RE S P I R A T O R Y

CARE
MO D A L I TI E S
PULSE OXIMETRY
LEARNING
• TO KNOW HOWOBJECTIVES:
PULSE OXIMETER WORKS.

• BE FAMILIAR WITH THE NORMAL LEVEL OF

SPO2.

• LIST THE SITES WHERE PULSE OXIMETER

CAN BE USED.

• IDENTIFY THE LIMITATIONS OF THE PULSE

OXIMETER.

• DEMONSTRATE THE SKILLS IN THE

PERFORMANCE OF PULSE OXIMETRY
CORRECTLY.
PULSE
• IS ONEOXIMETRY
OF THE MOST COMMONLY
EMPLOYED MONITORING
MODALITIES IN THE CRITICAL
CARE SETTING.

• A GOOD INDICATOR OF THE

OXYGENATION STATUS OF A
PERSON, ESPECIALLY

HYPOXEMIA.
PARTS
 A pulse oximeter
reads the
most of
concentration of
Oxygen that the oxygen bound to
is inhaled oxygen is hemoglobin in
from the bound to the blood by
atmosphere the shining infrared
diffuses hemoglob and red light
through the in through a
lungs and into compone translucent part
the nt of a red of the body and
bloodstream blood cell measuring the
to be used up
by body ratio of light
tissues for reflected and
energy light absorbed by
few are
dissolved in oxygenated and
plasma deoxygenated
hemoglobin
 • Normal SpO2.
95-100% or Normal oxygen saturation
of the
peripheral blood

below 95% • Hypoxemia

• Critical level
85% and Cerebral hypoxia (low oxygen level in the
brain) may follow in a few minutes and cause
irreversible brain damage. Several vital organs
below might also be affected. The person warrants
immediate treatment and oxygenation.
 WHERE CAN YOU USE A PULSE
OXIMETER?
• TO BE ABLE TO GET AN ACCURATE READING, A PULSE
OXIMETER PROBE MUST BE PLACED ON A TRANSLUCENT
PART OF THE BODY SO THAT LIGHT EMITTED FROM THE LIGHT
TRANSMITTER WILL BE RECEIVED BY THE PHOTODETECTOR
ON THE OPPOSITE SIDE.
 • most accessible segment of the
body
• nail polish/ varnish can affect
the measurement of oxygen
Fingertip saturation, particularly black,
green, and blue
 • as good as the fingers as a pulse
oximeter measuring site
• helpful in detecting problems in
arterial blood flow such as in lower
extremity arterial disease.
Toes
 • can be clipped either on the tip or
lower part of the pinna (earlobe)
• medical anomalies with the hands
or fingers that hinder precise
Earlobe measurement of oxygen saturation
 • pulse oximeter probes that
are used on the palm and
soles utilize a wrap sensor
instead of the ones that are
clipped
Soles and Palm
 • In more rare cases, wherein the
digits and ear are inaccessible, a
pulse oximetry reflectance probe
may be attached low across the
forehead and just right above the
eyebrows, making sure that it is
placed away from a major vessel.
Forehead
HANDHELD
OXIMETER

WRIST-WORN
OXIMETER

TABLETOP
OXIMETER
PULSE OXIMETERS ERRORS
& TROUBLESHOOTING
FAILURE TO OBTAIN A SIGNAL
• MEASURING SITE MUST BE KEPT CLEAN AND DRY. YOU MAY REPOSITION
THE USER’S FINGER.

• CHANGE THE MONITORING SITE.

• VITAL SIGNS SHOULD BE ASSESSED INCLUDING THE MEASURING SITE,
WHETHER THERE IS ADEQUATE BLOOD FLOW.

• THE SENSOR AND A BLOOD PRESSURE CUFF MUST NOT BE PLACED ON

THE SAME HAND.

• CHECK FOR LOOSE WIRINGS OR WHETHER THE PROBE IS PROPERLY

ATTACHED TO THE BASE UNIT THAT SHOULD BE CONNECTED TO A
POWER SOURCE.
LIMITATIONS
⚫ HIGH LEVELS OF ARTIFICIAL LIGHT AND DIRT UNDER YOUR NAILS OR
NAIL VARNISH MAY AFFECT THE READING.

⚫ THE OXIMETER NEEDS TO READ AT LEAST 5 FINGERTIP PULSE BEATS

AND THEREFORE SHOULD NOT BE READ IN AN INSTANT.

⚫ MOVEMENT, SUCH AS SHAKING OR SHIVERING CAN AFFECT THE

READING AND PRE EXISTING MEDICAL CONDITIONS SUCH AS
ANEMIA, HEART OR CIRCULATION PROBLEMS.

⚫ MAKE SURE TO READ IT IN A ROOM WITH ADEQUATE LIGHTING.

