Care of Patient with Respiratory

Problems

PREPARED BY ,
Dr.N.S.Sunitha Mercy
MACCON
OBJECTIVES
At the end of the session the students will be able to
list out the purpose.
explain the indications of oxygenation
discuss the factors affecting oxygenation.
describe the alterations in oxygenation.
explain the methods of oxygen administration.
INTRODUCTION
 Air, Water and food are the three essentials of life.
 ‘Oxygen’ is the most important component of air. is vital
to all existence.
 ‘Oxygen’ is given when there is inference with normal
oxygenation of body tissues.
 Oxygenation is the process that includes both
inspiratory and expiratory activities hence there occurs
the exchange transport of respiratory gases.
DEFINITION

 Oxygen is colourless, odourless, tasteless and

combustible gas.

 Oxygen therapy is defined as the administration of

oxygen by inhalation from a cylinder, piped in system

liquid oxygen concentration by various methods to

relieve anoxemia.
PURPOSES
 The body is constantly taking in oxygen and releasing carbon
dioxide.
 To facilitate normal metabolism of the tissues.
 To increase oxygen saturation tissues where the saturation levels
are too low due to illness or injury.
 If this process is inadequate, oxygen levels in the blood decrease
and the patient may need supplemental oxygen.
INDICATIONS
 The body is constantly taking in oxygen and releasing carbon
dioxide.
 To facilitate normal metabolism of the tissues.
 To increase oxygen saturation n tissues where the saturation
levels are too low due to illness or injury.
 If this process is inadequate, oxygen levels in the blood
decrease and the patient may need supplemental oxygen.
 FACTORS AFFECTING OXYGENATION

There are mainly 4 factors causing alteration in

oxygenation:

1. Physiological factors.

2. Developmental factors.

3. Lifestyle.

4. Environmental factors.
 FACTORS AFFECTING OXYGENATION

Physiological factors:
Conditions affecting broncho pulmonary functioning
Alterations in cardiac function conduction
disturbances altered cardiac output, impaired.
Alteration in respiration function, hyperventilation,
hypoventilation, etc.
 FACTORS AFFECTING OXYGENATION
DEVELOPMENTAL FACTORS:
 The developmental stage of the child and the normal
aging process can affect tissue oxygenation.
 Infants and toddlers upper respiratory tract infection,

nasal congestion etc.

 School age children and adolescents, - respiratory

infection, cigarette smoking.

 Young and middle adults unhealthy diet lack of

exercise, stress, illegal drugs, smoking etc.

FACTORS AFFECTING OXYGENATION
 LIFESTYLE RISK  ENVIRONMENTAL
FACTORS: FACTORS:

 Improper nutrition  Pulmonary Diseases- High

 Exercise Smoky Area

 Occupational
 Smoking

 Substance
Pollutants(asbestos)
abuse
 Farm vector.
 Stress.
TERMINOLOGY
• Cyanosis: Defined as bluish color of skin, nails
and mucous membrane due to lack of oxygen.
• Anemia: It is the deficiency of RBC/Hb in
body.
• Hypoxia: Inadequate oxygen in tissues
• Hypoxemia: A lower oxygen level in blood.
• Pulse oximetry: It is non invasive method of estimating
the atrial oxygen It’s used to measure SPO2
• Postural drainage: It is technique of draining secretions
by gravity from various lung segments using various
body positions.
• Pneumothorax: It is a condition in which air remains
inside pleura.
• Asphyxia: The state of being unable to breathe, which
causes somebody to die or to become unconscious.
 DYSPNEA

Dyspnea, the sensation of breathlessness or inadequate

breathing, is the most common complaint of patients
with cardiopulmonary diseases.
• Dyspnea - common complaint “shortness of breath”.
• Defined as uncomfortable breathing.
 DEFINITION OF COUGH
“A cough is a forced expulsive mechanism, forms in a
breathing passage of foreign particles, microbes,
irritants and mucus.”

Three Categories of Cough:

• Acute Cough = < 3 Weeks Duration

• Subacute Cough = 3 – 8 Weeks Duration

• Chronic Cough = > 8 Weeks Duration

 DEEP BREATHING EXERCISE
• Deep Breathing Exercise are usually recommended after
surgery.

