ATI Respiratory Review 2022
Pulse Oximetry - - Measures arterial oxygen saturation (SaO2, SpO2)
- Infrared light absorption by oxygenated & deoxygenated
... [Show More] Hgb in arterial blood
- <91%: require intervention
- <86%: life-threatening emergency
Nebulized Aerosol Therapy - - Nebulization: breaks up meds into minute particles to
be dispersed through resp tract
- Though hand-held nebulizer
- Used for bronchodilators or corticosteroids
- Txt can take up to 10-15min
- Slow, deep breaths w/ open mouth
- Tachycardia may result from medication
Metered-Dose Inhaler (MDI) - - Through hand-held device
- Used for bronchodilators or corticosteroids
- Can use spacer
- Procedure
1. Remove cap from inhaler.
2. Shake inhaler 5-6x.
3. Hold inhaler w/ mouthpiece at bottom. Put thumb near mouthpiece & index/middle
fingers at top.
4. Hold approximately 2-4cm (1-2in) away from front of mouth.
5. Take deep breath & exhale.
6. Tilt head back slightly & press inhaler. While pressing inhaler, begin slow, deep
breath for 3-5sec to facilitate delivery to air passages.
7. Hold breath for 10sec to allow med to deposit in airways.
8. Take inhaler out of moth & slowly exhale through pursed lips.
9. Resume normal breathing.
* Rinse inhaler, cap, spacer 1x/day w/ warm running water.
Dry Powder Inhaler (DPI) - - Through hand-held device
- Used for bronchodilators or corticosteroids
- Procedure
1. Do not shake device. Take cover off of mouthpiece.
2. Follow directions of manufacturer.
3. Exhale completely.
4. Place mouthpiece between lips & take deep breath through mouth.
5. Hold breath for 5-10sec.
6. Take inhaler out of mouth & slowly exhale through pursed lips.
7. Resume normal breathing.
* Rinse inhaler, cap, spacer 1x/day w/ warm running water.
Complications of MDI & DPI - Fungal Infections of oral cavity w/ corticosteroid use
(administer cool liquids & encourage cleaning)
Chest Physiotherapy (CPT) - - Gravity & positioning
- Percussion, vibration, postural drainage
- Loosens up respiratory secretions & moves them into central airways to be
removed by coughing, suctioning
Contraindications of CPT - - Decreased cardiac reserves
- Pulmonary embolism
- Increased ICP
CPT Pre-Procedure Nursing Care - - Schedule Tx 1hr before or 2hr after meals & at
bedtime (decrease vomiting/aspiration)
- Administer bronchodilator med or nebulizer Tx 30min-1hr before postural drainage
CPT Intra-Procedure Nursing Care - - Hand hygiene & privacy
- Proper positioning to promote drainage from specific areas
1. Apical section of upper lobes: Fowler's
2. Posterior section of upper lobes: Side-lying
3. Right lobe: Left side w/ pillow under chest
4. Left lobe: Trendelenburg
- Apply manual percussion to break up secretions
- Have pt cough after each set of vibrations
- Maintain position for 10-15min
- Stop if faint or dizzy
CPT Post-Procedure Nursing Care - - Auscultate lungs
- Assess amount, color, character of expectorated secretions
- Document
Complications of CPT - Hypoxia
- Monitor respiratory status
- Discontinue w/ dyspnea
Oxygen Therapy - - Increases oxygen concentration of air being breathed
- Humidification: moistens airways, promoting loosening & mobilization of pulmonary
secretions & prevents drying & injury of respiratory structures
- Use w/ hypoxemia
Early Signs of Hypoxemia - - Tachypnea
- Tachycardia
- Restlessness
- Pallor of skin & mucous membranes
- Elevated BP
- Symptoms of respiratory distress (accessory musle use, nasal flaring, tracheal
tugging, adventitious lung sounds)
Late Signs of Hypoxemia - - Confusion, stupor
- Cyanosis of skin & mucous membranes
- Bradypnea
- Bradycardia
- Hypotension
- Cardiac dysrhythmias
Oxygen Administration - 1. Warm oxygen to prevent hypothermia.
2. Place child in semi-Fowler's or Fowler's position to facilitate breathing & promote
chest expansion.
