H.

PULMONARY FUNCTION TESTS Steps:

1. ABG 1. Occlude radial and ulnar arteries.

2. Incentive spirometry 2. Open-close the fist for 3X.
3. Release the ulnar artery.
1.ARTERIAL BLOOD GASES (ABGS) 4. Assess perfusion.
5. Obtain sample and send to the laboratory
• Measurement of the dissolved oxygen and carbon dioxide in
the arterial blood helps indicate the acid-base state and how 3. Postprocedure
well oxygen is being carried to the body.
a) Place the specimen on ice.
 A blood test b) Note the client's temperature on the ratory form.
 Measures the levels of oxygen and carbon dioxide in c) Note the oxygen and type of ventilation that the client
the blood is receiving on the laboratory form.
 Checks the balance of acids and bases, know as the d) Apply pressure to the puncture site for 5 to 10
pH balance in the blood minutes or longer if the client is receiving
anticoagulant therapy or has a bleeding disorder.
ALLENS TEST e) Transport the specimen to the laboratory
Pre procedure ABG
• Perform Allen's test before drawing radial artery • Steps
specimens.
• Have the client rest for 30 minutes before specimen 1. PH : these measures hydrogen ions
collection to ensure accurate measurement of body 2. Respiratory/Metabolic
oxygenation. 3. Compensation (with or without) if with, full or partial
• Do not turn off oxygen unless the ABG sample is
prescribed to be drawn with the client breathing room Normal PH = Full compensation/Fully compensated
air.
Abnormal CO2/HCO3 = Partially compensated
• https://www.youtube.com/watch?v=gdgomN6Tsue
Normal CO2/ HCO3 = Uncompensated/ No compensation

IS IT COMPENSATED OR UNCOMPENSATED

pCO2 = Partial Pressure of Carbon Dioxide :

• Although this is a pressure measurement, it relates to

the concentration of gaseous oxygen in the blood. A
high pCO2 may indicate ACIDOSIS. A low pCO2 may
indicate alkalosis.

HCO3 = Bicarbonate :

• This measures the concentration of HCO3-ion only.

High values may indicate ALKALOSIS since
bicarbonate is base. Low values indicate acidosis.

NORMAL ARTERIAL BLOOD GAS VALUES

• How to do ABG analysis incredibly quick and accurate?

• Follow the the steps:

Step 1 : Remember the NORMAL VALUES

• Blood pH 7.35 to 7.45

• PaCo2 35 to 45 mm Hg
• HCO3 22 to 26 mEq/L
• paO2: 80 to 100 mm Hg
O2 saturation: 96% to 100% Oxyhemoglobin .

Step II. Look at the pH. Does it indicate presence of acidemia,

or alkalemia, or normal pH?

pH low (below 7.35) ACIDOSIS

pH high (above 7.45) ALKALOSIS

MIDDLE RANGE

Acid - 7.35 7.40 7.45 - Base

(ACIDOSIS) (ALKASOSIS)

• .ex: pH 7.31 (low) (ACIDOSIS)

• pH 7.48 (high) (ALKALOSIS )

Step III. Look at the PaCo2

• paCO2 is the RESPIRATORY INDICATOR.

• CO2 acts as an ACID. When CO2 combines with
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plasma, Carbonic ACID is formed (CO2 + H2O =
H2CO3)
PaCO2 High ( above 45mmHg) R. ACIDOSIS 2. METABOLIC ACID-BASE IMBALANCES

PaCO2 low (below 35 mmHg) R. ALKALOSIS • METABOLIC EQUAL: MEANS directions of pH

 and HCO3 are EQUAL or SAME directions.
MIDDLE RANGE
Ph Metabolic
Base = 35 40 45 = Acid
HCO3 ALKALOSIS
(ALKALOSIS) (ACIDOSID)

PH METABOLIC
Step IV. Look at the HCO3 ( BICARBONATE)
Hсоз ACIDOSIS
HCO3 high ( above 26) M. ALKALOSIS
pCO2 high low
HCO3 low ( below 22) M. ACIDOSIS
Acid-base imbalances
MIDDLE RANGE
1. Respiratory
Acid – 22 24 26 - Base
(ACIDOSIS) (ALKALOSIS) pH pCO2

Step V. Determine the primary ACID-BASE disturbance. Acidosis low high Opposite
Alkalosis high low directions
• The change that matches the pH is the primary ACID-
BASE DISTURBANCE.

