It includes Precaution, vibration, postural drainage.
Precaution; Clapping the affected area with cupped hands.
Vibration; Pressing affected area with flat hands.
Postural drainage: different position are given to drain out from different lobs of lung.
- Unstable vitals
- Increased ICP
- Increased bronchospasm
- History of pathological fracture
- Chest injury
- Perform CPT early morning up on arising.
- Perform CPT one hour before meals or 2 to 3 hr after meals
- Give each position for 5 to10 minute
- Administer bronco dilator 15 to 30 minute prior to procedure.
- Place a pad of clothing between hand and Clint skin.
- If cyanosis or chest pain occur stop procedure
- Dispose the sputum properly and rinse the mouth
POSITION DURING POSTURAL DRAINAGE
- UPPER LOBE ANTERIOR SEGMENT (RT AND LT)
Supine with head elevated
- UPPER LOBE POSTERIOR SEGMENT
RIGHT- Side line with right side of the chest elevated over a pillow (slight prone)
LEFT- Side line with left side of the chest elevated over a pillow (slight prone)
- MIDDLE LOBE ANTERIOR SEGMENT
3/4TH Supine with affected lung in dependent position.
- MIDDLE LOBE POSTERIOR SEGMENT
Prone with pillow under thorax and abdomen
- LOWER LOBE ANTERIOR SEGMENT
Supine with Trendelenburg position
- LOWER LOBE POSTERIOR SEGMENT
Prone with Trendelenburg position
- Assess color and vital signs prior to and during treatment
- Place an OXYGEN IN USE sign at the client’s bedside
- Assess for the presence of chronic lung problem.
- Humidify the oxygen
NASAL CANNULA (NASAL PRONGS)
- Used at flow rates of 1 to 6 L/min, providing approximate oxygen concentrations of 24%(at 1 L/min)to 44%(at 6 l/min)
- Flow rate higher than 6 L/min do not increase oxygenation, because the anatomic reserve or dead space is full
- Used the patient with chronic air flow limitation(CAL) and for long term oxygen therapy
- The CAL client who retain co2 should never receive o2 at a higher than 2 to 3 L/min unless on a mechanical ventilator
- Place the nasal prone in the nostrils, with the opening facing the client
- Add humidification when a flow rate higher than 2 litter/min.
- Check the water level and change as needed.
- Assess the mucosa, coz high flow rate have a drying effect.
- Assess the skin integrity, coz the oxygen tubing can irritate the skin.
- Assess the change in respiratory rate and depth.
SIMPLE FACE MASK
A face mask used to deliver oxygen concentration of 40% to 60% for short term oxygenation therapy or an emergency
A minimal flow rate of 5 L/min is needed to prevent the rebreathing the exhaled air
- Be sure that mask fits securely over the nose and mouth.
- Assess the skin to the area covered by the mask.
- Monitor the client closely for the risk of aspiration(mask limit the client’s ability to clear the mouth ,especially if vomiting occurs)
- Provide emotional support to decrease the anxiety
- Switching the client from a mask to a nasal prongs during eating.
PARTIAL REBREATHER MASK
It consist of a mask with a reservoir bag that provides an oxygen concentration of 70% to 90% with flow rate of 6 to 15 L/min. patient rebreathes one third of the exhaled air.
- Make sure that the reservoir does not twist or kink.
- Adjust the flow rate to keep the reservoir bag inflated two-third full during inspiration.
A nonrebreather mask provides the highest concentration of low flow system and it can provide oxygen concentration more than 90%.
Used in the client with deteriorating respiratory status who might need intubation.
Nonrebreather mask has a one-way valve between the mask and the reservoir and two flaps over the exhalation port.
- Remove mucus or saliva from the mask
- Assess the client closely
- Ensure that valve and flaps are intact and functional during each breath
- Valves should open during expiration and close during inhalation
- Suffocation can occur if reservoir bag kink or oxygen source disconnected
HIGH-FLOW OXYGEN DELIVERY SYSTEMS
It provide 24% to 100% of oxygen concentration. It deliver a consistent and accurate oxygen concentration. It include…
Venturi mask delivers the most accurate oxygen concentration. An adapter is located between the bottom of mask and the oxygen source. Fio2 delivery 24% to 55% with the flow rate of 4 to 10 L/min
- Monitor the patient closely.
- Keep the orifice of the venturi open.
- Assess the tubing for kink and mask for proper fit
- Humidity should be added to the system
Fits over the client’s chin with the top extending halfway across the face. Oxygen concentration various, this is used in patient with facial trauma or burns.
