Oxygenation

Promoting Respiratory
Functioning
 Purpose of the Respiratory
System
n The lungs, in conjunction with the circulatory
system, deliver oxygen to and expel carbon
dioxide from the cells of the body.
n The upper respiratory system warms and filters
air.
n The lungs accomplish gas exchange.
General Principles of Respiratory
Functioning
Anatomy and Physiology
Breathing (nose/mouth) delivers
air
Nasopharynx (funnels incoming
air through the mouth/nose to
the lower portions of the
pharynx)
Epiglottis
Trachea
Lobar bronchi – Segmental
bronchi
Lungs
Bronchioles
Alveoli (air sacs, air exchange)
 The Respiratory System structures

Airway - begins at the nose and ends in that the

terminal bronchioles
- the pathway for the transport and exchange of
O2 and CO2.
- Divided into upper and lower airways
 Upper Respiratory System
Upper airway-nose, pharynx, larynx and
epiglottis
Function – to warm, filter and humidified
inspired air
 Structures of the Lower
Respiratory System
n Lungs
n Pleura Lower airway
n Mediastinum (tracheobronchial
n Lobes of the lungs: tree)-
n Left: upper and lower
n Right: upper, middle, and
lower
n Bronchi and bronchioles
n Alveoli
Lower Respiratory System
 The Respiratory System structures
n Lungs - has 2 lobes which are subdivided into
segments or lobules
- main organ of respiration
- composed of elastic tissues that can be
stretched or recoil
- composed of alveoli (small air sacs that are
lined with fluid at the end of terminal bronchioles;
about 300million in an average adult)
Each alveolus is surrounded by a capillary bed. Gas
exchange occurs when the capillary meets the
alveolus.
 The Respiratory System structures
n Pleura are 2 layered membranes that are
continuous with each other and form a closed
sac .
Pleural fluid is between the membranes
that act as lubricant and as an adhesive agent
to hold the lungs in an expanded position.
A) visceral-covers the lungs
B) parietal-lines the thoracic cavity
-pressure within the pleural space is always
subathmospheric (a negative pressure) which
is essential in normal ventilation
 Function of lower airway
n conduction of air, mucociliary clearance and
production of pulmonary surfactant
n surfactant( a detergent like phospholipids manufactured
in the alveoli of the lungs and lines them ; serves to
decrease the surface tensions of the pulmonary fluid and
permits the lungs to expand during inspiration and
prevents them from collapsing during exhalation)

Protective layer of the airway

n Mucus - traps cell particles or infectious debris
- protect underlying tissues from irritation and infection
n Cilia - microscopic hairlike projections; propels mucus
toward the upper airways that mucus can be removed by
coughing
The Respiratory System structures
VENTILATION- the physical
process of moving air in and
out of the lungs

GAS DIFFUSION- oxygen and

carbon dioxide move between
the alveoli and the blood by
diffusion, the process in which
molecules move from an area
of a greater concentration to
an area of lesser concentration.
•Perfusion is the process
in which the oxygenated
capillary blood moves
through the lung tissues
n GAS TRANSPORT- as
oxygen crosses the
alveolar-capillary
membrane into the blood,
the blood transports it in
two forms; dissolved
plasma and attached to
hemoglobin molecules on
red blood cells.
Gas exchange in the respiratory system refers
to the intake of O2 and release of CO2. This is
made possible by respiration and perfusion

n RESPIRATION- refers to gas exchange,

occurs in the terminal alveolar capillary
system. Gas exchange happens via diffusion
n PERFUSION – oxygenated capillary blood
passes through tissues in this process.
Perfusion to the body tissues depend on
adequate blood supply and proper
cardiovascular functioning to carry oxygen and
carbon dioxide to and from the lungs
CONTROL OF VENTILATION-
specialized neurons in the brain stem, known
collectively as the respiratory centers(medulla
and the pons), generate regular impulses.
These impulses are transmitted to the respiratory
muscles causing them to contract and relax
rhythmically.