1. pH and PaCO2 match; Respiratory Acid - Base Imbalance 2. Metabolic

pH HCO3

a. pH ACIDOSIS RESPIRATORY Acidosis low low same

Alkalosis high high directions
PaCO2 ACIDOSIS ACIDOSIS
Step VI. Look for the degree of compensation
b. pH ALKALOSIS RESPIRATORY
• Check relationship between PaCO2 and HCO3 •
paCO2 AKALOSIS ALKALOSIS • Remember : the lungs and kidneys normally attempt
to help each other to maintain acid base balance
• If the lungs are unable to maintain acid-base balance
2. pH and HCO3 match: Metabolic Acid - Base imbalance the kidneys will attempt to adjust levels of HCO3
• If kidneys are unable to maintain acid-base balance,
a. pH ALKALOSIS METABOLIC the lungs will attempt to adjust levels of CO2.
HCO3 ALKALOSIS ALKALOSIS
• If CO2 and HCO3 levels move towards the same direction,

i.e. both are high or both are low then the acid-base imbalance
b. pH ACIDOSIS METABOLIC is compensated.
HCO3 ACIDOSIS ACIDOSIS
• Example;
• Therefore : If pH are primarily affected
PCO2 (same interpretation) • PaCo2 high (ACIDOSIS) HCO3 high (ALKALOSIS)
• PaCo2. low (ALKALOSIS) HCO3 low (ACIDOSIS )
RESPIRATORY ACID-BASE IMBALANCE OCCURS
• When is the acid-base imbalance considered as partial or
• Therefore: If pH are primarily affected complete compensation?
HCO3 (same interpretation)
1. When the acid-base balance is compensated, but the
METABOLIC ACID-BASE IMBALANCE OCCURS pH is still
Think about ROME ABNORMAL: PARTIAL COMPENSATION.
• R espiratory 2. When the acid-base balance is compensated, and the
 pposite pH is
• M etabolic
• E- qual NORMAL: COMPLETE COMPENSATION.

1. RESPIRATORY ACID – BASE IMBALANCES • When is the acid - base imbalance considered
uncompensated?
• Respiratory Opposite means : the directions of pH and • When the CO2 and HCO3 levels move towards
paCO2 are opposite. opposite directions. ( the problem is worsened)
• Samples : Example:
pH RESPIRATORY PaCO2 . high (ACIDOSIS) HCO3 low (ACIDOSIS)
PaCo2 ACIDOSIS
PaCo2 low (ALKALOSIS) HCO3 high (ALKALOSIS)

• Or when PacO2 is abnormal and HCO3 remains

pH METABOLIC normal and vice versa, the acid base imbalance is
HCO3, ALKALOSIS also Uncompensated.

