Chapter 14 Respiratory Procedures. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2...

Chapter 14

Respiratory Procedures

Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Patients at Risk for Poor Oxygenation

• Hypoxemia– Insufficient oxygen in the blood

• Patients at risk– Immobile – Cardiac or pulmonary disease


Risk Factors for Poor Oxygenation

• Postoperative

• Sleep apnea

• Morbidly obese

• Neuromuscular disease

• Decreased consciousness

• Kyphoscoliosis


Capillary Refill

• Indication of the peripheral circulation

• Cyanosis (problem with oxygen delivery)– Skin– Nailbeds– Mucous membranes– Lips


Capillary Refill

• Capillary refill varies with age, but will return to normal within 2 to 3 seconds.

• Check capillary refill on all four extremities


Pulse Oximeter

• Measures oxygen saturation of hemoglobin– 95% to 100% - normal– Below 90% - complications– Below 85% - probable hypoxemia– 70% or below - life-threatening emergency


Pulse Oximeter

• Monitor the patient! • Many variables interfere with accurate

values!


Oxygen Therapy

• Pressure gauge shows the amount of oxygen in the cylinder

• Never modify a gauge or part to make it fit!

• Humidification is not necessary in liter flows below 5

• Chain tank to a carrier or base


Oxygen Therapy

• Avoid sparks, post oxygen signs

• Remove smoking materials

• Follow all safety precautions


Keeping the Airway Open

• Measure oral airway from tip of ear to corner of mouth

• If the patient gags or tries to remove the airway, leave it out

• Nasal airway may be used in responsive patients


Keeping the Airway Open

• Do not use on patients with the following disorders:– Nasal deformity– Bleeding disorders– Sepsis– Receiving anticoagulants


Suction

• Patient cannot breathe during suctioning– Do not exceed 10 seconds for suctioning,

insertion, and removal

• A Yankauer (tonsil tip) is used for mouth and throat

• Flexible catheter is used for the nose, mouth, and throat


Small Volume Nebulizer

• A nebulizer converts liquid medicine into a mist– Loosens and lubricates secretions

• It may be large, small, ultrasonic, or placed inside ventilator tubing


Continuous PositiveAirway Pressure

• CPAP maintains positive pressure during the respiratory cycle

• Pressure opens partially or fully closed alveoli– Provides more surface area for gas exchange

• Improves oxygenation and prevents premature airway closure


Bilevel Positive Airway Pressure

• BiPAP is similar to CPAP

• Maintains positive airway pressure during inspiration and expiration

• Higher pressure during inhalation

• Reduces pressure during exhalation

• BiPAP reduces effort of breathing


Postural Drainage

• Drains secretions from lungs

• For patients with cystic fibrosis or certain types of pneumonia– Can be used to treat other conditions

• PCT assists with positioning patient

Chapter 14 Respiratory Procedures. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2...

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