Title: Module 11 Respiratory Assistive Devices
1Supporting Respiratory Function
2 Meet Mr. Y.
- Mr. Y. is an adult male and this is his first day
post-op, following abdominal surgery. - HCPs orders
- Turn, cough, deep breath q2h
- Incentive spirometer q2h while awake
- O2 per nasal cannula at 2 l/min
- Pulse oximetry continuous.
- Up to chair tomorrow a.m.
3Question re Turning
- Why does Mr. Ys HCP want him to be turned every
2 hours? - To decrease chest wall expansion.
- To permit minimum expansion of both sides of the
chest. - To assist with ventilation and redistribution of
pulmonary blood flow. - To promote pooling or stasis of secretions.
4 Coughing
- What is the rationale for having Mr. Y do
coughing exercises? - Coughing effectiveness
- Assess pain before coughing exercises medicate
as needed. Many patients do not want to cough
because of their pain or fear of the pain the
exercise might cause. - Proper technique is important because ineffective
coughing will increase the amount of energy the
patient uses as they work to clear the airways.
5 Promoting Proper Breathing
- How does performing breathing exercises support
Mr. Ys respiratory function? - Loosens respiratory secretions
- Improves pulmonary ventilation
- Counteracts the effects of anesthesia and /or
hypoventilation - Expands collapsed alveoli (atelectasis)
6 Promoting Proper Breathing
- Mr. Y. has an abdominal incision and it hurts him
to breath deeply so he is hypoventilating. Which
type of breathing would be appropriate to teach
Mr. Y to overcome hypoventilation (respiratory
depression)? - Deep Breathing
- Pursed-lip Breathing
- Abdominal Breathing
What would you include in Patient Teaching?
7 Promoting Proper Breathing
- When would the nurse teach a patient to perform
- pursed-lip breathing?
- Abdominal Breathing?
- How would they teach the patient to do these?
8 - Mr. Y is suppose to use an IS q2h while awake.
What is the purpose of using an IS? - This device
- Increases ______volume
- Inflates _______
- Allows patients to ________ their progress
- Provides __________ reinforcement for the
breathing efforts -
9 Question re Use of an Incentive Spirometer
(IS)
- What are 2 key points to state when instructing
Mr. Y on how to use an IS? - Incentive Inhalation
- Inhale slowly like you are sucking on a
straw. - Hold breath for several seconds before exhaling.
10Question Critical Thinking
- Which of the following patient(s) would the nurse
expect an incentive spirometer to be used? - A 16 year old with fracture of leg in hospital
for casting. - A 24 year old woman in post partum unit who had
vaginal delivery yesterday. - A 45 year old woman on bedrest for the past 4
days. - A 62 year old diabetic patient admitted for wound
care treatment of leg ulcers - All of the above
What did you base your decision making on?
11 Positioning
- Mr. Y becomes short of breath when he lies
down. - What is the first nursing intervention?
- Explain your answer.
12 Positioning
- Which position allows maximum chest expansion in
a patient who is on bed rest.
Semi-fowlers
Orthopnea
Explain your answer!
13Oxygen Therapy
Why might Mr. Y. be a candidate for oxygen
therapy?
- With hypoventilation, he could have inadequate
transport of oxygen and develop hypoxemia.
14Questions Flow Rate Humidification
- How is the nurse going to regulate the flow rate
of oxygen to 2liters/min? -
- What is the purpose of humidification?
-
15Mr. Ys HCP ordered O2 per nasal cannula at 2
liters/min.
- Why is a HCPs order needed to give oxygen?
- A HCPs orders for oxygen usually include
- Method/Oxygen delivery system
- Rate of oxygen administration in liters/minute
- For example
-
- 04-10-13 O2 2L NC as needed to keep O2 sat
- greater than 92 Dr. Jones
16 Question re O2 Delivery Systems
- What are some advantages of using a nasal cannula
(NC)? - What are 2 nursing interventions
- for a patient who is wearing a NC?
- What would be a precaution?
-
17 Question re Face Mask
- If Mr. Y had a face mask ordered, what care might
be different? - Simple face mask covers the patients nose and
mouth for oxygen inhalation. The mask is held in
place by adjustable elastic bands. - Delivers 40-60 oxygen with liter flows of 5-8
liters/minute. - Masks can cause anxiety and give a feeling of
confinement or claustrophobia.
18Safety Precautions
- Avoid open flames in the room
- Place No Smoking Oxygen in Use sign on the
door, at head of bed, and on the oxygen equipment - Instruct patient / visitors about precautions
- Make sure electrical devices are in good working
order to prevent sparks - Avoid materials that generate static electricity
- Avoid using oils in the area. No vaseline
- Ground equipment
- Make known location and use of
- fire extinguishers
19Safety Precautions
- Ensure electrical devices are grounded and in
working order to prevent - sparks.
- Instruct patient/visitors about precautions no
smoking in the room.
- Know the location and
- use of fire extinguishers.
- Know fire exits,
- especially for
- handicapped patient/visitors.
20Pulse Oximetry
Normal saturation 95 - 100. ? 95
oxygenation problems. ? 90 a life-threatening
which requires immediate attention.
- Used to assess a patients
- oxygenation saturation (SpO2) HR.
- ability to decrease O2 level.
- risk for hypoxia.
- postoperative ventilation status.
- Nursing Responsibilities
- Assess the patient first!
- Assess if there are any factors present that
might alter the pulse ox reading such as - Oxygen off
- Acetylic nail polish
- Cold extremity
- Not on the patient correctly
21 Question re Pulse Oximetry
- The nurse assesses the pulse oximetry of Mr. Y
and obtains a reading of 88. - What is the nurses next action?
22 Question re Critical Thinking
- Mr. Y becomes confused and restless. The nurse
thinks it might be a respiratory problem. - What should the nurse assess to establish if they
are correct? - Level of Conscious
- Breath Sounds
- O2 Therapy correct
- Pulse Ox (Oxygen Saturation in blood)