INCENTIVE SPIROMETRY
• An incentive spirometer is a handheld medical device
that measures the volume of breath
• helps the lungs recover after surgery or lung illness,
keeping them active and free of fluid.
• A piston rises inside the device to measure breath
volume when you breathe from an incentive
spirometer.
CLIENT INSTRUCTIONS FOR INCENTIVE SPIROMETRY
• Instruct the client to assume a sitting or
upright position.
• Instruct the client to place the mouth tightly
around the mouthpiece of the device.
• Instruct the client to inhale slowly to raise
and maintain the flow rate indicator between
the 600 and 900 marks.
• Instruct the client to hold the breath for 5
seconds and then to exhale through pursed
lips.
• Instruct the client to repeat this process 10
times every hour.
PULSE OXIMETRY
a. noninvasive test that registers the oxygen
saturation of the client's hemoglobin.
b. The capillary oxygen saturation (SaO2) is
recorded as a percentage.
c. The normal value is 96% to 100%.
d. After a hypoxic client uses up the readily
available oxygen (measured as the arterial
oxygen pressure, PaO2, on ABG testing),
the reserve oxygen, that oxygen attached to
the hemoglobin (SaO2), is drawn on to
provide oxygen to the tissues.
e. A pulse oximeter reading can alert the nurse
to hypoxemia before clinical signs occur.
Procedure
• A sensor is placed on the client's finger, toe,
nose, ear lobe, or forehead to measure oxy-
gen saturation, which then is displayed on a
monitor.
• Maintain the transducer at heart level.
• Do not select an extremity with an
impediment to blood flow.
A pulse oximetry reading lower than 91%
necessitate physician notification; if the reading is
lower than 85%, oxygenation to body tissues is
compromised, and a reading lower than 70% is
life-threatening.
Special pulmonary Treatments/ Procedures
1. Bronchial Hygiene Measures
• Suctioning - oropharyngeal, nasopharyngeal
• Steam inhalation
• Aerosol inhalation
• Medimist inhalation
Bronchial hygiene
1. Suctioning oropharyngeal secretions
• remove secretions from the oral cavity and
pharynx Secretions
• block the trachea and obstruct the normal
airflow, which can lead to an insufficient
oxygen supply
For individuals who are too weak or cannot cough
• Fowler's position, intact gag reflex
• Unconscious - side lying position
INDICATIONS FOR OROPHARYNGEAL SUCTIONING
• difficulty coughing up secretions and swallowing
• decreased consciousness
• visible secretions that obstruct the airflow
• vomitus in the mouth
• noisy breath sounds
• used to provide oral hygiene and prevent infection in
individuals that have impaired swallowing or artificial
airway.
2. Nebulization
• small machine that turns liquid medicine into a mist.
• sit with the machine and breathe in through a
connected mouthpiece
• Medicine goes into the lungs as patient take slow,
deep breaths for 10 to 15 minutes
Examples of medications used in nebulizers include:
a. Bronchodilators = drugs that help to open up the
airway.
b. Medical-grade saline (saltwater) solutions= are
solutions that help break up mucus in the lungs.
c. Antibiotics = help treat or prevent infections.
- Suction catheter used for oropharyngeal suctioning is
a rigid, bent, and plastic catheter called the Yankauer
suction catheter, or Yankauer tip.
- A Yankauer suction catheter is transparent, which lets
you see the secretions and fluids being suctioned out.
- The standard type of Yankauer catheter has a bulb tip
with one large and several smaller openings.
3. Humidification
- adds moisture to the air to prevent dryness that can
cause irritation in many parts of the body.
humidifiers:
• for treating dryness of the skin, nose, throat, and lips.
• provide relief some of the symptoms caused by the flu
or common cold.
Primary goal for humidity therapy is
• to condition medical gases to achieve normal
inspiratory conditions of 100% relative humidity and
98.6°F (37°C) just below the carina and before the
medical gases enter the airways.
2. Oxygen therapy
A. Interventions ----. Assess s/s of hypoxemia. • Is an indication
of the need for oxygen therapy.
1. Check doctor's orders
2. Position patient
 Semi-fowlers, to enhance lung expansion.
3. Assess color and vital signs before and during
treatment
4. Place an Oxygen in Use sign at the client's bedside.
5. Open source of oxygen before insertion of oxygen
device (To check for malfunctioning of the device).
6. Regulate oxygen flow accurately. Excessive
administration of oxygen can cause oxygen narcosis
(respiratory alkalosis)
7. Place a "NO Smoking "sign at the bedside.
 Strictly enforce warning.
 Oxygen is highly combustible and could
cause fire from small spark,
8. Avoid use of oil, greases, and alcohol near the patient
may support combustion)
9. Check electrical appliances before use small spark
can cause fire if there is leakage of oxygen)
10. Avoid woolen blankets and synthetic fabrics (can
generate static static electricity) use cotton blankets.
11. Humidify oxygen. Place sterile water into humidifier
(prevents dryness and irritation of mucous
membranes in the airways)
12. Provide good oronasal hygiene.
13. Lubricate nares with water soluble lubricant to soothe
the mucous membranes. Do not use oil, oil ignites
when exposed to compressed oxygen.
14. Assess effectiveness of oxygen therapy.
o Check VS, RR
o Note quality of respiration
o Evaluate ABG results
o O2 saturation