Used the patient who require high humidity after extubation or upper air-way surgery, or the patient with thick secretions.
TRACHEOSTOMY COLLAR AND T PIECE
The tracheostomy collar can be used to deliver high humidity and the desired oxygen to the client with a tracheostomy.
A special adapter, called the ‘T’ piece, can be used to deliver any desired Fio2 to the patient with tracheostomy, laryngectomy, or endo-tracheal tube.
Position the T piece so that it does not pull on the tracheostomy. Make sure that humidifier creates enough mist
PRESSURE-CYCLED VENTILATOR: Push air in to the lungs until an airway pressure reaches. Used for short period, post anesthesia, and for respiratory therapy.
TIME-CYCLED VENTILATOR; pushes air in to the lung until a preset time has elapsed. Uses the pediatric or neonatal client.
VOLUME-CYCLED VENTILATOR: pushes air in to the lungs until a preset volume is delivered. A constant tidal volume is delivered.
MODES OF VENTILATOR
- The client receives a preset tidal volume at a set rate. Use the patient who can not initiate respiration effort. The least use mode. If the patient attempts to initiate a breath, the efforts are blocked by the ventilator.
- Tidal volume and ventilator rate are preset on the ventilator. The ventilator takes over the work of breathing for the client. The ventilator is programmed to response to the client’s inspiratory effort if the patient does not initiate a breath. The ventilator delivers the preset tidal volume when the client initiates a breaths. If the client’s spontaneous ventilator rate increases, the ventilator continues to deliver a preset tidal volume with each breath, which may cause hyperventilation and respiratory alkalosis.
SYNCHRONIZED INTERMITTENT MANDATORY VENTILATION(SIMV)
- Similar to AC in that the tidal volume and rate are preset on the ventilator. SIMV allows the client to breath spontaneously at his or her own rate and tidal volume between the ventilator breaths. Can be used as a primary ventilator mode or as a weaning mode.
VENTILATOR CONTROLS AND SETTINGS
- TIDAL VOLUME: the volume of air that the client receives with each breath.
- RATE: Number of ventilator breaths delivered /minute.
- FRACTION OF INSPIRED OXYGEN(Fio2): The O2 concentration delivered to the client
- PEAK AIR-WAY INSPIRATORY PRESSURE (PIP): Pressure needed by the ventilator to deliver a set tidal volume at a given compliance. PIP reflects changes in compliance of the lung and resistance in the ventilator or client.
- CONTINUOUS POSITIVE AIR WAY PRESSURE (CPAP): Keep the alveoli open during inspiration and prevent alveolar collapse. Application of positive air way pressure throughout the entire respiratory cycle for spontaneously breathing client. During CPAP, no ventilator breaths are delivered but the ventilator delivers oxygen and provide monitoring and an alarm system. Respiratory rate is determined by the client efforts
- POSITIVE END EXPIRATORY PRESSURE (PEEP): Positive pressure exerted during the expiratory phase of ventilation. Improve oxygenation by enhancing gas exchange and preventing atelectasis
- Assess he client first and the ventilator second
- Assess the vital signs, lung sound, respiratory status, and breathing pattern.
- Monitor skin color, particularly in the lips and nail beds.
- Monitor chest for bilateral expansion.
- Obtain pulse oximetry reading.
- Monitor ABG result.
- Assess the need for suctioning and observe the type, color, and amount of secretions
- Assess the ventilator setting
- Assess the level of water in humidifier and temperature of the humidification system
- Ensure that alarms are set
- If a cause for an alarm cannot be determined, ventilate the client manually with a resuscitation bag until the problem solved.
- Empty the tubing when moisture collects.
- Reposition the client every 2nd
- Resuscitation equipment available at the bed side always.
CAUSE OF ALARMS
1 HIGH PRESSURE ALARM.
- Increased secretions in the air way
- Wheezing or bronchospasm causing decreased air way
- Displacement of ET tube
- Obstruction of ET tube caused by water collection or kink in the tube.
- Coughs, gags, or bites, on the oral ET tube
- Client is anxious or fights the ventilator.
2 LOW-PRESSURE ALARM
- Disconnection or leak in the ventilator.
- The client stops spontaneous breathing
- Hypotension caused by the application of positive pressure, which increase intrathoracic pressure and inhibits blood return to the heart
- Pneumothorax or emphysema
- Stress ulcers
- Malnutrition if nutrition is not maintain
- Ventilator dependence
WEANING: The process of going from ventilator dependence to spontaneous breathing
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