3. Provide oxygen at lowest liter flow that will correct hypoxemia.
4. Assess/monitor lung sounds, respiratory rate/rhythm/effort
5. Don't let oxygen blow directly in the face.
6. Discontinue oxygen gradually.
Oxygen Hood - - Small plastic hood that fits over infant's head
- Use minimum flow rate (4-5L/min) to prevent CO2 build-up
- Ensure neck, chin, shoulders don't rub against hood
- Continuous pulse ox
Oxygen Tent - - Large plastic tent that fits over crib or bed
- Provides oxygen & humidity
- For children older than 2-3mo
- Set tent on high flow rate to flood tent w/ oxygen
- Then, adjust flow meter to desired amount before placing child into tent
- Hard to maintain oxygen level >30-50%
- Keep tent around perimeter of bed
- Plan care to minimize how often tent is opened
- Monitor temp inside tent
- Use plastic or vinyl toys
- Keep child warm & dry
Nasal Cannula - - Disposable plastic tube w/ 2 prongs
- Delivers O2 concentrations of 24-40% at flow rate of 1-6L/min
- Safe, easy to apply, well-tolerated
- Child can eat, talk, ambulate
- Used by infants & older children
- Assess patency of nares & make sure that they fit properly
- Can cause skin breakdown & dry mucous membranes
- Provide humidification w/ >4L/min
Pediatric Face Mask - - Covers child's nose & mouth
- Not tolerated well
Complications of Oxygen Therapy - Combustion
- No flammable materials, smoking, sparking toys near oxygen
- Cotton gown & well-grounded electric devices only
Oxygen toxicity
- Can result from high concentrations of oxygen, long duration, lung disease
- Signs & symptoms: nonproductive cough, substernal pain, nasal stuffiness,
nausea, vomiting, fatigue, headache, sore throat, hypoventilation
- Use lowest level of oxygen needed
- Monitor ABGs & pulse ox
- Decrease amount of oxygen gradually
Suctioning - - Oral, nasal, endotracheal (ETS)
ETS Pre-Procedure Nursing Care - 1. Hand hygiene
2. Assist to high-Fowler's or Fowler's position
3. Though tracheostomy or endotracheal tube
4. Obtain suction catheter w/ outer diameter of no more than 1cm (0.5in) of internal
diameter of endotracheal tube
5. Hyperoxygenate child
6. Obtain baseline breath sounds & VS
ETS Intra-Procedure Nursing Care - 1. Open sterile suction package using surgical
asceptic technique
2. Place sterile drape or towel on child's chest
3. Set up container & pour 100mL of sterile water or NS
4. Use sterile gloves (left hand to hold connecting tube, right hand to hold sterile
catheter)
5. Connect suction catheter to wall unit's tubing
6. Set suction pressure to <110mmHg (children), <95mmHg (infants); use lowest
possible
7. Test suction set-up by aspirating splution from cup
8. Remove bag/ventilator from tracheostomy or endotracheal tube & insert catheter
into lumen of airway
9. Advance catheter until resistance met (should reach to carina)
10. Pull catheter back 0.5cm (0.2in) prior to applying suction
11. Apply suction intermittently by covering & releasing suction port w/ thumb for
5sec at a time
12. Apply suction only while w/drawing catheter & rotating with thumb & forefinger
13. Only suction for <5sec & only suction 2-3x
14.Reattach bag or ventilator & supply oxygen
15. Clear catheter & tubing
16. Allow 30-60sec to allow child to recover btwn sessions
17. When complete, clear suction tubing by aspirating sol'n
Complications of Suctioning - Hypoxia
- Stop
- Limit suction attempt to <10-15sec
- Limit suction to 2-3 attempts
- Allow child 30-60sec to recover btwn sessions
- Hyperoxygenate child before & after suctioning pass
Artificial Airways - - Orotracheal, nasotracheal, tracheostomy
- Tracheotomy: sterile surgical incision into trachea through skin & muscles for
purpose of establishing airway; emergency or scheduled
- Tracheostomy: stoma/opening that results from tracheotomy; permanent or
temporary
Nursing Care for Tracheostomy - - Use uncuffed endotracheal tube for children <8yr
- Assess oxygenation, ventilation, VS q1h
- Assess secretion characteristics
- Assess stoma & skin surrounding it...... [Show Less]