A.

OXYGEN THERAPY

DEFINITION
• It is the administration of oxygen to facilitate adequate tissue oxygenation.

PURPOSE
• To relieve respiratory distress.
• To facilitate tissue oxygenation.

EQUIPMENT
• Oxygen source (wall or cylinder)
• Plastic nasal cannula with connecting tubing
• Plastic aerosol mask
• Humidifier
• Sterile water for humidifier
• “NO SMOKING” sign

PROCEDURE
1. Determine current vital signs, and level of
consciousness. Assess breath sounds, signs
and symptoms of hypoxia
2. Check doctor’s order.
3. Wash hands.
4. Assemble all the equipment. Place a “NO
SMOKING” sign on the patient door in view of
patients and visitors.
5. Identify the client and explain the
procedure to the client.
6. Position client in a semi-fowlers or with
head of bed elevated.
7. Attach nasal cannula to oxygen source with
a humidifier with preferred water level.
8. Turn on oxygen flow rate until bubbling is
noted in humidifier.
9. Regulate flow rate at prescribed liters per
min. Feel to determine if oxygen is flowing
through the tips of the cannula.
10. Place oxygen cannula or mask on client
appropriately.
RATIONALE
• Provides a baseline data. Hypoxia can
produce cardiac problems and may lead
to death.
• Determine the order of oxygen
concentration, method of delivery, and
parameters of regulation
• To limit the transfer of organism
• Oxygen supports combustion, this means
rapid burning that takes place in the
presence of high oxygen.
• Decreases anxiety and facilitates
cooperation.
• Facilitates lung expansion for gas
exchange.
• Delivers moistened oxygen for gas
exchange.
• Determines if oxygen flow is adequate
and connections are intact.
• For regular oxygen delivery and assures
correct level of oxygen administration

A. Nasal Cannula
a. Clean nostrils of secretion with moist • To remove secretion.
cotton balls
a. Place cannula prongs into clients nose • To provide oxygen

a. Slip attached tubings around clint’s • Holds tubing in place

ear and under chin.
a. Tighten tubing to secure cannula, but • To secure the tube in place
make sure client is comfortable
B. Face Mask
a. Place mask over nose, mouth and • The mask should hold to the face, so that
chin. Adjust strap at nose bridge of little oxygen will escape
mask to fit securely over the client’s
nose
a. Pull elastic band around back of head. • Secures mask
11. Stay with the client for a time, to • Ensures that patient is receiving the
observe response to treatment. oxygen.
12. Remove cannula each shift of every 4 • Provides opportunity assess skin
hours to assess skin. Remove mask condition.
every 2 to 4 hours. Wipe away
accumulated mist and assess under
lying skin.
13. Discard used equipment appropriately. • To promote clean environment
14. Wash hands. • To reduce transfer of microorganism.
15. record the procedure. • To provide accurate data in the care of
 client.

B. STEAM INHALATION

DEFINITION
• Steam inhalation is the process of breathing vapor aerosol into lungs
through mouth or nose as a treatment for different respiratory conditions.

PURPOSE
• To liquify mucous secretion.
• To warm and humidify air.
• To relieve edema of airways.
• To soothe irritated airways.
• To administer medication.

EQUIPMENT
• Steam inhalator ( hospital management)
• Bowl or basin (household management)
• Towel
• Hot water
• Drops of medicated aroma

PROCEDURE RATIONALE
1. Assess client’s respiratory status • Provide assessment data and the
specific needs of the client to
undergo the procedure.
2. Wash hands • To limit the transfer of
microorganisms.
3. Assemble all the equipment. Place steam • Promotes efficiency, and prevents
inhalator or bowl on a flat, stable surface. accidental spilling of hot water.
4. Identify the client • Ensures doing the procedure on the
right person
5. Explain the procedure and purpose to the • To gain the cooperation of patient
client. by making him understands the
procedure.
6. Place the client in a semi-fowlers position. • Promotes lung expansion.
7. Add 2-3 drops of medicated aroma or any • Helps loosen secretion.
chosen remedy in a bowl of a steaming hot
water
8. Drape a towel over client’s head and basin. • To keep the steam on.
9. Cover the client’s eyes with washcloth • To prevent eye irritation.
10. Keep the face 20 cm away from the water. • To prevent burns due to dripping of
Cover the chest with towel condensate form the steam.
11.Instruct client to inhale the aromatic steam • To introduce into lungs the
slowly and deeply for around 15 minutes. aromatic medication.
12. Instruct client to perform deep breathing • Coughing facilitates expectoration
and coughing exercise after the treatment. of mucous secretion.
13 Provide oral care. • For comfort measures.
14. Do after-care of equipment. • To promote clean environment.
15. Wash hands. • Limits transfer of microorganisms.

