Assisting with Respiration and Oxygen
Delivery
Overview of Respiratory System
Function
Theory
1) Explain how the respiratory system functions.
2) Name three causes of hypoxia.
3) Outline procedures to follow in the event of respiratory or cardiac arrest.
4) Illustrate the functioning of respiratory system
5) List safety precautions to be observed when patients are receiving
oxygen therapy.
Clinical Practice
6) Prepare to assist patients in clearing the airway via coughing, postural
drainage, suctioning, abdominal thrusts (Heimlich maneuver), and
inhalation therapy.
7) Demonstrate the regulation of oxygen flow and correctly apply an O2
delivery device
8) Manage care of a patient who has a chest tube and drainage system.
Slide 2
Structure and Function of the
Respiratory System (Slide 1 of 3)
Nose, mouth, pharynx, and trachea compose
the upper airway
Trachea divides into right and left mainstem
bronchi
Lungs
Left lung has two lobes
Right lung has three lobes
In each lobe of the lung, bronchi divide into
bronchioles
The bronchioles divide into alveoli
Slide 3
Figure 28.1: The respiratory system
Slide 4
Structure and Function of the
Respiratory System (Slide 2 of 3)
Alveoli are lined with mucous membranes
and are the functional units of air exchange
Diaphragm is beneath the lungs
Contraction of the diaphragm enlarges the
thoracic cavity, causing inspiration
Relaxation of the diaphragm causes the
thoracic cavity to become smaller, causing
expiration
Slide 5
Structure and Function of the
Respiratory System (Slide 3 of 3)
Chest muscles (intercostal muscles) combine
with diaphragmatic movement to aid in
inspiration and expiration
Respiratory muscles depend on nerve
impulses from spinal cord nerves
Thoracic cage allows respiratory muscles to
function correctly
Slide 6
Functions of Respiratory Structures
(Slide 1 of 3)
Upper airways carry air to and from the lungs
Humidification takes place in the upper
airways
Bronchi channel air to and from the lungs
Cilia lining mucous membranes help trap and
remove foreign particles in the respiratory
tract
Slide 7
Functions of Respiratory Structures
(Slide 2 of 3)
Alveoli contain macrophages that
phagocytize inhaled bacteria
Mucus and cilia propel foreign substances to
airway openings to be expelled
Central nervous system controls rate and
depth of respiration
Chemoreceptors in the aorta and carotid
bodies send signals to the brainstem
Slide 8
Functions of Respiratory Structures
(Slide 3 of 3)
Chemoreceptors measure serum pH, serum
carbon dioxide, and serum oxygen to trigger
changes in rate and depth of respiration
Oxygen diffuses across the alveolar
membranes into the blood
Carbon dioxide diffuses across the alveolar
membranes out of the blood into the lungs for
exhalation
Slide 9
Changes Occurring with Aging
Decreased elasticity of thorax and respiratory
muscles
Decrease in total body water, drier mucous
membranes
Loss of elastic recoil during exhalation
Thickening of alveolar membrane; less
efficient gas exchange
Less respiratory reserve
Slide 10
Hypoxemia
Decreased amount of oxygen in the blood
Results in decreased oxygen at the cellular
level (called hypoxia)
Also results in increased levels of carbon
dioxide (called hypercapnia)
Onset may be rapid and obvious or insidious
and gradual
Slide 11
Hypoxia
(Slide 1 of 4)
Obstruction of the airway
Occlusion by the tongue or mucous secretions
Inflammation from croup, asthma, tracheobronchitis, or laryngitis
Occlusion by foreign body
Chemical and heat burns with inflammation
COPD causing airway collapse
Near drowning: occlusion by water
Restriction of the thoracic cage
Abdominal injuries
Chest injuries, flail chest
Pneumothorax
Extreme obesity, diseases
Slide 12
Hypoxia
(Slide 2 of 4)
Decreased neuromuscular function
Depressed central nervous system: drugs
including sedatives, anesthetic agents, and
analgesics, brain trauma; CVA
Coma (diabetic, uremic, brain injuries)
Diseases (multiple sclerosis, myasthenia gravis,
poliomyelitis, Guillain-Barré syndrome)
Slide 13
Hypoxia
(Slide 3 of 4)
Disturbances in diffusion of gases
Diseases (pulmonary fibrosis, emphysema)
Trauma (contusion)
Emboli (fat embolus, pulmonary embolus)
Tumors, benign and malignant
Respiratory distress syndrome
Environmental causes
High altitude
Slide 14
Hypoxia
(Slide 4 of 4)
Symptoms of Hypoxia
