Respiratory Therapy Techniques

Incentive Spirometry

• Encourages deep, slow breaths to fully expand lungs and prevent atelectasis, collapse, or pneumonia
• Used for post-operative and respiratory patients
• Patients inhale with the device to raise balls/piston higher with each breath
• Teach patients not to exhale into device to avoid injury
• Set goals with patients and monitor for progress

BiPAP/CPAP

• Machines delivering oxygen and air into lungs with pressure to prevent throat closure
• Used for patients with sleep apnea
• CPAP: Set for single pressure
• BiPAP: Timed according to patient's breathing pattern
• Secured across nose and around mouth and back of head
• Avoid tying straps too tight

Endotracheal Tube

• Tubing inserted through mouth or nose to provide airway when patient cannot breathe independently
• Used to support ventilation during surgery or life-saving measures
• Sterile technique required when suctioning to prevent pneumonia and respiratory illnesses
• Procedure must be completed quickly to prevent hypoxia

Tracheostomy Collar

• Incision into trachea with tubing to promote breathing without endotracheal tube
• Used for long-term ventilation, temporarily or permanently
• Tracheostomy performed after 7 days of endotracheal tube use to prevent tracheal erosion
• Made up of 3 parts: outer cannula, obturator, and inner cannula
• Inner cannula requires sterility when suctioning and cleaning

Suction and Cleaning of Tracheostomy Collar

• Aseptic technique used to remove mucus buildup
• Clean inner cannula with hydrogen peroxide and saline, then rinse, dry, and reinsert every 8 hours
• Sterile technique used unless permanent, then clean technique can be used

Chest Tubes

• Used to resolve pressure disturbances in the lungs, preventing full expansion
• If untreated, causes dyspnea, chest pain, hypoxia, and respiratory distress
• Air in the pleural space/cavity is referred to as pneumothorax
• Blood and drainage present is called hemothorax

Chest Tube Management

• Chamber One: Wet suction to remove drainage from pleural space
• Chamber Two: Water seal, establishing negative pressure in pleural space and allowing air to escape
• Air bubble indicates possible air leaks
• Chamber Three: Collection chamber for blood and fluids from pleural cavity
• Monitor drainage by checking every 8 hours with date, time, and initials

Nasopharyngeal and Oropharyngeal Suction

• Sterile procedure
• Listen to lungs before and after procedure
• Hyperoxygenate by increasing oxygen two liters above order for a minute before suctioning
• Be quick when suctioning to prevent hypoxia and maintain sterility
• Use a pulse oximeter to monitor oxygen saturation
• Evaluate patient's feelings after the procedure

Foley Catheter

• Perform a bladder scan and assess for signs and symptoms before inserting
• Indications: bladder retention, inability to control urination, producing less than 30 mL/hr of urine
• Prevent damage to open wounds in sacral or perineal area
• Used for surgical patients after abdominal or urological surgeries
• Comfort at end of life

Foley Catheter Management

• Sterile procedure
• If sterility is broken, risk of UTI is greatly increased
• Complications: enlarged prostate in male patients, atrophy in older female patients
• Measured in French to determine outer diameter of the catheter

NG Feeding

• NG Tube: inserted into the stomach to assist with gastric decompression
• NI Tube: inserted into the duodenum or jejunum, flexible
• Always perform an abdominal assessment before procedure
• Always verify placement of tubing by using pH strip, x-ray, and checking for residual
• Use clean technique when inserting
• Irrigate before and after giving medications, and when starting feedings
• Check residual content in the stomach to prevent overflowing and confirm feeding type before starting

Nasogastric Tube (NGT) Insertion

• Prepare the patient and explain the procedure before inserting the NGT
• Measure the tube from the nose to the earlobe and then to the xiphoid process to ensure proper length
• Lubricate the tube with water or lubricant to facilitate smooth insertion
• Insert the tube through the nostril, aiming towards the back of the throat, and advance as the patient swallows
• Rotate the tube as needed and verify the tube's position by aspirating stomach contents or using a pH indicator

Types of NGT Insertion

• Blind insertion: inserting the NGT without visualization
• Endoscopic insertion: inserting the NGT with visualization using a flexible endoscope
• Fluoroscopic insertion: inserting the NGT with visualization using X-ray

Nutrition Management

Nutrition Assessment

• Evaluate patient's nutritional needs and status considering factors such as age, weight, height, and medical condition

NGT Feeding Regimens

• Continuous feeding: continuous infusion of formula over 24 hours
• Intermittent feeding: feeding at set intervals (e.g., every 4 hours)
• Bolus feeding: feeding a large volume of formula at one time

Formula Selection

• Standard formula: for general nutrition support
• Specialized formula: for specific nutritional needs (e.g., diabetes, renal disease)

Complication Prevention

Common Complications

• Aspiration
• Tube displacement or clogging
• Nasal or sinus trauma
• Gastrointestinal bleeding or perforation

Prevention Strategies

• Secure the tube with tape or a tube holder
• Monitor tube position and patency regularly
• Use a pH indicator to verify tube placement
• Administer medications carefully to avoid tube clogging

Medication Administration

• Crush or dissolve medications in water before administration
• Flush the tube with water before and after medication administration
• Administer medications slowly and in small volumes
• Avoid administering medications that can clog the tube (e.g., thick liquids)
• Consider using liquid or crushed forms of medications

Patient Assessment

Pre-Insertion Assessment

• Evaluate patient's overall health and medical condition
• Assess patient's ability to cooperate with the procedure

Post-Insertion Assessment

• Monitor patient's tolerance to the tube and feeding regimen
• Evaluate patient's nutritional status and adjust feeding regimen as needed

Ongoing Assessment

• Monitor tube placement and patency regularly
• Evaluate patient's comfort and report any signs of complications

