Performing Postural Drainage

Assessment:

Listen to breath sound. Assess patient respiratory status. Observe the quality or characteristic of secretions. Identify what are the underlying complications. Note time of eating.

Planning/Implementation:

Gather materials needed, as follows: Pillows, Container for sputum, Hospital bed and towel. Establish the location of such lung segment. If the entire lung is to undergo chest physiotherapy, the most affected lobe or segment should be drained first. Protect patient from falling by keeping side rails up when possible. If possible, arrange for privacy during procedure. Stay with the patient during initial procedure. Administer treatment every two to four hours as ordered. Prepare patient by discussing certain exercises. Explain the importance of practicing PVD exercise after an operation to counteract affect of hypoventilation and to prevent complications. Demonstrate steps, allowing time fore patients practice. Place towel over skin to prevent reddened areas when performing. Instruct patient especially those with COPD, to perform diaphragmatic breathing with daily activities (sitting/walking) and to practice graded exercises to improve general physical fitness. Auscultate all lobes for adventitious sounds – prior to initiating PVD. Check chart for physicians order which is needed to perform postural drainage. Identify the specific segments of the lung, to be drained. Wash your hands for infection control. Proper poisoning of the patient. Placing one large or 2 small pillow to place under the patients hips to provide correct position. Obtain pillows and a sputum cup and tissues for the patient to use for expectorated secretions. Obtain clean gloves if the patient is unable to manage his/her secretions. Identify the patient to be sure you are performing the procedures for correct patient. Explain to the patient in the purpose and method of postural drainage, using the basic principles of health teaching. Position the patient. Drain the upper lobes. Have the patient sit up if possible. Have the patient lean to the right side. Have the patient lean forward at a 30º to 45º angle for 5 minutes. Have the patient lean backward at a 30º to 45º angle for 5 minutes. Have the patient lie in the abdomen, back and both sides while horizontal to drain the remaining segment of the upper lobes. Drain the lower lobes. Have the patient cough forcefully (lying on the abdomen) to expel secretions. Return the patient to a comfortable position after mouth care, and allow for a rest period.

Evaluation:

Coughing is more productive and effective. Lungs cleared for any breath sounds upon auscultation. Complications are prevented. Patient resting comfortably.

Performing Vibration

Assessment:

Listen to breath sound. Assess patient respiratory status. Observe the quality or characteristic of secretions. Identify what are the underlying complications. Note time of eating.

Planning/Implementation:

Gather materials needed, as follows: Pillows, Container for sputum, Hospital bed and towel. Establish the location of such lung segment. If the entire lung is to undergo chest physiotherapy, the most affected lobe or segment should be drained first. Protect patient from falling by keeping side rails up when possible. If possible, arrange for privacy during procedure. Stay with the patient during initial procedure. Administer treatment every two to four hours as ordered. Prepare patient by discussing certain exercises. Explain the importance of practicing PVD exercise after an operation to counteract affect of hypoventilation and to prevent complications. Demonstrate steps, allowing time fore patients practice. Place towel over skin to prevent reddened areas when performing. Instruct patient especially those with COPD, to perform diaphragmatic breathing with daily activities (sitting/walking) and to practice graded exercises to improve general physical fitness. Auscultate all lobes for adventitious sounds – prior to initiating PVD. Place your flattened hands, one over the other ( or side by side) against the affected chest area. Ask the client to inhale deeply through the mouth and exhale slowly through pursed lips of the nose. During the exhalation, straighten your elbow, and lean slightly against the clients chest while tesing your arm and shoulder muscles in isometric contractions. Vibrate during five rxhalations over one affected lung segment. Encourage the client’s lung and compare the findings to the baseline data. Auscultate the client’s lung and compare the findings to the baseline data. Document the percussion and vibration. Note the amount, color and character of expectorated secretions. Return the patient to a comfortable position after mouth care, and allow for a rest period.

Evaluation:

Coughing is more productive and effective. Lungs cleared for any breath sounds upon auscultation. Complications are prevented. Patient resting comfortably.

Performing Percussion

Assessment:

Listen to breath sound. Assess patient respiratory status. Observe the quality or characteristic of secretions. Identify what are the underlying complications. Note time of eating.