C. NEBULIZATION

DEFINITION
 • Nebulization is the process of adding mixture or medication to inspired air by mixing
particles of varying sized with the air.
PURPOSE
• It improves clearance of pulmonary secretion.
• It is often used for administration of bronchodilators and mucolytic agents.
• To warm and humidify air.
EQUIPMENT
• Nebulizer
• Nebulizing kit
• Medication of saline solution
PROCEDURE
1. Assess patient’s respiratory respiration
vital signs, heart rate before and after the
treatment using bronchodilator drugs.
2. Check for doctor’s order.
3. Wash hands.
4. Assemble the equipment device.
5. Identify the client. Explain the procedure
to the patient. This therapy depends on
patient effort.
6. Place patient in a comfortable sitting
position or a semi-fowler’s position.
7. Add the prescribed amount of
medication or saline to the nebulizer.
8. Instruct client to exhale.
9.Instruct the patient to take in a deep
breath from the mouthpiece, hold his
breath briefly, and then exhale.
10. Observe the expansion of the client’s
chest to ascertain that he is taking deep
breaths.
11.Upon completion of the treatment,
encourage the client to cough. After the
several deep breaths or bronchial
tapping, if permitted
12. Disassemble and clean nebulizer after
use. Keep this equipment in the
patient’s room.
13. Provide oral care
14. Wash hands.
15. Record.
D. OROPHARYNGEAL AND NASOPHARYNGEAL SUCTIONING
DEFINITION
• Suctioning is the aspiration of secretion, often through a rubber or polyethylene
catheter connected to suction machine.
RATIONALE
• Bronchodilators may cause tachycardia,
palpitation, dizziness, nausea or
nervousness.
• Determines the frequency and the mode
of treatment.
• To reduce the transfer of
microorganisms.
• To promote efficiency.
• Proper explanation of the procedure
helps ensure the patient’s cooperation
and effectiveness of the treatment.
• Promotes lung expansion and ensures
maximal distribution and deposition of
aerosolized particles to all areas of the
lungs.
• To obtain the desired effect.
• To facilitate force in deep breathing
• This encourages optimal distribution of
the medication.
• This will ensure that medication is
deposited below the level of orpharynx.
• The medication may dilate airways,
facilitating expectoration of secretion.
Bronchial tapping and coughing helps
to loosen secretion.
• Each patient must use his own
breathing circuit (mouthpiece and
tubing) to prevent the transfer of
microorganisms.
• To provide comfort.
• To limit transfer of microorganisms.
• To provide data needed in the care of
client.
PURPOSE
• To clear airway of secretion.
• To facilitate breathing.
• To obtain secretion for diagnostic procedures.
EQUIPMENT

• Suction machine
• Suction catheter (adult size 14 to 16; pedia size 8 to 12)
• Sterile gloves
• Irrigating saline or sterile water
• Large towel or linen saver
• Tongue depressor
• Face mask for protection if patient’s coughs

