Chapter 21 : Respiratory Care Modalities
● Oxygen Therapy
○ Administration of oxygen
at greater than 21% to
provide adequate
transport of oxygen in the
blood while:
- Decreasing the
work of breathing
and reducing
stress on the
myocardium
○ Hypoxemia: a decrease
in the arterial oxygen
tension in the blood
○ Hypoxia: a decrease in
oxygen supply to the
tissues and cells that can
also be caused by
problems outside the
○ respiratory system
○ Severe hypoxia can be
life threatening
Oxygen Toxicity
● May occur when too high a
concentration of oxygen (greater
than 50%) is administered for an
extended period
● Symptoms include substernal
discomfort, paresthesias,
dyspnea, restlessness, fatigue,
malaise, progressive respiratory
difficulty, refractory hypoxemia,
alveolar atelectasis, and alveolar
infiltrates on x-ray
● Prevention:
○ Use lowest effective
concentrations of oxygen
○ PEEP or CPAP prevent
or reverse atelectasis
and allow lower oxygen
percentages to be used
Oxygen Administration
● Cylinder, piped-in, concentrator
● Classified as low flow or high
flow
● Devices
○ Oropharyngeal catheter
○ Masks
○ Transtracheal catheter
Mini-Nebulizer Therapy
● Handheld apparatus that
disperses a moisturizing agent
or medication into the lungs
● Indication
○ Difficulty in clearing
secretions, reduced vital
capacity, and
unsuccessful with simpler
methods
● Nursing care:
○ Instruct patient to take
slow, deep breaths
through the mouth and
hold a few seconds
○ Encourage patient to
cough
○ Monitor effectiveness of
therapy
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Chest Physiotherapy (CPT)
● Includes:
○ Postural drainage
○ Chest percussion and
vibration
○ Breathing retraining
● Goals:
○ Remove secretions
○ Improve ventilation
○ Increased efficiency of
respiratory muscles
Postural Drainage
● Allows force of gravity to assist
in removal of bronchial
secretions
● Secretions drain from the
affected bronchioles into the
bronchi and trachea and are
removed by coughing or
suctioning
● Used to prevent or relieve
bronchial obstruction caused by
accumulation of secretions
● Because the patient usually sits
in an upright position, secretions
are likely to accumulate in the
lower parts of the lungs
Home Oxygen
● Nurse instructs the patient about
oxygen: of Safe methods for
administering in the home
○ Available in gas, liquid,
concentrated
○ Portable devices
○ Humidity must be
provided
Emergency Management of Upper
Airway Obstruction
● Acute upper airway obstruction
may be caused by food particles,
vomitus, blood clots, or anything
that obstructs the larynx or
trachea
● Rapid observations:
○ Inspection
○ Palpation
○ Auscultation
● As soon as it is identified, nurse
takes emergency measures
Endotracheal Intubation
● Passing an endotracheal tube
through the nose or mouth into
the trachea
● Provides patent airway, access
for mechanical ventilation,
facilitates removal of secretions
Tracheostomy
● Surgical procedure in which an
opening is made into the trachea
● The indwelling tube inserted into
the trachea is called a
tracheostomy tube
● Preventing Complications
Associated With Endotracheal
and Tracheostomy Tubes.
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Nursing Management of ● Bilevel positive airway pressure

Tracheostomy (BIPAP)
● Continuous monitoring and ● Indications: respiratory arrest,
assessment serious dysrhythmias, cognitive
● Maintain patency by proper impairment, head/facial trauma
suctioning
● Semi-Fowler Nursing Process: The Patient
● Administer analgesia and Receiving Mechanical Ventilation
sedatives ● Assessment
● Provide an effective means of ○ Systematic assessment
communication of all body systems:
■ In-depth
Mechanical Ventilation respiratory
● Positive or negative pressure assessment
device to maintain ventilation including all
and oxygenation for a prolonged indicators of
period oxygenation
● General Indications, refer to status
Chart 21-9 ■ Neurologic status
● Classification of Ventilators, see ■ Effective coping
Figure 21-8 and emotional
● Prevention of VAP, refer to Chart needs
21-11 → Patient perspective, ■ Comfort level and
refer to Chart 21-12 ability to
communicate
Noninvasive Positive-Pressure needs
Ventilation
● Method of positive-pressure Nursing Process: Planning
ventilation that can be given via ● Goals include:
facemasks that cover the nose ○ Maintenance of patent
and mouth, nasal masks, or airway
other oral or nasal devices such ○ Optimal gas exchange
as the nasal pillow ○ Absence of trauma or
● Eliminates need for endotracheal infection
intubation ortracheostomy ○ Attainment of optimal
● Continuous positive airway mobility
pressure (CPAP)

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○ Adjustment to nonverbal
methods of
communication o
Successful coping
measures
Nursing Diagnoses
● Impaired Gas Exchange
● Ineffective Airway Clearance
● Risk for Trauma
● Impaired Physical Mobility
● Impaired Verbal Communication
● Defensive Coping
● Powerlessness
Collaborative Problems
● Ventilator problems
● Alterations in cardiac function
● Barotrauma
● Pulmonary infection and sepsis
● Delirium
Nursing Interventions
● Enhancing gas exchange
● Promoting effective airway
clearance Preventing trauma
and infection
● Promoting optimal level of
mobility
● Promoting optimal
communication
● Promoting coping ability
Enhancing Gas Exchange:
Interventions
● Judicious use of analgesics to
relieve pain without suppressing
respiratory drive
● Frequent repositioning to
diminish the pulmonary effects of
immobility
● Monitor for adequate fluid
balance:
○ Assess peripheral edema
○ 180 and daily wts
● Administer medications to
control primary disease
Trauma and Infection: Interventions
● Infection control measures
● Tube care
● Cuff management
● Oral care
● Elevation of HOB
Other Interventions
● ROM and immobility
● Communication methods
● Stress reduction techniques
● Interventions to promote coping
● Include in care: family teaching,
and the emotional and coping
support of the family
Weaning #1
● Process of withdrawal of
dependence upon the ventilator
● Three stages:
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○ Patient is gradually
removed from the
ventilator
○ Then from either the
endotracheal or
tracheostomy tube
○ And finally from oxygen
● Successful weaning is a
collaborative process
Weaning #2
● Criteria for weaning
● Patient preparation
Thoracic Surgery
● Procedures to relieve conditions:
○ Lung abscesses
○ Lung cancer
○ Cysts
○ Benign tumors
○ Emphysema
Preoperative Management
● Assessment and diagnosis
● Improving airway clearance
● Educating the patient
● Relieving anxiety
Postoperative Management
● Vital signs checked frequently
● Oxygen
● Careful positioning
● Medication for pain
● Mechanical ventilation
● Chest drainage
Postoperative Nursing Management-
Thoracic Surgery
● Monitoring respiratory and
cardiovascular status
● Improving gas exchange and
breathing
● Improving airway clearance
● Relieving pain and discomfort
● Promoting mobility and shoulder
exercises Maintaining fluid
volume and nutrition
● Monitoring and managing
potential complications
Chest Tube Drainage System
● Chest drainage systems have:
○ A suction source
○ A collection chamber for
pleural drainage
○ And a mechanism to
prevent air from
reentering the chest with
inhalation
● Used in removal of air and fluid
from the pleural space and re-
expansion of the lungs
● Wet (water seal) or dry suction
control
Patient Teaching and Home Care
Considerations
● Signs and symptoms to report
● Use of home respiratory
treatment modalities
● Importance of progressive
increased activity Instruction on
shoulder exercises.