Ventilation of the lungs is accomplished through

the act of breathing: inspiration and expiration
ALTERED RESPIRATORY FUNCTION
HYPOXIA –insufficient oxygenation of tissues, can
cause severe and sometimes irreparable damage to
brain, kidneys and other vital organs
CLINICAL S/S OF HYPOXIA
EARLY LATE

1. Tachycardia 1. Bradycardia
2. Increase rate and depth 2. Dyspnea
of respirations 3. Decreased systolic BP
3. Slight increase in 4. Cough
systolic BP 5. Hemoptysis
n Anoxia- total lack of oxygen can result to
death
n Cyanosis – indication of respiratory
insufficiency
- most easily observed on the lips ,tongue,
mucus membrane and nail bed.
n HYPOXEMIA – insufficient oxygen in the
blood
n HYPOVENTILATION – inadequate alveolar
ventilation= CO2 accumulates in the blood =
HYPERCARBIA/HYPERCAPNIA
HYPERVENTILATION – increased movement of
air in & out of the lungs = increase rate & depth =
more CO2 eliminated than produced
EUPNEA – easy, noiseless breathing
TACHYPNEA – rapid RR
BRADYPNEA – slow RR
APNEA – cessation of breathing
KUSSMAUL S BREATHING – hyperventilation
due to metabolic acidosis & renal failure
Hemoptysis = coughing out of blood
CHEYNE-STOKE S – marked rhythmic waxing &
waning of respirations from very deep to very shallow
then apnea
BIOT S RESPIRATIONS – shallow breaths
interrupted by apnea
DYSPNEA – difficult / labored breathing
ORTHOPNEA – inability to breathe when lying flat
WHEEZING –high pitched musical sound
appreciated during expiration
STRIDOR=high pitched crowing sound appreciated
during inspiration
FACTORS AFFECTING RESPIRATORY
FUNCTION
n Health Status - acute and chronic illness, renal
and cardiac disorders, anemia
n Age
Developmental considerations -infant ,child
and older adult
n Medications -opiods
n Lifestyle –activity level and habits
n Environment
n Psychological Health-hyperventilation, anxiety
Assessing the Respiratory System

n The nurse assess the rate, rhythm and depth

respirations.
n Inspection: The nurse notes the physical
appearance of the chest. He checks for
symmetry and presence of deformities (Barrel
chest).
Palpates the thorax for bulges, tenderness or
abnormal movements,
Assessing chest expansion

1.Place the thumb side by

side over the posterior
vertebrae at about the level
of the 10th rib.

2.As the patient inhales note

how far the thumb
separates: normally the
distance is 1 -2 (3-5cm)
 Diagnostic Tests
n Pulmonary function tests – measures lung
volumes and lung capacities
n Arterial blood gases- assess ventilation and
acid base balance
n Sputum tests – may indicate certain diseases
n Chest x-ray -
n Computed tomography (CT)
n Magnetic resonance imaging (MRI)- strong
magnetic field and radiowaves are use to
detect and define differences between healthy
And disease tissues
n Fluoroscopic studies and angiography

n Radioisotope procedures (lung scans)

n Bronchoscopy – visualization of larynx,trachea

and bronchi through flexible or rigid

bronchoscope
n Thoracoscopy

n Thoracentesis – aspiration of fluid or air from

the pleural space
n Biopsies – to detect presence of cancer
 Bronchoscopy
n Is the direct visualization of the larynx, trachea
and large bronchi using a flexible fiberoptical
scope passed into the lungs.
n It is used to visually guide the physician in
obtaining specimens of secretions or tissue for
biopsy, removing foreign bodies and mucus
plugs, or implanting medications for treating
tumors
Fiberoptic Bronchoscopy and
Rigid Bronchoscopy
Endoscopic Thoracoscopy
 Sputum Specimen
n Early morning specimen is collected . Mucus
secretions accumulate during the night. This
enables the client to expectorate adequate
sputum specimen.
n Instruct client to rinse mouth with plain water.
Do not use astringent mouthwash. Its alcohol
content can destroy microorganisms in
specimen
 Sputum Examination
n Sputum C and S – detects the actual
microorganism causing infection
- use sterile container, specimen is collected
before the first dose of antimicrobial. This is to
ensure that microorganisms present in the
specimen can be accurately detected
AFB staining – use in diagnosing tuberculosis. Collect
sputum in three consecutive mornings
 Throat Culture
n Collected from the mucosa of the oropharynx and
tonsils using a culture swab, to detect the presence of
disease producing microorganism. The most common
use is to evaluate possible streptococcal infection
Nursing Consideration:
n Do not contaminate the sputum

