Supporting Oxygen Needs

• Oxygen is a basic life need.
• Brain damage and serious illnesses can occur quickly if there is insufficient oxygen.
• PSWs assist but do not "give" oxygen.
• The oxygen level should not be adjusted.

Supporting Oxygen Needs Task Considerations

• To support a client's O2 needs, it must be allowed in a PSW's province or territory.
• The task must be within the job description.
• PSW's must have the necessary training and know how to use the equipment.
• The task must be reviewed with a nurse.
• A nurse or technician must supervise the task.

Altered Respiratory Function Processes

• Involves air moving into and out of the lungs.
• Oxygen and CO2 are exchanged at the alveoli.
• Blood carries oxygen to cells and removes carbon dioxide.
• Cells, tissues, and organs die without oxygen (O2).
• The inability to excrete carbon dioxide (CO2) leads to death.
• The respiratory and cardiovascular systems work together to deliver oxygen and excrete carbon dioxide.
• Proper oxygenation and carbon dioxide excretion requires both systems to function optimally.
• A malfunction in any body system can impact oxygenation since all body systems work together.

Factors Affecting Oxygen Needs

• Respiratory system function relies on an open airway.
• Respiratory system function requires an adequate number of alveoli, necessary to absorb oxygen and excrete carbon dioxide.
• Circulatory system function depends on red blood cell count.
• Circulatory system function requires hemoglobin to pick up and carry oxygen.
• Circulatory system requires bone marrow to produce RBC's.
• Examples of possible respiratory issues: asthma, and upper respiratory infections
• Examples of possible circulatory issues: iron deficiency, anemia, blood loss, cancers of the blood
• Nervous system function is affected by disease or injury to respiratory muscles.
• Brain deterioration can affect signals to the rest of the body to breathe.
• Some illnesses asstroke, ALS, and multiple sclerosis can cause nervous system dysfunction.
• Muscles weaken, lungs become less elastic with age causing difficulty coughing.
• Exercise requires more oxygen.
• Fever increases oxygen needs, as the body works harder to fight infection.
• Pain increases oxygen needs, chest or abdominal surgery can make it difficult.
• Good nutrition is necessary to produce RBCs.
• Certain drugs such as morphine and narcotics depress the respiratory center or cause respiratory arrest.
• People with substance abuse problems are at risk for respiratory depression or arrest
• Smoking can damage lung tissue, which leads to lung cancer and COPD.
• Allergies Swelling of upper airway can result in chronic bronchitis, asthma, and death.
• Pollutant exposure damages lungs.
• Alcohol depresses the cough reflex, and increases risk of aspiration.

Signs and Symptoms of Altered Respiratory Function

• Shortness of breath (SOB) can be acute or chronic.
• Clients may feel anxious or panic, when they can't breathe.
• Struggling to breathe can be exhausting.
• Shortness of breath on exertion (SOBOE) can occur.
• "On exertion" means with activity, which is different from SOB at rest.
• Client may prefer to sit up in bed or chair, since it is difficult to breathe when lying flat (orthopnea).

Observable Signs and Symptoms

• Notice any abnormal breathing pattern.
• Note the frequency of cough.
• Note whether a cough is productive or non-productive.
• Observe the colour, odour, and consistency of sputum. Note if there is any blood (hemoptysis).
• Listen for noisy respirations such as wheezing and gurgling.
• Be aware of any chest pain.
• Look for cyanosis or a grey/pale hue in the skin. Can be seen in lips, nail beds, skin, mucous membranes
• Monitor for increased heart and respiratory rate. And decreased SpO2
• Observe the body position of client who wants to sit up and forward as body's effort to expand chest.

