Chapter 18
Respiratory Care
Health Care
Science
Technology
Copyright © The McGraw-Hill Companies, Inc.
Objectives
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Define the respiratory system.
Summarize the services provided by
respiratory care professionals.
Identify diagnostic and therapeutic
procedures performed by a respiratory
therapist.
Identify the therapeutic effects and
hazards of oxygen therapy.
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Chapter 18
Objectives (cont.)
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Order the steps for providing oxygen.
Assess the advantages and
disadvantages of aerosolized medications.
Evaluate the outcomes of medicated
aerosol therapy.
Give reasons for performing hyperinflation
therapy.
Successfully complete 3 respiratory
procedures.
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Chapter 18
Careers in Respiratory Care 18-1
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The Certified Respiratory Therapist and
the Registered Respiratory Therapist
The Pulmonary Function Technologist
Anatomy and Physiology of the
Respiratory System
Respiratory Diagnostic Procedures
Respiratory Therapeutic Procedures
Mechanical Ventilation
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Chapter 18
The Certified Respiratory Therapist and
the Registered Respiratory Therapist
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Both require a 2- or 4-year educational
program approved by the Committee
on Accreditation for Respiratory Care
(CoARC).
Both must pass board examinations
given by the National Board for
Respiratory Care (NBRC).
Both work to help clients breathe more
easily.
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Chapter 18
The Pulmonary
Function Technologist
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Uses tests that detect the presence
or absence of lung disease.
Measures the effect of a known
disease on lung function.
Measures the effects of occupational
and environmental exposure.
Determines the effects of therapy.
Assesses the risk for surgery.
Evaluates disability or impairment.
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Chapter 18
The Pulmonary
Function Technologist (cont.)
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Job Responsibilities
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To assess the need for therapeutic
respiratory procedures.
To determine the potential benefits of
the therapy.
To monitor the outcome of the therapy
to determine whether the treatment
objectives were met.
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Chapter 18
Anatomy and Physiology
of the Respiratory System
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Components of the respiratory system:
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The job of the respiratory system:
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Upper air passages.
The lungs.
The bloodstream.
Muscles that cause inhaling and exhaling.
To bring oxygen into the body.
To expel carbon dioxide.
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Chapter 18
Anatomy and Physiology
of the Respiratory System (cont.)
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The airways consist of:
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Nasal passages.
Oral cavity (the mouth).
Throat or pharynx.
Voice box or larynx.
Windpipe.
Bronchi (main airways in
the lungs).
Bronchioles (airways off
the bronchi).
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Chapter 18
Respiratory Diagnostic Procedures
Help assess the level of lung
function.
 Determine whether specific
types of illness or conditions
are present.
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Chapter 18
Respiratory Therapeutic Procedures
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Prevent and treat lung disease by
using a number of therapies.
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Chapter 18
Mechanical Ventilation
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Reasons to use:
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To keep moving enough
oxygen into the bloodstream
and removing enough
carbon dioxide from the
lungs when other respiratory
procedures fail.
When the client has gone
into respiratory arrest
(stopped breathing).
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Chapter 18
Section 18-1
Apply Your Knowledge
Certified Respiratory Therapists
and Registered Respiratory
Therapists must pass boards
given by what agency?
Answer:
National Board for Respiratory Care
(NBRC).
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Chapter 18
Respiratory Care Procedures 18-2
Oxygen Therapy
 Medicated Aerosol Therapy
 Hyperinflation Therapy
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Chapter 18
Oxygen Therapy
Common lung diseases can
lower the level of oxygen in the
blood, causing the need for
supplemental oxygen.
 Oxygen is considered a drug
and must be ordered by a
physician.
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Chapter 18
Oxygen Therapy (cont.)
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Reasons for Oxygen Therapy
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Low levels of oxygen in the blood
(hypoxemia).
Work demands of breathing.
Work of the heart.
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Chapter 18
Oxygen Therapy (cont.)
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Oxygen Delivery Devices
Nasal Cannula
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Simple Mask
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Chapter 18
Oxygen Therapy (cont.)
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Monitoring Oxygen Therapy
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Improvements expected with oxygen
therapy:
 Client’s
thinking ability should improve.
 Shortness of breath (SOB) should decrease.
