RESP IR AT O RY

C AR E
MO D A L IT IE S
 PULSE
OXI ME T E R
LEARNING OBJECTIVES:

• TO KNOW HOW 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 OXIMETRY

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

below 95% • Hypoxemia

• Critical level
• Cerebral hypoxia (low oxygen level in the brain) may
85% and follow in a few minutes and cause irreversible brain damage.
Several vital organs might also be affected. The person

below 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 saturation, particularly black, green,
and blue

Fingertip
 • 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 measurement of oxygen
saturation
Earlobe
 • 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
CONTRAINDICATIONS:
1. 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
 PROCEDURE
• SIT OR LIE UPRIGHT IN A COMFORTABLE POSITION.

• 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

THROUGH EIGHT, 10 TIMES EACH HOUR WHILE YOU ARE
AWAKE.
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 lalabas din tong parts, kahit 2-
3 lang kabisado niyo
INDICATIONS CONTRA-
• TIGHTNESS IN CHEST INDICATIONS
• INCREASED OR THICK • INCREASED BLOOD PRESSURE
SECRETIONS
• INCREASED PULSE
• PNEUMONIA (CONGESTION)
AND/OR • HISTORY OF ADVERSE REACTION TO
THE MEDICATION.
• ATELECTASIS

lalabas din to, kahit 2 or 3 lang

lang na indications and
contraindications
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 kahit 2-3 lang makabisado
niyo

• 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.
CONTRAINDICATIONS

• ACTIVE PULMONARY BLEEDING WITH HEMOPTYSIS ANDsame

THE
dito, 2-3 langs
IMMEDIATE 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
lalabas tong 2 full breaths
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)

alam ko lumabas tong

positions na to, review niyo na
rin
• 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 lumabas tong percussion at
vibration

• 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.

di ko suree kung lumabas din
to samin hahaha review niyo
na lang din
LIVE RETURN
DEMONSTRATION/
PERFORMANCE TASK

•PULSE OXIMETER 24/24

•CHEST PHYSIOTHERAPY 40/40