Chapter 28
Respiratory Care
579
Skill 28.3 (continued) 5. Instruct the patient to take a deep breath through the mouth, then exhale through the nose. This helps the patient under- stand that the focus is on deep inhalation, not exhalation.
7. Instruct the patient to repeat the inhalations 10 times every hour while awake to prevent respiratory complications of immobility such as pneumonia and atelectasis. 8. Follow the Ending Implementation Steps located on the inside back cover. Evaluation Steps 1. Ask the patient to demonstrate the use of the incentive spi- rometer without verbal cues to ensure that they understand how to correctly use it. 2. Check back frequently to be sure the patient is using the incentive spirometer as ordered.
Sample Documentation
10/10/28 1100 Assisted with incentive spirometry. Able to raise 2 out of 3 balls in unit. Instructed to repeat 10 times each hour. ___________________________ Nurse’s signature and credentials
6. Show the patient how far the platform or balls moved. Iden- tify the goal for the patient to work toward. Set the slide pointer to the goal volume on the spirometer.
Skill 28.4 Administering a Nebulizer Treatment
Assessment Steps 1. Verify the health-care provider’s order for nebulizer treatment and medication. Determine whether the medication is to be diluted with saline or administered full strength. 2. Research the medication if you are unfamiliar with it. Know the expected effects, side effects, and contraindications before administering any medication. (See Chapter 35 for more information on researching medications.) 3. Assess the patient’s lungs for adventitious breath sounds and the patient for dyspnea. Planning Steps 1. Obtain a nebulizer if one is not already in place at the bed- side. Obtain ordered respiratory medications according to facility policy. 2. Determine whether the patient can use a handheld mouth- piece or needs a mask for treatment. Use a mask if the patient is unable to hold the mouthpiece or to breathe in through the mouth and out through the nose during the treatment. 3. Pour the ordered medication and saline into the medication cup, checking the medication three times (see Chapter 35). 4. Assemble the mouthpiece parts or mask parts and attach the compressor tubing to the medication cup. Implementation Steps 1. Follow the Initial Implementation Steps located on the inside front cover. 2. Assist the patient to an upright position in the bed or chair to enlarge the rib cage and allow for maximum lung expansion.
3. Check the patient’s pulse. Safety: Bronchodilators, if ordered, will increase the pulse rate. If the pulse is above 100, you may want to consult with the health-care provider before adminis- tering a bronchodilator. 4. Place the mouthpiece between the patient’s teeth and have them close the lips around it to prevent escape of medica- tion around the mouthpiece. If using a mask, place it over the nose and mouth and tighten the elastic straps to keep it in place. 5. Turn on the air compressor. This causes the medication to be converted to a fine mist for inhalation. 6. Instruct the patient to breathe slowly and deeply to inhale the medication into the small airways and lungs. 7. Instruct the patient to continue the treatment until the vapor is no longer visible from the spacer on the mouth- piece or in the mask. This indicates that the medication has been completely inhaled. 8. Remain with the patient if necessary to ensure that the treat- ment is completed correctly. 9. Turn off the air compressor when the vapor is gone and the medication cup is empty. 10. Check the patient’s pulse again to determine the effect of the medication. Expect an increase of approximately 20 beats per minute. Safety: If the pulse rate is significantly higher than expected, notify the health-care provider. 11. Disassemble the parts of the mouthpiece or mask and rinse them in warm water to remove any remnants of med- ication or saline that could crust in openings and affect function.
(skill continues on page 580)
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