Chapter 6
Advanced Respiratory Care Skills
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Respiratory and Cardiovascular System
See Figure 6-1.
Ventilation-process of inhalation and exhalation
Gas Exchange-o2 and co2 exchange
Oxygen Transport-to tissue and cells and back to the lungs
Anything that affects this process affects the persons
ability to meet the need for oxygen.
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Disorders of the Respiratory System
• Neuromuscular disorders
• Neurologic disorders
• Trauma
– causing blockage of the airway or collapse of the
lung
• Disorders that result in blocking of the airway
– cancer
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Disorders of the Respiratory System
(cont)
• Disorders that cause the alveoli to fill with fluid
– pneumonia
• Disorders that cause the alveoli to collapse
– atelectasis (a common complication after
surgery)
– emphysema
• Disorders that prevent blood from entering the
lungs to receive oxygen
– such as pulmonary
embolism
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Disorders Affecting Ability to Transport
Oxygen
• A low red blood cell count (anemia)
• Blood circulation through the body
– heart failure
• Inability of oxygen to get to the cells
– carbon monoxide poisoning
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Monitoring Blood Oxygen Levels
• Pulse oximetry:
– Measures the amount of oxygen in the blood
– Use of pulse oximeter
– applied
• finger, toe, earlobe, nose, or forehead (or to
the toe or foot in babies)
• Normal=95%=-100%
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Factors affecting accuracy of pulse
oximetry
• Dark fingernail polish
• Using the same arm for blood pressure
• Poor circulation
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Pulse Oximetry
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Arterial Blood Gases
• More accurate than pulse oximetry
• Much more invasive
• Requires a sample of arterial blood, usually from the
radial artery in the wrist
– Done by respiratory therapist, RN, or MD
– Complications
• Bleeding or swelling
• c/o numbnessor tingling
• Pale or blue color
• Cold to touch
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Devices Delivering Supplemental Oxygen
• Nasal cannula
• Simple facemask
• Non-rebreather mask
• Continuous positive airway pressure
• Mechanical ventilator
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Nasal Cannula
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Facemask
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Caring for a Patient With Supplemental
Oxygen
• Provide good oral care
• Check water in humidity bottles
• Check person for pressure sores from tubing on face and
behind ears
• Check person for nose bleeds
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Types of airways
• Oropharyngeal or nasopharyngeal airway
– Inserted through the nostril or mouth
– Short term use
• Endotracheal intubation
– Flexible plastic
– Inserted through the mouth or nostril
• Extends to the trachea
• Balloon hold it in place
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Endotracheal Tube
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Nasopharyngeal/Oropharyngeal Airway
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Types of airways
• Tracheostomy
– Surgically created opening in the neck into the trachea
– Can be cuffed or cuffless
– Used when upper airway is blocked
– Can be permanent or temporary (less than 3 weeks
• Care and Suctioning the tracheostomy
– May or may not be allowed by the PCT
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Tracheostomy
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Tracheostomy Care
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Suctioning
• Done by RN or Respiratory therapist
• Dangers of suctioning
– Puts person at risk for hypoxia (low oxygen in the
blood
– Stimulates the vagal nerve (can lower heart rate)
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A Person May Need Suctioning if:
• The person cannot stop coughing
• The person is having trouble breathing
• The person asks to be suctioned
• The pulse oximetry reading is less than 90%
and his or her heart rate is increased
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APPLICATION
• Trach care
• Oral suctioning
• Tracheal suctioning
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Mechanical Ventilation
• Ventilator breathes for a person who cannot breathe on
his own
• Ventilator forces air into a person’s lungs
– endotracheal or tracheostomy tube
• Refer to Figure 6-12
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Reasons for Mechanical Ventilation
• surgery
• pain medication because of severe injuries
• head injury
• Stroke
• drug overdose
• A spinal cord injury
• neurologic disorder
• An acute disorder
– respiratory infection or heart attack
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Chest Tube System
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Conditions Requiring Chest Tubes
• Pneumothorax: the build-up of air in the space
between the lungs and the chest wall
• Hemothorax: the build-up of blood in the space
between the lungs and the chest wall
• Severe lung infection: can cause the build-up of pus
and fluid around the lung, making insertion of a
chest tube necessary
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Caring For a Person With a Chest Tube
• Place the chest tube drainage system where it
cannot be knocked over
• Make sure that the chest tube drainage system is
below chest level
• Never disconnect the chest tube from the chest
tube drainage system
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Caring For a Person With a Chest Tube
(cont)
• If suction is used, never disconnect the chest tube
drainage system from the suction without a doctor’s
order
• Make sure tubing that connects the chest tube to
the chest tube drainage system is not coiled or
kinked or pulled out
• When positioning a person with a chest tube in the
lateral position, use pillows to provide for comfort
and to prevent the person from lying directly on the
tubing
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Question
What disorder affects the ability to carry oxygen to the
body?
A. Anemia
B. Paralysis
C. Cancer
D. Pulmonary embolism
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Answer
A. Anemia
The body’s ability to transport oxygen can be affected by a
low red blood cell count.
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Question
Which is a normal pulse oximetry reading?
A. 60%–80%
B. 70%–90%
C. 95%–100%
D. 40%–60%
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Answer
C. 95%–100%
The amount of light that reaches the sensor is translated
into a measurement of how much oxygen the arterial
blood is carrying.
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Question
Tell whether the following statement is true or false.
A person with sleep apnea may also use a CPAP.
A. True
B. False
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Answer
A. True
People with sleep apnea may also use a CPAP mask. Sleep
apnea is a disorder that causes the person to stop
breathing for varying periods of time while he or she is
asleep.
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Question
A person with a chest tube should maintain which of the
following?
A. Not be allowed to eat
B. Never get out of bed
C. Have the drainage system opened and drainage
measured at the end of each shift
D. Never raise the drainage system above chest level
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Answer
D. Never raise the drainage system above chest level.
Raising the drainage system above chest level may cause
drainage to flow back into the chest cavity.
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