PROCEDURE
1. Check for the doctor’s written order for
suctioning.
2. Assess client’s respiratory status (respiratory
character, and breath sounds). Assess for chest
sounds and audible secretion during respiration.
3. Wash hands.
4. Organize all needed materials.
5. Identify the client. Explain the procedure to
the client.
6. Position client in a semi-fowlers position if
conscious. If un conscious, on side lying
position facing towards you.
7. Place clean towel or drape under patient’s
chin.
8. Set up the sterile container and open and pour
the sterile solution.
9. Set the pressure on the suction gauge, turn on
the suction and place the thumb over the end
of suction tubing.
10. Put on sterile gloves. Reserve the sterile
glove on your dominant hand for contact
with suction catheter and use the non
dominant hand with the tubing.
11. Holding suction catheter in sterile dominant
hand, attach suction control port tubing of
suction source held in non sterile non
dominant hand.
12. Slide sterile hand from contact port to
suction catheter tubing ( wrap tubing
partially around hand).
13. Lubricate 3 to 4 inches of the catheter tip
with irrigating solution
14. Insert the catheter either:
a. Through the mouth, using a toungue
depressor if necessary, to hold the
tongue for visibility. Slide the catheter
along the side of the mouth to
RATIONALE
• To determine if suctioning is not
contraindicated to patient’s health
status.
• To determine the client’s specific
needs in suctioning.
• To limit the transfer of
microorganisms.
• To promote efficiency.
• Suctioning can be threatening to any
patient. Explaining the procedure will
alleviate the patient’s fear and help
gain his cooperation.
• These positions promote insertion of
catheter. Side lying position for
unconscious patient promotes drainage
of secretion.
• Prevents soiling of clothing.
• Allows for sterile rinsing of catheter.
• Test suction pressure for portable unit
(5-10) mmHg for children up to 10-15
mmHg).
• Prevents contact with secretion.
• Maintains sterility while establishing
suction.
• Facilitates control of tubing.
• Prevents trauma on the mucosal
membrane.
• Prevents application of suction is
catheter is inserted.
 oropharynx until the client coughs or
resistance is felt. ( Be sure finger is not
covering opening of suction port).
a. Through the nose, insert the catheter
into an unobstructed nostril, using
slanted, downward motion. ( Be sure
finger is not covering opening of suction
port).
15. Holding your thumb over the opening in the
catheter, apply suction for 5 to 10 seconds
(maximum of 15 seconds)
16. Withdraw catheter slowly while applying
suction and rotating catheter between
fingers.
17. Place tip of suction catheter in sterile
solution and apply suction for 1 to 2
seconds.
18. Encourage client to breathe deeply and to
cough between suction; allowing 20 to 30
seconds interval between each suction (
Never apply suction more that three times.
Limit suction to 5 minutes in total.)
19. Turn off suction source using non dominant
hand to listen to patient’s breath sound and
assess the need for repeat suctioning.
20. Disconnect suction catheter from suction
tubing.
21.Using the non dominant hand, pull the cuff
of the sterile glove downward over the gloved
catheter in gloved hand.
22. Position client for support.
23. Provide oral and nasal care.
24. Discard equipment appropriately.
25. Wash hands.
26. Record the procedure.
• Facilitates unrestricted insertion of
catheter.
• Prevents application of suction is
catheter is inserted.
• Prolonged suctioning may decrease
client’s oxygen supply thus creating
hypoxia.
• Facilitates removal of pooled
secretions.
• Clears tubings from secretions.
• Coughing and deep breathing help to
bring up secretions. Oversuctioning
may cause decrease in client’s oxygen
supply.
• Determines the need of repeat
suctioning.
• Permits further use of the tubing.
• This method neatly encloses the used
catheter in the glove making disposal
more sanitary.
• Facilitates slow, deep breathing for
comfort.
• To prevent pooling of secretions.
• Promotes clean environment.
• To remove microorganisms that
lodges in the hands.
• To provide data needed in the care of
client.

E. BULB SUCTIONING AN INFANT

DEFINITION
• It is the aspiration of secretion through the use of bulb syringe.

PURPOSE
• To clear air passages of infant.
• To maintain patent airway.

EQUIPMENT

• Sterile bulb syringe

• Clean diaper or towel
• Small container
• Clean gloves
 PROCEDURE
1. Assess the rate and depth of the
infant’s
respiration as well as the breathing
sounds and chest movement. Note
also
the pulse rate and the skin color.
Check
the mouth and nose for the presence
of
secretions.
2. Wash hands
3. Assemble the equipment
4. Identify the client. Explain the
procedure
to the mother or family.
5. Put on clean gloves
6. Position the infant. Wrap the infant
with
a small sheet if necessary. The infant’s
head should be flat on the surface of
the
crib. A newborn can be held in a
“football” fashion, with the held slightly
downward.
7. Compress the bulb before inserting the
syringe tip into the infant’s mouth.
8. Insert the syringe tip into the mouth
and
release the bulb.
9. Remove the syringe and compress the
bulb, expressing the contents into the
basin.
10. Repeat steps 7 to 9 until the infant’s
cheeks and mouth are clear.
11. Carefully suction the nostril, placing
the syringe tip just at each opening.
12. Remove gloves and discard them
appropriately.
13. Place the infant on the side after
suctioning.
14. Wash your hands.
15. Record the
RATIONALE
• Provides assessment data;
determines the need of
suctioning. Usually doctor’s order
is not needed.
• To limit the transfer of
microorganisms
• To promote efficiency.
• To gain cooperation of each
member of the family
• To protect against secretion.
• Gravity will help move secretions
from the back of the throat to the
mouth, where they can be
suctioned more readily.
• Any compression with the syringe
tip in the mouth may force
secretions deeper into the
respiratory tract.
• To aspirate or suck secretions
form the mouth.
• Clear bulb from secretion.
• To ensure thorough draining of
secretions.
• To prevent irritation on the nasal
passages.
• To prevent contact with the
secretions.
• To drain remaining secretions.
• To limit transfer of
microorganisms.
• To provide accurate data in the
care of client.