15. Document relevant observations.
Types of oxygen device
1. Nasal cannula (nasal prongs)
 Used at a flow rate of 1 to 6 L/min,
 Provides oxygen concentrations of 24% (at 1 L/min)
to 44% (at 6 L/min).
 Flow rates higher than 6 L/min do not significantly
increase oxygenation because the anatomical reserve
or dead space (oral and nasal cavities) is full.
 Used in clients with chronic airflow limitation and for
long-term oxygen use.
 Effective oxygen concentration can be delivered to
nose breathers and mouth breathers
A client who is hypoxemic and has chronic hyper-capnia
requires low levels of oxygen delivery at 1 to 2 L/min because
a low arterial oxygen level is the client's primary drive for
breathing.
Interventions
a. Place the nasal prongs in the nostrils, with the openings
facing the client,
b. Add humidification as prescribed when a flow rate higher
than 2 L/min is prescribed.
c. Check the water level and change the humidifier as
needed.
d. Assess the client for changes in respiratory rate or depth.
e. Assess the nasal mucosa because high flow rates have a
drying effect and increase mucosal irritation.
f. Assess skin integrity because the oxygen tub-ing can
irritate the skin.
2. Simple face mask
 deliver oxygen concentrations of 40% to 60% for
short-term oxygen therapy
 to deliver oxygen in an emergency.
 A minimal flow rate of 5 L/min is needed to prevent
the rebreathing of exhaled air.
Interventions
 Fit securely over the nose and mouth because a
poorly fitting mask reduces the fraction of inspired
oxygen (Fo2) delivered.
 Assess skin and provide skin care to the area covered
by the mask because pressure and moisture under
the mask may cause skin breakdown (remove mucus
and saliva from the mask).
 Monitor the client closely for the risk of aspiration
because the mask limits the client's ability to clear the
mouth, especially if vomiting occurs.
 Provide emotional support to decrease anxiety in the
client who feels claustrophobic.
 Consult with the physician regarding switching the
client from a mask to a nasal cannula during eating.
3. Partial rebreather mask
 consists of a mask with a reservoir bag that provides
an oxygen concentration of 70% to 90% with flow
rates of 6 to 15 L/min.
 client rebreathes one third of the exhaled tidal
volume, which is high in oxygen, thus providing a high
FIO2.
Interventions
a. Make sure that the reservoir does not twist, kink, or
become deflated.
b. Adjust the flow rate to keep the reservoir bag
Allows for the delivery of higher concentrations of oxygen.
4. Nonrebreather mask
 low-flow systems
o provides the
highest
concentration of
 oxygen and can deliver an FIO2 higher than
90%, depending on the client's ventilatory
pattern.
 used in the client with a deteriorating respiratory
status who might require intubation
 Has a one-way valve between the mask and the
reservoir and two flaps over the exhalation ports.
 The valve allows the client to draw the entire quantity
of oxygen from the reservoir bag.
 The flaps prevent room air from entering through the
exhalation ports.
 During exhalation, air leaves through these exhalation
ports while the one-way valve prevents exhaled air
from reentering the reservoir bag.
5. Venturi mask
 High-flow oxygen delivery system involves a
mechanism that pulls in a specific proportional
amount of room air for each liter of oxygen delivered.
 An adapter is located between the bottom of the mask
and the oxygen source; the adapter contains holes of
different sizes that allow only specific amounts of air
to mix with the oxygen.
 24% to 55% FIO2, with flow rates
 The adapter allows selection of the amount of oxygen
desired of4to 10L/min
Interventions
 Monitor the client closely to ensure accurate rate flow
rate for a specific FiO2.
 keep the air entrapment port for the Venturi adapter
open and uncovered to ensure adequate oxygen
delivery.
 Ensure that the mask fits snugly and that the tubing is
free of kinks, because the FIO2 is altered if kinking
occurs or if the mask fits poorly.
 Assess the client for dry mucous membranes;
humidity or aerosol can be added to the system.
Breathing and coughing exercises
- Pursed lip breathing
 Abdominal breathing
 Blowing exercises
Pursed lip breathing
- can slow down breathing, reducing the work of
breathing by keeping your airways open longer.
- This makes it easier for the lungs to function and
improves the exchange of oxygen and carbon dioxide.
• Indicated for conditions can include;
 obstructive lung disease, such as: asthma,
 restrictive lung disease, such as pulmonary fibrosis
(PE), which is a type of interstitial lung disease
Practice technique four (4) to five (5) times daily until patient
can manage the breathing patter, then anytime patient feel
short of breath.
To practice the pursed-lips breathing technique:
 is a technique used to relieve shortness of breath.
 Breathe in slowly through nose with mouth closed for
2 seconds, feeling the air move into your abdomen.
Try to fill your abdomen with air instead of just your
lungs..
 Then, purse lips as if you were about to whistle.
 Finally, breathe out through your pursed lips to a
count of four.
 Then repeat. Over time, you can increase the inhale
and exhale counts from 2 seconds to 4 seconds, and
so on.
- Pursed lip breathing is also used:
a. as part of treatment for chronic obstructive pulmonary
disease (COPD). .
