❑ Safety pin

CARE OF CLIENTS WITH PROBLEMS WITH OXYGENATION, FLUID AND ELECTROLYTES BALANCE, ❑ Plaster
INFECTIOUS, INFLAMMATORY, AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS ACUTE
AND CHRONIC B. CANNULA
Nasal Cannula and Tubing
NCM 112 SKILLS Tape
COURSE CONTENT Gauzes
Prescribed face mask fit for the patient
Padding for elastic band
OXYGEN ADMINISTRATION
OXYGEN TENT
⮚ Is the process by which supplemented oxygen is administered in high concentration than that of atmospheric ⮚ Consist of a rectangular, clear, plastic canopy with outlets that connects to an oxygen or compressed air
air. source and to a humidifier that moisturizes the air or oxygen.

PURPOSES

⮚ To relieve dyspnea
⮚ To prevent hypoxemia and hypoxia
⮚ To increase oxygenation in tissues

INDICATIONS FOR OXYGEN ADMINISTRATION:

⮚ Severe respiratory distress

⮚ Intra and post operatively
⮚ Hypoxia and Hypoxemia
⮚ Shock
⮚ Severe Trauma
⮚ Acute Myocardial Infarction
CROUPETTE

DIFFERENT TYPES/ ROUTES OF OXYGEN ADMINISTRATION: Consists of a nebulizer with attached tubing that connects with a canopy to enclose the patient and contain the humidifying
mist.
⮚ Nasal
⮚ Mask
⮚ Cannula
⮚ Tent

NASAL CATHETER
- Introduction of oxygen through the oropharynx by means of a soft rubber tube with hole at the end.

CANNULA
- The most common inexpensive low-flow device used to administer ocxygen.
- Consists of rubber or plastic tube that extends around the face, with 0.6 – 1.3cm (1/4 1/2 inch) curved prongs
that fit into the nostril.

FACE MASK
⮚ covers the client’s nose and mouth for oxygen inhalation
PARTS OF AN OXYGEN CYLINDER

OXYGEN TENT
- Consist of a rectangular, clear, plastic canopy with outlets that connects to an oxygen or compressed air
source and to a humidifier that moisturizes the air or oxygen.

EQUIPMENTS:
⮚ Oxygen supply
⮚ Humidifier with sterile, distilled water or according to agency protocol
⮚ “NO SMOKING” sign

ADDITIONAL EQUIPMENTS FOR:

A. CATHETER
❑ Nasal Catheter
Children – French # 8 -10
Adult – French # 12 -14
❑ Tongue Depressor
❑ Flashlight
STEPS c. Assess the client regularly for signs of hypoxia, tachycardia, confusion,dyspnoea, restlessness, & cyanosis.
Rationale: Obtain arterial blood gas results; if they are available.
A. NASAL CATHETER
d. Inspect the facial skin frequently for dampness
1. Measure the length of catheter to be or chafing, & dryness & treat it as needed.
inserted by holding it horizontally from the tip
of the nose to the earlobe.

2. Moisten the tip of the catheter with water to NASAL CATHETER

facilitate easy passage of the catheter.
Assess the client’s nares for encrustations & irritations. Apply a water soluble lubricant as required.
3. Elevate the tip of the nose gently until the mark Rationale: Change catheter every 8 hours as necessary. Water soothes the mucous membrane.
on the catheter is reached.
INSPECT THE EQUIPMENT ON A REGULAR BASIS:
4. Check if the catheter is in the right position by
depressing the tongue. Use the flashlight for better *Check the liter flow & the level of water in the humidifier in 30 minutes & whenever providing care to the client.
visualization
Rationale: The catheter should be behind the uvula *Check the liter flow & the level of water in the humidifier in 30 minutes &whenever providing care to the client membrane.
Rationale: Change catheter every 8 hours as necessary. Water soothes the mucous membrane.
5. Fasten the catheter to the side of the patient’s face & drape it over his ear.
-Maintain the level of water in empty humidifier, rinse, & fill the humidifier. with distilled or tap water every 24 hours.
Rationale: Pin the connecting tube on the pillow case or back of the mattress. Some models have a strap to adjust
under the chin - Make sure that safety precautions are being followed

