A ppt file about pulse oximetry, incentive spirometry, nabulization and cpt

2. PULSE OXIMETRY

3. LEARNING OBJECTIVES:
• TO KNOW HOW PULSE OXIMETER WORKS.
• BE FAMILIAR WITH THE NORMAL LEVEL OF SPO2.
• LIST THE SITES WHERE PULSE OXIMETER CAN BE USED.
• IDENTIFY THE LIMITATIONSOF THE PULSE OXIMETER.
• DEMONSTRATETHE SKILLS IN THE PERFORMANCEOF PULSE OXIMETRY
CORRECTLY.

4. PULSE OXIMETRY
• IS ONE OF THE MOST COMMONLY EMPLOYED
MONITORINGMODALITIESIN THE CRITICAL CARE
SETTING.
• A GOOD INDICATOR OF THE OXYGENATION STATUS OF A
PERSON, ESPECIALLY HYPOXEMIA.

5. PARTS

6. Oxygen that is
inhaled from the
atmosphere
diffuses through
the lungs and into
the bloodstream to
be used up by body
tissues for energy
most of the
oxygen is
bound to the
hemoglobin
component of
a red blood
cell
A pulse oximeter reads
the concentration of
oxygen bound to
hemoglobin in the blood
by shining infrared and
red light through a
translucent part of the
body and measuring the
ratio of light reflected
and light absorbed by
oxygenated and
deoxygenated
hemoglobin
few are
dissolved in
plasma

7. • Normal SpO2.
or Normal oxygen saturation
of the
peripheral blood
95-100%
• Critical level
Cerebral hypoxia (low oxygen level in the
brain) may follow in a few minutes and cause
irreversible brain damage. Several vital organs
might also be affected. The person warrants
immediate treatment and oxygenation.
85% and
below
below 95% • Hypoxemia

8. WHERECAN YOUUSEA PULSE
OXIMETER?
• TO BE ABLE TO GET AN ACCURATE READING, A PULSE OXIMETER
PROBE MUST BE PLACED ON A TRANSLUCENT PART OF THE BODY SO
THAT LIGHT EMITTED FROM THE LIGHT TRANSMITTER WILL BE
RECEIVED BY THE PHOTODETECTOR ON THE OPPOSITE SIDE.

9. • most accessible segment of the
body
• nail polish/ varnish can affect
the measurement of oxygen
saturation, particularly black,
green, and blue
Fingertip

10. • as good as the fingers as a pulse
oximeter measuring site
• helpful in detecting problems in
arterial blood flow such as in lower
extremity arterial disease.
Toes

11. • can be clipped either on the tip
or lower part of the pinna
(earlobe)
• medical anomalies with the
hands or fingers that hinder
precise measurement of oxygen
saturation
Earlobe

12. • pulse oximeter probes
that are used on the palm
and soles utilize a wrap
sensor instead of the ones
that are clipped
Soles and Palm

14. • In more rare cases, wherein the
digits and ear are inaccessible,a
pulse oximetry reflectance probe
may be attached low across the
foreheadand just right above the
eyebrows,making sure that it is
placed away froma major vessel.
Forehead

15. HANDHELD OXIMETER
TABLETOP OXIMETER
WRIST-WORN OXIMETER

16. PULSE OXIMETERS ERRORS &
TROUBLESHOOTING

17. FAILURETOOBTAINA SIGNAL
• MEASURINGSITE MUST BE KEPT CLEAN AND DRY. YOU MAY REPOSITION THE
USER’S FINGER.
• CHANGE THE MONITORINGSITE.
• VITAL SIGNS SHOULDBE ASSESSED INCLUDING THE MEASURING SITE, WHETHER
THERE IS ADEQUATE BLOOD FLOW.
• THE SENSORAND A BLOOD PRESSURE CUFFMUST NOT BE PLACEDON THE SAME
HAND.
• CHECK FORLOOSE WIRINGSOR WHETHERTHE PROBE IS PROPERLY ATTACHED TO
THE BASE UNIT THAT SHOULD BE CONNECTED TO A POWER SOURCE.

18. LIMITATIONS
⚫HIGH LEVELS OF ARTIFICIAL LIGHT AND DIRT UNDER YOUR NAILS OR NAIL
VARNISH MAY AFFECT THE READING.
⚫THE OXIMETER NEEDS TO READ AT LEAST 5 FINGERTIP PULSE BEATS AND
THEREFORE SHOULD NOT BE READ IN AN INSTANT.
⚫MOVEMENT, SUCH AS SHAKING OR SHIVERING CAN AFFECT THE READING
AND PRE EXISTING MEDICAL CONDITIONS SUCH AS ANEMIA, HEART OR
CIRCULATION PROBLEMS.
⚫MAKE SURE TO READ IT IN A ROOM WITH ADEQUATE LIGHTING. DIRECT
AVOID BRIGHT LIGHT SHINING AT THE PROBE, SUCH AS SUNLIGHT OR
OPERATING LIGHT.