Restlessness, irritability, confusion
Difficulty in breathing (dyspnea)
Rapid breathing (tachypnea, stridor)
Abnormal lung sounds
Cyanosis, retractions, dysrhythmias
Acid-base imbalance
Decreased oxygen saturation
Slide 15
Pulse Oximetry
Pulse oximeter
Used to monitor any patient at risk for hypoxia
Measures changes in serum oxygen continuously
Sensor attached to fingers, toes, ears, or skin
Helps track changes in oxygen therapy
Slide 16
Airway Obstruction and
Respiratory Arrest
Common airway obstructions
Choking; obstruction by the tongue, foreign bodies,
or food
Abdominal thrusts (Heimlich maneuver) used to
clear foreign objects
Respiratory secretions
Complete or partial obstruction
Present with different disease states such as
pneumonia or COPD
Usually can be cleared by coughing; can be
facilitated by postural drainage
Slide 17
Clearing Respiratory Secretions: The
Effective Cough
Most effective in the sitting position
Two deep breaths and then inhale deeply
again
Breath rapidly and forcibly exhaled as quickly
as possible with the mouth open
This moves secretions up the bronchial tree
Repeated forceful exhalation bring secretions
up to where they can be more easily coughed
up
Slide 18
Postural Drainage
Different positions drain different segments of
the lungs
Specific segments drained into the bronchi to
facilitate coughing
Each position assumed for 5 to 15 minutes
two to four times a day as tolerated
Percussion used: rhythmic clapping with
cupped hands over the thoracic area,
avoiding spine or sternum
Slide 19
Question 1
The most common cause of respiratory
insufficiency is:
1) chronic obstructive pulmonary disease.
2) pneumothorax.
3) obstruction of the airway.
4) asthma.
Slide 20
Question 2
Bruce’s patient is showing early signs of
hypoxia. Which of the following signs is not an
early sign of hypoxia?
1) His patient sits up to breathe
2) Restlessness
3) Mental dullness
4) Cyanosis
Slide 21
Oxygen Delivery Overview
Theory
4) Describe the various methods used for
oxygen delivery.
5) List safety precautions to be observed when
patients are receiving oxygen therapy.
Clinical Practice
6) Regulate oxygen flow and correctly apply an
oxygen delivery device.
Slide 22
Oxygen Administration
(Slide 1 of 5)
Oxygen: colorless, tasteless, odorless gas
present in the air
Although essential for life, use of oxygen is
not without its disadvantages
High concentrations cause fires to burn very rapidly
Very drying to the tissues of the respiratory tract
Equipment needed for oxygen therapy
Oxygen source, the flowmeter, the humidifier, the
tubing, and the appropriate appliance for the method
ordered
Slide 23
Oxygen Administration
(Slide 2 of 5)
Used to supplement oxygen in inspired air
Inspired air is 21% oxygen
Can be delivered by nasal cannula, mask,
tent, croupette, or catheter
Requires humidification, flow rate prescribed
by a physician
Common flow rates are 4-6 L/min
COPD patients given only 2 to 3 L/min to prevent
causing respiratory arrest
Slide 24
Oxygen Administration
(Slide 3 of 5)
Cannula
A plastic tube with short, curved prongs that
extend into the nostril about ¼ to ½ inch
Held in place by looping it over the ears and
cinching under the chin; can be easily adjusted for
the patient’s comfort
Slide 25
Figure 2.7: Oxygen cannula in use by
home care patient
Slide 26
Oxygen Administration
(Slide 4 of 5)
Masks
Various types available for administering oxygen in
concentrations ranging from 24% to 55% at flows
of 3 to 7 L/min
Oxygen concentrations above 60% rarely used
because of the danger of oxygen toxicity
Slide 27
Oxygen Administration
(Slide 5 of 5)
Artificial Airways
Several purposes:
• Relieve an obstruction, protect the airway, facilitate
suctioning, and provide artificial ventilation
Nasopharyngeal and oropharyngeal airways
• Keep the tongue from falling back into the throat
Endotracheal tubes maintain an airway in those
who are unconscious or unable to ventilate on
their own
Slide 28
Figure 28.9: Types of airways
Slide 29
Nasopharyngeal Suctioning
(Slide 1 of 2)
Required for patients unable to clear secretions
from their own airway effectively
Nasopharyngeal
Oral suction
Can be performed with a Yankauer suction tip or
with a 14 to 16 Fr. suction catheter attached to
wall suction
Suction pressure set between 80 and 120 mm Hg