PERFORMING
STEPS INCENTIVE SPIROMETER
AND
B. NASAL CANNULA PULSE OXIMETER

1. Put the cannula over client’s face, -A device that measures how deeply you can inhale (breathe in). It helps you take slow, deep breaths to expand and fill
with the outlet prongs fitting into your lungs with air. This helps prevent lung problems, such as pneumonia.
the nares & the elastic band around the head. -Is made up of a breathing tube, an air chamber, and an indicator.
-Most commonly used after surgery. People who are at an increased risk of airway or breathing problems may also use
2. If the cannula will not stay in one. These include people who smoke or have lung disease. This may also include people who are not active or cannot
place, tape it at the sides of the face. move well.

3. Slip gauze pads under the tubing over the cheekbones.

Two types of incentive spirometry that are commercially available:
Rationale: To prevent skin irritation
1. Volume-oriented Incentive
Spirometry (VIS)
C. FACE MASK
1. Place the mask towards the
client’s face, & apply it from the
nose downward

2. Apply the mask making sure that it fits to the contour of the client’s face.
Rationale : The mask should mold to the face, so that very little oxygen escapes into the eyes or around the cheeks.

3. Secure the elastic band around

the client’s head so that the mask
is comfortable but snug.

4. Pad the band behind the ears &

over the bony prominences. 2. Flow-oriented Incentive
Spirometry (FIS)
5.Make the client comfortable

6. Fill out oxygen slip taped to oxygen tank

a. Assess the client’s level of anxiety, color, ease

of respirations, & provide support while the client
adjusts to the cannula

b. Assess the client in 15-30minutes depending on the client’s condition, & regularly thereafter Both VIS and FIS are used to encourage the patient to inhale to lung capacity through maximal inspiration aided with
Rationale : Assess vital signs, color, breathing patterns & chest movements. visual feedback
 PULSE OXIMETER

- a device that is used to quickly and easily monitors a person’s oxygen saturation
- It can measure the level of oxygen within the blood specifically in arterial blood without using invasive means.
- it provides a heart rate measurement as well.

Clinical indications for incentive spirometry are:

▪ Presence of pulmonary atelectasis.

▪ Presence of conditions predisposing to atelectasis:

Upper abdominal surgery
Thoracic surgery
Surgery in patients with COPD.

▪ Presence of a restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm.

Normal range for incentive spirometer

o healthy males aged 20-60 range from 4.5 to 3.5 liters,

o healthy females aged 20-60 range from 3.25 to 2.5 liters.

