Professional Documents
Culture Documents
Forceful striking of
the skin with cupped
hands
Can mechanically
dislodge tenacious
secretions
Steps:
Cover the area with a towel or gown to reduce discomfort
Ask the client to breathe slowly and deeply to promote relaxation
Alternately flex and extend the wrists rapidly to slap the chest
Percuss each affected lung segment for 1-2 minutes
CHEST PHYSIOTHERAPY:
Vibration
Series of vigorous
quiverings
produced by hands
that are placed
against the client’s
chest wall
Used after percussion to increase the turbulence of the exhaled air
Done alternately with percussion
Steps:
Place hands, palms down, on the chest area to be drained, one hand over
the other with the fingers together and extended
CHEST PHYSIOTHERAPY:
Vibration
Ask the client to inhale deeply and exhale slowly through the nose and pursed lips
During exhalation, tense all the hand and arm muscles, and using mostly the heel of the hand,
vibrate the hands, moving them downward. Stop when client inhales
Vibrate during five exhalations over one affected lung
After each vibration, encourage client to cough and expectorate secretions
CHEST PHYSIOTHERAPY:
Postural Drainage
The drainage by gravity secretions from various lung segments
Bronchodilators or nebulization therapy may be given before postural drainage
Scheduled 2 or 3 times a day depending on degree of lung congestion
Each position is usually assumed for 10-15 minutes
OXYGEN THERAPY
Prescribed by the physician; but can be
given without order in emergency cases
Physician specifies method of delivery, liter
flow per minute (LPM) and concentration of
oxygen (Fi02: fraction of inspired oxygen)
Indications:
Difficulty ventilating all areas of the lungs
Impaired gas exchange
Heart failure (MI)
Hypoxia/ hypoxemia
Hazards or complications:
Ventilatory depression
Oxygen toxicity (Retrolental Fibroplasia: O2 toxicity
in newborns) this can occur if the Fi02 given is >50%
in a 24hour duration
Bacterial contamination- contaminated humidification
system
Skin irritation from device material
Drying effect on the mucous membranes of
respiratory tract-use humidifiers
Oxygen supply:
Wall outlets
Tanks and cylinders
Portable oxygen cylinders
OXYGEN THERAPY:
Types of O2 delivery systems
Low flow systems: will not meet the entire flow
demand of the patient
NASAL CANNULA/ NASAL PRONGS AND NASAL
CATHETER
O2 concentration: 24-45% at flow rates 2-6L
per minute
Advantages:
most common and inexpensive device
easy to apply
does not interfere with the client’s ability to
talk or eat
comfortable and allows freedom of movement
Disadvantages:
inability to deliver higher
concentrations of O2
drying and irritating to mucous
membranes
can be easily dislodged
SIMPLE FACE MASK
covers the client’s nose and mouth
-40-60% concentration at 5-8L per
minute
OXYGEN THERAPY:
Types of O2 delivery systems
NASAL CANNULA SIMPLE FACE
MASK
OXYGEN THERAPY:
Types of O2 delivery systems
Partial rebreather mask
same as non-rebreather mask but without
valves
allows the client to rebreathe about the first
third of the exhaled air (the reservoir bag)
increases the FiO2 by recycling oxygen
O2 concentration of 60-90% at 6-10L per
minute flow
nurse should not let bag be totally deflated; if
this occurs increase the flow rate
OXYGEN THERAPY:
Types of O2 delivery systems
Non-rebreather mask
delivers highest O2 concentration as possible
contains one-way valves which prevents the air
room and client’s expired air from entering the
reservoir bag
only oxygen in the bag is inspired again
should not be totally deflated during inspiration
to prevent CO2 build up; if it occurs increase
flow rate
95-100% concentration at 10-15L per minute
flow
OXYGEN THERAPY:
Types of O2 delivery systems
High flow systems: will meet the entire flow
need of the patients
Venturi mask
has wide bore tubing and color coded jet
adapters
delivers 24-40% or 50% at 4-10L pr minute
flow
color coded adapters:
Blue- 24% Green- 35%
Yellow- 28% Peach- 40%
White-31% Orange- 50%
OXYGEN THERAPY:
Types of O2 delivery systems