Abnormal Respiratory Patterns

• Tachypnea = rapid breathing, with respiration more than 24 per minute.
• Bradypnea = slow breathing, with respiration fewer than 12 per minute.
• Apnea = lack or absence of breathing.
• Sleep apnea and periodic apnea of newborns are other types of apnea.
• Kussmaul respirations = deep and rapid respirations, that are characteristic of diabetic acidosis
• Hypoventilation = slow, shallow, and sometimes irregular breaths.
• Hyperventilation = respirations are rapid and deeper than normal
• Dyspnea = Difficult, labored, or painful breathing
• Cheyne-Stokes = Respirations gradually increase in rate and depth and then become shallow and slow.
• Breathing may stop for 10 to 20 seconds with Cheyne-Stokes.
• Cheyne-Stokes respirations are common when death is near.
• Orthopnea = breathing deeply and comfortably only when sitting.

Hypoxia

• Hypoxia is a deficiency of oxygen in the cells that stops them from functioning properly.
• Any factor that affects respiratory function can cause hypoxia.
• The brain is very sensitive to inadequate oxygen supply.
• Early signs of hypoxia include restlessness, dizziness, and disorientation. These signs are easy to miss and confuse with aging or dementia.
• Hypoxia is life threatening and the signs and symptoms must be reported immediately.

Promoting Oxygenation

• To get enough oxygen, air must reach the alveoli to exchange O2 and CO2.
• Disease and injury can prevent air from reaching the alveoli, and can be prevented with deep breathing and coughing.
• Pain and immobility interfere with deep breathing and coughing.
• Narcotics can interfere with deep breathing and coughing.
• Care plan will outline measures to promote oxygenation.

Positioning

• Breathing is easier in semi-Fowler's and Fowler's positions.
• Clients with difficulty breathing often prefer the orthopneic position.
• Unless there are positioning restrictions, the client should never lie on one side for long periods.
• Frequent position changes are needed at least every 2 hours.

Deep Breathing and Coughing

• Deep breathing moves air into most parts of the lungs.
• Coughing removes mucus.
• Deep breathing and coughing help prevent pneumonia and atelectasis (lung collapses).
• Clients may be reluctant to do exercises as painful after injury or surgery, or be afraid of breaking open an incision.
• The postsurgical period, bed rest, lung disease, and paralysis are factors for atelectasis
• Deep breathing and coughing may be done every 1-2 hours or four times a day, as ordered.

Incentive spirometry

• Is a machine that measures the amount of air inhaled.
• It is also known as sustained maximal inspiration [SMI].
• Incentive spirometry provides a visual guide for the client with a goal to improve lung function.
• The client takes slow, deep breath until the balls rise to the desired height.
• The client hold his breath for at least 3 seconds, and exhales slowly.
• The client's care plan or supervisor gives instructions about how often the client should use it, the desired height, and the number of breaths needed.

Assisting with Oxygen Therapy

• Oxygen is treated as a drug because some clients need oxygen constantly, and others need it for symptom relief.
• Support workers do not give oxygen.
• You assist the nurse in providing safe care.
• PSW's may be trained to transfer oxygen or provide oral suction.

Oxygen sources:

• There are 3 main delivery systems:
• Oxygen concentrator which filters oxygen from the air in the room. It is plugged into a grounded electrical outlet.
• Oxygen cylinder that contains compressed oxygen. The oxygen tank is placed at the bedside.
• Liquid oxygen system uses a portable unit filled from a stationary container which unit can be worn over the shoulder.
• Oxygen is piped directly into a person's unit through a wall oxygen outlet in hospitals and some continuing care facilities.

Oxygen therapy

• ASSIST with oxygen therapy.
• Do not administer oxygen.
• Give safe care to clients receiving oxygen by following safety guidelines.

Oxygen and Fire Safety

• Keep oxygen source away from heat and open flame because oxygen is flammable.
• Physician, nurse, and respiratory therapist are responsible for teaching client and family members about oxygen safety.
• Warn client of dangers and the safety hazard, and report concerns to supervisor.

