Download RESPIRATORY TREATMENT MODALITIES

Nadeeka Jayasinghe
Week 06
Discuss treatment modalities for:
 Tracheostomy care
 Metered dose inhalers
 Artificial airway management
 Deep breathing, coughing and turning
 Chest drainage and IC tube management
 Nasotracheal suctioning
 Weaning a patient from mechanical
ventialtion
A
tracheostomy is an opening surgically
created through the neck into the trachea to
allow direct access to for ventilation
 Done in operating theatre or during an
emergency
 Provides an airway
 Can remove secretions easily
 Temporary vs Permanent
Congenital abnormalities (laryngeal hypoplasia,
vascular web)
 Upper airway obstruction due to foreign body
 Supraglottic or glottic conditions (infection,
vocal cord paralysis)
 Neck trauma with severe injury to thyroid or
cricoid cartiledges
 Subcutaneous emphysema
 Severe sleep apneoa
 Aspiration, inadequate cough
 Inability to wean off a ventilator (sec. to resp
failure)

 Provides
a small secure airway for suctioining
and mechanical ventilation
 Nebulized meds and oxygen delivery
 Useful for long term mechanical ventilation
 Able to protect the skin from facial pressure
sores due to straps, tube holders etc
 Increases
disability / dependency
 Coughing to clear the small airway is difficult
 The stoma site is prone to infection, bleeding
and swelling
 It requires specialized nursing skill and care
required may be complicated
 May lead to difficulty with speech and
swallowing
VIDEO – tracheostomy care
 Inhaler,
mist type delivery method
 Most efficient and quickest way of getting
the medication into airway
 Acts more quicker than oral medications
 Important for delivering quick relief
medications (i:e; bronchodilators)
 Short term vs long term medications
delievery
 Not all MDIs are the same but the delivery
method is similar
 VIDEO – MDI delivery
WHEN WOULD YOU REQUIRE ARTIFICAL
AIRWAY MANAGEMENT?
Oropharyngeal airways
 Used to maintain patent airway
 Often used during CPR
 Pulls tongue forward to prevent occlusion of
airway
 Tolerated by comatose patient (conscious
patient will gag)
 Designed to accommodate suction catheter
 Can prevent biting of endotracheal tube if
patient is intubated
NASOPHARYNGEAL AIRWAYS
Nasopharyngeal Airways:
 Various sizes and materials (soft, latex)
 Maintain patent airway
 Inserted through nare into oropharyngeal
area
 Requires lubrication
 Frequently used for naso-tracheal suctioning
 Endotracheal
Intubation
INTUBATION( Indications):
1.Keep a patent airway - (relief of obstruction)
2. Protect airway from aspiration in patients
with profound disturbance in consciousness
with the inability to protect the airway.
3. Provide bronchial hygiene (suctioning).
4. Provide mechanical ventilation.
severe pulmonary or multi-system injury
associated with respiratory failure, such as
sepsis, airway obstruction, hypoxemia, and
hypercarbia
 Bypasses
normal defense pathways (risk of
infection)
 Removes effectiveness of cough
 No ability of for verbal communication
 Loss of dignity
 The
process where intensive care staff try to
get the patient to breath alone without the
use of the mechanical ventilator
 Patients are given a ‘trial period’ on the
ventilator to breath spontaneously before
they are extubated
 Arterial blood gases determine if the
patient’s spontaneous breathing is adequate
 Patient’s
level of conciousness (awake,
ability to obey commands)
 Satisfactory cough and breathing volumes
 Arterial blood gases
 Chest xray
 Minimal secretions
 Hemodynamic stability
CHEST TUBES:
 Used for pneumothorax, chest surgery and
trauma
 A chest tube is a large catheter inserted
through the thorax to remove blood, fluid
and/or air
 Traditional drainage systems: 3 bottle system
 Modern drainage system: mobile chest drain
system which allows the patient to move
about with less restrictriction
 Tube
is inserted when air or fluid enters the
pleural space, compromising oxygenation and
ventilation (eg: chest trauma, open chest
surgery, or a large pleural leak)
 A closed chest drainage system with or
without suction is attached to the chest tube
to promote drainage of air and/or fluid
 Lung re-expansion occurs as the fluid or air is
removed from the pleural space
 VIDEO
 Activity
1: Discuss how deep breathing and
coughing can assist a patient’s oxygenation 
 Activity
TIME 
2: RESPIRATORY SYSTEM QUESTION