Essential Respiratory Therapy Techniques for Patient Care
* Respiratory Physiotherapy Concept: A set of procedures aimed at helping patients remove respiratory secretions, as an impasse could lead to respiratory failure.
In chronic respiratory processes, immobilization reduces the drainage of secretions. Postoperatively, patients have a decreased cough reflex due to analgesics, are generally less mobile, and avoid coughing due to pain. Neurological conditions can lead to a loss of muscle strength and diminish the cough reflex.
Some of the procedures include chest physiotherapy exercises such as percussion and respiratory vibrations. This technique involves the passive removal of secretions, facilitated by appropriate positions that help move these secretions from the lungs to the peripheral bronchi. The positions must be prescribed by a doctor and maintained for 10 minutes. These procedures are performed by physiotherapists and nurses, with auxiliary nursing staff assisting as necessary.
* Breathing Exercises: The purpose is to achieve deep breathing, mobilize secretions, and improve the permeability of the respiratory pathways. These exercises are frequently used in preoperative preparation and repeated postoperatively.
* Incentive Spirometer: This device is used when patients find it difficult or painful to breathe deeply, aiming to avoid pulmonary complications, increase lung capacity, and strengthen respiratory muscles.
* Drum Vibration: Chest physiotherapy is a procedure aimed at removing deeper secretions, which can be performed using hands (percussion) or an ultrasonic vibrator.
* Oxygen Therapy: This involves the administration of gaseous oxygen to a patient to restore normal blood oxygen levels. Atmospheric air contains 21% oxygen and 78% nitrogen, with a small percentage of carbon dioxide.
– It is indicated for all diseases that cause difficulty breathing, with symptoms such as dyspnea, orthopnea, and cyanosis, which may indicate respiratory failure. Oxygen therapy aims to raise the concentration of oxygen in the blood and tissues without causing respiratory depression.
* Determination of Blood Oxygen Levels: The arterial blood gas analysis determines the gases in arterial blood, including:
+ Partial pressure of oxygen: indicates the presence of oxygen in arterial blood, with a normal dissolved value of 80 mmHg. A value below this indicates hypoxemia.
+ Partial pressure of carbon dioxide indicates the presence of dissolved carbon dioxide in arterial blood: typical values are 35 to 45 mmHg. Values above this indicate hypercapnia.
+ Other parameters include pH, bicarbonate levels, and oxygen saturation.
The oxygen saturation and heart rate are parameters that can be measured and recorded by pulse oximetry, a non-invasive method for monitoring oxygen saturation (SaO2) in hemoglobin. This procedure is done using a finger cot and can be used for several days, while monitoring the patient’s skin condition in the area where the clamp is placed, changing it periodically to avoid skin disorders (ischemia or allergic reactions). The great advantage of this method is that it provides constant information on the patient’s oxygenation.
* Overall Oxygen Administration Source: In addition to oxygen, a gauge, humidifier, and flowmeter should be used. Oxygen is stored in a central hospital supply or in portable cylinders.
The source is generally from pipelines leading to patient units and other hospital departments, or from cylindrical containers of varying capacities that store gas at a pressure greater than atmospheric pressure. This can be checked with a pressure gauge, which allows flow when administering oxygen to the patient.
There are also backpacks or portable cylinders that facilitate ambulation.
For use with the source or flowmeter: the pressure meter administers oxygen from a cylinder. It is measured in kg/cm². A graduated scale is used when oxygen is supplied centrally.
The deposit allows for the removal and use of oxygen, measured in liters per minute. The gas flow is measured using a small floating ball inside the meter, which indicates varying levels of gas flow.
The container, attached to the flowmeter, is filled with distilled water to a level that indicates the container’s capacity. The goal is to humidify the gas before it reaches the patient to prevent drying and irritation of the respiratory mucous membranes.