Oxygen Administration Devices

• Oxygen can be delivered by nasal cannula, simple face mask, partial-rebreather mask, non-rebreather mask, and Venturi mask.
• Moisture can build up under the mask so face should be cleaned and dried.
• Mask can easily cause skin breakdown so face must be cleaned and dried.
• Masks are typically removed for eating, where oxygen is given by the cannula during meals.
• Masks are sometimes changed from masks to nasal cannula

Oxygen Administration Set-up

• If oxygen is not humidified, it will dry the airway's mucous membranes.
• Distilled water is often added to the humidifier.

Oxygen Flow Rates

• The flow rate is the amount of oxygen given, measured in liters per minute (L/min).
• The doctor orders the flow rate or orders a range for the nurse to adjust according to the patient's condition.
• The nurse or respiratory therapist sets the flow rate.
• The nurse and care plan will tell you the person's flow rate.
• Your role is to know the flow rate that is ordered and check that the flow rate is correct.
• Tell the supervisor at once if the flow rate is too high or too low, and a nurse or respiratory therapist will adjust the flow rate.

Collecting Sputum Specimens

• Sputum is mucus from the respiratory system, not saliva (spit).
• Sputum is studied for blood microbes and abnormal cells.
• The client will have to cough up sputum from the bronchi and trachea which can be painful or hard to do.
• The specimen should be collected in the morning.
• Instruct the client not to use mouthwash prior to the procedure.
• Acknowledge that the procedure can be embarrassing so provide privacy and follow standard practices.

Artificial Airways

• Artificial airways keep the airway open.
• They are needed for disease, injury, secretions, or aspiration where they obstruct the airway.
• They are needed for mechanical ventilation, some clients who are semi-conscious or unconscious, and the client is recovering from anaesthesia.
• Intubation means inserting an artificial airway.
• Common types of these airways are oro-pharyngeal, naso-pharyngeal, endo-tracheal (ET), and tracheostomy tube.
• An oro-pharyngeal airway is inserted through the mouth and into the pharynx.
• A naso-pharyngeal airway is inserted through a nostril.
• An endo-tracheal (ET) tube is inserted through the mouth or nose and into the trachea.
• A cuff is inflated to keep the airway in place
• A tracheostomy tube is inserted through a surgically created opening into the trachea and cuffed tubes are common.

Care Measures for Client With Artificial Airways

• Vital signs are checked often, and observe for hypoxia and other signs and symptoms.
• If an airway comes out or is dislodged, tell the nurse at once.
• Frequent oral hygiene is needed, and follow the care plan.
• Follow the care plan for communication methods to comfort and reassure the client.
• Always keep the call bell within reach.
• Use touch to show you care, if appropriate for your client's culture and ethnicity.

Tracheostomy

• A tracheostomy is a surgically created opening into the trachea and can be temporary or permanent.
• A tracheostomy tube has three parts: the obturator, the inner cannula, and the outer cannula.
• The obturator is used to guide the insertion of the outer cannula.
• The inner cannula is inserted and locked in place, but the outer cannula is not removed.
• The tube must not come out (extubation), and must remain patent.
• A loose tube can damage the trachea.
• If the client is unable to cough up secretions, suctioning is needed.

Safety Measures for Clients With Tracheostomies

• Call for the nurse or supervisor if you note signs and symptoms of hypoxia or respiratory distress, or if the outer cannula comes out.
• Nothing must enter the stoma.
• Tracheostomy care involves cleaning the inner cannula to remove mucus and keep the airway patent.
• Cleaning the stoma to prevent infection and skin breakdown.
• Apply clean ties or a Velcro collar to prevent infection.
• The stoma or tube should always be covered when the client goes outside.
• Never cover stoma with plastic or leather.
• The client should take tub baths instead of showers and water should never enter the stoma.
• Medical Alert jewellery should always be worn.
• Trachea dressing should never have anything that can be inhaled.