DIRECT AVOID BRIGHT LIGHT SHINING AT THE PROBE, SUCH AS
SUNLIGHT OR OPERATING LIGHT.
 INCENTIVE
SPIROMETRY
LEARNING OBJECTIVES:
• TO KNOW THE
INDICATIONS AND
CONTRAINDICATIONS OF
DOING INCENTIVE
SPIROMETRY.

• TO KNOW THE STEPS ON

HOW TO USE AN
INCENTIVE SPIROMETER.
 INCENTIVE
SPIROMETRY
• ALSO REFERRED TO AS SUSTAINED
MAXIMAL INSPIRATION (SMI), IS A
COMPONENT OF BRONCHIAL
HYGIENE THERAPY.

• AS IT MEASURES HOW WELL YOUR

LUNGS FILL UP WITH EACH BREATH.

• AN INCENTIVE SPIROMETER HELPS

EXERCISE YOUR LUNGS TO HELP KEEP
YOUR ALVEOLI (air sacs where oxygen and
carbon dioxide are exchanged) INFLATED.
PARTS
INDICATIONS:
1. PRESENCE OF CONDITIONS PREDISPOSING TO THE
DEVELOPMENT OF PULMONARY ATELECTASIS

▪ UPPER-ABDOMINAL SURGERY
▪ THORACIC SURGERY
▪ SURGERY IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)

2. PRESENCE OF PULMONARY ATELECTASIS

3. PRESENCE OF A RESTRICTIVE LUNG DEFECT

ASSOCIATED WITH QUADRIPLEGIA AND/OR
DYSFUNCTIONAL DIAPHRAGM
1.CONTRAINDICATIONS:
IF PATIENT CANNOT BE INSTRUCTED OR
SUPERVISED TO ASSURE APPROPRIATE USE OF THE
DEVICE.

2. IF PATIENT COOPERATION IS ABSENT OR PATIENT

IS UNABLE TO UNDERSTAND OR DEMONSTRATE
PROPER USE OF THE DEVICE.

3. IS CONTRAINDICATED IN PATIENTS UNABLE TO

DEEP BREATHE EFFECTIVELY (EG, WITH VITAL
CAPACITY [VC] LESS THAN ABOUT 10 ML/KG OR
INSPIRATORY CAPACITY [IC] LESS THAN ABOUT
ONE THIRD OF PREDICTED).

4. THE PRESENCE OF AN OPEN TRACHEAL STOMA IS

NOT A CONTRAINDICATION BUT REQUIRES
ADAPTATION OF THE SPIROMETER.
MATERIALS
• INCENTIVE SPIROMETER (MAY REQUIRE A PRESCRIPTION
FROM YOUR DOCTOR)

• PILLOW (IF YOU HAVE AN INCISION)

• COMFORTABLE PLACE TO SIT
• SIT OR LIE UPRIGHT IN A COMFORTABLE POSITION.
PROCEDURE
• HOLD THE INCENTIVE SPIROMETER UPRIGHT, WITH BOTH
HANDS.

• SLIDE THE INDICATOR (LOCATED IN THE LEFT-HAND COLUMN

WHEN YOU ARE FACING THE SPIROMETER) TO THE DESIRED
LEVEL. FOR EXAMPLE, START AT 1250 MILLILITERS AND
SLOWLY INCREASE AS YOUR TREATMENT PROGRESSES.

• PLACE THE MOUTHPIECE INTO YOUR MOUTH AND TIGHTLY

SEAL YOUR LIPS AROUND IT.

• WITH YOUR LIPS TIGHTLY SEALED AROUND THE

MOUTHPIECE, BREATHE IN SLOWLY AND AS DEEPLY AS
POSSIBLE. THE PISTON THAT IS RESTING BELOW THE
INDICATOR SHOULD NOW RISE TOWARD THE TOP OF THE
COLUMN.

• HOLD YOUR BREATH FOR AT LEAST 3 SECONDS AND ALLOW

THE PISTON TO FALL BACK TO THE BOTTOM OF THE COLUMN.

• AFTER EACH SET OF DEEP BREATHING, COUGH TO HELP

CLEAR YOUR AIRWAYS OF MUCUS.

• REST FOR A FEW SECONDS AND REPEAT STEPS TWO

TIPS
• IF YOU ARE COUGHING AND YOU HAVE AN
INCISION, PRESS FIRMLY AGAINST THE AREA
WITH A PILLOW. IT WILL OFFER ADDITIONAL
SUPPORT AND COMFORT.