Aseptic technique used for airway suctioning
Slide 30
Nasopharyngeal Suctioning
(Slide 2 of 2)
Maintain patent airway by removing
accumulated secretions
Involves upper air passages of nose, mouth,
and pharynx
Used most often for infants, gravely
debilitated or unconscious patients, and those
who have an ineffective cough
Suction pressure set between 80 and 120
mm Hg
Slide 31
Tracheobronchial Suctioning
Deep suctioning to remove secretions from the
trachea and bronchi using sterile technique
Most often performed on intubated patients or
patients with a tracheostomy
Patients need preoxygenation
Sterile technique is mandatory
Should be performed no longer than 10
seconds at a time, with oxygenation in
between
Slide 32
Question 3
Lisa’s patient has an order for nasopharyngeal suction.
Which one is not true regarding nasopharyngeal
suctioning?
1) The purpose of suctioning is to maintain a patent
airway by removing accumulated secretions.
2) The amount of suction pressure should be set between
40 and 80 mm Hg.
3) It is best to use aseptic technique for all airway
suctioning.
4) A catheter that has been used in the mouth is not used
again for nasopharyngeal or tracheobronchial
suctioning.
Slide 33
Question 4
Linda’s patient has a tracheostomy. Which is true
regarding tracheostomy care?
1) Tracheostomy care is performed every 12 hours.
2) Ties are replaced when soiled or at least weekly.
3) A tracheostomy tube has an inflatable cuff, which
must be deflated every 24 hours.
4) Tracheobronchial suctioning is a sterile
procedure.
Slide 34
Question 5
Linda’s patient cannot maintain a sufficient amount
of oxygen in his body. Linda must administer
oxygen to her patient. Oxygen should be
administered by:
1) mask, cannula, tent, or catheter only.
2) anyone; a physician’s order is not necessary.
3) nebulizer.
4) humidified apparatus to prevent drying to the
mucosa.
Slide 35
Care of the Patient Receiving Tracheostomy or
Chest Tube and Drainage System
Theory
5) List safety precautions to be observed when
patients are receiving oxygen therapy.
(Continued)
Clinical Practice
6) Prepare to provide care for the tracheostomy
patient.
7) Prepare to care for the patient who has a
chest tube and drainage system.
Slide 36
Tracheostomy
A surgical opening into the trachea to
facilitate insertion of a cuffed tracheostomy
tube
Cuff enables controlling the airway and preventing
aspiration
Maintains a patent airway; facilitates
suctioning and mechanical ventilation
May be temporary or permanent
Slide 37
Chest Drainage Tubes
Used to remove air from patient with a
pneumothorax or hemothorax or after chest
surgery
Connected to a drainage device that allows air or
drainage to escape and not enter the cavity
May require suction to operate or may use
gravity drainage
Tubes are removed and an occlusive dressing is
applied when the air is removed from the plural
space
Slide 38
Figure 28.12: Disposable chest
drainage unit
Slide 39
Nursing Role in Airway Support
Always maintain a patent airway
Patients should be turned and encouraged to
cough and deep-breathe every 2 hours when in
bed
Splint surgical patients with a pillow to help them
deep-breathe and cough
For unconscious patients, use an oral or nasal
airway to keep the tongue from obstructing the
airway, and suction as necessary
Encourage use of an incentive spirometer
Slide 40
Figure 28.16: Teaching the patient to
splint incision while coughing
Slide 41
Figure 28.18: Teaching use of
incentive spirometer
Slide 42
Nursing Diagnosis/Problem Identification
Alteration in airway clearance related to muscle
weakness and impaired cough; decreased level of
consciousness; or thick secretions
Altered gas exchange related to retained respiratory
secretions
Potential for infection related to alteration in airway
(tracheostomy)
Insuffeciient knowledge related to use of oxygen
equipment, tracheostomy, ventilator, or incentive
spirometer
Potential for injury related to improper safety
precautions when using oxygen
Slide 43
Nasopharyngeal Suctioning (Each bulletin is worth 1 point)
o ______ How the nurse determined the need for suctioning
o ______ Suctioning was performed with sterile technique
o ______ Noting preoxygenated
o ______ Size catheter use
o ______ Oral suction performed 1st charted, and patient unable to clear secretions
o ______ What was suction set at?