Suctioning the Airway

• Secretions can collect in the upper airway.
• Retained secretions can obstruct air flow into and out of the airway, and provide an environment for microbes.
• Retained secretions can also interfere with oxygen (O2) and carbon dioxide (CO2) exchange.
• Hypoxia can occur due to retained secretions.
• Persons who cannot cough or have a cough that is too weak to remove secretions need suctioning.
• Suction is the process of withdrawing or sucking up fluid (secretions).

Suctioning Sites

• These routes are used to suction the airway such as oro-pharyngeal, naso-pharyngeal, and lower airway.
• Oro-pharyngeal involves suctioning the mouth and pharynx.
• Naso-pharyngeal involves suctioning the nose and pharynx.
• Lower airway involves the suction catheter being passed through an endotracheal (ET) or tracheostomy tube.

Safety Measures for Suctioning

• If suctioning is not done correctly, the client may be unable to breathe and hypoxia can occur.
• Life threatening complications can arise.
• Client's lungs are hyperventilated prior to suctioning by use of an ambu bag.
• You must ensure that suctioning is within your scope of practice for your province or agency.

Mechanical Ventilation

• Mechanical ventilation is using a machine to move air into and out of the lungs.
• It is needed for a variety of health care problems where by there is hypoxia from weak muscle effort, airway obstruction, and damaged lung tissue.
• It is needed for nervous system diseases and injuries that can affect the respiratory centre which interferes with messages between the lungs and the brain.
• It is needed for drug overdoses that can depress the brain's hypothalamus or the breathing control centre.

Chest Tubes

• The doctor inserts chest tubes to remove the air, blood, or fluid.
• Chest tubes attach to a drainage system.
• The system must be airtight, and water-seal drainage keeps the system airtight.

Caring for Chest Tubes

• Keep drainage system below the level of the chest.

• Keep tubing coiled on the bed with no kinks.

• Check vital signs as directed.

• Observe chest drainage.

• Turn and reposition the client carefully.

• Assist with deep breathing, coughing, and incentive spirometry.

• Keep sterile petrolatum gauze at bedside.

• Oxygen is a basic life need.

• Brain damage and serious illnesses can occur quickly if there is insufficient oxygen.

• PSWs assist but do not "give" oxygen.

• The oxygen level should not be adjusted.

Supporting Oxygen Needs Task Considerations

• To support a client's O2 needs, it must be allowed in a PSW's province or territory.
• The task must be within the job description.
• PSW's must have the necessary training and know how to use the equipment.
• The task must be reviewed with a nurse.
• A nurse or technician must supervise the task.

Altered Respiratory Function Processes

• Involves air moving into and out of the lungs.
• Oxygen and CO2 are exchanged at the alveoli.
• Blood carries oxygen to cells and removes carbon dioxide.
• Cells, tissues, and organs die without oxygen (O2).
• The inability to excrete carbon dioxide (CO2) leads to death.
• The respiratory and cardiovascular systems work together to deliver oxygen and excrete carbon dioxide.
• Proper oxygenation and carbon dioxide excretion requires both systems to function optimally.
• A malfunction in any body system can impact oxygenation since all body systems work together.

Factors Affecting Oxygen Needs

• Respiratory system function relies on an open airway.
• Respiratory system function requires an adequate number of alveoli, necessary to absorb oxygen and excrete carbon dioxide.
• Circulatory system function depends on red blood cell count.
• Circulatory system function requires hemoglobin to pick up and carry oxygen.
• Circulatory system requires bone marrow to produce RBC's.
• Examples of possible respiratory issues: asthma, and upper respiratory infections
• Examples of possible circulatory issues: iron deficiency, anemia, blood loss, cancers of the blood
• Nervous system function is affected by disease or injury to respiratory muscles.
• Brain deterioration can affect signals to the rest of the body to breathe.
• Some illnesses asstroke, ALS, and multiple sclerosis can cause nervous system dysfunction.
• Muscles weaken, lungs become less elastic with age causing difficulty coughing.
• Exercise requires more oxygen.
• Fever increases oxygen needs, as the body works harder to fight infection.
• Pain increases oxygen needs, chest or abdominal surgery can make it difficult.
• Good nutrition is necessary to produce RBCs.
• Certain drugs such as morphine and narcotics depress the respiratory center or cause respiratory arrest.
• People with substance abuse problems are at risk for respiratory depression or arrest
• Smoking can damage lung tissue, which leads to lung cancer and COPD.
• Allergies Swelling of upper airway can result in chronic bronchitis, asthma, and death.
• Pollutant exposure damages lungs.
• Alcohol depresses the cough reflex, and increases risk of aspiration.