• NORMALLY, AN INCENTIVE SPIROMETER IS

RECOMMENDED FOR PEOPLE WHO CAN'T WALK
OR GET OUT OF BED. IF YOU ARE RECOVERING
FROM SURGERY OR A COPD EXACERBATION,
YOU CAN USE YOUR INCENTIVE SPIROMETER TO
KEEP YOUR LUNGS INFLATED.
NEBULIZATION
LEARNING OBJECTIVES:

• RECOGNIZE THE INDICATIONS AND

CONTRAINDICATIONS OF NEBULIZATION
THERAPY.

• PERCEIVE HOW TO PERFORM THE PROCEDURE.

NEBULIZATION

• IS THE PROCESS BY WHICH A LIQUID MEDICATION IS

CONVERTED INTO A FINE MIST THAT CAN BE
INHALED.

• THE DEVICE THAT IS USED TO CONVERT THE LIQUID

DRUG INTO AEROSOL DROPLETS SUITABLE FOR
PATIENTS TO INHALE IS KNOWN AS A “NEBULIZER”.
 NEBULIZERS
⚫ CAN BE USED TO DELIVER
BRONCHODILATOR
nebules
(AIRWAY-OPENING) MEDICINES
SUCH AS ALBUTEROL (VENTOLIN®,
PROVENTIL® OR AIRET®) OR
IPRATROPIUM BROMIDE
(ATROVENT®).
PARTS
INDICATIONS
• TIGHTNESS IN CHEST
• INCREASED OR THICK
SECRETIONS

• PNEUMONIA (CONGESTION)
AND/OR

• ATELECTASIS
CONTRAINDICATIONS
• INCREASED BLOOD PRESSURE
• INCREASED PULSE
• HISTORY OF ADVERSE REACTION TO
THE MEDICATION.
PROCEDURE
CAREFULLY MEASURE THE MEDICINE
EXACTLY AS YOU HAVE BEEN INSTRUCTED. USE
A SEPARATE, CLEAN  MEASURING DEVICE
(DROPPER OR SYRINGE) FOR EACH MEDICINE. 

ONCE YOU TURN ON THE COMPRESSOR, YOU

SHOULD SEE A LIGHT MIST COMING FROM THE
BACK OF THE TUBE OPPOSITE THE
MOUTHPIECE.
SIT UP STRAIGHT ON A COMFORTABLE CHAIR.

IF YOU ARE USING A MASK, POSITION IT COMFORTABLY AND

SECURELY ON YOUR FACE.

IF YOU ARE USING A MOUTH PIECE, PLACE IT BETWEEN YOUR

TEETH AND SEAL YOUR LIPS AROUND IT.

TAKE SLOW, DEEP BREATHS THROUGH YOUR MOUTH. IF POSSIBLE,

HOLD EACH BREATH FOR TWO TO THREE SECONDS BEFORE
BREATHING OUT. THIS ALLOWS THE MEDICATION TO SETTLE INTO
THE AIRWAYS.
CONTINUE THE TREATMENT UNTIL THE MEDICATION IS
GONE (ABOUT 7 TO 10 MINUTES).

IF YOU BECOME DIZZY OR FEEL "JITTERY," STOP THE

TREATMENT AND REST FOR ABOUT FIVE MINUTES. THEN
CONTINUE THE TREATMENT, BUT TRY TO BREATHE
MORE SLOWLY. IF THESE SYMPTOMS CONTINUE WITH
FUTURE TREATMENTS, INFORM YOUR HEALTH CARE
PROVIDER.

TAKE SEVERAL DEEP BREATHS AND COUGH.

 CHEST
PHYSIOTHERAPY
LEARNING OBJECTIVES:

•TO DISCERN HOW TO AUSCULTATE THE PATIENT’S LUNGS

PROPERLY.

•TO BE ABLE O PERFORM CHEST PHYSIOTHERAPY CORRECTLY

CHEST PHYSIOTHERAPY

•INCLUDES POSTURAL DRAINAGE, CHEST

PERCUSSION, VIBRATION, COUGHING AND
DEEP BREATHING EXERCISE

•PVPD
PURPOSES
•TO MOBILIZE AND ELIMINATE SECRETIONS,
RE-EXPAND LUNG TISSUE, AND PROMOTE
EFFICIENT USE OF RESPIRATORY MUSCLES

•TO PREVENT OR TREAT ATELECTASIS OR TO

PREVENT PNEUMONIA
INDICATIONS
•IT IS INDICATED FOR PATIENTS IN WHOM COUGH IS
INSUFFICIENT TO CLEAR THICK, TENACIOUS, OR
LOCALIZED SECRETIONS

•CYSTIC FIBROSIS
•BRONCHIECTASIS
•ATELECTASIS
•NEUROMUSCULAR DISEASES
•PNEUMONIAS IN DEPENDENT LUNG REGIONS.
• ACTIVE PULMONARY BLEEDING WITH HEMOPTYSIS AND THE IMMEDIATE
CONTRAINDICATIONS
POST-HEMORRHAGE STATE