19. INCENTIVE
SPIROMETRY

20. LEARNING OBJECTIVES:
• TO KNOW THE INDICATIONSAND
CONTRAINDICATIONSOF DOING
INCENTIVE SPIROMETRY.
• TO KNOW THE STEPS ON HOW TO USE AN
INCENTIVE SPIROMETER.

21. INCENTIVE
SPIROMETRY
• ALSOREFERRED TO AS SUSTAINED
MAXIMALINSPIRATION (SMI), IS A
COMPONENT OF BRONCHIALHYGIENE
THERAPY.
• AS IT MEASURESHOW WELL YOUR LUNGS
FILL UP WITH EACH BREATH.
• AN INCENTIVE SPIROMETER HELPS EXERCISE
YOUR LUNGS TO HELP KEEP YOUR ALVEOLI
(air sacs where oxygen and carbon dioxide are
exchanged) INFLATED.

22. PARTS

23. INDICATIONS:
1.PRESENCE OF CONDITIONS PREDISPOSING TO THE
DEVELOPMENT OF PULMONARY ATELECTASIS
▪ UPPER-ABDOMINAL SURGERY
▪ THORACIC SURGERY
▪ SURGERY IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
2. PRESENCE OF PULMONARY ATELECTASIS
3. PRESENCE OF A RESTRICTIVE LUNG DEFECT
ASSOCIATED WITH QUADRIPLEGIA AND/OR
DYSFUNCTIONAL DIAPHRAGM

24. CONTRAINDICATIONS:
1.IF PATIENT CANNOT BE INSTRUCTED OR SUPERVISED TO
ASSURE APPROPRIATEUSE OF THE DEVICE.
2.IF PATIENT COOPERATION IS ABSENT OR PATIENT IS
UNABLE TO UNDERSTAND OR DEMONSTRATE PROPER
USE OF THE DEVICE.
3.IS CONTRAINDICATED IN PATIENTS UNABLE TO DEEP
BREATHE EFFECTIVELY (EG, WITH VITAL CAPACITY[VC]
LESS THAN ABOUT 10 ML/KG OR INSPIRATORY CAPACITY
[IC] LESS THAN ABOUT ONE THIRD OF PREDICTED).
4.THE PRESENCE OF AN OPEN TRACHEAL STOMA IS NOT A
CONTRAINDICATION BUT REQUIRES ADAPTATION OF THE
SPIROMETER.

25. MATERIALS
• INCENTIVE SPIROMETER (MAY REQUIRE A PRESCRIPTION
FROM YOUR DOCTOR)
• PILLOW (IF YOU HAVE AN INCISION)
• COMFORTABLE PLACE TO SIT

26. PROCEDURE
• SIT OR LIE UPRIGHT IN A COMFORTABLE POSITION.
• HOLD THE INCENTIVE SPIROMETER UPRIGHT, WITH BOTH
HANDS.
• SLIDE THE INDICATOR (LOCATED IN THE LEFT-HAND COLUMN
WHEN YOU ARE FACING THE SPIROMETER) TO THE DESIRED
LEVEL. FOR EXAMPLE, START AT 1250 MILLILITERS AND
SLOWLY INCREASE AS YOUR TREATMENT PROGRESSES.
• PLACE THE MOUTHPIECE INTO YOUR MOUTH AND TIGHTLY
SEAL YOUR LIPS AROUND IT.
• WITH YOUR LIPS TIGHTLY SEALED AROUND THE
MOUTHPIECE, BREATHE IN SLOWLY AND AS DEEPLY AS
POSSIBLE. THE PISTON THAT IS RESTING BELOW THE
INDICATOR SHOULD NOW RISE TOWARD THE TOP OF THE
COLUMN.
• HOLD YOUR BREATH FOR AT LEAST 3 SECONDS AND ALLOW
THE PISTON TO FALL BACK TO THE BOTTOM OF THE COLUMN.
• AFTER EACH SET OF DEEP BREATHING, COUGH TO HELP
CLEAR YOUR AIRWAYS OF MUCUS.
• REST FOR A FEW SECONDS AND REPEAT STEPS TWO
THROUGH EIGHT, 10 TIMES EACH HOUR WHILE YOU ARE
AWAKE.

27. TIPS
• IF YOU ARE COUGHING AND YOU HAVE AN
INCISION, PRESS FIRMLY AGAINST THE AREA
WITH A PILLOW. IT WILL OFFER ADDITIONAL
SUPPORT AND COMFORT.
• NORMALLY, AN INCENTIVE SPIROMETER IS
RECOMMENDED FOR PEOPLE WHO CAN'T WALK
OR GET OUT OF BED. IF YOU ARE RECOVERING
FROM SURGERY OR A COPD EXACERBATION,
YOU CAN USE YOUR INCENTIVE SPIROMETER
TO KEEP YOUR LUNGS INFLATED.