n Protect against contact with body fluids. Wear clean

gloves.
n Obtain specimen from back of throat not the mouth. If
the posterior pharynx can't be seen use a penlight and
depress the tongue with a tongue blade.
n Promote comfort: decrease gag reflex
 Common Diagnostic Methods to
Assess Respiratory Function
1.Pulmonary Function Studies are routinely
done to evaluate pulmonary status and detect
abnormalities,
Spirometry studies- measure lung
capacity, volumes and flow rates while the
patient inhales deeply and exhales forcefully
into a spirometer an instrument that measure
these volumes and airflow.
Pulmonary function test..con t
measure the following lung volumes and
capacities
n Tidal volume (TV) –the amount of air inspired
and expired in a normal respiration. Normal is
500 ml.
n Residual volume (RV) - the amount of air
remaining in the lungs after a maximal
expiration. Normal is 1,200 ml.
n Vital capacity (VC) the maximal amount of
air that can be exhaled beyond tidal volume
after a maximal inhalation. Normal is 4,800ml.
2.Peak Expiratory Flow Rate (PEFR)
refers to the volume of air that can be forcibly
exhaled
n decrease PEFR can signal airway obstruction

n measures by a peak flow meter

n a test which is noninvasive, inexpensive, quick and

easy.
n results are used to check severity of asthma and to
track responses to medication.
Using a Peak Flow Meter
 3.Pulse Oximetry
- a noninvasive
transcutaneous technique
for periodically or
continuously monitoring Pulse Oximeter
the oxygen saturation of hemoglobin (SpO2)
in the blood.
NV- 95% -100% Less than 70% is life threatening
- useful for monitoring patient s receiving
oxygen therapy, those at risk for hypoxia, and
post operative patient.
4.Thoracentesis
- chest fluid aspirated and
subjected to lab studies;
aids in the diagnosis of
neoplasm and
inflammatory disease of
the lungs.
-performed with the
patient sitting in a setting
position and sterile
technique is used. A local
anesthetic precedes
insertion of the
thoracentesis needle.
Position of a Patient for
Thoracentesis
 5. Chest X-ray
n Chest Roentgenography
Detect pneumonia, broken ribs, lung tumors
a. Postero-Anterior view (PA)
b. Antero-posterior view (AP)
 Nursing Diagnoses to promote
Oxygenation
n Ineffective airway clearance r/t thick yellow
secretions ,dehydration ,poor nutrition
n Activity Intolerance related to shortness of breath
n Anxiety related to feeling of suffocation
n Acute pain related to pleural inflammation
n Fatigue related to impaired oxygen transport system
n Imbalanced nutrition :Less than the body
requirement, related to difficulty of breathing
Respiratory Rates Through the
Lifespan
Age Group Breaths/minute
New born and Infant 30 – 60

1 – 5 years 20 – 30
6 -10 years 18 – 26
10 – adult 12 – 20
Older adult (60yrs 16 - 25
and older)
 Planning
n Overall outcomes for a patient with
oxygenation problems are to:
n Maintain patent airway
n Improve comfort and ease of breathing
n Improve ventilation and oxygenation
n Improve ability to participate in physical
activities.
n Prevent risks associated with oxygenation
problem
Measures to Promote
Optimal Respiratory
Function
I. ADEQUATE OXYGEN SUPPLY
- human requires 21% of the oxygen
concentration to sustain life
11.Nursing measures for maintenance of
efficient respiration
PROMOTE PROPER BREATHING
DEEP BREATHING
-is done to produce hyperventilation, a
condition in which there are more than normal
amounts of air entering and leaving the lungs.
- It is often used to overcome hypoventilation.
 PROMOTE PROPER BREATHING