• This exercise will help to improve breathing, clear

secretions from lungs, and lower risk of pneumonia.

• It helps to expand the lungs.

• This exercise will be more effective if done in sitting

position.

• A patient may start by inhaling for 2 seconds and then

exhaling for 4 seconds.
 Technque of Deep Breathing Exercise
1. Breath deeply and slowly through nose, expanding
lower rib cage and letting abdomen move forward.
2. Hold for a count of 3 to 5
3. Breathe out slowly and completely through pursed
lips.
4. Don’t force breathe out.
5. Rest and repeat 10 times every hour.
6. Provide a rest if patient become dizzy.
COUGHING EXERCISE
It’s best to do coughing exercise when patient is fresh and
comfortable.
1. Patient advised to sit upright/lye his back
2. For the controlled cough, pt purse their lips and take a
deep breathe.
3. Provides support to incision with pillow/hands.
4. Encourage patient to breathe deeply and cough firmly.
5. If pt come out some mucous, clear it.
6. Repeat coughing until there is not any more mucous.

If pt have lots of mucous, provide rest in between exercise so

that he should not be tired.
 ALTERATIONS IN OXYGENATION

 Apnea: Apnea is a temporary stoppage of respiration.

 Hypoxia: Hypoxia is inadequate oxygen supply to the
tissues, it may be caused due to,
 decreased o2 & Po2 carrying capacity of blood.
 decreased rate of blood flow to the tissues.
Types of Hypoxia:
 Arterial, Hypokinetic, Anemia & Histotoxic
 ALTERATIONS IN OXYGENATION

 Chronic hypoxia: It is due to exposure of po2 for

long periods. It causes severe fatigue, dyspnoea,
shortness of breath. Due to lack of o2 support to
tissues, person may be bedridden or limited to sitting
may get respiratory arrhythmia.
 Hypercapnia : It is increased pco2 level of body
fluids.
 ALTERATIONS IN OXYGENATION
 Hyperventilation: It is increased rate and depth of
respiration.
 Hypoventilation: It is decreased rate and depth of
respiration.
 Asphyxia: It is the condition in which there is hypoxia
associated with hypercapnia. Almost all types of hypoxia
are associated with hypercapnia expect the arterial
hypoxia occurring at high altitude.
METHODS OF O2 THERAPY
(a) Nasal Cannula
(b) Oxygen by mask
(i) Simple face mask
(ii)Partial Rebreather Mask
(iii) Non-Rebreathing mask with reservoir
(c) Oxygen tent/wood
METHODS OF OXYGEN ADMINISTRATION
 Nasal Cannula (Prongs):
 It is disposable, plastic device with two protruding
prongs for insertion into the nostrils
 Used for low medium concentration of oxygen (24-
44%)
 NASAL CANNULA (PRONGS)

NURSING INTERVENTION:
 Be alert the skin break down over the ears and in the
nostrils from too tight an application
 Observe for mucous dryness
 Check frequently that both prongs are in client nares
 NASAL CANNULA (PRONGS)
ADVANTAGES:
 Client able to talk and eat with oxygen in place
 Easily used in home setting & it is safe and simple
 Easily tolerated & Delivers low concentration
DISADVANTAGES:
• Unable to use with nasal obstruction
• Drying mucous membrane so flow greater than need
4l/min need to be humidified
• Can dislodge from nares easily
• Causes skin irritation or breakdown over ears or at nares
 FACE MASK
 The simple oxygen mask.
 Partial Re-Breather mask.
 Non- ReBreather mask (NRBM)
 Venturi Mask.
 SIMPLE OXYGEN MASK

 Simple face mask is made clear, flexible, plastic or rubber

that can be molded to fit the face
 It is held to the head with plastic bands
 Some have a metal clip that can be bent over the bridge
of the nose for a comfortable fit.
 It is deliver 35% to 60% of oxygen with flow rate of 6 to
10 liters per minute.

 SIMPLE OXYGEN MASK

 It has vents on its sides which allow room air to leak in

many places, thereby diluting the source of oxygen.

