor may suggest that you check
your oxygen levels at home. This can help you know when you need medical attention, even if
you don't have any symptoms. Turn on the pulse oximeter. (Make sure it has a battery.) Clamp it
on the tip of your finger, with your fingernail facing up. You will see results in seconds. The device
gives two results: your blood oxygen (SpO2) and pulse (PR) levels. Your doctor can help you
figure out what numbers are normal for you. The device may not show results if your hands are
cold or if you are wearing nail polish or artificial nails. Warm your hand, remove nail polish or
fingernails, or try another finger. Your doctor may suggest that you check your oxygen levels twice
a day, during exercise or whenever your symptoms get worse. Monitor your level in case you need
to show it to your doctor. Your doctor may have already told you what numbers to watch for when
using the pulse oximeter. If not, here are some tips. Call your doctor if: Your blood oxygen (SpO2)
level drops below 95%. This is true although the number only decreases as you are active. If you
have certain health conditions, such as COPD, your oxygen level may remain below 95%. Ask
your doctor what oxygen levels to expect when using your pulse oximeter. Find out which number
is a sign you need to call for help. Carefully monitor changes in your condition and be sure to
contact your doctor if: Your symptoms get worse and when you do not improve as expected.
2. A 72-year-old man who has COPD from working as a coal miner has pneumonia in
his right lower and middle lobes. To mobilize and drain the secretions, CPT is
prescribed. The patient only wants to sit in bed because it is easier for him to breath
when in the semi-Fowler’s position. What positions are the most important for
successful CPT? What can you do to aid him during the treatments?

CHEST PHYSIOTHERAPY (CPT)

Chest physiotherapy (CPT) is a technique used to mobilize or release secretions in the lungs and
airways. This is especially helpful for patients with excessive secretions or unproductive coughs.
Respiratory physiotherapy includes external mechanical manipulations, such as chest percussion, postural
drainage, vibration, to increase mobilization and movement of secretions of the airways, diaphragmatic
breathing with pursed lips, cough and controlled cough.
With postural drainage, the patient lies down or sits in different positions so that the part of the
lung being drained is as high as possible. This part of the lung is then drained by percussion, vibration,
and gravity. Your health care team can tailor these positions to you or your child. When the person with
cystic fibrosis is in one of the positions, the caregiver can bump into the person's chest wall. This is usually
done for three to five minutes and is sometimes followed by vibrations over the same area for about 15
seconds (or for five breaths). The patient is then encouraged to cough or blow vigorously to clear the
mucus from the lungs. The caregiver's beating (percussion) to the chest wall above the drained lung helps
move mucus in the larger airways. The cup-shaped hand is like a container for water, but the palm is
facing down. The cupped hand is bent toward the chest wall and placed a cushion of air to soften the clap.
Percussion is performed with steady force and rhythm. Each beat should have a hollow sound.
Much of the movement is at the wrist with the arms relaxed, making percussion performance less tiring.
If the hand is cupped properly, percussion should not cause pain or stinging.
Special care should be taken not to touch:

➢ Spine
➢ Sternum
➢ Stomach
➢ Lower ribs or back (to avoid injuring the spleen on the left, the liver on the right, and the
kidneys on the lower back)
 Possibly using a variety of devices in place of the traditional brush method for percussion. Ask
the doctor or respiratory therapist to recommend which is best for you.
Vibration is a technique of gently shaking mucus so it can move through larger airways. The
caregiver places a firm hand on the chest wall above the drained lung and contracts the muscles in the
arms and shoulders to create a gentle rocking motion. The caregiver then applies gentle pressure to the
area to be vibrated. (Caregivers can also place one hand on top of the other, and then press the upper and
lower hands together to vibrate.) Vibration with a flattened hand, not a cupped hand. Exhale as slowly
and fully as possible.

Deep breathing pushes the mucus out and can cause coughing. Diaphragm breathing (belly
breathing or chest breathing) is used to help the person breathe more deeply and bring air into the lower
lungs. The abdomen turns outward when the person inhales and inhales when the patient exhales. A
respiratory therapist or physical therapist can help you learn more about this breathing pattern.

Usually, each treatment session can last from 20 to 40 minutes. CPT is best done before a meal or
an hour and a half to two hours after eating, to reduce the risk of vomiting. Usually, you should wake up
early and go to bed in the morning. The duration of CPR and the number of CPTs performed per day may
need to be increased if the person is more congested or ill. Your CF doctor or respiratory therapist can
recommend the location, frequency, and duration of CPT. Both the person with cystic fibrosis and the
career should feel comfortable during the procedure. Before starting, the person should remove tight
clothing, jewelry, buttons, and zippers around the neck, chest, and waist. May wear light, soft clothing,
such as a t-shirt. Do not do CPT on bare skin. Caregivers should remove rings and other bulky jewelry,
such as watches or bracelets. Keep a supply of tissues or a place to cough up mucus nearby. Caregivers
should not lean forward when performing percussion but should stay upright to protect their backs. The
surface of the person with CF should be at a comfortable height for the caregiver. Many find it helpful to
use pillows, sofa cushions, or bundles of newspaper under the pillows for support, as well as a height/tilt
adjustable crib, foam mattress, or a bean bag chair. CPT time. The infant can be placed with or without a
pillow on the caregiver's lap.
3. Make a simple illustration of patient’s position and list down the ways you can
assist him during these treatments (minimum of 5).

Instructions for CPT: The following diagrams describe the positions for CPT. In the diagrams,
shaded areas show where the chest should be clapped or vibrated. As a reminder:

➢ Pillows may be used for added comfort. If the person tires easily, the order of the positions
can be varied, but all areas of the chest should be percussed or clapped.
➢ Please remember to clap and vibrate only over the ribs.
➢ Avoid clapping and vibrating over the spine, breastbone, stomach, and lower ribs or back to
prevent trauma to the spleen on the left, the liver on the right, and the kidneys in the lower
back.
➢ Do not clap or vibrate on bare skin.

1. Upper Front Chest -- Upper Lobes

o Have your child sit upright. Clap on both sides of the upper front chest over the
muscular area between the collarbone and the top of the shoulder blade.

2. Upper Back Chest -- Upper Lobes

o Have your child sit up and lean forward on a pillow over the back of a sofa or soft
chair at a 30-degree angle. Stand or sit behind your child and clap both sides of the
upper back. Take care not to clap on your child's backbone.
3. Upper Front Chest -- Upper Lobes
o Have your child lie on his or her back with arms to sides. Stand behind your child's
head. Clap both sides of your child's chest between the collarbone and nipple.

4. Left Side Front Chest

o Have your child lie with left side up and raise his or her left arm overhead. Clap over
the lower ribs just below the nipple area on the front side of left chest. Do not clap on
your child's stomach.
5. Right Side Front Chest
o Have your child lie with right side up and raise his or her right arm overhead. Clap
over the lower chest just below the nipple area on the front side of right chest. Do not
clap your child's lower ribcage.