Signs and Symptoms of Altered Respiratory Function

• Shortness of breath (SOB) can be acute or chronic.
• Clients may feel anxious or panic, when they can't breathe.
• Struggling to breathe can be exhausting.
• Shortness of breath on exertion (SOBOE) can occur.
• "On exertion" means with activity, which is different from SOB at rest.
• Client may prefer to sit up in bed or chair, since it is difficult to breathe when lying flat (orthopnea).

Observable Signs and Symptoms

• Notice any abnormal breathing pattern.
• Note the frequency of cough.
• Note whether a cough is productive or non-productive.
• Observe the colour, odour, and consistency of sputum. Note if there is any blood (hemoptysis).
• Listen for noisy respirations such as wheezing and gurgling.
• Be aware of any chest pain.
• Look for cyanosis or a grey/pale hue in the skin. Can be seen in lips, nail beds, skin, mucous membranes
• Monitor for increased heart and respiratory rate. And decreased SpO2
• Observe the body position of client who wants to sit up and forward as body's effort to expand chest.

Abnormal Respiratory Patterns

• Tachypnea = rapid breathing, with respiration more than 24 per minute.
• Bradypnea = slow breathing, with respiration fewer than 12 per minute.
• Apnea = lack or absence of breathing.
• Sleep apnea and periodic apnea of newborns are other types of apnea.
• Kussmaul respirations = deep and rapid respirations, that are characteristic of diabetic acidosis
• Hypoventilation = slow, shallow, and sometimes irregular breaths.
• Hyperventilation = respirations are rapid and deeper than normal
• Dyspnea = Difficult, labored, or painful breathing
• Cheyne-Stokes = Respirations gradually increase in rate and depth and then become shallow and slow.
• Breathing may stop for 10 to 20 seconds with Cheyne-Stokes.
• Cheyne-Stokes respirations are common when death is near.
• Orthopnea = breathing deeply and comfortably only when sitting.

Hypoxia

• Hypoxia is a deficiency of oxygen in the cells that stops them from functioning properly.
• Any factor that affects respiratory function can cause hypoxia.
• The brain is very sensitive to inadequate oxygen supply.
• Early signs of hypoxia include restlessness, dizziness, and disorientation. These signs are easy to miss and confuse with aging or dementia.
• Hypoxia is life threatening and the signs and symptoms must be reported immediately.

Promoting Oxygenation

• To get enough oxygen, air must reach the alveoli to exchange O2 and CO2.
• Disease and injury can prevent air from reaching the alveoli, and can be prevented with deep breathing and coughing.
• Pain and immobility interfere with deep breathing and coughing.
• Narcotics can interfere with deep breathing and coughing.
• Care plan will outline measures to promote oxygenation.

Positioning

• Breathing is easier in semi-Fowler's and Fowler's positions.
• Clients with difficulty breathing often prefer the orthopneic position.
• Unless there are positioning restrictions, the client should never lie on one side for long periods.
• Frequent position changes are needed at least every 2 hours.

Deep Breathing and Coughing

• Deep breathing moves air into most parts of the lungs.
• Coughing removes mucus.
• Deep breathing and coughing help prevent pneumonia and atelectasis (lung collapses).
• Clients may be reluctant to do exercises as painful after injury or surgery, or be afraid of breaking open an incision.
• The postsurgical period, bed rest, lung disease, and paralysis are factors for atelectasis
• Deep breathing and coughing may be done every 1-2 hours or four times a day, as ordered.

