RESPIRATORY CARE

Positioning
1. High Fowlers
Position
2. Semi-Fowlers
Position
3. Orthopneic
position

MODALITIES
The head of the bed is elevated to 90 degrees to promote oxygenation via
maximum chest expansion.
The head of the bed is elevated 30 to 45 degrees.
The patient assumes an upright or semivertical position by using pillows to
support the head and chest, or sits upright in a chair. (FOR CLIENTS W/
ASTHMA)
Patient should lean forward to _

Compress the chest,

give better
expulsion of CO2
NSG RESPONSIBILITIES
pillows or splints
Support patients body in correct alignment using_.
BREATHING EXERCISES
I. Pursed-Lip
Breathing
1. Breathe in through your nose for about _ seconds.
2 seconds
2. Pucker your lips.
3. Breathe out very slowly through the pursed-lip for about _ seconds.
4 seconds
4. Repeat
II. Abdominal
(Diaphragmatic
Breathing)-PATIENTS
W/ COPD

1. Place one hand on your belly just below the ribs and the other hand on
your chest.
2. Take a deep breath through your nose. As you inhale, let your belly push
your hand out while keeping the chest still.
3. Exhale.

5-10 min, 4x a day

Deep breathing exercises
3-4 times
Exhalation is _times longer than inhalation
COUGHING EXERSICES
I. Controlled
coughing
1. Sit on a chair or on the edge of your bed, with both feet on the floor. Lean
slightly forward.
2. Fold your arms across your abdomen and breathe in slowly through your
Forward, 2-3
nose.
3. To exhale: lean _, pressing your arm against your abdomen. Cough
_times through a slightly open mouth.
4. Breathe in again by sniffing slowly and gently through your nose.
II. Huff coughing
1. Sit on a chair with both feet on the floor.
2. Take a slow, deep breath through your nose and hold for two counts.
technique
3. To exhale, open your mouth and make a huff sound in your throat.
4. Huff _times as you exhale.
2 to 3
NEBULIZATION
The process of medication administration via inhalation.
nebulization
Drug delivery device used to administer medication in the form of a mist
inhaled into the lungs.
nebulization
Used for the treatment of bronchospasms, chest tightness, excessive and
thick mucus secretions, respiratory congestions, pneumonia, atelectasis,
and asthma.
POSSIBLE SIDE
*Palpitations
EFFECTS AND
*Tremors
INHALATION
*Tachycardia
REACTIONS OF
*Headache
NEBULIZATION
*Nausea
*Bronchospasms
CTT
chest tube

*Pneumothorax (air)
*Hemothorax
( Fluid)

a tube inserted into the thoracic cavity for the purpose of removing air or
fluid, or both.
Chest Drainage can be used to treat:
1. second or third interspace along midclavicular or anterior axilliary line.
2. sixth or seventh lateral interspace interspace in the midaxillary line.

3
2-3 cm
2 inches
10-2- cm
2nd bottle
Intermittent
bubbling
Continuous bubbling
No bubbling
Heparin
3rd
*Clamp the tube
*Immerse the tube
with sterile water
Subcutaneous
emphysema
Single bottle water
1 in
Single bottle water
seal system
2 bottle system
two bottle system
3 bottle system
3 bottle system

1st tube of bottle

2nd tube
3rd tube
seven and one half

Heimleich
maneuver
Stand or kneel
Postural Drainage
Postural Drainage
two to four, 3 to 15

Bottles #
Immersion of tube to water(cm)
Bottles are how many inches apart
Measurement of water in bottles
Bottle that acts as artificial lungs
Monitor in CTT:
Normal
Abnormal/leakage
abnormal
What we inject if theres blood clot in the tube to remove it
Bottle that may not be connected to the ventilator
Nursing interventions if the bottles were broken:

Complication
seal system
The tube from the patient extends approximately _inch( 2.5 cm) below the
level of the water in the container.
The end of the drainage tube from the patient chest is covered by the layer
of the water, which permits the drainage of the air and fluid from the
pleural space.
Consist of the same water-seal chamber, plus a fluid collection bottle.

