NCLEX Review Guide: Respiratory Treatments

Oxygen Delivery Systems

• Low-flow systems include nasal cannula (1-6L/min, 24-44% FiO2) and simple face mask (5-8L/min, 40-60% FiO2). These systems allow room air mixing and provide variable oxygen concentrations.
• High-flow systems include Venturi mask, partial rebreather, and non-rebreather masks. These deliver precise, consistent oxygen concentrations regardless of patient's breathing pattern.
• Never reduce oxygen below 5L/min on face masks to prevent CO2 rebreathing and potential suffocation.

Ventilator Modes and Settings

• Assist-Control (AC) delivers a preset tidal volume with every breath, whether patient-triggered or machine-triggered. Provides full ventilatory support but may cause respiratory alkalosis if patient hyperventilates.
• Synchronized Intermittent Mandatory Ventilation (SIMV) delivers preset breaths synchronized with patient effort, allowing spontaneous breathing between mandatory breaths. Used for weaning patients from mechanical ventilation.
• PEEP (Positive End-Expiratory Pressure) maintains alveolar recruitment and prevents collapse, typically set at 5-15 cmH2O for ARDS patients.

Ventilator Alarm Response

1. Assess patient first - manual ventilation if needed
2. Check ventilator connections and tubing
3. Suction if secretions present
4. Notify respiratory therapist and physician
5. Document findings and interventions

Suctioning Techniques

• Endotracheal suctioning should be performed using sterile technique with suction pressure 80-120 mmHg for adults. Limit suctioning to 10-15 seconds to prevent hypoxemia and bradycardia.
• Pre-oxygenate with 100% oxygen for 30 seconds before suctioning and monitor for cardiac arrhythmias during procedure.
• Nasotracheal suctioning requires sterile technique and should be avoided in patients with head trauma, facial fractures, or bleeding disorders.

Chest Tube Management

• Water seal chamber should fluctuate with respirations (tidaling) - absence may indicate lung re-expansion or tube obstruction. Continuous bubbling in water seal indicates air leak.
• Never clamp chest tubes except for brief periods during tube changes or when ordered by physician, as this can cause tension pneumothorax.
• Suction control chamber should have gentle, continuous bubbling when wall suction is applied at ordered pressure (usually -20 cmH2O).

Self-Assessment

• ☐ Can you identify appropriate oxygen delivery device for different FiO2 requirements?
• ☐ Do you know the normal parameters for ventilator settings (TV, RR, PEEP)?
• ☐ Can you prioritize interventions for ventilator alarms?
• ☐ Do you understand chest tube drainage system components and troubleshooting?