What does pulse oximeter measure?
- Arterial blood
- SpO2

Normal ranges of a pulse oximeter

- Heart rate- 60-100 beats/ min

How to use an incentive spirometer:
- O2 saturation-95-100%
- If there is lack of oxygen in the blood,that means your body tissues will not be oxygenated properly and
1. Sit up as straight as possible.
can be hazardous to your health.
2. Do not bend your head forward or backward. Hold the incentive spirometer in an upright position.
3. Place the target pointer to the level that you need to reach.
4. Exhale (breathe out) normally and then do the following:
a. Put the mouthpiece in your mouth and close your
lips tightly around it. Do not block the mouthpiece with your tongue. EQUIPMENTS:
b. Inhale slowly and deeply through the mouthpiece - Oximeter
to raise the indicator. Try to make the indicator rise up to the level of the goal marker. - Oximeter probe appropriate for client
c. When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 3 seconds. - Acetone or nail polish remover
d. Exhale normally. - Gloves (optional)
e. Repeat these steps 10 to 12 times every hour when you are awake, or as often as directed.
f. Clean the mouthpiece with soap and water after each use. Do not use a disposable mouthpiece for longer than 24
hours. PROCEDURE:
g.Keep a log of the highest level you are able to reach each time This will help healthcare providers see if your lung
function improves. ✔ Checked prescribed medications for vasoconstrictive effects.
✔ Determine how much the client understands about pulse oximetry,
✔ Wash hand or perform hand antisepsis with an alcohol.
✔ Position the sensor so that the light emission is directly opposite the sensor.
✔ Attach the sensor cable to the machine. Observe the numeric display, audible sounds & waveform on the machine.
✔ Set the alarms for saturation level and pulse rate according to the manufacturer’s directions. - purpose of percussion is to break up thick secretions in the lungs so they can more easily be removed.
✔ Move an adhesive finger sensor if the finger becomes pale, swollen, or cold: remove and reapply a spring-tension - performed on each lung segment for one to two minutes at a time.
every 2hours. - any dullness or hyper-resonance is indicative of lung pathology, such as pleural effusion or pneumothorax,
✔ Document the following: respectively.
- Abnormal oxygen saturation measurements when they are sustained.
- Nursing measure to improve oxygenation if oxygen saturation levels fall below 90% & are prolonged.
- Removal & relocation of sensor. VIBRATION
- Condition of skin at sensor site.
- a gentle, shaking pressure applied to the chest wall to move secretions into larger airways.
NOTE: - it is done after percussion and you should vibrate towards the carina. Be sure to have the patient inhale and then
⮚ Sites where sensor is best applied: perform the vibration while they are exhaling.
1. finger - these are massage techniques in which tissues are pressed and released in an up and down movement. It creates a
2. Toe vibrating and shaking motion onto the muscles that can be perfomed in a soothing or stimulating way
3. Earlobe
4. Bridge of the nose
HOW TO PERFORM VIBRATION:
⮚ Normal Value of SpO2: 95% - 100%
- During vibration, place your flat hand firmly against the chest wall, on the appropriate lung segment to be drained.
- The nurse uses rhythmic contractions and relaxations of arm and shoulder muscles over the patient’s chest
- Stiffen your arm and shoulder, apply light pressure and create a shaking movement, similar to that of a vibrator.
- Vibrate the chest wall as the patient exhales slowly through the pursed lips.
- Ask service user to breathe in deeply during vibration therapy, and exhale slowly and completely.
- After each vibration, encourage the client to cough and expectorate secretions into the sputum container.
- Taking a deep breath and then exhaling slowly and forcefully without straining will hopefully stimulate a productive
cough.

INDICATION:

1. Neuropathic pain- Whole body vibration has positive

long term effects on neuropathic pain caused by diabetes
2. Low back pain-Combined vibration and traction therapy
are more effective than traction alone.
3. Heel lance pain among neonates-Mechanical vibration
may be an effective and safe method for pain management
of heel lance pain among neonates.
4. Muscle pain-delayed onset of muscle soreness

Other applications of vibration

- improved muscular strength, power development, kinesthetic awareness, range of motion, and increased blood flow
under the skin.
- local vibration can be a safe and effective alternative for chronic post-stroke patients.
- improve physiotherapy effects in individuals with Parkinson’s and Multiple Sclerosis induce muscle contractions,
they may be used to enhance osteoclast metabolism and prevent osteoporosis in patients with reduced mobility
PERFORMING - treatment for spasticity with good results.
PERCUSSION & VIBRATION

CONTRAINDICATIONS:
PERCUSSION
- Blood-thinning medications
- a manual technique which involves clapping of the chest and/or back to loosen the thick, sticky mucus from the - Advanced diabetes
sides of the lungs. This will enable the secretions to move into the larger airway when you take deep breaths so that - Heart disease
you are able to cough and clear the secretions effectively. - Pregnancy
- let the patient do purse lip breathing
- involves rhythmically striking the chest wall with cupped hands. It is also called cupping or clapping.
Contraindications for vibration therapy
(Whole Body Vibration Therapy)
- Kidney or bladder stones.
- Arrhythmia.
- Pregnancy.
- Epilepsy.
- Seizures.
- Cancer.
- A pacemaker.
- Untreated orthostatic hypotension.
- Recent implants (joint/corneal/cochlear, etc.). CONTRAINDICATIONS
- Recent surgery.
- Recently placed intrauterine devices or pins. - Severe Hemoptysis
- Acute thrombosis or hernia, acute rheumatoid arthritis. - Untreated acute condition
- Serious cardiovascular disease. - Severe pulmonary edema
- Severe diabetes. - Congestive heart failure
- Migraines - Large pleural effusion
- Pulmonary embolism
- Pneumothorax
- Cardiovascular instability
PERFORMING - Cardiac arrhythmia
POSTURAL DRAINAGE - Severe hypertension or hypotension
AND - Unstable angina
STEAM INHALATION - Recent neusurgery
- Recent MI
- Head down position-may cause increased ICP- use modified positions
POSTURAL DRAINAGE

