ATI Respiratory Review 2022

ATI Respiratory Review 2022 Pulse Oximetry - - Measures arterial oxygen saturation (SaO2, SpO2) - Infrared light absorption by oxygenated & deoxygenated 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......