Care of patients with respiratory
problems
COMMON CAUSES OF RESPIRATORY
PROBLEMS
• Cardiac or Pulmonary diseases
• Allergies like asthma, wheezing
• Nasal obstruction
• Hypoxemia
Conti...
• Anxiety causing hyperventilation, panic attack
• Chest trauma
• Occupational exposure to dust, chemicals
• Smoking
COMMON RESPIRATORY SIGNS AND SYMPTOMS
• Dyspnoea/shortness of breathing
• Wheezing
• Chest pain
• Cough
• Haemoptysis
Conti...
• Cough
• Haemoptysis
• Sputum production
Dignosis
• Health History: Allergies, Occupation, Lifestyle, Health Habits
• Inspection: Skin color, Level of consciousness, emotional state,
characteristics of respiration
• Palpation: Tenderness, Mass
• Percussion: Resonance of sounds
• Auscultation: Normal and Adventitious
MANAGEMENT
• Positioning of the patient.
• Oxygen Therapy
• Dry & Moist Inhalation.
Conti...
• Oronasal Suctioning
• Pulmonary rehabilitation
• Deep breathing & coughing exercises
• Spirometry
Deep Breathing Exercise
• Deep Breathing Exercise are usually recommended after
surgery.
• This exercise will help to improve breathing, clear secretions
from lungs, It helps to expand the lungs.
• This exercise will be more effective if done in sitting
position.
• A patient may start by inhaling for 2 seconds and then
exhaling for 4 seconds.
Technique of Deep Breathing Exercise
• 1. Breathe is deeply and slowly through nose, expanding lower rib cage
and letting abdomen move forward.
• 2. Hold for a count of 3 to 5
• 3. Breathe out slowly and completely through pursed lips.
• 4. Don't force breathe out.
• 5. Rest and repeat 10 times every hour.
TYPES OF BREATHING EXERCISES
• Abdominal breathing
• Diaphragmatic breathing
• Glossophryngeal breathing
• Pursed lip breathing
Oxygen Inhalations
"Oxygen therapy is an administration of O2 at concentrations
greater than room air to treat/prevent Hypoxia."
Pt with Respiratory dysfunctions are treated with oxygen
inhalations.
Normal amount of o2 in Atrial blood: 80-100 mm/Hg
If it falls below 60 mm/Hg, respiratory dysfunction may
occurs.
Indications of O2 Therapy
• Cyanosis
• Breathlessness (Dyspnea)
• Anemia
• Poisoning
Conti...
• Shock
• Hemorrhage
• Patient under Anesthesia
• Asphyxia
Methods of O2 Therapy
• a) Nasal Cannula
• (b) Oxygen by mask
• (i) Simple face mask
• (ii) Partial Rebreather Mask
• (iii) Non-Rebreathing mask with reservoir
• (c) Oxygen tent/wood
a) Nasal Cannula (Catheter)
• a) Nasal Cannula (Catheter)
• The nasal cannula is inserted into the nostrils.
• The cannula doesn't interfere with the patient's eat, to talk, and to
move in bed.
• Flow: 1 to 6 liters of O2 will be sufficient to maintain 22-30% of
oxygen
b) Oxygen by mask
• O2 mask covers the patient's nose and mouth.
• Mask are the advantages of those patients who are unable to
breathe through the nose.
• (i) Simple Face mask:
• Flow: 5-8 liter/min will be provides 40-60% 02
iii) Partial Rebreather Mask:
• Partial rebreathing mask with reservoir
• It is a moderate o2 device delivers 35-60% 02.
• O2 reservoir bag attached allows the patient to rebreathe about the
first third of the exhaled air.
• Reservoir bag should be inflated during inspiration & Expiration.
iii) Non-Rebreathing mask with Reservoir
• It is high 02 deliver device, delivers 95% O2 at 10-12 l/min.
• Two valves added in rebreathing mask which prevents entry
of room air during inspiration & expiration.