 People with this condition have severely declining
lung function and breathing ability.
 The disease progresses to overinflated lungs and
reduced ability to exhale air. It can make breathing so
difficult that it impacts the quality of the person's life
- Pursed lip breathing can help improve and control breathing
by:
 relieving shortness of breath by slowing the breath
rate
 keeping the airways open longer, which decreases
the work that goes into breathing
 improving ventilation by moving old air (carbon
dioxide) trapped in the lungs out and making room for
new, fresh oxygen
Pursed lip breathing has no risks or complications associated
with it. Make sure, however, that you let your doctor know right
away if you notice your lung function decreasing noticeably. A
change in treatment may be needed.
Abdominal / diaphragmatic breathing
 diaphragm is a large muscle that sits below the lungs.
It helps move air in and out of the lungs.
 diaphragmatic breathing, or "belly breathing," involves
fully engaging the stomach, abdominal muscles, and
diaphragm when breathing. This means actively
pulling the diaphragm down with each inward breath.
In this way, diaphragmatic breathing helps the lungs
fill more efficiently.
  During diaphragmatic breathing, a person consciously
engages their diaphragm in order to take deeper
breaths. A person will notice their stomach rising and
falling. They will also feel an expanding or stretching
sensation in the stomach, rather than solely in their
chest and shoulders.
Procedure
 Relax your shoulders and sit back or lie down.
 Place one hand on your belly and one on your chest.
 Inhale through your nose for two seconds, feeling the
air move into your abdomen and feeling your stomach
move out. Your stomach should move more than your
chest does.
 Breathe out for two seconds through pursed lips while
pressing on your abdomen.
 Repeat.
To perform basic diaphragmatic breathing, follow the
instructions below:
 Lie down on a flat surface with a pillow under the
head and pillows beneath the knees. Pillows will help
keep the body in a comfortable position.
 Place one hand on the middle of the upper chest.
 Place the other hand on the stomach, just beneath
the rib cage but above the diaphragm.
 To inhale, slowly breathe in through the nose, drawing
the breath down toward the stomach. The stomach
should push upward against the hand, while the chest
remains still
 To exhale, tighten the abdominal muscles and let the
stomach fall downward while exhaling through pursed
lips. Again, the chest should remain still.
 People should practice this breathing exercise for 5-
10 minutes at a time, around three to four times each
day.
Benefits
Diaphragmatic breathing helps a person engage the
diaphragm fully while breathing. This may provide a number of
health benefits, including:
 strengthening the diaphragm
 improving stability in the core muscles
 slowing the breathing rate
 lowering heart rate and blood pressure
 reducing oxygen demand
 promoting relaxation
Diaphragmatic breathing may be beneficial for a range of
conditions.
 Stress and anxiety
 Chronic obstructive pulmonary disease
 Asthma
Balloon breathing exercise
 allows the lungs to expand with enough oxygen to
meet the body's needs. Blowing a balloon is an
exercise can be done home to improve lung capacity.
 practice this simple exercise by blowing up a certain
number of balloons each day.
 Blowing balloons works out the intercostals muscles
that are responsible for spreading and elevating your
diaphragm and ribcage.
 This allows the lungs to take in oxygen during
inhalation and expel carbon dioxide as you exhale.
 Blowing up balloons, while effectively exercising the
lungs' ability to expand and take in air, does not affect
the size or number of alveoli contained in the lungs.
 Alveoli are air sacs through which oxygen and carbon
dioxide exchange happens with the blood
Benefits of Blowing Up Balloons
 Oxygen restores energy to cells and muscles by
breaking down glucose and creating fuel for muscles.
 When plenty of oxygen is available, your muscles will
equip themselves with more energy reserves that will
increase your lung endurance.
 Committing to a daily routine of blowing up 10 or 20
balloons will steadily increase lung capacity and will
also amplify the lungs' ability to maintain a sufficient
supply of oxygen over time. Start with a few a day and
then build up to more.
Blowing up Balloons and your Respiratory Muscles
a. exercises your respiratory muscles a group of
muscles that contribute to inhalation and exhalation
by aiding in the expansion and contraction of the
chest.
 Basic respiratory muscles are the diaphragm, the
internal intercostal and the external intercostal.
 Accessory muscles, or muscles that contribute to
lifting your ribcage so that lungs can expand and take
in air, are frequently used during vigorous physical
activity.
 When you steadily blow up several balloons, it
effectively exercises all these muscles, building your
lung capacity and stamina.
Caution
 People with healthy lungs may not have any problems
blowing up balloons.
 However, people with impaired lung function and
capacity, such as those with pulmonary fibrosis may
feel lightheaded or dizzy while blowing balloons.
 This effect will likely go away once you stop blowing.
 As your lung capacity increases, these sensations
should reduce and may eventually disappear.