• FRACTURED RIBS OR UNSTABLE CHEST WALL

• LUNG CONTUSIONS
• PTB
• UNTREATED PNEUMOTHORAX
• ACUTE ASTHMA OR BRONCHOSPASM
• LUNG ABSCESS OR TUMOR
• BONY METASTASIS
• HEAD INJURY
• RECENT MI
POSTURAL DRAINAGE

•LOWER AND MIDDLE LOBE

BRONCHI : HEAD-DOWN POSITION

•UPPER LOBE BRONCHI :

HEAD-UP POSITION
•IF ONE LUNG IS MORE AFFECTED THAN
THE OTHER OPPOSITE SIDE
•WHEN TIPPING THE CHILD OVER
PILLOWS
PLACE UNDER THE PELVIS, NOT UNDER
THE CHEST.

•IN BABIES, IT MAY BE MORE USUAL FOR

THE UPPER LOBES TO BE AFFECTED
SITTING POSITION
RIGHT LEFT
• UPPER LOBE:
-APICAL BRONCHUS *
- SITTING UPRIGHT (A)

-ANTERIOR BRONCHUS *
- LYING SUPINE WITH THE KNEES
SLIGHTLY FLEXED. (C)
• POSTERIOR BRONCHUS:
-RIGHT
LYING ON THE LEFT SIDE AND
TURN HIS FACE 45º RESTING
AGAINST A PILLOW, WITH
ANOTHER PILLOW SUPPORTING
THE HEAD. (F)
-LEFT
LYING ON THE RIGHT SIDE
TURNING HIS/HER FACE 45º
WITH 3 PILLOWS ARRANGED TO
LIFT THE SHOULDERS BY 12
INCHES. (B)
• MIDDLE LOBE (RIGHT):

-LATERAL AND MEDIAL

BRONCHUS
LYING SUPINE WITH THE BODY A
QUARTER TURNED TO THE LEFT
MAINTAINED BY A PILLOW UNDER
THE RIGHT SIDE FROM
SHOULDER TO HIP AND FOOT
END RAISED BY 14 INCHES (35
CMS). (D)
• LINGULA (LEFT):

-SUPERIOR AND INFERIOR

BRONCHUS LYING SUPINE WITH
THE BODY A QUARTER TURNED
THE RIGHT MAINTAINED BY A
PILLOW UNDER THE LEFT SIDE
FROM SHOULDER TO HIP AND
FOOT END RAISED BY 14 INCHES (35
CM). (E)
• LOWER LOBE
-APICAL BASAL BRONCHUS*
LYING PRONE WITH A PILLOW
UNDER THE HIPS. (G)
-ANTERIOR BASAL
BRONCHUS* LYING SUPINE
WITH THE BUTTOCKS RESTING
ON A PILLOW AND THE KNEES
FLEXED. FOOT OF THE BED
RAISED BY 18 INCHES (45 CM).
(H)
PERCUSSION
• CHEST PERCUSSION INVOLVES STRIKING THE CHEST WALL OVER
THE AREA BEING DRAINED.

• PERCUSSING LUNG AREAS INVOLVES THE USE OF CUPPED PALM

TO LOOSEN PULMONARY SECRETIONS SO THAT THEY CAN BE
EXPECTORATED WITH EASE.

• USUALLY THE PATIENT WILL BE POSITIONED IN SUPINE OR PRONE

AND SHOULD NOT EXPERIENCE ANY PAIN. 
CUP YOUR HANDS WHEN
PERFORMING CHEST PERCUSSIONS.
 VIBRATION
• IN VIBRATION, THE NURSE USES RHYTHMIC CONTRACTIONS
AND RELAXATIONS ON HER ARM AND SHOULDER MUSCLES
WHILE HOLDING THEE PATIENT FLAT ON THE PATIENT’S CHEST
AS THE PATIENT EXHALES.

• THE PURPOSE IS TO HELP LOOSEN RESPIRATORY SECRETIONS

SO THAT THEY CAN BE EXPECTORATED WITH EASE.
POSITION HANDS AS SHOWN
BELOW TO PERFORM CHEST
VIBRATION
NURSING CARE
• KNOW THE NORMAL RANGE OF PATIENT’S VITAL SIGNS            
• KNOW THE PATIENT’S MEDICATIONS.
• KNOW THE PATIENT’S MEDICAL HISTORY
• KNOW THE PATIENT’S COGNITIVE LEVEL OF FUNCTIONING.
• BEWARE OF PATIENT’S EXERCISE TOLERANCE.
LIVE RETURN DEMONSTRATION/
PERFORMANCE TASK
•PULSE OXIMETER 24/24

•CHEST PHYSIOTHERAPY 40/40