Oxygen Therapy - Wall unit- tubing behind the wall that supplies O2 - We give to those with difficulty breathing,

COPD, asthma, dec. LOC Parts of oxygen delivery system - Green O2 Prec - No smoking (supports combustion) - Check the electric parts- short circuits - Avoid woolen blankets- use cotton instead Humidifier - Distilled water dead water - Level preferred for water How to read - Liters per Min (LPM) - Righty-tighty; Lefty-Lucy Oxygen System A. Low flow administration devices - Nasal cannula (25-45%) at 2-6 LPM - *do not exceed because it just wastes O2 - *Humidification >4LPM o May be used in clients with COPD at 2-3LPM if venture mask is not available - Simple face Mask (40-60%) at 5-8LPM - Partial rebreathing mask (60-90%) o Always inflated o No one way flap valve - Non-rebreathing mask (95-100%) - Croupette o Always inflated o One way flap valve o No exhalation ports o - Oxygen tent - *flooding- assess if O2 is coming out of the device B. High flow Oxygen - Low concentration venture-type mask is preferred for clients with COPD because it provides accurate amount of oxygen. They require 2-3L minimum 28% Oxygen - Face Mask - Oxygen Hood o Can be used for high and low slow oxygen o Incubator or isolette Tracheostomy collar AMBU air mask bag unit T-piece

Oxygen hood covers head and shoulders, flood before use - Oxygen Tent- croupette- cluster activities to avoid leak of O2 - Hyperbaric Inhalation Therapy - Moist inhalation o Steam Inhalation To liquefy secretions Prevent congestion To humidify air Relieve edema or airway Admin. Meds Dependent function Inform client about procedure Place patient in semifowlers Cover clients eye with wash cloth Check electrical device before use Place steam inhalation in a flat stable surface Place 12-18 inches away from the clients nose and adjust PRN To be effective it is done 15-20 min Right after you have to provide deep breathing, coughing techniques or chest physiotherapy Provide hygiene after Do after care docu o Aerosol inhalation/small volume nebulizer Smaller particles compared to medimist (pedia) For bronchodilators or expectorants o Medimist inhalation adults admin bronchodilators - Dry Inhalation Metered-Dose Inhalers - Patients with COPD or Asthma - Each puff 5mins apart - Spacer ensures that the lower airway receive the medication

Indication 1. with unstable oxygen status 2. at risk for impaired gas exchange - Light emitting diodes Device: Sites - Adults- finger, bridge of the nose, earlobe, forehead - Children- index finger - Infants- dorsum of the foot, big toe **the more saturated the blood is with oxygen, the more it absorbs light Consideration for site selection 1. Site must have sufficient flow of blood a. Check capillary refill b. NO BP at used site 2. Free of moisture 3. A finger free of nail polish 4. Patient is obese, use disposable table-on sensor 5. Factors that affect light transmission a. Pt. movement tremors b. Direct sunlight/fluorescent light Care of patient on pulse oximetry - If to be used continuously o Present alarm of SpO2 with PR to high-low o Check sensor probe every 2hrs o Relocate sire q 4h PRN - If intermittently used for spot checking Pulmonary Hygiene Breathing exercises p. 950 Coughing exercises p.951 Indications 1. For clients with restricted chest expansion 2. Recovering from thoracic surgery Abdominal (Diaphragmatic) Breathing p. 950 Time Required: 5-10 mins, 3-4x/day Benefits 1. Increase tidal vol 2. Increase alveolar ventilation 3. Decrease RR 4. Increase exercise tolerance The pattern: Belly goes out as you breathe in Belly goes in as you breathe out - 400-700ml normal tidal vol, - Diaphragmatic excursion

Turbo Haler

Rota disk

Handy haler- spiriva meds - Gargle - Clean mouthpiece with plain water

Respiratory Modalities Pulse Oximetry A non-invasive measurement f peripheral blood oxygen saturation (Expressed as SpO2: N=95-100%)

Pursed Lip breathing (smell the rose, blow the candle) Benefits: Pursed lips create resistance to the air flowing out of the lungs thus prolonging exhalation and preventing airway collapse Technique: - Inhale slowly at the count of 3 and exhale to a count of 7 - Allow air to pass thru pursed lips as if blowing a candle or whistle Coughing exercise (p.951) - To increase expectoration of secretions Procedure: - Take 2 slow, deep breaths, inhaling thru nose and exhaling thru pursed lips - Inhale 3rd time holding breath to count 3 - Cough for 2-3 consecutive coughs without inhaling between coughs (Huff coughing or forced expiratory coughing) - Contraindicated for client with inc. ICP or after brain, spinal, eye surgery Incentive Spirometry - A methods of deep breathing that provides a visual feedback to encourage the client to inhale slowly and deeply thus maximizing lung inflation Purposes: 1. To improve pulmonary ventilation 2. To counteract the effects of anesthesia to hypoventilation 3. To loosen secretory secretions 4. To facilitate respiratory gaseous exchange 5. To expand collapsed alveoli Indications 1. For clients with thick tenacious secretions 2. After abdominal/thoracic surgery 3. With lung diseases like COPD and asthma Equipment - Incentive spirometer - Analgesic- PRN for post-op patients ** SMI- sustained maximal inspiration- incentive spirometry Types 1. Volume oriented - Tidal volume is present by the practitioner 2. Flow oriented - Tidal vol is not present -

Peak flow meter

Peak Flow Meter- a small hand-held device that measures peak expiratory flow rate- the flow of air that is expelled from the lugs Indication: Clients taking asthma meds every day Standard range is 60-900 lpm Low range is 30-400lpm Purposes: 3. To better monitor and manage asthma 4. To indicate how well client is responding to meds **Measure Zones of peak flow meter to interpret readings 1. Green or safety zone 2. Yellow or caution zone 3. Red or danger zone Chest of Physiotherapy p. 931-933 - A group of therapies used to mobilize pulmonary secretions - Includes: o Percussion o Vibration o Postural drainage - Recommended for clients producing more than 30ml of sputum/day Percussion - Involves striking the area over the chest wall being drained with cupped hands - Perform over a thin layer of cloth not over snaps, buttons, zipper, spine, soft tissue below the rib cage, painful area

Contraindicated if with bleeding disorders, osteoporosis with fractured ribs

Correct hand position for chest percussion

Vibration - A sense of vigorous quivering produced by hands that are placed flat or ball of palm of hand against the chest wall to loosen secretions Postural Drainage - Expulsion of secretion from various lung segments by gravity - Positioning the body in such a way that the segment of the lung to be drained is in a vertical position with the bronchioles - Contraindications p. 981 Nursing Considerations 1. Each position is assumed for 10-15 mins 2. Entire tx should last for 30 min only 3. Before postural drainage nebulization with bronchodilator is given 4. Best time to do is before meals and at bed time