n Use of Incentive Spirometry

n Pursed Lip Breathing
n Abdominal or Diaphragmatic breathing

B. Managing Chest tubes

III. Promoting and Controlling Coughing
COUGHING-expels thick ,tenacious, copious secretion
Non Productive Cough- if cough is dry, patient is
said to be congested with non-productive cough
- forceful expiratory effort caused by irritation that
produces no secretions (dry cough).
Productive Cough- if cough produces secretions,
patient is referred to as being congested with productive
cough
produces respiratory tract secretions (phlegm).
Congested Lungs- person with secretions or fluids in
his lungs.
n Voluntary Coughing -A cough does not does not occur

as a result of reflex stimulation of the cough sensitive

areas. It can be induced voluntarily
n Involuntary Coughing
Involuntary cough often accompanies respiratory
tract infections and irritations. It helps clear the air
way if it is productive, but it is fatiguing and irritating
when it is non productive.
n Medications may control involuntary coughing like-
cough suppressants, expectorants, lozenges.

n COUGHING EXERCISES
n Inhale as deeply as possible-2-3

n Try to expel all air as possible

n After on deep inspiration cough 3 times trying to

expel all air from the lungs
IV. PROMOTING COMFORT

POSITIONING THE PATIENT PROPERLY

- for the free movement of the diaphragm
and expansion of the chest wall
- promotes ease of respirations.

Eg. High fowler s, semi fowler s, side lying

position
.V ADEQUATE HYDRATION
- to maintain moisture of the mucous
membrane, prevent irritation and
infection
-

- to minimize the viscosity of respiratory

secretions.

- The patient s fluid intake (2-3L/

day) should be increased to the
maximum that his health will tolerate.

VI. PATENT AIRWAY

- to promote gaseous exchange between

individual & environment

- obstruction is characterized by NOISY

BREATHING
VII. AVOIDING POLLUTANTS, ALCOHOL
& SMOKING
Cilia are hair like processes on the free
surfaces of epithelium lining respiratory
passages.
2 Methods:
a. Adequate hydration is important to decrease
the viscosity of the secretions and to help in
the proper movement of cilia
b. Eliminate/minimize conditions that destroy
their ability to function. E.g.. Smoking,
inhaling polluted air, and excessive use of
alcohol.
VII. PROMOTING CHEST PHYSIOTHERAPY
CPT – Chest Percussion Therapy
PERCUSSION(Clapping or Cupping) – forceful
striking of skin with cupped hands to mechanically
dislodge tenacious secretions
VIBRATION – series of vigorous quivering or
contraction/relaxation produced by hands placed flat
against chest wall
POSTURAL DRAINAGE – expulsion of
secretions from various lung segments by gravity
VIII.MAINTAINING GOOD NUTRITION
-adequate intake of protein vitamins and minerals
especially to people who have hard of breathing and
often don t have the energy to eat.
- six small meals per day

IX. MEETING RESPIRATORY NEED WITH

MEDICATION
Administering inhaled medications to open narrowed
airways (bronchodilator), to liquefy or loosens thick
secretions (mucolytic agent) or reduced inflammation in
the airways (corticosteroids) administered via a
nebulizers or metered- dose inhalers
Removing Respiratory
Tract Secretions
I. Humidification of Air and
Maintaining an Adequate
Fluid intake