28. NEBULIZATION

29. LEARNING OBJECTIVES:
• RECOGNIZE THE INDICATIONS AND
CONTRAINDICATIONS OF NEBULIZATION THERAPY.
• PERCEIVE HOW TO PERFORM THE PROCEDURE.

30. NEBULIZATION
• IS THE PROCESS BY WHICH A LIQUID MEDICATION IS
CONVERTED INTO A FINE MIST THAT CAN BE INHALED.
• THE DEVICE THAT IS USED TO CONVERT THE LIQUID DRUG
INTO AEROSOL DROPLETS SUITABLE FOR PATIENTS TO
INHALE IS KNOWN AS A “NEBULIZER”.

31. NEBULIZERS
⚫CAN BE USED TO DELIVER
BRONCHODILATOR
(AIRWAY-OPENING) MEDICINES
SUCH AS ALBUTEROL (VENTOLIN®,
PROVENTIL® OR AIRET®) OR
IPRATROPIUM BROMIDE
(ATROVENT®).
nebules

32. PARTS

33. INDICATIONS
• TIGHTNESS IN CHEST
• INCREASED OR THICK SECRETIONS
• PNEUMONIA (CONGESTION)
AND/OR
• ATELECTASIS
CONTRAINDICATIONS
• INCREASED BLOOD PRESSURE
• INCREASED PULSE
• HISTORY OF ADVERSE REACTION TO THE
MEDICATION.

34. CAREFULLY MEASURE THE MEDICINE EXACTLY AS
YOU HAVE BEEN INSTRUCTED. USE A SEPARATE,
CLEAN MEASURING DEVICE (DROPPER OR SYRINGE)
FOR EACH MEDICINE.
ONCE YOU TURN ON THE COMPRESSOR, YOU SHOULD
SEE A LIGHT MIST COMING FROM THE BACK OF THE
TUBE OPPOSITE THE MOUTHPIECE.
PROCEDURE

35. SIT UP STRAIGHT ON A COMFORTABLE CHAIR.
IF YOU ARE USING A MASK, POSITION IT COMFORTABLY AND SECURELY ON
YOUR FACE.
IF YOU ARE USING A MOUTH PIECE, PLACE IT BETWEEN YOUR TEETH AND
SEAL YOUR LIPS AROUND IT.
TAKE SLOW, DEEP BREATHS THROUGH YOUR MOUTH. IF POSSIBLE, HOLD
EACH BREATH FOR TWO TO THREE SECONDS BEFORE BREATHING OUT. THIS
ALLOWS THE MEDICATION TO SETTLE INTO THE AIRWAYS.

36. CONTINUE THE TREATMENT UNTIL THE MEDICATION IS GONE
(ABOUT 7 TO 10 MINUTES).
IF YOU BECOME DIZZY OR FEEL "JITTERY," STOP THE
TREATMENT AND REST FOR ABOUT FIVE MINUTES. THEN
CONTINUE THE TREATMENT, BUT TRY TO BREATHE MORE
SLOWLY. IF THESE SYMPTOMS CONTINUE WITH FUTURE
TREATMENTS, INFORM YOUR HEALTH CARE PROVIDER.
TAKE SEVERAL DEEP BREATHS AND COUGH.

37. CHEST
PHYSIOTHERAPY

38. LEARNING OBJECTIVES:
• TO DISCERN HOW TO AUSCULTATE THE PATIENT’S LUNGS
PROPERLY.
• TO BE ABLE O PERFORM CHEST PHYSIOTHERAPY CORRECTLY

39. CHESTPHYSIOTHERAPY
• INCLUDES POSTURAL DRAINAGE, CHEST
PERCUSSION, VIBRATION, COUGHING AND DEEP
BREATHING EXERCISE
• PVPD

40. PURPOSES
• TO MOBILIZE AND ELIMINATE SECRETIONS, RE-
EXPAND LUNG TISSUE, AND PROMOTE EFFICIENT
USE OF RESPIRATORY MUSCLES
• TO PREVENT OR TREAT ATELECTASIS OR TO
PREVENT PNEUMONIA

41. INDICATIONS
• IT IS INDICATED FOR PATIENTS IN WHOM COUGH IS
INSUFFICIENTTO CLEAR THICK, TENACIOUS, OR LOCALIZED
SECRETIONS
• CYSTIC FIBROSIS
• BRONCHIECTASIS
• ATELECTASIS
• NEUROMUSCULAR DISEASES
• PNEUMONIAS IN DEPENDENT LUNG REGIONS.

