The purpose of this presentation is to familiarize nursing personnel with respiratory therapies.

1. BETTER TOGETHER!
COVID 19 READINESS
Respiratory and Nursing

2. 1 hospital
1 community
1 healthcare team
1 purpose
1 RESPIRATORY +
NURSING
=
BETTER TOGETHER!

3. WHY?
We need YOU!
In the incident of increased census/workload due to COVID 19, the patient
population will largely require respiratory services. Our current staffing
model includes 1 therapist on duty 24/7 (except on days when outpatient
procedures are scheduled). Respiratory and Nursing must collaborate in
order to provide medical care and treatment to all patients.
The purpose of this guide is to familiarize nursing personnel
with respiratory medications and therapies.
PURPOSE

4. The State Board of Medical Examiners is keenly aware of the
challenges our Nation and State face with this pandemic. As
licensees, you are at the forefront of the battle against this
specific and ominous threat to our public health and safety.
Many other state and federal agencies are also at the
vanguard. We understand that this pandemic presents
unique challenges to the practice of our licensees. While the
Board can provide general guidance as other agencies and
organizations, given the rapidly changing nature of this crisis,
specific guidance in all individual scenarios is difficult to
provide at this time. We urge our licensees to use good
sense and practice, just as you would in times of normalcy. -
LLR

5. Contents
• Oxygen Delivery Devices
• Respiratory Medications
• Ventilators: The Nitty Gritty Basics

6. OXYGEN DELIVERY DEVICES

7. Oxygen Delivery Devices
Device Flow Rate Oxygen Percent Notes
Nasal Cannula 1-6 LPM 24-40%
(approximation)
May use in-line
humidity
Simple Mask 5-10 LPM 35-50%
(approximation)
Humidity NOT
allowed
Non-Rebreather Mask
Partial Rebreather Mask
>10 LPM 80-100%
(approximation)
Humidity NOT
allowed
Oxymizer 1-15 LPM Largely Variable Humidity NOT
allowed

8. RESPIRATORY MEDS

9. Aerosolized Medications
Nebulizers deliver medications, such as albuterol, to patients in order to
dilate airways by relaxing the bands of smooth muscles that line the airways.
Most single vial respiratory medications are 2.5-3ml unit doses, and require
approximately 12+/- minutes to deliver per vial.
Aerosol should be delivered using a flow of 6-8 LPM of compressed air or
oxygen for ideal particle size and delivery efficacy.
PLAN to use Inhalers/MDIs for COVID/Droplet precaution patients.
Also plan to exchange aerosols for MDI’s where possible for non-critical patients.

10. Aerosolized Medications: Tips
Aerosolized medications prescribed at AHC are safe to mix together in
one aerosol cup for delivery
Monitor HEART RATE (may increase, especially with Albuterol/Ventolin
and Epinephrine). An increase >20 bpm = abnormal. If this occurs, turn
off the treatment and notify RT/Physician immediately.
MEDICATION CART – BE MOST CAREFUL that you do NOT
ACCIDENTALLY access the wrong medication. EPINEPHRINE
could be detrimental!

11. Unscrew lid; place
medications in this cup
The mouthpiece
attaches here
If a mask is used,
remove the top T-piece
and attach the mask to
the medication cup.
Tubing attaches to an
oxygen or air flowmeter
(6-8 lpm)
Nebulizer –
Quick Set-up Guide
*place patient in
the upright or
semi-fowlers
position when
possible for the
best delivery of
medication

12. Inhaler with Spacer
Quick Guide

13. VENTILATORS: THE
NITTY GRITTY BASICS

14. DON’T ALLOW THE MACHINE TO INTIMIDATE YOU!
The BASICS:
Ventilators push air into the lungs and allow air move out of the
lungs
All of the buttons and wheels allow for “finessing” and “massaging”
of that process.
VENTILATORS
The following slides include a brief discussion of ventilators for the
purpose of expanding knowledge. YOU WILL NOT BE ASKED to change
or manage ventilator settings. The only exception = adjusting settings
for oxygenation.