- decreases the viscosity of

respiratory secretions
II. Coughing
- To expel secretions either voluntarily or
involuntarily
III. Percussion
- Cupping is used for the manual
percussion of lung areas to loosen
pulmonary secretions
n Cup hands & strike rhythmically over the
lobes of the lungs to be drained. Move the
cupped hands from the bottom to the top.
n Listen for a hollow sound while
percussing. The patient should experience
no pain.
n Do not percuss on bare skin. The patient
may wear a gown or underclothing.
n Do not percuss below the ribs or over the
spine or breast because of the danger of
tissue damage.
n Use percussion for 30-60 seconds over an
area several times a day, or for up to 3-5
minutes for patients with very tenacious
secretions.
Providing Supplemental Oxygen
X. BRONCHIAL HYGIENE
XI. SUCTIONING
XII. ADMINISTRATION OF SUPPLEMENTAL
OXYGEN
 Providing
Supplemental
Oxygen
OXYGEN THERAPY
- the provision of therapeutic
oxygen.
IMPLICATIONS
• OXYGEN is colorless, odorless
and tasteless = leakage cannot be
detected
• OXYGEN is dry = can irritate

mucous membrane
• OXYGEN supports combustion =
can cause fire
 OXYGEN THERAPY
Goal- to prevent or relieve hypoxia
Oxygen-not a substitute for other treatment and
should be used when indicated.
- should be treated as a drug therefore has
dangerous side effect
- dosage and concentration of O2 should be
ordered and continuously monitored.
Oxygen Toxicity is a potential hazard(-lung
damage that develops when oxygen
concentrations of more than 50% are
administered .S/S are H/A sore throat ,fatigue
hypoventilation,substernal chest pain
Nursing Responsibility during oxygen
administration
n The nurse should routinely refer to the
physician s orders to verify that he patient is
receiving prescribed oxygen concentration.

n The nurse is responsible for correctly

administering oxygen including adjusting
oxygen flow rate and assessing patient s
response to oxygen therapy.
 Safety Precautions When
Administering Oxygen
1. open source of oxygen before
insertion of oxygen device
2. regulate flow accurately
- measured in LITERS PER
MINUTE
3. place a NO SMOKING sign
in the patient s area
4.Instruct the patient ,family and
visitors that smoking is not
permitted because oxygen support
combustion.
 Safety Precautions When Administering
Oxygen
5. avoid use of oil, grease, alcohol and
ether near the patient.
6.Avoid use of electrical appliances such as razors,
blankets and heating pads
7. check electrical appliances before use. Ensure
that all electrical appliances is functioning
appropriately and is well grounded. Avoid frayed,
tangled or cluttered cords and do not overload
circuit with too many appliances.
8. avoid use of materials that will generate static
electricity.
 Safety Precautions When Administering
Oxygen
9.Secure portable oxygen delivery systems such
as cylinders, to prevent falling accidentally
being tripped over
10. Avoid placing oxygen cylinder near sources
of heat such as lamps or radiators.
11. Know the institution s fire procedure and
location of fire extinguishers.
12. Administer oxygen as ordered by a
physician who determined the method
of administration and the flow
rate of oxygen.
 Administering Oxygen

Portable Oxygen Tank

Oxygen gauge
n Flow meter gauge

n Pressure gauge

n Flow adjustment Knob

n Humidifier

n Tubing

n On and off Handle

n Humidifier-device that produce
small water droplet used during
oxygen administration bec O2 is
drying to the mucus membranes
n Use of sterile water for
humidification reduces the
possibility of growth of organism in
the oxygen delivery system
n Flow meter gauge to regulate the
amount of oxygen delivered to the
patient and attached to oxygen
source.
 Administering Oxygen
Oxygen can be administered by;
n Nasal cannula Flow 2-3L/min at 28-32% FiO2

n Nasal catheter

n Simple mask -6-10L/min.or 35-60%FiO2

n Partial rebreather mask, non rebreather mask,

n Venturi mask

n Oxygen Tent/ Face tent

The choice of oxygen delivery device and liter flow

depends on the client s condition, oxygenation
status, and amount of oxygen needed.
 OXYFEN DELIVERY
DEVICES
n 1. Nasal Cannula (nasal prongs)
n Flexible plastic tubing with 2 nasal ports and
adjustable elastic strap.
n Low flow oxygen delivery system
n Tidal volume mixes with ambient air (room air)
n Inspired oxygen concentration depends on the flow
rate through the cannula and the patient s tidal
volume
n Provide up to 44% oxygen
Special Nursing Consideration for giving O2
via nasal cannula