NURSING INTERVENTION:
 Monitor client frequently to check placements of the
mask
 Secure the physicians order to replace mask with nasal
cannula during meal time
 SIMPLE OXYGEN MASK

ADVANTAGES: DISADVANTAGES:
 Tight seal required to deliver
 It can provide increased
higher concentration
delivery of oxygen for short
period of time
 Difficult to keep mask in
position over nose and mouth
 Uncomfortable while eating or
talking
 Potential for skin breakdown
(pressure,moisture)
 PARTIAL REBREATHER MASK

 The mask is with a reservoir bag that must remain

inflated during both inspiration & expiration
 It is used to deliver oxygen concentration up to 80%.
 The oxygen flow rate must be maintained at a minimum
of 6L/minute to ensure that the patient does not re-
breath large amount of exhaled air.
 The remaining exhaled air exists through vents.
 PARTIAL REBREATHER MASK

NURSING INTERVENTION
 set flow rate so mask remains two third full during
inspiration
 keep reservoir bag tree of twists or kinks
ADVANTAGES
 Client can inhale room air through opening in
mask if oxygen supply is briefly interrupted
DISADVANTAGES
 Requires tight seal (eating and talking difficult,
uncomfortable)
 NON REBREATHER MASK
 This mask provides the highest concentration oxygen
(95- 100%) at a flow rates 6-5 L/minute.
 It is similar to the partial re-breather mask except two
one-way valves prevent conservation of exhaled air.
The bag has an oxygen reservoir.
 When the patient exhales air the one-way valve
closes and all of the expired air is deposited into the
atmosphere not the reservoir bag.
 In this way, the patient is not re-breathing any of the
expired gas.
NON RE-BREATHER MASK

• Maintain flow rate so reservoir bag collapses

only slightly during inspiration.
• Check that valves and rubber flaps are function
properly (open during expiration)

• Monitor sco2 with pulse oximeter.

 NON RE-BREATHER MASK
 ADVANTAGES:

 Delivers the highest possible oxygen

concentration.
 Suitable for patient breathing spontaneous with
severe hypoxemia.
 DISADVANTAGES:

 Impractical for long term therapy.

 Malfunction can cause co2 buildup.
 Suffocation
 Expensive.
 Uncomfortable.
 VENTURI MASK
 It is high flow oxygen delivery device.
 Oxygen from 40- 50 %. At liters flow to 4 to 15
L/min.
 Designed with wide bore tubing and various
color-coded jet adapter
 It is used primarily for patients with COPD.
 ADVANTAGES

 Delivers most precise oxygen concentration

 Does not dry mucous membrane
VENTURI MASK
 VENTURI MASK
NURSING INTERVENTION
 Requires careful monitoring to verify fio2 at flow
rate ordered
 Check that air intake valves are not blocked
 OXYGEN HOOD
• An oxygen hood is used for babies who can breathe
on their own but still need extra oxygen.
• A hood is a plastic dome or box with warm moist
oxygen inside.The hood is placed over the baby’s
head
 OXYGEN TENT
 It consists of a canopy placed over the head and
shoulders, or over entire body of a patient to provide
oxygen at a higher than normal.
 Typically the tent is made of see- through plastic
material.
 It can envelop the patient’s bed with the end sections
held in place by a mattress to ensure that the tent is
alright.
 The enclosure often has a side opening with a zipper.
OXYGEN TENT
 AMBU BAG
 It is also called as Bag- valve mask ventilation
 It is a hand-held device commonly used to provide
positive pressure ventilation to patients who are
not breathing or not breathing adequately.
 TRACHEOSTOMY COLLAR/ MASK

 Inserted directed into trachea.

 Is indicated for chronic o2 therapy need.

 o2 therapy need flow rate 8 to 10 L.

 Provides good humidity.

 Comfortable, more efficient.

 Provides accurate FIo2

TRACHEOSTOMY COLLAR/ MASK
 T- PIECE

 Used on end of ET tube when wearing from

ventilator.

 Provides accurate FIo2

 Provides good humidity.

