Chapter 21

Respiratory Care Modalities

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Oxygen Therapy
Administration of oxygen at greater than 21% (the
concentration of oxygen in room air) to provide adequate
transport of oxygen in the blood, to decrease the work of
breathing, and to reduce stress on the myocardium, refer
to Chart 21-2
Assess for signs and symptoms of hypoxia, arterial blood
gas results, and pulse oximetry, refer to Chart 21-1
Oxygen delivery systems, refer to Figures 21-1 and 21-2
and Table 21-1

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Oxygen Delivery by Mask

Venturi Mask Nonrebreathing Partial

Mask Rebreathing Mask
Figure 21-1
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T-Piece and Tracheostomy Collar

Figure 21-2
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 Question
Is the following statement true or false?

The primary oxygen administration method for a patient

with COPD is a nasal cannula.

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 Answer

False

The primary oxygen administration method for a patient

with COPD is a Venturi mask, not a nasal cannula.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Complications of Oxygen Therapy

Suppressed respiratory drive and low O2 tension

Fire
Oxygen toxicity: O2 concentrations of greater than 50%
for extended periods of time (longer than 48 hours) can
cause an overproduction of free radicals, which can
severely damage cells

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Toxicity
Symptoms include substernal discomfort, paresthesias,
dyspnea, restlessness, fatigue, malaise, progressive
respiratory difficulty, refractory hypoxemia, alveolar
atelectasis, and alveolar infiltrates on x-ray
Prevention:
Use lowest effective concentrations of oxygen
PEEP or CPAP prevent or reverse atelectasis and
allow lower oxygen percentages to be used

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 Question
Is the following statement true or false?

A patient with hypoxemia will have an increase in the

PaO2 level.

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 Answer
False

A patient with hypoxemia will have a decrease in the PaO2

level, not an increase in the PaO2 level

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Incentive Spirometry
Two types: volume or flow
Device encourages patient to inhale slowly and deeply to
maximize lung inflation and alveoli expansion
Used to prevent or treat atelectasis
Nursing care
Positioning of patient, encourage use, set realistic
goals, and record outcomes.
Patient education, refer to Chart 21-3

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Question
Is the following statement true or false?

The patient should be encouraged to use an incentive

spirometer approximately 10 breaths per hour between
treatments while awake

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
True

The patient should be encouraged to use an incentive

spirometer approximately 10 breaths per hour between
treatments while awake

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mini-Nebulizer Therapy
Handheld apparatus that disperses a moisturizing agent
or medication into the lungs, make a visible mist
Nursing care: Refer to Chart 21-4
Slow, deep breathes through mouth and hold a few
seconds at the end of inspiration
Coughing exercises to mobilize secretions
Assess patent before treatment and evaluate patient
response after treatment

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Chest Physiotherapy

Includes postural drainage, chest percussion and

vibration, breathing retraining, and effective coughing,
refer to Chart 21-4
Goals: remove secretions, improve ventilation, and
increased efficiency of respiratory muscles

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Postural Drainage: Lower Lobes, Anterior
Basal Segments

Figure 21-3
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Postural Drainage: Upper Lobes, Anterior
Segments

Figure 21-3
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Postural Drainage: Lower Lobes, Lateral
Basal Segments

Figure 21-3
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Postural Drainage: Upper Lobes, Apical
Segments

Figure 21-3

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Postural Drainage: Lower Lobes, Superior
Segments

Figure 21-3

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Postural Drainage: Upper Lobes, Posterior
Segments

Figure 21-3
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 CPT: Postural Drainage, Percussion,
Vibration, and HFCWO

Figure 21-4
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Patient Teaching: Home Oxygen
Safety Humidification
Flow rate and adjustment Ordering of supplies and
oxygen
Maintenance of equipment
Signs and symptoms
Identification of
malfunction Diet, activity, travel

Airway obstruction, refer Electrical outlets

to Chart 21-6

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Endotracheal Intubation

Provides patent airway, access for mechanical

ventilation, facilitates removal of secretions
Care, refer to Chart 21-7

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Endotracheal Tube

Figure 21-6
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 Technique for Supporting Incision While
a Patient Coughs

Figure 21-12
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