Planning/Implementation:

Gather materials needed, as follows: Pillows, Container for sputum, Hospital bed and towel. Establish the location of such lung segment. If the entire lung is to undergo chest physiotherapy, the most affected lobe or segment should be drained first. Protect patient from falling by keeping side rails up when possible. If possible, arrange for privacy during procedure. Stay with the patient during initial procedure. Administer treatment every two to four hours as ordered. Prepare patient by discussing certain exercises. Explain the importance of practicing PVD exercise after an operation to counteract affect of hypoventilation and to prevent complications. Demonstrate steps, allowing time fore patients practice. Place towel over skin to prevent reddened areas when performing. Instruct patient especially those with COPD, to perform diaphragmatic breathing with daily activities (sitting/walking) and to practice graded exercises to improve general physical fitness. Auscultate all lobes for adventitious sounds – prior to initiating PVD. Ensure that the area to be percussed is covered. Ask patient to beath slowly and deeply. Cup your hands hold your fingers and thumb together, and flex slightly to form a cup, as you would to scoop cup water. Relax your wrists, and flex your elbow. With both hands cupped, alternately flex and extend the wrists rapidly to slap the chest. Percuss each affected lung segment for 1-2 minutes. The percussing action should produce a hollow, popping sound when done correctly. Return the patient to a comfortable position after mouth care, and allow for a rest period.

Evaluation:

Coughing is more productive and effective. Lungs cleared for any breath sounds upon auscultation. Complications are prevented. Patient resting comfortably.

Administering Oxygen using Self Inflating Breathing Bag/Mask

Assessment:

Check airway patency. Assess patient’s respiratory status. Observe breathing pattern. Observe for signs of hypoxia. Check the physician’s immediate status. Identify the types of oxygen source in the facility.

Planning:

Plan for any assistance needed. Choose the appropriate equipment for the method of oxygen administration ordered. Gather the materials needed, as follows: Flow meter, Lubricant, Regulator, Connecting tube, Humidifier, Humidity tent/croup tent, Oxygen catheter, self-inflating bag, Oxygen mask, Pulse Oximeter, Nasal catheter, Sterile water, and Oxygen tank. Wash your hands. Check the innediate environment.

Implementation:

Identify the patient. Carefully and calmly explain what you are going to do. Connect flowmeter to the oxygen source. Attach humidifier filled with sterile water. Attach humidifier filled with sterile water. Attach the oxygen supply tube to the cannula, catheter or mask. Turn on oxygen and test flow by placing over hand. Allow 3 to 5 L oxygen to flow through the tubing. Proceed to specific procedure you are using. Assess patient for need for breathing assistance of for hyperoxygenation before suctioning. Wash your hands for asepsis. Obtain assistance if needed. Identify the patient. Explain to the patient what you are doing. Connect the mask to the oxygen supply and turn on the highest flow rate that does not cause the device to stick or jam. Apply the mask sbugly over the patient’s nose and mouth to form an occlusive seal. Compress the bag as completely as possible to force air into the patient’s nose and mouth. Release the bag to allow expiration. Count 1, 2, 3, 4. Repeat compression in a rhythmic pattern to provide ventilation at a rate of 12 breaths/minutes or for the desired number of deep breaths. Assess the effectiveness of the oxygen delivery. Explain safety precaution to the patient and significant others. Assess the patient’s nose and mouth and provides oronasal care. Stay with the patient. Post “oxygen in use” sign on the patient’s door. Check physician’s order to discontinue oxygen. Turn off the flow meter followed by the oxygen tank.

Evaluation:

Breathing pattern, regular and at normal rate. Pink color in nail, lips, conjuctiva, and eyes. No disorientation, confusion, difficulty with cognition. Patient resting comfortably. Laboratory measurement of arterial O2 concentration (PaO2) or Hgb O2 saturation (Hgsat) within normal limits.

Documentation:

Date and time O2 started. Method of delivery. Specific O2 concentration or flow rate in L/min. Subjective and objective

Administering Oxygen by Oxygen Humidity Tent

Assessment:

Check airway patency. Assess patient’s respiratory status. Observe breathing pattern. Observe for signs of hypoxia. Check the physician’s immediate status. Identify the types of oxygen source in the facility.

Planning:

Plan for any assistance needed. Choose the appropriate equipment for the method of oxygen administration ordered. Gather the materials needed, as follows: Flow meter, Lubricant, Regulator, Connecting tube, Humidifier, Humidity tent/croup tent, Oxygen catheter, self-inflating bag, Oxygen mask, Pulse Oximeter, Nasal catheter, Sterile water, and Oxygen tank. Wash your hands. Check the innediate environment.

Implementation:

Identify the patient. Carefully and calmly explain what you are going to do. Connect flowmeter to the oxygen source. Attach humidifier filled with sterile water. Attach humidifier filled with sterile water. Attach the oxygen supply tube to the cannula, catheter or mask. Turn on oxygen and test flow by placing over hand. Allow 3 to 5 L oxygen to flow through the tubing. Proceed to specific procedure you are using. Prepare the “tent” by attaching the metal frame to the bedsprings of the crib and suspending that canopy from the fame. Be certain that all access ports are closed. Tuck all sides of the canopy securely under the crib mattress. Ensure that the ice trough is filled with ice and the under jar with sterile water up to indicator liner. Attach the tent to the oxygen or compressed air source. Turn on the oxygen and adjust the flow rate to 15 L/min for about 15 minutes. Open the value that controls the mist output. Check the doctor’s order to see if it is to be left open continuously or partially or opened intermittently. Adjust the oxygen flow rate to the ordered level of oxygen after 15 minutes. Place the child in tent.  Assess the effectiveness of the oxygen delivery. Explain safety precaution to the patient and significant others. Assess the patient’s nose and mouth and provides oronasal care. Stay with the patient. Post “oxygen in use” sign on the patient’s door. Check physician’s order to discontinue oxygen. Turn off the flow meter followed by the oxygen tank.

