Ther 2, Module 1

Front 1

Dyspnea

Back 1

Difficulty breathing

Front 2

Atelectasis

Back 2

The collapse of alveoli that occurs when the lungs are not fully ventilated

Front 3

Orthopnea

Back 3

Difficulty breathing when lying down

Front 4

Effective breathing

Back 4

Some chronic conditions result in loss of elasticity of the lungs—air gets trapped in alveoli. Certain breathing exercises can strengthen the accessory muscles of respiration and result in better oxygenation. such as pursed lip breathing and diaphragmatic breathing

Front 5

pursed lip breathing

Back 5

the client is taught to contract the lips—this creates a smaller opening to air outflow, and thus increases resistance to exhalation slightly. The end result is that the expiratory phase is lengthened, which helps prevent alveoli from collapsing while maximally expelling air from the lungs. Exhalation should take twice as long as inhalation. Teach patient to breathe in through nose (count “1..2..”) and exhale through pursed lips (count “1…2…3…4…”). Having patients blow through a straw into a glass of water may help patients to learn to gain control of the expiratory phase. Many patients with chronic lung disease breathe through pursed lips “automatically”

Front 6

helps to remove secretions and keep alveoli open. Inhaling as deeply as possible allows air to bypass mucus that partially obstructs the airway. Patients often need help and encouragement with coughing after surgery, when it hurts to inhale deeply and cough. Splinting helps.

Back 6

what does coughing do?

Front 7

. If they can’t reposition themselves and you need to assist, breathing is almost always easier the more “upright” a client can get. Whenever a client is having difficulty breathing, THE VERY FIRST THING TO DO is to raise the head of the bed (if permitted). Gravity causes the abdominal contents to “move away” from the lungs, thus allowing the lungs to expand more freely.

Back 7

What does moving the bed "upright" do?

Front 8

incentive spirometry

Back 8

A device that encourages deep inspiration (and, consequently, full expansion of alveoli) by providing a visual goal. The most common type is a disposable plastic device in which slow steady inspiration causes a ball to rise in a graduated plastic column. The client is given a “goal”, and encouraged to “hold” the ball at the selected level for 3 seconds. Postoperatively, clients often are helped to use the device. It is important for proper function that the device be held so that it is straight up-and-down.10-20 times per hour to prevent atelectasis.

Front 9

Metered-Dose Inhalers (MDI)

Back 9

used to deliver precise doses of medication directly to the lungs. Mostly used for asthma control drugs.

Front 10

a. Higher concentrations of medication can be delivered directly to the inflamed lung tissue
b. Avoid systemic effects (particularly of steroids).

Back 10

why use inhaled route?

Front 11

Pulse Oximetry

Back 11

A method of assessing the oxygen saturation of hemoglobin. MUCH more reliable than visually examining the patient for cyanosis as an indicator of hypoxia. Recently, instrumentation has become portable, and much cheaper. Measurement can be intermittent or continuous. In this technique, a sensing device is clipped to a patient’s finger (most common), earlobe, or nose. A photoelectric cell in the sensor records the amount of light, generated by a light-emitting diode that is transmitted by the hemoglobin (there is a difference in transmission between hemoglobin saturated with oxygen and hemoglobin that is desaturated) and converts it to a digital readout.

Front 12

The normal SAO2 is 95 or greater. Saturation levels below 90 are associated with critical levels of hypoxia.

Back 12

what is the normal SAO2 level?

Front 13

oral suctioning

Back 13

suctioning of the mouth. It is a clean, rather than sterile, procedure. Often a Yankauer tip is used (demo). It is usually used when the patient can cough up sputum from the lungs but can’t get it past the oropharynx

Front 14

Endotracheal suctioning

Back 14

involves the use of a soft whistle-tip catheter to actually enter the trachea (and perhaps the bronchi). Usually the catheter is inserted through the nares. In the acute phase, it is usually done as a sterile procedure (although clean technique is often used for long-term patients at home when their respiratory system has “acclimated” to being suctioned). After the suction is turned on at the wall, the catheter has a thumb control that “turns the suction on and off”. The procedure will be demonstrated in detail in the video. Whenever the suction is turned on, it is important to remember that not only is sputum being removed, but oxygenated air is being stolen from the lungs as well. Dangerous hypoxemia can result.