VENTURI MASK YELLOW ADAPTER
ADAPTERS ATTACHED TO
35%
28% 31% MASK
Position:
conscious: Semi-
Fowler’s
unconsious: Lateral
Presssure
Wall unit
adult- 100- 120 mmHg
child- 95-110 mmHg
infant- 50-95 mmHg
Portable unit
adult- 10-15 mmHg
child-5-10
infant- 2-5
Size
adult- Fr 12-18
child- Fr 8-10
infant- Fr 5-8
Reminders:
Sterile technique
Length: 13 cm (5 in)
Lubricate catheter
Apply suction during withdrawal
Apply suction 10-15 sec
Interval: 20-30 sec
ARTIFICIAL AIRWAYS
Oropharyngeal and
nasopharyngeal airways
Endotracheal tubes
Tracheostomy tubes
Oropharyngeal and
nasopharyngeal airways
Used to keep the upper air passages open when
they may become obstructed by secretions or
the tongue
Easy to insert and have less risk for
complications
Oropharyngeal stimulate gag reflex and are
used only for unconscious clients
To insert:
Place patient in supine or semi-fowlers
Put clean gloves
Hold lubricated airway by the outer flange
open the mouth and insert along the top of
the tongue
Endotracheal tubes
Most commonly inserted for clients who have
general anesthesia or mechanical ventilators
Inserted by the physician or respiratory therapist
Inserted through the mouth and guided by a
laryngoscope
The tube terminates just superior the bifurcation
of the bronchi
Patient is unable to speak
Nursing interventions for patient with ET:
Assess client’s respiratory status at least
every 2hours or more if indicated
Endotracheal tubes
Frequently assess nasal and oral mucosa for redness and
irritation andf report any abnormal findings to the
physician
Secure the ET rube with tape or a commercially prepared
tracheostomy holder to prevent movement of the tube
farther into or out of the trachea. Assess position
frequently. Notify physician if tube is displaced
Unless contraindicated, place the patient in a semi-prone
position to prevent aspiration of secretions
Using sterile technique, suction ET tube as needed
Closely monitor cuff pressure and maintain at 20-25mmHg
Provide oral and nasal care every 2-4 hours
Move the ET tubes to other side of mouth every 8 hours
Provide humidified oxygen because ET tube bypasses
upper airways
Communicate with client frequently, provide notepad as
needed
Tracheostomy
An opening into the trachea
through the neck
Two techniques:
Traditional open surgical
method: done in OR
Percutaneous insertion: can be
done at bed side
Tracheostomy tubes
May be plastic or metal
Components:
outer cannula: inserted into the trachea
flange: rests against the neck and allows the tube
to be secured in place with tape or ties
inner cannula:
obturator: kept at the client’s bedside in case the
tube becomes dislodged and needs to be reinserted
inflatable cuff: produces an airtight seal to prevent
aspiration of oropharyngeal secretions and air
leakage between tube and trachea
low pressure cuff: used to distribute a low, even
pressure against the trachea thus decreasing risk
for necrosis of tissue
Tracheostomy care:
Purposes
Maintain airway patency
Maintain cleanliness and prevent infectrion
at the tracheostomy site
Facilitate healing and prevent skin
excoriation around the incision
Promote comfort
Assessment:
Secretions: amount and character
Drainage
Appearance
Signs of infection
Tracheostomy care:
Equipment
Sterile tracheostomy kit
Towel or drape to protect linens
Sterile suction catheter kit
Sterile NSS
Sterile gloves 2 pairs
Clean gloves
Moisture proof bag
Gauze: 4x4
Cotton will ties
Scissors
Tracheostomy care:
Procedure:
Hand hygiene
Prepare equipment
Suction the tube as needed
Clean the inner cannula
Remove inner cannula from soaking
solution
Clean lumen and entire cannula using
brush or pipe cleaners
Rinse
Replace the cannula and secure It in place
Tracheostomy care:
Procedure:
Clean the incision site and tube flange
Using sterile applicators or gauze dressing
moistened in NSS
One stroke one applicator
Apply sterile dressing
Fold dressing
Place dressing under flange
Support tube while placing dressing
Change tracheostomy ties
Tape and pad tie and knot
Check tightness
Document