Chapter 28
Respiratory Care
563
Table 28.2 Normal Ranges for Arterial Blood Gases and the Significance of Abnormal Levels
Blood Gas Component
Normal Range Signi fi cance of Levels Above Normal Signi fi cance of Levels Below Normal
pH
7.35–7.45
Alkalosis
Acidosis
80–100 mm Hg Hyperventilation
Hypoxemia
PaO 2
35–45 mm Hg Converts to carbonic acid and causes acidosis
Lack of carbonic acid causes alkalosis
PaCO 2
22–26
Excess of alkalinity causes alkalosis
Lack of alkalinity leads to acidosis
HCO 3 SaO 2
–
95%–99% Hyperventilation or excess supple- mental oxygen
Hypoxemia and hypoxia
the patient to turn, cough, and deep breathe every 2 hours to help prevent hypostatic pneumonia. If the patient has an inci- sion or is weak, they may fi nd this task dif fi cult to perform. If the patient has an abdominal or chest incision, encourage them to hold a pillow against the incision while taking deep breaths and coughing. The pillow will splint the incision, making it less uncomfortable for the patient to comply with coughing and deep breathing. After the pillow is in place, have the patient follow these steps: 1. Breathe in through the nose and hold your breath for 3 to 5 seconds. 2. Slowly exhale through your mouth with the lips in the “whistle position.” This is called pursed-lip breathing. 3. Repeat deep breathing in this manner three times. 4. On the fourth inhalation, cough during the exhalation. To be most effective, you should cough three times during one exhalation. This helps bring the mucus up from deep in the airways and move it up and out. This is referred to as “huff coughing.” 5. Repeat the deep breathing and coughing exercise two or three times, until the cough no longer produces sputum. Incentive Spirometry One way to encourage patients to take frequent deep breaths is through the use of an incentive spirometer, which is a device with one or more chambers and a mouthpiece. As the patient inhales, a set of balls or a piston with a platform top rises, showing the patient the volume of the inhalation. The patient continues to try to improve the volume of inhalations to raise the balls or piston higher, which helps to expand the lungs fully and prevent atelectasis. Instruct the patient to use the incentive spirometer every hour and to repeat the inha- lations 10 times. Skill 28.3 provides more information on assisting with incentive spirometry.
Patient Teaching Connection Incentive Spirometry When you instruct the patient to use an incentive spirometer, it is important to give clear directions. Often, patients think they should blow into the device using a forceful exhalation, which could cause lung injury. Explain that the purpose of the incentive spirometer is to increase the amount of air inhaled, which expands the air sacs in the lungs. This decreases the patient’s risk for developing pneumonia and atelectasis, or a collapsed lung. Instruct the patient to breathe in slowly and deeply, trying to raise the platform above the piston to the preset slide pointer. Alternatively, if you are using a three- chamber device, the patient tries to inhale slowly and deeply enough to raise all three balls in the chambers. Instruct the patient to use the incentive spirometer 10 times each hour to expand the lungs fully. However, your responsibility does not end with those instructions. Follow up with your patient several times during your shift to ensure that they are using the incentive spirometer. Ask the patient to demonstrate using it for you so that you can be sure that they are performing the procedure correctly and you can see the volume of air the patient is inhaling. Enlist the assistance of family or friends if necessary to help remind the patient to use the incentive spirometer. Nebulizer Treatments A nebulizer is a medication delivery system containing an air compressor and a mask or handheld mouthpiece. Liquid medication, usually a bronchodilator, is ordered by the health- care provider and is placed in a small cup that attaches to the air compressor via tubing. The medication may be ordered to
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