It is similar in all respect to the two way bottle system, except for the
addition of a third bottle to control the amount of suction applied.
above the water level comes from the water seal bottle
leads to the vacuum or suction motor, or to wall suction.
long tube that extends below the water level in the bottle and opens to the
athmosphere outside the bottle.
3rd tube regulate the amount of the vacuum in the system, depending on
the depth to which the tube submerged- the usual depth is _inches (20 cm)
Used for removal of foreign bodies blocking the upper airway.
If the person can't breathe, cough, or make sounds, then: _behind the
person and wrap your arms around his or her waist.
one way to help treat breathing problems due to swelling and too much
mucus in the airways of the lungs.
Treat or prevent an infection
Make breathing easier
The exercise usually performed _times daily, before meals and at the
bedtime. Each position is held for _minutes.
the procedure should be discontinued if _occur

tachycardia,
palpition, dsypnea
or chest pain
ENDOTRACHEAL INTUBATION
endotracheal
Medical procedure in which a tube is placed into the windpipe (trachea)
intubation
through the mouth or nose.
endotracheal
An emergency procedure most often performed in patients who are
intubation
unconscious or who cannot breathe on their own.
General anesthesia, _and a _medication are usually administered so that you do not feel
muscle relaxing
anything
PROCEDURE:
80-100
Prior to attempting the insertion of an ETT and as indicated by clinical
condition, one should ventilate the infant with bag and mask using _%
oxygen
sniffing
Infant's head should be slightly extended (in the _position) with the body
aligned straight.
1-2
The ETT is held in the right hand and inserted between the vocal cords so

5-6

1/4
chest x-ray
TRACHEOSTOMY
tracheostomy
tracheostomy
Bandage scissors
Hydrogen peroxide
Semi fowlers
Side lying
2.5-4mm
6-9 mm
15-20cm H2O
4 hrs
Exerts much
pressure, no blood
supply leading to
trabstracheal
tissue necrosis
8 hrs
Weaning off
H. peroxide Half
strength
To promote lung
expansion
SUCTIONING

that the tip is _cm below the vocal cords.

Ensure endotracheal position by the use of a CO2 detector- this has become
a standard of care. The detector should change color (purple to yellow) by
_breaths.
Secure ETT with two pieces of _inch adhesive tape placed on lip and
securely around ETT.
Verify the position of the ETT by _
Surgical incision in the trachea just below the larynx
For clients who need a long term airway support
Equipment at bedside of the client
Solution used in providing tracheostomy
Position of conscious client
Position of unconscious client
Measurement of tube for infant:
Measurement of tube for adult:
Cuff pressure
Check cuff pressure every _ hrs
Above 20/25 cm H2O of cuff pressure indicates

Reposition client every _ hrs

Removing of tube in the ventilator
Kind of hydrogen peroxide that is given to client
Why semi fowlers position to client

Aspirating secretions through a catheter connected to a suction machine or

wall suction outlet
OROPHARYNGEAL, NASOPHARYNGEAL, NASOTRACHEAL SUCTIONING
Wall unit
100-120
ADULT: _mmHg
95-110
CHILD: _mmHg
50-95
INFANT: _ mmHg
Portable unit
10-15
ADULT: _mmHg
5-10
CHILD: _ mmHg
2-5
INFANT: _mmHg
yankauer
Moisten the tip of the _or suction catheter with sterile water or saline.
Yankauer device
Used for oral suctioning
10-15
Advance the catheter about _ cm
FOR NASOPHARYNGEAL AND NASOTRACHEAL SUCTION
13
Measure the distance between the tip of the clients nose and the earlobe,
or about _cm (5 in.) in adults.
10-15
A suction attempt should last only _ seconds
ENDOTRACHEAL SUCTIONING
semi-fowlers
place the client in a _position to promote deep breathing, maximum lung
expansion, and productive coughing.
100-120, 50-95
WALL UNIT- ADULT: _mmHg CHILDREN AND INFANTS: _mmHg.
12-15
Using your non dominant hand, turn on the oxygen to _L/min.
3-5
Compress the Ambu bag _x
3-5
Remove ENT in the ventilator, give _doses in hyperoxygenating
2-3ml
Additional water if we suction thick secretions
Fr 8-12
Pedia catheter size
Fr 14-16
Adult catheter size
12.5
Insert the catheter about _cm for adults
5-10
Apply suction for _ secs.by placing the non dominant thumb over the thumb
port.
3
Give not more than _ blows in hyperoxygenating client
THORACENTESIS
Invasive procedure that involves insertion of needle into the pleural space
for the removal of pleural fluid or air.
*Arm is elevated
TWO POSITIONS COMMONLY USED:

and stretched
forward
*Client leans
forward over a
pillow
*2nd & 3rd Upper
anterior intercostal
space/upper
anterior chest
*6th & 7th Lower
posterior intercostal
space/lower
posterior chest
1000ml
INCENTIVE
SPIROMETRY
Incentive spirometry
Incentive spirometer

4 or 5
semi-fowlers
500
100-250ml
*Flow oriented
*Vol oriented
CHESTPHYSIOTHE
RAPY
CPT

2 sites of thoracentesis:

