Question

1. Describe the nursing management of patients receiving oxygen therapy, incentive spirometry, small-volume nebulizer therapy, chest physiotherapy, and breathing retraining.

2. Discuss the principles of chest drainage and the nursing responsibilities related to the care of the patient with a chest drainage system

Answer 1

1.Nursing management  of patients on :

a.oxygen therapy;

• Assess the vitals signs .
• Monitor oxygen saturation and titrate oxygen based on the physicians order.
• check for the signs of hypoxemia which includes tachypoenia,cyanosis and poor capillary refill.
• Educate the patient and family regarding the use of oxygen therapy.
• Arterial blood gas as per the physicians order

b.Incentive spirometry;

• check for physicians order for incentive spirometry.
• Educate the patient on the techenique and expected benefits of the the therapy.
• Asses the vital signs and pain prior to commence incentive spirometry.
• postion the patient as per the patient comfort and patient condition before the therapy.
• Instruct the patient to make normal exhalation and thereafter keep the mouth piece sealed in between the lips and make an inhalation slowly as tolerated.
• Document the volumes made with each incentive spirometry therapy.
• Document any difficulties faced during therapy.

c.small volume Nebulizer therapy;

• Asses the vitals signs of the patient .
• Asses for the oxygen saturation prior ,during and post therapy.
• check for doctors order for nebulizer therapy.
• check for any allergies.
• Follow the seven rights of medication administration.
• provide patient education on therapy and expected outcomes.
• position the patient comfortably.
• prepare the nebulizer articles-appropriate size mask or mouth piece,respules and dilution solutions.
• commence the therapy to the patient .
• if mouth piece is used make sure the patient lips are sealed around the mouthpiece.
• Encourage the patient to take slow,deep ,inspiratory breaths.
• Tap the nebulizer chamber occasionally and at the end of the treatment.
• stop the therapy once the mist is finished with the medications in the chamber.
• Encourage the patient to perform deep breathing and coughing exercises to clear out secretions.
• Document nebulizer therapy with the outcomes and vitals.

d.Chest physiotherapy;

• Asses the vitals signs of the patient .
• Asses for the oxygen saturation prior ,during and post therapy.
• check for doctors order for the therapy and the specifications mentioned for percussion ,vibration and postural drainage.
• Asses the patients indications for the therapy.
• perform phsyisical examination of patient including inspection ,palapation and asuscultation of the chest.
• Educate the patient on the procedure and obtain verbal consent.
• postion the patient based on the condition of the patient .
• Exclude the contraindication like flial chest ,rib fracture,bleeding,increased icp and spinal cord injury etc.
• Perform the percussions with cupped arms over the lung areas for 30 to 60seconds.
• perform chest vibrations as per the doctor order.
• Encourage the patient to cough out the secretion after each therapy.
• Document the therapy with time,tolerance and sputum color and consistency.

e.Breathing retraining;

• Asses the vitals signs of the patient .
• Asses for the oxygen saturation prior ,during and post therapy.
• check for doctors order for Breathing retraining .
• Asess the medical history ,physical examination ,current respiratory problems,psycological status of patient.
• Position the patient comfortably.
• Encourage the patient to slowly inhale and exhale over the recommended time by the physician.
• Encourage the patient and family to continue the sessions of exercise as tolerated by the patient.
• Document the breathing exercises done and patient tolerability in the patient records.

2.Principles of chest drainage and the nursing responsibilities related to the care of the patient with a chest drainage system

Principles;

when patient exhale the excess fluid or air which is collected in the pleural cavity pulls out through the chest tube into a water seal drainage bottle.Upon inhalation the water seals prevents enterence of air into the thoracic or pleural cavity and keep the negative pressure.Thereby draining the excess exudate into the collection bottle on exhalation over time.some times minimal suction is used for creating excessing negative pressure .egs-hemothorax.

Nursing responsibilities ;

• Asses the vitals signs of the patient .
• Asses for the oxygen saturation prior ,during and post therapy.
• perform routine physical examination which includes inspection ,palpation and auscultation of chest.
• keep the system closed and below chest level always.
• Make sure all connections are secured well with tapes .
• Identify for any leaks and correct it immediately if not refer to the physician at the earliest.
• Assess the amount ,color and consistency of chest drainage in the chamber.
• Mark the level of drainage in the chamber with date,time and intials.
• Notify the physician any increased amount of drainage noted.
• Encourage the patient to perform deep breathing ,coughing and incentive spirometry.
• provide adequate pain management for ease breathing.
• Asses the insertion site for any leaks and do the dressing as needed.
• watch for subcutaneous emphysema.
• Apply sterile occlusive dressing upon removal of chest tube.
• change the drainage bottle at the respective filling marks .
• Notify the physician if any change of breathing noted.
• Encourage ambulation as decided by physician.
• Document the time of insertion,daily output and procedure tolerance.