Evaluation:

Breathing pattern, regular and at normal rate. Pink color in nail, lips, conjuctiva, and eyes. No disorientation, confusion, difficulty with cognition. Patient resting comfortably. Laboratory measurement of arterial O2 concentration (PaO2) or Hgb O2 saturation (Hgsat) within normal limits.

Documentation:

Date and time O2 started. Method of delivery. Specific O2 concentration or flow rate in L/min. Subjective and objective

Administering Oxygen by Mask

Assessment:

Check airway patency. Assess patient’s respiratory status. Observe breathing pattern. Observe for signs of hypoxia. Check the physician’s immediate status. Identify the types of oxygen source in the facility.

Planning:

Plan for any assistance needed. Choose the appropriate equipment for the method of oxygen administration ordered. Gather the materials needed, as follows: Flow meter, Lubricant, Regulator, Connecting tube, Humidifier, Humidity tent/croup tent, Oxygen catheter, self-inflating bag, Oxygen mask, Pulse Oximeter, Nasal catheter, Sterile water, and Oxygen tank. Wash your hands. Check the immediate environment.

Implementation:

Identify the patient. Carefully and calmly explain what you are going to do. Connect flow meter to the oxygen source. Attach humidifier filled with sterile water. Attach humidifier filled with sterile water. Attach the oxygen supply tube to the cannula, catheter or mask. Turn on oxygen and test flow by placing over hand. Allow 3 to 5 L oxygen to flow through the tubing. Proceed to specific procedure you are using.  Fit mask against the face over mouth and nose. Adjust elastic band around patient’s head and tighten. Assess the effectiveness of the oxygen delivery. Explain safety precaution to the patient and significant others. Assess the patient’s nose and mouth and provides oronasal care. Stay with the patient. Post “oxygen in use” sign on the patient’s door. Check physician’s order to discontinue oxygen. Turn off the flow meter followed by the oxygen tank.

Evaluation:

Breathing pattern, regular and at normal rate. Pink color in nail, lips, conjuctiva, and eyes. No disorientation, confusion, difficulty with cognition. Patient resting comfortably. Laboratory measurement of arterial O2 concentration (PaO2) or Hgb O2 saturation (Hgsat) within normal limits.

Documentation:

Date and time O2 started. Method of delivery. Specific O2 concentration or flow rate in L/min. Subjective and objective

Administering Oxygen Therapy by Nasal Cannula

Assessment:

Check airway patency. Assess patient’s respiratory status. Observe breathing pattern. Observe for signs of hypoxia. Check the physician’s immediate status. Identify the types of oxygen source in the facility.

Planning:

Plan for any assistance needed. Choose the appropriate equipment for the method of oxygen administration ordered. Gather the materials needed, as follows: Flow meter, Lubricant, Regulator, Connecting tube, Humidifier, Humidity tent/croup tent, Oxygen catheter, self-inflating bag, Oxygen mask, Pulse Oximeter, Nasal catheter, Sterile water, and Oxygen tank. Wash your hands. Check the immediate environment.

Implementation:

Identify the patient. Carefully and calmly explain what you are going to do. Connect flowmeter to the oxygen source. Attach humidifier filled with sterile water. Attach humidifier filled with sterile water. Attach the oxygen supply tube to the cannula, catheter or mask. Turn on oxygen and test flow by placing over hand. Allow 3 to 5 L oxygen to flow through the tubing. Proceed to specific procedure you are using. Hold the cannula to the patient’s face and gently insert the prongs into the nostrils. Adjust straps either behind the head or around the ears and under the chin and tighten to comfort. Adjust the flow to the ordered level. Pad the area where the straps rub the top of the ears, if necessary.

Assess the effectiveness of the oxygen delivery. Explain safety precaution to the patient and significant others. Assess the patient’s nose and mouth and provides oronasal care. Stay with the patient. Post “oxygen in use” sign on the patient’s door. Check physician’s order to discontinue oxygen. Turn off the flow meter followed by the oxygen tank.

Evaluation:

Breathing pattern, regular and at normal rate. Pink color in nail, lips, conjuctiva, and eyes. No disorientation, confusion, difficulty with cognition. Patient resting comfortably. Laboratory measurement of arterial O2 concentration (PaO2) or Hgb O2 saturation (Hgsat) within normal limits.

Documentation:

Date and time O2 started. Method of delivery. Specific O2 concentration or flow rate in L/min. Subjective and objective