 COMPLICATIONS OF OXYGEN
THERAPY
 Oxygen toxicity.
 Retro lental fibroplasia
 Absorption atelectasis.
INHALATION
OBJECTIVES

At the end of the session the learner can able to attain

knowledge, attitude and skill regarding ,

• definition of inhalation
• explain about the administration of oxygen
• enlist the indication of oxygen therapy
• list out the method of oxygen administration
• explain the Procedure
• describe oxygen inhalation
INHALATIONS

Inhalation means breathing air into the lungs through the

nose/mouth.
There are 2 types of inhalation:
(i) DRY INHALATION:
 Oxygen Inhalation
 Inhalation of general Anesthetic Drugs

(II) MOIST INHALATION:

 Steam Inhalation
 Nebulization
OXYGEN INHALATION
• “Oxygen therapy is an administration of oxygen at
concentrations greater than room air to treat/prevent
Hypoxia.”
• Patient with Respiratory dysfunctions are treated with
oxygen inhalations.
• Normal amount of oxygen in Atrial blood : 80-100
mm/Hg
• If it falls below 60 mm/Hg, respiratory dysfunction
may occurs.
INDICATIONS OF O2 THERAPY
 Cyanosis
 Breathlessness (Dyspnea)
 Anemia
 Poisoning
 Shock
 Hemorrhage
 Patient under Anesthesia
 Asphyxia
 Oxygen cylinder description

• It is never kept near inflammable material

• Avoid using oil (or) grease around oxygen
connections
• Post ‘No smoking’ sign on the patients door and in
view of the patients visitors
• Avoid electric pads
• Turn off flow valve when cylinder valve is being
opened and always check for leakage
• EMPTY mark should be placed when the cylinder
is empty
• The ordinary nasal catheter should have 3 or 4
holes in the sides of the tip
• Humidifies should be half fill
CARE OF O2 CYLINDER
• Use cylinder in metal case to prevent danger of
falling & breaking
• O2 cylinder should be placed at head end of the
bed
• Any source of fire should be kept away from
cylinder.
• When cylinder is empty, always labelled it.
• To test any leakage.
•
explain the application of nasal catheter
• describe the application of oxygen mask
• enlist the complication of oxygen therapy
• explain about moist inhalation and its
methods
• describe the pre-preparation of moist
inhalation
• describe the procedure of moist inhalation
• explain the after care of moist inhalation
• describe steam inhalation
Humidification
• Humidification of inspired air normally takes place in
the Upper Respiratory Tract. When O2 given by
artificial airway, humidification must be perform
outside the body.
• To prevent drying and irritation of respiratory tract.
• There are humidification devices are available that
can be attached to oxygen flow meters.
NURSE’S RESPONSIBILITY
• Check the name, bed number and other identification
of pt.
• Check the diagnosis and need for O2 therapy
• Check the doctors order for the initiation of therapy,
Ex dosage, flow
• Assess the pt for any sign of clinical analysis
• Check the pt’s vital signs
• Check the result of Atrial Blood Gas (ABG)
• Check the articles available in unit
• Check the O2 cylinder for its accessories and their
working conditions.
 Moist Inhalation
The inhalation of plane steam
or with a drug is known as
steam inhalation
Method :
1. Jug method (Nelsons
inhaler is used)
2. Steam tent
3. Electric steam inhaler
Drugs used:
• Plain water
• Tr.Benzoin, Eucalyptus,
Methyl salicylate, Menthol,
Camphor.
MOIST INHALATION
• The inhalation of plain steam or steam with a drug
is known as moist inhalation.
• “Utilization of moist heat to loosen lung
congestion & helps to liquefy secretion.
• Ex. Steam, tincture benzoin
• Nebulization is the process of medication
administration via inhalation, it utilizes a nebulizer
which transports medications to the lungs.
PURPOSE
• To relieve inflammation of mucous membrane in
acute colds.
• To relieve irritation in bronchitis & cough
• To provide antiseptic action on the respiratory tract.
• To provide warmth & moist
• To soften the secretions which are thick & tenacious
• To relieve cough
 General uses

• The spout of the inhaler must be placed in such a way

that the patient cannot touch it or put his face too near
• Fill the jug only 2/3 with boiling water. Water should
remain below the spout level
• Have the water in the jug at a moderate temperature
(120-160 f) (or) 54.4 to 76.7 c)
• Keep the patient warm and prevent drought before ,
during and after the inhalation
• When voltage group like menthols are used keep his
eyes closed to prevent the drug irritating the conjunctiva
• Watch the patient closely through out the procedure
• Place sputum cup within the reach of the patient
• Explain the procedure to the patient
Preliminary assessment:
• Check patients name, bed no, and other identification
• Check the diagnosis and general condition of the patient
• Check the physicians order
• Assess the patients ability for self care
• Assess the level of consciousness
• Check the articles available
• Nelsons inhaler with a mouth piece fitted to
the neck of the inhaler
Articles