n C/I for patients with nasal obstruction

n Variable oxygen concentration due to
breathing pattern
n Flow rate >6LPM may dry mucus membranes
; may cause headache
n Easily dislodged
 2.Face Mask (Standard Face Mask)

n Low flow oxygen delivery system

n Oxygen enters through the bottom port and
thru the side holes.
n Inspired oxygen is also diluted by room air
n Oxygen flow should be higher than 5Lpm
n Up to 60% can be supplied through the oxygen
port at 6-10 liters per min.
 Special consideration
n Potential for improper fitting
n Oxygen concentration depends on the flow rate
and patient's respiration
n Patient may feel like he s suffocating
 3. Face mask with oxygen reservoir
(Nonrebreather mask)
n On inhalation the one way inspiratory valve
opens , directing the oxygen from the reservoir
bag into the mask,
n One exhalation gas exits the mask through the
one way expiratory valves and enters the
atmosphere
n Provide 90-100% oxygen
n Each LPM increase in flow of 6LPm will
increase the inspired air concentration by 10%
 Disadvantage of nonrebreather mask
n - must fit snugly on the patient's face to
prevent room air from mixing with oxygen
inhaled from the reservoir bag.
n -can only be use with spontaneous breathing
patients.
Special Considerations
The reservoir bag must remain completely
inflated so sufficient supplemental oxygen is
available for each breath
n Must use high flow rates at 10-15 L/min.
 Venturi Mask
n Similar in concept to the simple mask with a
modification that allows relatively fixed
concentrations of supplemental oxygen to be
inspired
Venturi Mask, Nonrebreathing
Mask, Partial Rebreathing Mask
T-Piece and Tracheostomy Collar
Administering Oxygen by Nasal
Cannula or Mask
Purpose
1. Deliver low to moderate levels of oxygen to relieve
hypoxia
Assessment/Preparation
n Assess respiratory status

n Assess past medical history, noting chronic

obstructive pulmonary disease (COPD)

n Assess for clinical signs and symptoms of hypoxia:
anxiety, decrease level of consciousness, inability to
concentrate, fatigue, dizziness, cardiac dysrhythmias,
pallor or cyanosis, dyspnea.
Equipment

n Appropriate oxygen delivery system:

1. Nasal cannula and tubing (O2
concentrations: 22%-44%)
2. Simple oxygen mask (concentrations: 40%-
60%)
n Oxygen source
n Flow meter
n No Smoking sign
n Humidifier and distilled water (for high flow
O2 therapy)
Oxygen Mask (adult)
Oxygen Mask ( pedia )
Nasal canula
Ambubag
Oxygen Pipe-in
Oxygen Tank
Procedure
1. Review physicians order for oxygen to ensure
that it includes method of delivery, flow rate,
duration of therapy; identify client.
2. Wash your hands
3. Explain the procedure to the client. Explain
that O2 will ease dyspnea or discomfort, and
inform client concerning safety precautions
associated with oxygen use. If he is using the
cannula, encourage him to breath through the
nose.
4. Assist client in semi fowlers position if tolerated.
5. Insert flow meter into wall outlet. Attach oxygen
tubing to nozzle on flow meter. If using a high
O2 flow, attach humidifier.
6. Turn on the oxygen at the prescribed rate. Check
that oxygen is flowing through the tube.
7. Cannula:
a. Place cannula prongs in nares
b. Wrap tubing over and behind the ears
c. Adjust plastic slide under the chin until cannula
fits snugly.
Mask:
a. Place mask on face, applying from the nose and
over the chin.
b. Adjust the metal rim over the nose contour the
mask to the face.
c. Adjust elastic band around the head so mask fits
snugly.
9. Assess for proper functioning of equipment and
observe client s initial response to therapy.
10. Monitor continuous therapy by assessing for
pressure areas on the skin and nares every 2 hrs.
and rechecking flow rate every 4-8 hrs.
11. Document Procedure and observations
 I. Humidification of Air and
Maintaining an Adequate
Fluid intake