Incentive spirometry

• Is a machine that measures the amount of air inhaled.
• It is also known as sustained maximal inspiration [SMI].
• Incentive spirometry provides a visual guide for the client with a goal to improve lung function.
• The client takes slow, deep breath until the balls rise to the desired height.
• The client hold his breath for at least 3 seconds, and exhales slowly.
• The client's care plan or supervisor gives instructions about how often the client should use it, the desired height, and the number of breaths needed.

Assisting with Oxygen Therapy

• Oxygen is treated as a drug because some clients need oxygen constantly, and others need it for symptom relief.
• Support workers do not give oxygen.
• You assist the nurse in providing safe care.
• PSW's may be trained to transfer oxygen or provide oral suction.

Oxygen sources:

• There are 3 main delivery systems:
• Oxygen concentrator which filters oxygen from the air in the room. It is plugged into a grounded electrical outlet.
• Oxygen cylinder that contains compressed oxygen. The oxygen tank is placed at the bedside.
• Liquid oxygen system uses a portable unit filled from a stationary container which unit can be worn over the shoulder.
• Oxygen is piped directly into a person's unit through a wall oxygen outlet in hospitals and some continuing care facilities.

Oxygen therapy

• ASSIST with oxygen therapy.
• Do not administer oxygen.
• Give safe care to clients receiving oxygen by following safety guidelines.

Oxygen and Fire Safety

• Keep oxygen source away from heat and open flame because oxygen is flammable.
• Physician, nurse, and respiratory therapist are responsible for teaching client and family members about oxygen safety.
• Warn client of dangers and the safety hazard, and report concerns to supervisor.

Oxygen Administration Devices

• Oxygen can be delivered by nasal cannula, simple face mask, partial-rebreather mask, non-rebreather mask, and Venturi mask.
• Moisture can build up under the mask so face should be cleaned and dried.
• Mask can easily cause skin breakdown so face must be cleaned and dried.
• Masks are typically removed for eating, where oxygen is given by the cannula during meals.
• Masks are sometimes changed from masks to nasal cannula

Oxygen Administration Set-up

• If oxygen is not humidified, it will dry the airway's mucous membranes.
• Distilled water is often added to the humidifier.

Oxygen Flow Rates

• The flow rate is the amount of oxygen given, measured in liters per minute (L/min).
• The doctor orders the flow rate or orders a range for the nurse to adjust according to the patient's condition.
• The nurse or respiratory therapist sets the flow rate.
• The nurse and care plan will tell you the person's flow rate.
• Your role is to know the flow rate that is ordered and check that the flow rate is correct.
• Tell the supervisor at once if the flow rate is too high or too low, and a nurse or respiratory therapist will adjust the flow rate.

Collecting Sputum Specimens

• Sputum is mucus from the respiratory system, not saliva (spit).
• Sputum is studied for blood microbes and abnormal cells.
• The client will have to cough up sputum from the bronchi and trachea which can be painful or hard to do.
• The specimen should be collected in the morning.
• Instruct the client not to use mouthwash prior to the procedure.
• Acknowledge that the procedure can be embarrassing so provide privacy and follow standard practices.

Artificial Airways

• Artificial airways keep the airway open.
• They are needed for disease, injury, secretions, or aspiration where they obstruct the airway.
• They are needed for mechanical ventilation, some clients who are semi-conscious or unconscious, and the client is recovering from anaesthesia.
• Intubation means inserting an artificial airway.
• Common types of these airways are oro-pharyngeal, naso-pharyngeal, endo-tracheal (ET), and tracheostomy tube.
• An oro-pharyngeal airway is inserted through the mouth and into the pharynx.
• A naso-pharyngeal airway is inserted through a nostril.
• An endo-tracheal (ET) tube is inserted through the mouth or nose and into the trachea.
• A cuff is inflated to keep the airway in place
• A tracheostomy tube is inserted through a surgically created opening into the trachea and cuffed tubes are common.