Ostomies

• A type of surgical diversion that redirects the flow of waste from the body to the abdominal wall
• Can be temporary or permanent, depending on the underlying condition

Colostomy

• A type of ostomy that diverts the colon to the abdominal wall
• Created to allow the passage of stool when the anus or rectum is not functioning properly
• Types of colostomies:
  • End colostomy: involves closing the distal end of the colon and bringing the proximal end to the surface of the abdomen
  • Loop colostomy: involves creating a loop of colon on the surface of the abdomen, allowing for both proximal and distal ends to be brought to the surface

Ostomy Care

• Importance of proper ostomy care:
  • Prevents complications such as infection, skin irritation, and peristomal hernias
  • Promotes healthy skin and stoma
• Steps for ostomy care:
  • Clean the stoma and surrounding skin
  • Apply a barrier ring or paste to protect the skin
  • Attach the ostomy pouch or appliance
  • Empty the pouch regularly
  • Monitor for signs of complications

Ileostomy

• A type of ostomy that diverts the small intestine to the abdominal wall
• Created to allow the passage of digestive waste when the colon or rectum is not functioning properly
• Types of ileostomies:
  • End ileostomy: involves closing the distal end of the small intestine and bringing the proximal end to the surface of the abdomen
  • Loop ileostomy: involves creating a loop of small intestine on the surface of the abdomen, allowing for both proximal and distal ends to be brought to the surface

Urostomy

• A type of ostomy that diverts the urinary system to the abdominal wall
• Created to allow the passage of urine when the bladder or urethra is not functioning properly
• Types of urostomies:
  • Ileal conduit: involves creating a passage from the ureters to the abdominal wall using a segment of small intestine
  • Ureterosigmoidostomy: involves connecting the ureters to the sigmoid colon

Ostomy Surgery

• Types of ostomy surgeries:
  • Elective surgery: planned surgery to create an ostomy for a non-emergency condition
  • Emergency surgery: surgery to create an ostomy in response to a life-threatening condition
• Risks and complications of ostomy surgery:
  • Infection
  • Bleeding
  • Adhesions
  • Peristomal hernias

LVN (Licensed Vocational Nurse) Role in Ostomy Care

• Responsibilities of an LVN in ostomy care:
  • Educating patients on ostomy care and management
  • Assisting with ostomy pouch changes and maintenance
  • Monitoring for signs of complications
  • Providing emotional support and counseling to patients and their families
• Importance of LVNs in ostomy care:
  • LVNs provide essential care and support to patients with ostomies
  • LVNs play a key role in promoting healthy skin and stoma, and preventing complications

Nasopharyngeal Suction

• Insert nasal trumpet or flexible suction catheter 2-3 inches into the nostril
• Advance slowly while suctioning

Oropharyngeal Suction

• Use Yankauer suction device or flexible suction catheter
• Insert into the mouth, aiming towards the back of the throat
• Suction in a gentle, sweeping motion

Equipment

• Nasal trumpet
• Flexible suction catheter
• Yankauer suction device
• Suction source (e.g. suction machine or wall suction)

Contraindications

• Nasopharyngeal suction: recent nasal or sinus surgery, nasal polyps or tumors, recent trauma to the face or nose
• Oropharyngeal suction: recent oral or laryngeal surgery, bleeding disorders or anticoagulant therapy, tracheostomy or laryngectomy

Indications

• Nasopharyngeal suction: excess nasal secretions, nasal bleeding, foreign body removal
• Oropharyngeal suction: excess oral secretions, oral bleeding, airway obstruction

Complications

• Nasopharyngeal suction: nasal trauma or bleeding, infection, epistaxis
• Oropharyngeal suction: oral trauma or bleeding, infection, laryngospasm

LVN Considerations

• Assist with suctioning procedures
• Monitor patient's vital signs and oxygen saturation during suctioning
• Provide emotional support and reassurance to patients during suctioning procedures

Indwelling Catheter Care

• Prevents infection, reduces discomfort, and promotes healing
• Key steps include cleaning the catheter with soap and water, securing the catheter with a catheter strap, monitoring for signs of infection, changing the catheter bag regularly, and performing routine catheter care (e.g., every 8 hours)

Catheter Sizes

• Measured in French units (Fr): 1 Fr = 0.33 mm
• Common sizes: Adult (12-18 Fr), Pediatric (8-14 Fr), Neonatal (5-8 Fr)
• Selection based on individual patient needs and anatomy

Catheterization Complications

• Infection: Urinary Tract Infections (UTIs), sepsis, and catheter-associated bacteriuria
• Trauma: Hemorrhage, urethral injury, and bladder perforation
• Allergic reactions: Latex allergy or sensitivity to catheter materials
• Obstruction: Catheter blockage or kinking
• Patient discomfort: Pain, anxiety, and decreased mobility

Catheter Maintenance

• Regular cleaning and disinfection of the catheter and drainage system
• Monitoring for signs of infection or obstruction
• Securing the catheter to prevent accidental removal
• Documenting catheter care and maintenance in patient records

Urinary Catheterization

• Indications: Urinary retention, incontinence, surgery, or medical conditions
• Contraindications: Urinary tract infection, bleeding, or urethral injury
• Types of catheterization: Intermittent (temporary catheter insertion for bladder drainage), Indwelling (long-term catheter insertion for continuous drainage)

LVN (Licensed Vocational Nurse) Role in Foley Catheter Care

• Assesses patient's need for catheterization
• Inserts and removes catheters under the supervision of a registered nurse (RN) or physician
• Provides catheter care and maintenance
• Monitors patient for signs of complications and reports to RN or physician
• Documents patient's response to catheterization and catheter care