- decreases the viscosity of

respiratory secretions
II. Coughing
- To expel secretions either voluntarily
or involuntarily
III. Percussion
- Cupping is used for the manual
percussion of lung areas to loosen
pulmonary secretions
n Cup hands & strike rhythmically over
the lobes of the lungs to be drained.
Move the cupped hands from the
bottom to the top.
• Listen for a hollow sound while
percussing. The patient should experience
no pain.
• Do not percuss on bare skin. The patient
may wear a gown or underclothing.
• Do not percuss below the ribs or over the
spine or breast because of the danger of
tissue damage.
•Make use of gravity. Move from the lower
ribs to the shoulders in back and from the
lower ribs to the top of the chest in front.
Percussion
 Percussion
n Make use of gravity. Move from the lower ribs
to the shoulders in back and from the lower
ribs to the top of the chest in front.

n Use percussion for 30-60 seconds over an area

several times a day, or for up to 3-5 minutes
for patients with very tenacious secretions
several times a day.
IV . Vibration
increases the turbulence of exhaled air to
aid in the expectoration of secretions.
Vibration is the rhythmic contraction and
relaxation of the arm and shoulder muscles
while holding the hands flat on the patient s
chest wall as patient exhales
n Place your hands flat on the patient s chest
wall, where vibration is desired, and hold the
hands side by side with the fingers extended
and together.
n Ask the patient to inhale deeply and exhale
slowly.
n While the patient exhales, vibrate the chest
wall by contracting and relaxing your arm
and shoulder muscles rhythmically and
quickly going downwards.
n Stop vibrations on the patient s inhalations.
n Do not vibrate over the patient s breast,
spine, sternum, and lower rib cage.
n Vibrate during 5 exhalation over 1 affected
lung segment
n After each, encourage to cough &
expectorate secretions
 SEQUENCE OF ACTIVITIES:

1. POSITIONING
2. PERCUSSION- each assumed for 10-15
mins
3. VIBRATION
4. REMOVAL OF SECRETIONS BY
COUGHING/SUCTIONING
Percussion and Vibration
V. Postural Drainage
-use of gravity to drain secretions from the lungs
- promotes drainage of small pulmonary branches

into larger ones, where they can be removed by

drainage or coughing.
- preceded by vibration, percussion, or both.

n Have tissues and emesis basin close at hand for

the patient to use for coughing and
expectorating secretions.
Postural Drainage Positions: lower lobes,
anterior basal segment
Place the patient in trendelenburg s position
to drain the lower lobes of the lungs.
Postural Drainage Positions: lower
lobes, superior segments
Postural Drainage Positions: lower
lobes, lateral basal segment
Postural Drainage Positions:
upper lobes, anterior segment
Postural Drainage Positions: upper
lobes, posterior segments
Use a high fowlers s position to drain the apical
secretions of the upper lobes of the lungs
Postural Drainage Positions:
upper lobes, apical segment
n Use a high fowlers s position to drain
the apical secretions of the upper lobes
of the lungs
n Place a patient in a lying position, half
on his abdomen and half on his side,
right and left, to drain the posterior
secretions of the upper lobes of the
lungs.
n Place the patient lying on his left side
with a pillow under the chest wall to
drain the right middle lobe of the lung.
n Place the patient in trendelenburg s
position to drain the lower lobes of the
lungs.
n Carry out postural drainage two to four times a
day for 20 to 30 minutes. Discontinue the
drainage if the patient begins to feel weak or
faint.
n Delay postural drainage after meals for 1 to 2
hours to avoid vomiting
Suctioning Secretions from Airways
Purpose
1. Remove excess mucous secretions to
maintain patent airway
2. Collect sputum or secretions for
diagnostic testing.
Assessment/Preparation
n Assess respiratory system
n Assess client s ability to cough. Note
amount and character of sputum
n Assess vital signs, note for elevation in
temperature
n Assess level of consciousness and ability
to protect airway
Equipment
n Portable or wall suction apparatus
with tubing and reservoir
n Sterile suction kit containing:

Appropriate sized catheter: infants, 5

to 8 Fr.
children, 8 to 10 Fr
adults, 12 to 18 Fr
Pair of gloves
Container for saline to flush and
lubricate catheter
n Sterile saline
n Water resistant disposable bag

n Facial tissues
n Towel (optional)
Suction Machine (pipe-in)
Suction Machine (portable)
Suction Catheters
Procedure
n Verify the physician s order and identify the client

n Wash your hands

n Explain procedure and purpose to the client

n Position the conscious client with intact gag reflex in

a semi-Fowler s position
n Position the unconscious client in a side-lying
position facing you.
n Turn on suction device and adjust pressure:

AGE WALL UNIT PORTABLE

ADULT 100-120 10-15

CHILD 95-110 5-10

INFANT 50-95 2-5

n Open and prepare sterile suction
catheter kit,
a. Unfold sterile cup, touching only
the outside table
b. Pour sterile saline into cup
n Pre oxygenate client with 100%
oxygen. Hyper inflate with
manual resuscitation bag.
n Don sterile gloves. If kit provides
only one glove, place on
dominant hand.
n Pick up catheter with dominant
hand. Pick up connecting tubing
with non dominant hand. Attach
catheter to tubing without
contaminating sterile hand.
n Place catheter end into cup of
saline. Test functioning of
equipment by applying
thumb from non dominant
hand over open port to create
suction. Return catheter to
sterile field.
n Insert catheter to trachea
through the nostrils , or
artificial inspiration during
inspiration.
n Advance catheter until you feel
resistance. Retract catheter 1 cm
before applying suction.
n Apply suction by placing thumb of
non dominant hand over open port.
Rotate the catheter with your
dominant hand as you withdraw the
catheter. This should take 5-10
seconds.
n Hyperoxygenate and hyperinflate
using manual resuscitation bag for a
full minute between subsequent
suction passes. Encourage deep
breathing.
Connect Suction Catheter to
Suction Tubing
 Maintaining A Patent Airway
Using Artificial Airways
n In case of a totally obstructed airway an open
airway must be established in fewer than 4
minutes to prevent brain damage or death
n A partially obstructed airway can cause
hypoxemia and may result tin irreversible brain
damage which is corrected thru the useof the
following:
n Oropharyngeal and Nasopharyngeal Airways
n Endotracheal Tube
n Tracheostomy Tubes
 Oropharyngeal and Nasopharyngeal
Airways
n An oropharyngeal airways is a curved rubber
or plastic piece that is inserted into the mouth
over the posterior tongue; maintains patent
airway in through the pharynx
n It is used for conscious and semi conscious
clients.
n It is used when patient condition is
deteriorating and the airway is becoming
obstructed, because with the loss of
consciousness the muscles of the throat relax
and allow the tongue to occlude the airway,
 Oral Airway
Curved device that keeps the
tongue positioned forward
within the mouth
Endotracheal Tubes
 Endotracheal Intubation
n Placement of a tube to provide a patent airway
for mechanical ventilation and for removal of
secretions
n Purpose and complications related to the tube
cuff
n Assessment of cuff pressure
n Patient assessment
n Risk for injury/airway compromise related to
tube removal
n Patient and family teaching
 Endotracheal Tubes
n Polyvinylchloride airway that is inserted
through the nose or mouth into the trachea
using laryngoscope as a guide
n Used to administer oxygen by mechanical
ventilator, to suctions secretion easily ,or to by
pass an upper airway obstruction (Tongue or
tracheal edema)
Tracheostomy
 Tracheostomy
n Formation of an opening into the trachea
n Facilitating aspiration of secretion
n Patient is prone to infection, subject to
blockage of airway since one is no longer able
to cough out his own secretion
n Insertion of tracheostomy tube with built in
inflatable cuff which when inflated the cuff
expand to fill the entire airway to ensure that
no oxygen is lost through the leakage.