• Bowl or basin large the inhaler towel

• Tr, Benzoin or any other inhalant ordered
• Kettle with boiling water, Gauze piece
• Cotton swab, kidney tray
• Acetone or milk of magnesia in a container
 Preparation of the patient

• Explain the procedure to the patient

• Ask the patient to empty bowel and bladder if needed so
that he will not be disturbed during the procedure and he
will remain on the bed for several hours after the inhalation
• Place the patient in a fowlers position with a cardiac table
• Close the door and window and put off the fan to prevent
draft
• Place the sputum cup in a convenient place within the easy
reach of the patient
• Mouth piece should be boiled and cooled before use.
 Procedure

• Explain the procedure to the patient

• Measure the capacity of the inhaler with cold water
• Warm the inhaler by pouring a little hot water into
the jug and emptying it.
• Pour the required amount of inhalant into the inhaler
and fill the jug 2/3 with hot water. The water should
remain just below the spout
• Cover the mouth piece and close the jug tightly see
that the mouth piece is in the opposite direction to
the spout
• Cover the jug with towel
• Cover the mouth piece with a gauze piece and plug the spout
with a cotton ball
• Place the inhaler in the basin and take it to the bedside
quickly
• Place the apparatus conveniently in front of the patient with
the spout opposite to the patient . Remove the cotton plug
and discard it into the paper bag.
• Instruct the patient to place the lips on the mouth piece and
breath in the vapour. After removing the lips from the mouth
piece, breath out the air.
 After care

• Continue the treatment for 15-20 min as long as the

patients gets vapour
• Remove the inhaler from the patient after the stated time
• Remove the backrest and cardiac table. Adjust the
position of the patient in bed
• Instruct hi to remain in bed for 1-2 hours to avoid drafts
• Replace the articles and record the procedure with date
and time
• Return to the patient to assess his comfort . Offer hot
drinks if needed
 Steam inhalations (or) Aerosol therapy
It is the procedure to prevent (or) treat
condition of the respiratory tract by
adding airborne water particles and
possibly by medications
Types of medication used for the
inhalation
a. Mucolytes
b. Decongestant
c. Bronchodilators
d. Antimicrobial agents
i. moist – Intermittent and continuous
ii. Dry – Smelling salts
• Laryngeal Mask
• Endotracheal Tube
• Tracheostomy
Tube
Suctioning
• “Suctioning is inserting a sterile catheter into
respiratory tract to remove the secretions of those
patients who are not able to cough effectively.
• The primary suctioning techniques are :
o Oropharyngeal Suctioning
o Nasopharyngeal Suctioning
o Orotracheal Suctioning
• NOTE: Suction procedure should not take more than
15 seconds (10-15 seconds), because oxygen does not
rich the lungs during suctioning.
 Oropharyngeal Suctioning
• It is the process of removing secretions from
the oral cavity and pharynx.
• It is performed when client is able to cough
effectively but unable to clear secretions.
 Orotracheal Suctioning
• It is necessary when client with pulmonary
secretions is unable to cough out and not have
an artificial airway.
1. PEE VEE ; ‘‘ FUNDAMENTALS OF NURSING’’ SECOND
EDITION; PUBLISHED BY JAYPEE BROTHERS MEDICAL
PUBLISHERS (P) LIMITED;NEW DELHI; P NO.-484-494.

2. LOTUS PUBLISHERS; ‘‘A TEXT BOOK OF NURSING

FOUNDATIONS’’2ND EDITION;EDITED BY CELESTINA FRANCIS
& KRITIKA ;P.NO. 298 to 328.

3. WEBPAGE; WWW.WIKIPEDIA.COM: THE TOPIC OF

“NURSING CARE FOR PATIENT WITH RESPIRATORY
PROBLEMS” BY DR RITIKA ARJUN. Bibliography