Dont remove more than _ ml of fluid from pleural cavity within the first 30
minutes. (after proc.)
Also called Sustained Maximal Inspiration Devices (SMIs)
Measures the flow of air inhaled through the mouthpiece
Improve pulmonary ventilation, counteract the effects of anesthesia or
hypoventilation,
Loosen respiratory secretions.
Repeat the procedure several times and then _times hourly.
Place the patient in a comfortable sitting of _position
Set the incentive spirometer VT indicator at the desired goal the patient is
to reach of exceed. (_mL is often used to start.)
Increase gradually by _ml each try
Types of spirometers:
set of techniques that include percussion, vibration, and postural drainage.

to loosen respiratory secretions and move them into the central airways
where they can be removed by coughing or suctioning
1. PERCUSSION
CLAPPING
PERCUSSION
Forceful striking of the skin with cupped hands.
PERCUSSION
When the hands are used, the fingers and thumb are held together and
flexed slightly to form a cup.
12
Percuss each affected lung segment for _minutes.
Wills tumor
1 danger of percussion
2. VIBRATION
series of vigorous quiverings produced by hands that are placed flat against
the clients chest wall.
five
Vibrate during _exhalations over one affected lung segment
Striding
Position for vibration
PERCUSSION (CLAPPING) & VIBRATION
*The lower ribs to
Percuss with cupped hands over the chest wall for 1 2 minutes. Work
shoulders in the
from:
back.
*The lower ribs to
top of chest in the
front
OXYGEN THERAPY required by patients who have difficulty ventilating all areas of their lungs,
whose gas exchange is impaired, or people with heart failure to prevent
hypoxia.
O2 promotes
No Smoking because _
combustion
NASAL PRONGS
Most inexpensive device used to administer oxygen
(CANNULA)
2 6, 24% - 45%
Delivers flow rates of _ LPM. _O2 concentration
27-29%
2L
30-33%
3L
33-37%
4L
36-41%
5L
39-45%
6L
FACE MASK
Covers the clients nose and mouth.
FACE MASK
Exhalation ports on the sides of the mask allow exhaled carbon dioxide to

nd

rd

escape
Insert transtracheal catheter at _ tracheal cartilage

2 & 3 tracheal
cartilage
1. SIMPLE FACE
MASK
Delivers _% - _% O2 concentration
40%-60%
58
LPM
2. PARTIAL REBREATHER MASK
60% - 90%
O2 concentration
6 10
Liter flows: _LPM
PARTIAL
There is an O2 reservoir bag that is attached which allows the client to
REBREATHER MASK
rebreathe the first third of the exhaled air in conjunction with Oxygen.
3. NONREBREATHER Delivers the highest O2 concentration possible
MASK
95% - 100%
O2 concentration
10 15
Liter flows at _LPM
NONREBREATHER
One way valves on the mask and between the reservoir bag and mask
MASK
prevent room air and the clients exhaled air from entering the bag so only
O2 in the bag is inspired.
4. VENTURI MASK
Delivers O2 concentrations varying from 24% - 40% or 50%
4 10
Liter flows of _ LPM
VENTURI MASK
Has wide-bore tubing and color-coded jet adapters that correspond to a
precise O2 concentration and liter flow
ADMINISTERING OXYGEN BY CANNULA & FACE MASK
CANNULA
deliver a relatively low concentration of oxygen when only minimal O 2
support is required.
FACE MASK
- To provide moderate O2 support and a higher concentration of oxygen
and/or humidity than is provided by the cannula.
30
Check the liter flow and the level of water in the humidifier in _minutes and
whenever providing care to the client
Intermittent
Therapeutic application of inspiratory positive pressure to the airway.
positive pressure
building (IPPB)
CONTINUOUS
Provides for positive airway pressure during all parts of a respiratory cycle,
POSITIVE AIRWAY but refers to spontaneous ventilation rather than mechanical ventilation.
PRESSURE (CPAP)
POSITIVE ENDManeuver by pressure during mechanical ventilation is maintained above
EXPIRATORY
atmospheric at end of exhalation, resulting in increased functional residual
PRESSURE
capacity.
Positive endPurpose: Increase functional residual capacity
expiratory pressure
Low flow O2
Use simple face mask, cannula woth O2 conc of 24-48%
High conc.
Higher than 30%
1. Check the
Puposes of suctioning NSS:
patency and
integrity
2. The inner lining
to be coated with
water
Withdrawal
Apply suctioning upon _
Hyperoxygenate
Nsg intervention in all suctionings
and hyperinflate the
lungs
Terminates
Danger of endotracheal intubation
bifurcation of
bronchi