 Vital signs should become closer to normal.
 PaO2 should rise to an acceptable level.
 Pulse oximetry values should improve.
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Chapter 18
Oxygen Therapy (cont.)
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Hazards of Oxygen Therapy
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Oxygen toxicity – too much oxygen
for too long a time.
Retinopathy of prematurity (ROP) –
high oxygen levels in infants.
Atelectasis – lung collapse.
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Chapter 18
Medicated Aerosol Therapy
Causes airways to open up, or
bronchodilate.
 Has minimal side effects, since
the medication travels directly
into the lungs.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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The Advantages of Aerosolized
Medications
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Can use smaller doses.
Act very quickly.
Side effects are minimal.
Convenient, easy, and painless to
use.
Can be used at home.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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The Disadvantages of Aerosolized
Medications
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Difficult to administer the correct
dosage each time.
Difficult to teach the client how to
use.
Health care providers may not know
how to instruct the client on the
proper techniques.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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Types of Drugs Given by Aerosol
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Nasal decongestants – Contain
vasoconstrictors, drugs that decrease the
blood flow to nose vessels causing nasal
passages to open.
Bronchodilators – Drugs that increase the
diameter of lung airways.
Antiasthmatics – Used to prevent or
decrease the number of asthma attacks.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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Types of Drugs Given by Aerosol (cont.)
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Corticosteroids – Drugs that may be inhaled
and are used for anti-inflammatory
maintenance.
Mucolytics – Drugs used to break down
secretions within the lungs.
Antimicrobials – Used to treat a number of
bacterial and fungal pulmonary infections.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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Aerosol Drug Delivery System
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The Metered Dose Inhaler (MDI)
 The
most commonly used aerosol drug
delivery system.
 A small portable pressurized device that
delivers medication to the lungs.
 Consists of a canister that contains a
pressurized gas propellant and
medication.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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Metered Dose Inhaler Accessories
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Add-on devices include: spacer, holding
chamber, and extension device.
Advantages of using accessories are:
 Medication
enters through the client’s mouth
and does not hit the face.
 Particle size is kept consistent.
 Client is able to inhale particles more deeply
into lungs.
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Chapter 18
Medicated Aerosol Therapy (cont.)
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Evaluating Aerosol Therapy
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Listen to the breath sounds before
and after the treatment and note
any improvement.
Ask the client if he or she feels
better after the treatment.
Use a test of pulmonary function
before and after treatment.
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Chapter 18
Hyperinflation Therapy
Also known as lung expansion
therapy.
 Partial or full lung collapse is
known as atelectasis.
 Used when the client is unable
to take an occasional deep
breath.
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Chapter 18
Hyperinflation Therapy (cont.)
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Indications for Hyperinflation Therapy
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Surgery of the chest wall or upper abdominal
region.
Heavily sedated.
Neuromuscular disease.
Spinal cord injuries.
Bedridden.
History of chronic lung disease that causes
mucus production.
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Chapter 18
Hyperinflation Therapy (cont.)
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Incentive Spirometry
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The most common
hyperinflation
therapy.
Clients can see when
the desired volume
or flows have been
reached.
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Chapter 18
Hyperinflation Therapy (cont.)
Incentive spirometer is used to
prevent or treat existing atelectasis.
 Clients who may be prone to
atelectasis :
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Have had upper abdominal surgery.
Have had thoracic (chest) surgery.
Have chronic obstructive pulmonary
disease (COPD).
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Chapter 18
Hyperinflation Therapy (cont.)
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Clients who may be prone to
atelectasis (cont.):
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Are undergoing or have
undergone surgery.
Have been bedridden for extended
periods of time.
Are heavy smokers and are
undergoing or have undergone
surgery.
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Chapter 18
Section 18-2
Apply Your Knowledge
What is another name for
hyperinflation therapy?
Answer:
Lung expansion therapy.
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Chapter 18
Procedures in Student Text
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18A
Administering Oxygen
18B
Delivering an MDI Treatment
18C
Administering Incentive
Spirometry (IS)
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Chapter 18
Chapter 18 Credits
35
Slide 12
Courtesy Mallinckrodt, Inc.
Slide 17
Aaron Haupt
Slide 30
Doug Martin
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Chapter 18