• One way valve between the mask and the reservoir prevent
the room air and the pt's exhaled air entering the bag, so only
O2 in the bag is inspired O2 dilution.
iv) Venturi Mask
• It provides 24% - 50% oxygen by mixing room air with a
precise amount of oxygen after filtering.
(d) Oxygen Tent
It's made up of rectangular clear plastic canopy with outlets
that connects to oxygen sources. Flow rate is adjusted at 10-
15 L/min .
Oxygen Hood
• Oxygen hood ia a clear plastic shell encompasses the baby’s head, it
is well tolerated by infants.
• Size of hood limits use to younger than age 1 year.
• Oxygen hood delivers 80-90% oxygen at 10-15 lit/min.
Hazards of oxygen inhalation
• Infection
• Fire
• Drying of mucus membrane of the respiratory tract
• Atelectasis
• Retrolental fibroplasis - Very high concentration of oxygen
will develop fibrotic changes behind lens which impaires
light penetration to retina.
• Oxygen toxicity
Care of O2 Cylinder
• Use cylinder in metal case to prevent danger of falling &
breaking
• O2 cylinder should be placed at head end of the bed
• Any source of fire should be kept away from cylinder.
• When cylinder is empty, always labeled it.
• To test any leakage.
Nurse's Responsibility
• Check the name, bed number and other identification of pt.
• Check the diagnosis and need for O2 therapy.
• Check the doctors order for the initiation of therapy, Ex dosage,
flow.
• Assess the pt for any sign of clinical analysis.
• Check the pt's vital signs.
• Check the result of Atrial Blood Gas (ABG).
• Check the articles available in unit.
• Check the O2 cylinder for its accessories and their
working conditions.
Steam Inhalation
Application of warm and moist heat into respiratory passage
for local effects.
• Purpose - to relieve the symptoms of cold and sinusitis
caused by inflammation and congetion of mucus membrane.
• To lose mucus and relieve coughing.
• to warm and moisten the air to relieve dyspnea and irritation
in air passages.
• To provide antiseptic effect.
Nebulization Therapy
• Nebulization is the process of medication administration via
inhalation, it utilizes a nebulizer which transports
medications to the lungs for the purpose of liquefing and
retained thick secretions.
Nebulizer Therapy - Metered- dose Nebulizer
Nebulizer Therapy - Jet medication
Nebulizer
Nebulizer Therapy - Ultrasonic Nebulizer
Airway Management
• Airway management involves ensuring that the patient has a
clear airway through which effective ventilation can take place.
• An obstructed airway means that the body is deprived of 02, if
ventilation is not reestablished, brain death will occur within
minutes.
• The primary purpose of airway management is to provide a
continuously open airway along with continuous oxygen.
• Laryngeal Mask, Endotracheal tube and Tracheostomy tube
are the equipments which are maintained patent airway.
Suctioning
• "Suctioning is inserting a sterile catheter into respiratory tract
to remove the secretions of those patients who are not able to
cough effectively.
• Oropharyngeal Suctioning
• Nasopharyngeal Suctioning
• Orotracheal Suctioning
• NOTE: Suction procedure should not take more than (10-15
seconds), because oxygen does not rich the lungs during
suctioning.
• NOTE: Suction procedure should not take more than (10-15
seconds), because oxygen does not rich the lungs during
suctioning.
• Suction pressure is 120-150 mmHg
• Provide oxygen prior to the suctioning in order to prevent
further hypoxemia.
• If the patient is not in oxygen , have him to take a minimum of
five deep breaths.
• If the patient is not in oxygen , have him to take a minimum of
five deep breaths.
• allow the patient to rest between suctioning and reoxygenate
the patient before each suctioning .
Endotracheal intubation
• It is the insertion of et tube in the trachea of the petient
• Purpose- protection from gastric aspiration and secretions
• maintenance in difficult airway and difficult surgical procedure.
• Oxygenation to provide a controlled concentration of oxygen
upto 100% .
Tracheostomy
• A tracheostomy provides direct access to the trachea by
surgically making an opening in the neck.
Indication
• Maintain a patent airway.
• Facilitate removal of secretions
• Permit long term ventilation
• Prevent aspiration of gastric content