- It is a form of Airway Clearance Therapy that involves placing the patient’s body in various positions in order to drain
secretions from the lung segments into the central airways using gravity. From there, the secretions can be removed INTERMITTENT POSITIVE PRESSURE BREATHING
via cough or suctioning.
- use gravity to drain mucus out of your lungs by changing positions. -is an instrument used to help a patient to breathe when they are unable to breathe on their own
It's used to treat a variety of conditions, including chronic diseases such as :
1.cystic fibrosis - uses a mechanical respirator to deliver a controlled pressure of a gas to assist in ventilation or expansion of the lungs,
2.Bronchiectasis thereby providing an increased tidal volume for patients with a variety of pulmonary conditions.
3. temporary infections, such as pneumonia. -IPPB machines are also used for the delivery of aerosol medications.

-the provision of air under pressure by a mechanical respirator, a machine designed to improve the exchange of air
It's used to treat a variety of conditions, including chronic diseases such as : between the lungs and the atmosphere.

1.cystic fibrosis
2.Bronchiectasis Possible complication of positive pressure ventilation
3. temporary infections, such as pneumonia.

• the best time to do postural drainage is either before a meal or an hour and a half after a meal, when your
* Barotrauma — a well-known complication of positive pressure ventilation. Consequences include pneumothorax,
subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum.
stomach is emptiest.

• The person lies or sits in various positions so the part of the lung to be drained is as high as possible.
Use one of the following positions: Sitting
* Barotrauma -A complication resulting from damage to the lungs by pressure due to mechanical ventilation, sudden
decompression valsava manuever or blast injury.

Postural Drainage Positions INDICATIONS:

- indicated for patients who are at risk for developing

atelectasis
- those who are unable or unwilling to breathe
deeply without assistance.
- In patients with severe lung hyperinflation
- may decrease dyspnea and discomfort during
nebulized therapy.

Most contraindications are relative:

a. nausea
b. hemodynamic instability,
c. tracheal fistula
d. singulation
e. hemoptysis
f. untreated tension pneumothorax
g. pressure can be increased to reach VT goal if tolerated by patient.

STEAM INHALATION

- is one of the most widely used home remedies to soothe and open the nasal passages and get relief from the
symptoms of a cold or sinus infection.
 also called steam therapy, it involves the inhalation of water vapor. The warm, moist air is thought to work

•
-
loosening the mucus in the nasal passages, throat, and lungs.
- may relieve symptoms of inflamed, swollen blood vessels in your nasal passages Avoid allowing the steam to make contact with your eyes. Your eyes should be closed and directed away from the
- won’t cure an infection, like a cold or the flu, but help make you feel a lot better while your body fights it off. steam.

•
- Steam is not likely to harm the lungs

Steam inhalation may provide some temporary relief from the symptoms of: Keep the bowl of hot water out of reach of children or pets.

- common cold
- flu(influenza)
- sinus infections (infectious sinusitis)
- bronchitis
- nasal allergies

Steam inhalation helps alleviate:

- headache
- congested (stuffy) nose
- throat irritation
- breathing problems caused by airway congestion
- dry or irritated nasal passages
- cough

* The biggest risk is accidentally knocking over the bowl of hot water into your lap, which can
cause severe burn.

How to inhale steam:

You’ll need the following materials:

1. A large bowl 4. A towel
2. Water
3. A pot or kettle and a stove or microwave for heating up water

Here’s the process:

• Heat up the water to boiling.

• Carefully pour the hot water into the bowl.
• Drape the towel over the back of your head.
• Turn on a timer.
• Shut your eyes and slowly lower your head toward the hot water until you’re about 8 to 12 inches away from the
water. Be extremely careful to avoid making direct contact with the water.
• Inhale slowly and deeply through your nose for at least two to five minutes.

* An electric steam inhaler (also called a vaporizer) can be purchased online or at a drugstore.

Don’t steam longer than 10 to 15 minutes for each session. However, you can repeat steam inhalation two or three
times per day if you’re still having symptoms.

To avoid burns:

• Make sure the bowl of hot water is on a level, sturdy surface and can’t be knocked over.

• Don’t shake or lean on the bowl.