o ______ The color of sputum suctioned
o ______ Amount of the sputum suctioned
o ______ Was additional suctioning needed?
o ______ Tolerance by the patient
o ______ Post assessment of lungs
o ______ Safety factors
o ______ Date
o ______ Time
o ______ Signature
Example: 08/12/25 0830 Coarse crackles Auscultated in anterior Right upper lobe. Preoxygenation of 02 at 100 %
completed prior and after procedure. Oral suctioning with yankuer was unsuccessful and patient is unable to clear
secretions. 14 Fr suction catheter used to perform sterile technique. Suction set at 80-120 mmhg. Moderate amount
thick white sputum returned to suction canister. Lungs now clear to auscultation; breathing returns to normal. Tolerated
well, no signs or symptoms of respiratory distress noted. Head of bed in High Fowler's. O2 at 2 L nasal cannula. Bed in
lowest locked position, side rails up x 2. Call light within reach, hydration offered. Kcaughron, BSN RN
Slide 44
Trach Care: (Each bulletin is worth 1 pt each)
o ______ Trach care performed using sterile technique.
o ______ If the inner cannula was cleaned and replaced or a new one was inserted
o ______ If cleaned, what Solution was it cleaned with
o ______ The condition of the skin around the trach opening.
o ______ New dressing applied
o ______ If the strings were changed/who assisted
o _____ Tolerance for the procedure
o ______ How the patient was left/ 02 in place
o ______ Safety factors
o ______ Date
o _____ Time
o _____ Signature
08/12/25 0800 Trach care performed using sterile technique. Inner cannula was cleaned with 1
parts peroxide and sterile saline. The inner cannula was removed; cleaned and replaced. No
redness or irritation noted to skin around under trach. Cleansed under trach. Patted dry and
applied new split Sponge. Trach strings were changed with help from a family member.
Tolerated well, no respiratory distress noted. Head of bed at 30 degrees. Bed in the lowest
locked position. Side rails up x 2. O2 in place via trach collar at 2 L. Call light within reach,
hydration offered. ------Kcaughron,BSN RN
Slide 45
Trach suctioning: (Each bulletin is worth 1 point)
•______ How the nurse determined the need for suctioning.
•______ Suctioning was performed using sterile technique
•______ Patient unable to clear secretions
•______ Size catheter used
•______ What was suction set at
_____ The color of sputum suctioned
•______ Amount of the sputum suctioned
•______ Noting suctioning as head is turned to the left
•______ Noting suctioning as head is turned to the Right
•______ Noting pre oxygenation
______ Noting oxygenation between times
• ______ Noting suctioning as head is midline
• ______ Tolerance by the patient
• ______ Post assessment of lungs
o ______ O2 in place
o ______ Safety factors
o ______ Noting personnel to assist (Family or nurse)
o ______ Date
o ______ Time
o ______ Signature
Example: 10/24/24 1400 :Coarse crackles Auscultated in anterior Right upper lobe. Patient unable to clear secretions. Preoxygenated
with trach o2 at 100 % prior to and during procedure. 14 Fr suction catheter used to perform sterile technique with assistance from
family. Suction set at 80-120 MMHG . Moderate amount thick white sputum returned to suction canister on midline, left and right head
positions. Lungs now clear to auscultation; breathing is easier. Tolerated well, no signs or symptoms of respiratory distress noted. Head
of bed in High Fowler's. O2 at 2 L nasal cannula. Bed in lowest locked position, side rails up x 2. Call light within reach, hydration
offered. Kcaughron, RN
Slide 46