Nursing Procedures and Therapies

• Oxygen Therapy

  • Humidifies oxygen to prevent irritation of mucous membranes of airways.
• Oxygen Therapy

  • Place a "no smoking" sign at the bedside (to prevent fire)
  • Cotton bed sheets; Nylon and woolen bed sheets can cause static electricity.
• Oxygen Therapy

  • Venturi Mask - most accurate and precise
• Oxygen Therapy

  • Nasal Cannula: flow rate - 1 to 6 L/min
• Oxygen Therapy

  • Non-rebreather mask: flow rate - 10 to 15 L/min
• Oxygen Therapy

  • Non-rebreather mask: highest oxygen delivery
• Oxygen Therapy

  • Venturi mask - used for COPD clients
• Oxygen Therapy

  • Non-rebreather mask: oxygen concentration - 95 to 100 %
• Oxygen Therapy

  • Nasal Cannula: oxygen concentration - 24 to 44 %
• Oxygen Therapy

  • Non-rebreather mask: preferred oxygen delivery in case of emergency
• Tracheostomy Suctioning

  • Use sterile technique
  • Hyperoxygenate before and after suctioning (to prevent hypoxia)
  • Apply suction during withdrawal of catheter (to prevent trauma)
  • Suction for 5 to 10 seconds (max. 15 seconds)

  * Over suctioning may cause hypoxia bleeding and vagal stimulation

  * Vagal stimulation is manifested by bradycardia and hypotension

  • Indicate effectiveness = clear breath sounds (auscultate)
• Chest Physiotherapy 


  Performed over the thorax to loosen secretions in the affected are of the lungs and move them into more central airways
• Chest Physiotherapy

  Techniques: Percussion, vibration, and postural drainage
• Chest Physiotherapy

  • Time performed: Morning on arising, 1 hour before meals, or 2 to 3 hours after meals
  • Stop CPT if pain occurs
  • Administer bronchodilator 15 minutes before the procedure
  • Sequence: Positioning then percuss then vibrate then expectorate
  • Maintain each position for 10 minutes
• Chest Tube Drainage System


  Used to remove abnormal accumulations of air and fluid from pleural space.
• Chest Tube Drainage System returns negative pressure to the intrapleural space. (Most common site: 5th intercostal space)
• Chest Tube Drainage System: Chambers

  Nearest to farthest from patient:

  1. Drainage bottle
  2. Water seal chamber
  3. Suction control chamber
• Chest Tube Drainage System: Suction Control Chamber


  Stabilizes negative pressure within the lungs
• Chest Tube Drainage System: Pleur-evac


  Most commonly used drainage system
• Chest Tube Drainage System

  Drainage Bottle

  • Normal: no bubbling and drainage of less than 100 mL
  • Bright red: bleeding
• Chest Tube Drainage System

  Water Seal Chamber - filled with 2 to 3 cm of sterile NSS.
• Chest Tube Drainage System

  Suction Control Chamber - filled with 20 cm of sterile NSS.
• Chest Tube Drainage System

  Water Seal Chamber

  • filled with 2 to 3 cm of sterile NSS
  • Normal: intermittent bubbling
  • Oscillation: Normal

  *Inhale = UP

  *Exhale = DOWN

  • Abnormal: continuous bubbling indicates air leakage (NI: refer or clamp)
• Chest Tube Drainage System

  Suction Control Chamber

  • filled with 20 cm of sterile NSS
  • Normal: continuous gentle bubbling
  • Abnormal: continuous vigorous bubbling
• Chest Tube Drainage System

  Bottle: below chest level; may ambulate
• Chest Tube Drainage System

  At bedside:

  1. Occlusive dressing
  2. Clamp (air leakage)
  3. Extra bottle
• Chest Tube Drainage System

  Dislodgement: cover with sterile gauze
• Chest Tube Drainage System

  Disconnection: submerge CT in sterile water
• Chest Tube Drainage System

  Broken system: immerse end of tubing in sterile water
• Chest Tube Drainage System

  Chest XRay confirms reexpansion of lungs and position of tube.
• Chest Tube Drainage System

  When will MD remove chest tube?

  1. (-) fluctuations
  2. (+) breath sounds
  3. CXR = reexpansion of lungs
• Chest Tube Drainage System

  NI Removal:

  1. Instruct client to exhale deeply and do valsalva maneuver.
  2. After removal, cover with occlusive dressing (petroleum gauze). (to prevent entry of air into the pleural space)
• Mechanical Ventilation is the use of a machine to provide breathing for patients who cannot do it themselves.
• Mechanical Ventilation

  Controlled Mandatory Ventilation

  • preset number of breaths is delivered per minute
• Mechanical Ventilation

  Positive End Expiratory Pressure

  • opens up collapsed alveoli and keep them open
• Mechanical Ventilation

  Synchronized Intermittent Mandatory Volume

  • the tidal volume and ventilatory rate (number of breaths) are preset on the ventilator.
• Mechanical Ventilation

  • Controlled Mandatory Ventilation (CMV)
  • Positive End Expiratory Pressure (PEEP)
  • Synchronized Intermittent Mandatory Volume (SIMV)
• Mechanical Ventilation

  CMV

  • indicated for no spontaneous or voluntary breathing (post anesthesia)
• Mechanical Ventilation

  PEEP

  • prevents atelectasis
• Mechanical Ventilation

  SIMV

  • allows client to breath spontaneously at his or her own rate and tidal volume between the ventilator breaths.