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Module 11 Respiratory Assistive Devices

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* * * * * Mr. Y. is an adult male and this is his first day post-op, following abdominal surgery. HCP s orders: Turn, cough, deep breath q2h Incentive spirometer ... – PowerPoint PPT presentation

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Title: Module 11 Respiratory Assistive Devices


1
Supporting 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.

3
Question 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.

10
Question 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!
13
Oxygen Therapy
Why might Mr. Y. be a candidate for oxygen
therapy?
  • With hypoventilation, he could have inadequate
    transport of oxygen and develop hypoxemia.

14
Questions Flow Rate Humidification
  • How is the nurse going to regulate the flow rate
    of oxygen to 2liters/min?
  • What is the purpose of humidification?

15
Mr. 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.

18
Safety 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

19
Safety 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.

20
Pulse 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)
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