15. Ventilator: Terms and Definitions
Respiratory Rate Normal: 12-20 bpm – The rate at which a patient is breathing per minute
Set Rate
(Mechanical
Rate)
Normal: 12-20 bpm – The rate at which the ventilator will deliver breaths to the
patient. The patient may breathe spontaneously over this set rate.
PEEP Positive End Expiratory Pressure – Normal: 4-10 – A back-pressure that is applied to
the airways and alveoli in order to keep alveoli from collapsing and improve oxygen
diffusion.
FiO2 Fraction of Inspired Oxygen – Normal: 21-100% - The percentage of oxygen being
delivery to a patient.
PIP Peak Inspiratory Pressure – Normal: <35 – The amount of positive pressure used to
deliver a breath to a patient.
PS Pressure Support – Normal: 5-15(may vary) – Pressure delivered to assist a patient
during a spontaneous breath.
VT (Set VT) Tidal Volume - Normal: 5-10ml per KG of IBW – The set size of the breath delivered
by the ventilator during a mechanical breath, not during a spontaneous breath.

16. Ventilator: Modes of Ventilation
PRVC Pressure Regulated Volume Control = Most common mode used in our facility.
The ventilator delivers a set tidal volume using whatever pressure it needs in order to deliver
that breath, however, to prevent injuries due to high pressure, the amount of pressure it is
allowed to use is “regulated”. The ventilator always uses the lowest possible pressure to
deliver a breath. This mode is almost like a combination of volume control and pressure
control. Volume: Set, Pressure: Variable
SIMV Synchronized Intermittent Mandatory Ventilation. Not as commonly used in our facility. In this
mode the ventilator delivers the set amount of mandatory mechanical breaths while allowing
the patient to take their own spontaneous breaths at any time. The ventilator synchronizes
these breaths so that they do not overlap each other. May be used as Volume Control or
Pressure Control.
Volume Control - Tidal Volume: Set, Pressure: Variable
Pressure Control – Tidal Volume: Variable, Pressure: Set

17. VENTILATOR = ALARMING
WHAT DO YOU DO?
STEP 1 = ALWAYS CHECK THE PATIENT FIRST!
The endotracheal/trach tube may be disconnected from the vent circuit
The endotracheal/trach tube may be crushed/collapsed
The endotracheal/trach tube may be out of the trachea –extubation
The patient may be in severe pain/anxiety/withdrawal
STEP 2 = CHECK THE MACHINE
Which alarm is sounding?
Is the vent circuit connected to the machine?
WHEN IN DOUBT – GRAB AN AMBU BAG AND PROVIDE MANUAL
VENTILATION. This will “buy time” to assess the situation and call for
additional resources to assist.

18. Alarm silence is for 2 minutes

19. High Priority = RED ALARM
Low/Medium Priority= YELLOW ALARM

20. 02 Breaths
Button
Use this to
provide 100%
02 BEFORE
suctioning a
patient.
Apply suction for no longer than 10
consecutive seconds. Applying suction for
longer periods of time can cause injury,
hypoxia and bradycardia.

21. Ventilator Alarms & Troubleshooting Tips
Alarm Action
High PIP Patient coughing? Evaluate for need to suction.
Humidity/Secretions blocking the circuit? – drain circuit
Circuit may be pinched – examine the entire circuit
Patient may be bighting ETT – reposition bite block
High VE Is patient tachypneic? – assess for pain and/or proper sedation
Assess circuit for leaks or leak around ETT cuff
Patient coughing? Evaluate for need to suction.
Low Pressure Assess circuit for leak, disconnect, or possible accidental extubation
Low VE Assess circuit for leak, disconnect, or possible accidental extubation
High RR Patient coughing? Evaluate for need to suction.
Is patient tachypneic? – assess for pain and/or proper sedation

22. NURSING +
RESPIRATORY
BETTER TOGETHER