Procedures for Maintaining Respiratory Function

Procedures for Maintaining Respiratory Function

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Inhalation therapy• All-inclusive term that encompasses a variety of

therapies that involves changing of composition, volume, or pressure of inspired gas.

• Therapies includes: increasing the oxygen concentration of inspired gas

(oxygen therapy) Increasing the water vapor content of inspired gas

(humidification)Adding airborne particles with beneficial properties

(aerosol therapy)Employing various means for controlling or assisting

respiration (artificial ventilation, continous positive airway pressure)


Inhalation Therapy

Oxygen TherapyWays of delivery: 1. Plastic hood – highest concentration which is almost 100%,

indicated to infant on an incubatorNursing responsibilities:

humidified O2 should not blow directly on infants face, and the hood should not rub against the infant’s face, neck and shoulder.

2. Nasal cannula or prongs – supplies 50% concentration of oxygen, for older cooperative infants* Mask is not well tolerated by children



Inhalation Therapy

3. Oxygen tent –delivers 30-50% of O2, for children beyond early infancy* difficult to maintain since O2 is reduced whenever tent is opened.Nursing responsibilities:

Loss is greater at the bottom of tent, therefore the tent is tucked snugly without opening open edges.

Flush with O2 after tent has been opened for an extended period of time by increasing the flow meter for a few minutes



Inhalation Therapy

The temp of the tent becomes very warm so some type of cooling mechanism is provided. Check temp periodically to be certain that it is maintained at the desired level. Although the cool environment can reduce fever and airway inflammation, it can also produce hypothermia and cold stress

Kept child warm and dry . Check beddings and clothing frequently.

Since gas is humidified this will cause moisture to condense on the tent walls. Therefore, there is a need to inspect all toys for safety and suitability.


Inhalation Therapy

Remove child from tent for activities such as feeding, bathing. Observe patient for any change in color, increased respiratory effort or restlessness which would indicate that child needs other source of O2 while outside tent.

Younger children may feel frightened of the forced enclosure. Reduce this distress by encouraging parent to stay with child and by putting familiar toys that are not allowed inside the tent at the foot of the bed or otherwise in view.


Inhalation Therapy

Oxygen Toxicity – prolonged exposure to high oxygen tensions can be damaging to some body tissues and functions, where the most vulnerable is the retina of the premature infant and the lungs of person at any age.

* Oxygen-induced carbon dioxide narcosis – occurs in patients with chronic pulmonary disease


Monitoring Oxygen Therapy1. Pulse Oximetry- simple continuous , noninvasive method of determining oxygen

saturation to guide O2 therapy. A light-emitting diode(LED) and a photodetector is placed in opposition around a foot, hand, finger, toe or ear. It measures the hemoglobin that is saturated by O2.

2. Transcutaneous Monitoring (TCM) – provides continual monitoring of trancutaneous partial pressure oxygen in arterial blood where an electrode is attached on a warmed skin. Site should be changed every 3-4 hours to prevent burning of skin and machine must be calibrated each time site is changed.

Nursing Responsibilities: Infant. Tape the sensor securely to the great toe and tape the wire to the sole of the

foot (or use a commercial holder that fastens with a self-adhering closure) . Place a snug fitting sock over the foot.

Child. Tape the sensor securely on the index finger and tape wire to the back of the hand. Use self-adhering Ace-type wrap around the finger and/or hand to further secure the sensor and wire.

Cover sensor to block ambient light source since this could interfere with the reading. Dyes, green, purple or black nail polish, non opaque synthetic nails and possibly ink

used for foot printing can also cause inaccurate measurements.


Inhalation TherapyAerosol Therapy can be effective in depositing medication into the airway, can be

useful in avoiding systemic side effects of certain drugs and in reducing the amount of drugs necessary to achieve desired effects.

Bronchodilators, antibiotics and steroids can be suspended in particulate form and inhaled so that the medication reaches the small airways.

Equipments used:Hand-held nebulizers – the medicated “mist” is discharged into a small

plastic mask which the children holds over the nose and mouth, and is instructed to take slow, deep breaths through the open mouth during the treatment.

Metered-dose inhaler - self-contained hand-held device that allows intermittent delivery of a specified amount of medications


Inhalation Therapy

Aerosol TherapyNursing Responsibilities: Assess effectiveness of the treatment by listening to breath

sounds and work of breathing Assess patient’s tolerance of the procedure. Calm the child before getting v/s.


Bronchial (Postural) Drainage• Done by positioning the child to take maximum advantage of

gravity facilitates removal of secretions.• Indicated whenever excessive fluid or mucus in the bronchi is not

being removed by ciliary activity and cough.• Carried out 3-4 times daily and is more effective if it follows other

respiratory therapy.• Generally performed before meals or 1 to 1 ½ hours after meals

and repeated at bedtime.• The length and duration depends on the tolerance of child, usually

20-30 minutes with percussion 2-5 min in each position.• Infants should not be placed on a trendelenburg position because

they do not have an autonomic regulation of blood flow on the head.


Chest Physiotherapy

• Refers to the use of postural drainage in combination with adjunctive techniques that are thought to enhance the clearance of mucus from the airway. These techniques include manual percussion, vibration, and squeezing of the chest, cough, forceful expiration and breathing exercises.

• Used for patients with increased sputum production . • Contraindicated in patients with pulmonary hemmorrhage,

pulmonary embolism, end-stage renal disease, increased intracranial pressure, osteogenesis imperfecta and minimal cardiac reserves.


Percussiona. Rhythmic clapping on the thorax over the affected lung areab. Neonates Use adapted resuscitation mask, cups, rubber cup with wandc. Children Use hands or mechanical percussor

Vibrationa. Rapid, constant motion used to help mobilize secretions in the airwaysb. NeonatesUse fingertips or commercial vibratorc. ChildrenUse hands or commercial vibrator




These procedure done :- Before morning meal .- At bed time (if the child is subject to nighttime

mucous retention , plugging of airways , and coughing) .

- If infection is present .- Bronchodilator is administered by nebulizer .


ECG in Pedia

• ECG (electrocardiogram) is a test that measures the electrical activity of the heart. The heart is a muscular organ that beats in rhythm to pump the blood through the body.


IndicationsDifficulty of breathingUsed to monitor the effects of medicinesReveals rhythm problems such as the cause of

a slow or fast heart beatTo see if there are too few minerals in the

blood




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Procedures for Maintaining Respiratory Function