42. CONTRAINDICATIONS
• ACTIVE PULMONARYBLEEDING WITH HEMOPTYSIS AND THE IMMEDIATE POST-
HEMORRHAGE STATE
• FRACTUREDRIBS OR UNSTABLE CHEST WALL
• LUNG CONTUSIONS
• PTB
• UNTREATEDPNEUMOTHORAX
• ACUTE ASTHMA OR BRONCHOSPASM
• LUNG ABSCESS OR TUMOR
• BONY METASTASIS
• HEAD INJURY
• RECENT MI

44. POSTURALDRAINAGE
•LOWER AND MIDDLE LOBE BRONCHI :
HEAD-DOWN POSITION
•UPPER LOBE BRONCHI :
HEAD-UP POSITION

45. •IF ONE LUNG IS MORE AFFECTED THAN THE
OTHER OPPOSITE SIDE
•WHEN TIPPING THE CHILD OVER PILLOWS
PLACE UNDER THE PELVIS, NOT UNDER THE
CHEST.
•IN BABIES, IT MAY BE MORE USUAL FOR THE
UPPER LOBES TO BE AFFECTED
SITTING POSITION

47. RIGHT LEFT

49. • UPPER LOBE:
-APICAL BRONCHUS *
- SITTING UPRIGHT (A)
-ANTERIOR BRONCHUS *
- LYING SUPINE WITH THE KNEES
SLIGHTLY FLEXED. (C)

50. • POSTERIOR BRONCHUS:
-RIGHT
LYING ON THE LEFT SIDE AND TURN
HIS FACE 45º RESTING AGAINST A
PILLOW, WITH ANOTHER PILLOW
SUPPORTING THE HEAD. (F)
-LEFT
LYING ON THE RIGHT SIDE TURNING
HIS/HER FACE 45º WITH 3 PILLOWS
ARRANGED TO LIFT THE SHOULDERS
BY 12 INCHES. (B)

51. • MIDDLE LOBE (RIGHT):
-LATERAL AND MEDIAL BRONCHUS
LYING SUPINE WITH THE BODY A
QUARTER TURNED TO THE LEFT
MAINTAINED BY A PILLOW UNDER
THE RIGHT SIDE FROM SHOULDER TO
HIP AND FOOT END RAISED BY 14
INCHES (35 CMS). (D)

52. • LINGULA (LEFT):
-SUPERIOR AND INFERIOR BRONCHUS
LYING SUPINE WITH THE BODY A
QUARTER TURNED THE RIGHT
MAINTAINED BY A PILLOW UNDER THE
LEFT SIDE FROM SHOULDER TO HIP AND
FOOT END RAISED BY 14 INCHES (35
CM). (E)

53. • LOWER LOBE
-APICAL BASAL BRONCHUS* LYING
PRONE WITH A PILLOW UNDER
THE HIPS. (G)
-ANTERIOR BASAL BRONCHUS*
LYING SUPINE WITH THE
BUTTOCKS RESTING ON A PILLOW
AND THE KNEES FLEXED. FOOT OF
THE BED RAISED BY 18 INCHES (45
CM). (H)

54. PERCUSSION
• CHEST PERCUSSION INVOLVES STRIKING THE CHEST WALL OVER THE
AREA BEING DRAINED.
• PERCUSSING LUNG AREAS INVOLVES THE USE OF CUPPED PALM TO
LOOSEN PULMONARY SECRETIONS SO THAT THEY CAN BE EXPECTORATED
WITH EASE.
• USUALLY THE PATIENT WILL BE POSITIONED IN SUPINEOR PRONE AND
SHOULD NOT EXPERIENCE ANY PAIN.

55. CUPYOURHANDSWHEN
PERFORMINGCHESTPERCUSSIONS.

56. VIBRATION
• IN VIBRATION, THE NURSE USES RHYTHMIC CONTRACTIONS AND
RELAXATIONS ON HER ARM AND SHOULDER MUSCLES WHILE
HOLDING THEE PATIENT FLAT ON THE PATIENT’S CHEST AS THE
PATIENT EXHALES.
• THE PURPOSE IS TO HELP LOOSEN RESPIRATORY SECRETIONS SO
THAT THEY CAN BE EXPECTORATED WITH EASE.

57. POSITIONHANDSAS SHOWN
BELOWTO PERFORMCHEST
VIBRATION

58. NURSINGCARE
• KNOW THE NORMAL RANGE OF PATIENT’S VITAL SIGNS
• KNOW THE PATIENT’S MEDICATIONS.
• KNOW THE PATIENT’S MEDICAL HISTORY
• KNOW THE PATIENT’S COGNITIVE LEVEL OF FUNCTIONING.
• BEWARE OF PATIENT’S EXERCISE TOLERANCE.

59. LIVE RETURN DEMONSTRATION/
PERFORMANCETASK
• PULSE OXIMETER
24/24
• CHEST PHYSIOTHERAPY 40/40