Care Measures for Client With Artificial Airways

• Vital signs are checked often, and observe for hypoxia and other signs and symptoms.
• If an airway comes out or is dislodged, tell the nurse at once.
• Frequent oral hygiene is needed, and follow the care plan.
• Follow the care plan for communication methods to comfort and reassure the client.
• Always keep the call bell within reach.
• Use touch to show you care, if appropriate for your client's culture and ethnicity.

Tracheostomy

• A tracheostomy is a surgically created opening into the trachea and can be temporary or permanent.
• A tracheostomy tube has three parts: the obturator, the inner cannula, and the outer cannula.
• The obturator is used to guide the insertion of the outer cannula.
• The inner cannula is inserted and locked in place, but the outer cannula is not removed.
• The tube must not come out (extubation), and must remain patent.
• A loose tube can damage the trachea.
• If the client is unable to cough up secretions, suctioning is needed.

Safety Measures for Clients With Tracheostomies

• Call for the nurse or supervisor if you note signs and symptoms of hypoxia or respiratory distress, or if the outer cannula comes out.
• Nothing must enter the stoma.
• Tracheostomy care involves cleaning the inner cannula to remove mucus and keep the airway patent.
• Cleaning the stoma to prevent infection and skin breakdown.
• Apply clean ties or a Velcro collar to prevent infection.
• The stoma or tube should always be covered when the client goes outside.
• Never cover stoma with plastic or leather.
• The client should take tub baths instead of showers and water should never enter the stoma.
• Medical Alert jewellery should always be worn.
• Trachea dressing should never have anything that can be inhaled.

Suctioning the Airway

• Secretions can collect in the upper airway.
• Retained secretions can obstruct air flow into and out of the airway, and provide an environment for microbes.
• Retained secretions can also interfere with oxygen (O2) and carbon dioxide (CO2) exchange.
• Hypoxia can occur due to retained secretions.
• Persons who cannot cough or have a cough that is too weak to remove secretions need suctioning.
• Suction is the process of withdrawing or sucking up fluid (secretions).

Suctioning Sites

• These routes are used to suction the airway such as oro-pharyngeal, naso-pharyngeal, and lower airway.
• Oro-pharyngeal involves suctioning the mouth and pharynx.
• Naso-pharyngeal involves suctioning the nose and pharynx.
• Lower airway involves the suction catheter being passed through an endotracheal (ET) or tracheostomy tube.

Safety Measures for Suctioning

• If suctioning is not done correctly, the client may be unable to breathe and hypoxia can occur.
• Life threatening complications can arise.
• Client's lungs are hyperventilated prior to suctioning by use of an ambu bag.
• You must ensure that suctioning is within your scope of practice for your province or agency.

Mechanical Ventilation

• Mechanical ventilation is using a machine to move air into and out of the lungs.
• It is needed for a variety of health care problems where by there is hypoxia from weak muscle effort, airway obstruction, and damaged lung tissue.
• It is needed for nervous system diseases and injuries that can affect the respiratory centre which interferes with messages between the lungs and the brain.
• It is needed for drug overdoses that can depress the brain's hypothalamus or the breathing control centre.

Chest Tubes

• The doctor inserts chest tubes to remove the air, blood, or fluid.
• Chest tubes attach to a drainage system.
• The system must be airtight, and water-seal drainage keeps the system airtight.

Caring for Chest Tubes

• Keep drainage system below the level of the chest.
• Keep tubing coiled on the bed with no kinks.
• Check vital signs as directed.
• Observe chest drainage.
• Turn and reposition the client carefully.
• Assist with deep breathing, coughing, and incentive spirometry.
• Keep sterile petrolatum gauze at bedside.