Respiratory care in the winter

Respiratory care in the winter

Posted by AskNurseLinda on Dec 11, 2017 9:12 am

There has been a significant change in the weather across the country. With it comes some drier air and heat from furnaces. Both can dry out those precious mucous membranes or lining of the nose and lungs. Without moisture to constantly moisten and clean our breathing body parts, bacteria can settle in. This is just part of the reason why so many people get colds and flu in the winter. The reason is being enclosed where germs are easily spread.

You can help yourself by taking care of your respiratory system. Remember colds and flu are spread by bacteria and viruses. You cannot tell when someone has a germ ready to spread to you, especially if they do not have symptoms. If you know someone has a cold or flu, it is best to ask them to stay home rather than expose you to those germs. This might be a caretaker, family member or visitor. For someone with paralysis, respiratory illness can have severe consequences.

The respiratory system consists of the nose and mouth, where oxygen and air are taken in. The nose is lined with tiny hairs in the nasal passages which will help to brush out particles both large and small typically in the form of mucous. From the nose, there are four sinus cavities in the skull that help to equalize pressure. These are great hiding places for bacteria and viruses. When a bacteria or virus finds a home in the sinus and multiply, a sinus infection is diagnosed.

The mouth does not have the same hair like cleaning process as the nose but does contain saliva. Since saliva is slightly acidic, it can help by killing some germs. Usually bacteria and viruses enter the mouth through breathing or food intake or even just multiply there if you have dry mouth. Teeth can harbor food particles which can leading to bacteria that can develop in your mouth.

Your mouth and nose connect to the trachea which is the passageway to the lungs. It is right next to the esophagus. Way down deep in the back of your throat is one opening which contains both the esophagus and the trachea. These two passageways are separated by just a flap. When the flap is open, air goes into the lungs. When the flap is closed, food and saliva flow from the esophagus into the stomach. You cannot control the movement of the flap, it automatically happens for you when you swallow food, fluid or saliva or are breathing.

Air that you breathe in will flow into your lungs from the trachea. The trachea divides into two branches, one branch going to each lung. Air is brought into the lungs as you inhale which requires the work of your lungs to pull air in by the diaphragm pulling down, the intercostal muscles between each rib opening the rib cage wider, and the abdominal muscles to assist the diaphragm by pulling the muscles around the ribs down as well. All this pulling and opening of the lungs draws air in. When the diaphragm, intercostal muscles and abdominal muscles relax, air is pushed out of the lungs.

The lungs are made up of the tiniest sacs called alveoli. These many, many sacks in the lungs allow oxygen from the air into your bloodstream, as well as release carbon dioxide from your blood back into the air that you will exhale. It is a beautiful process. However, germs can harbor in these tiny sacs in your lungs leading to infection as well.

After paralysis, sometimes, this system is not working as well as it should. There can be difficulty with that little flap in the back of your throat from closing properly allowing food or saliva into the lungs. Easily choking can be a problem. You might not have full power to bring air into your lungs or to be able to initiate a cough to clear your airway. Your mouth can become dry from lack of saliva production or as a side effect from medication.

It is not possible for anyone to completely eliminate the chance of getting an infection, cold or flu but you can help reduce the possibilities by using your strengths.  First, is to be vigilant about hand washing. This seems so simple. It is often over looked but it is the number one activity to reduce infection in your body.

Wash your hands thoroughly including your nail beds. Think of your hands as having four sides, the palms, the tops and a left and right side. This includes each finger as well.  Wash your hands on all sides with warm soapy water for the length of time it takes to sing happy birthday or the alphabet, twice. If someone is providing any type of care, including wiping your nose or mouth, preparing food, or feeding food or drink to you, be sure they do the same.

Keep your respiratory system clean and healthy. Along with being sure your hands are clean, be sure your mouth is clean. Food debris, small or large, will decay naturally as well as being broken down by saliva in your mouth. Rinse your mouth with water or non-alcohol mouthwash. Alcohol in mouthwash will dry your mouth rather than allowing it to stay moist. If your mouth is clean and you happen to get some food in your lungs, at least the particles will be fairly clean. This reduces the risk for a severe lung infection. If you breathe in old or decayed food, your risk is much higher as bacteria are already present.

If you are ventilator dependent, include your equipment in your cleaning processes. Water in the hose can become stagnant if left too long. The water is moving so it does not become bacteria laden for a while but it will over time. Use your sigh button to expand your lungs a bit more than just your regular breathing pattern. Check with your healthcare provider to get an idea about how often you should be doing this.

Suction when needed. Sometimes people like to avoid this but it is easier to clear less from your lungs than more. Suctioning helps remove bacteria and stagnant secretions which build up over time. If you are able, turn your head to one side for suctioning and the other way then with the next entry of the suction catheter. This will give your body and extra ability to naturally follow a path from one lung to the other.

A device called an ‘insufflator/exsufflator’ is much gentler in removing debris from your lungs than suctioning. Talk with your healthcare provider about this option if suctioning is uncomfortable. The insufflator/exsufflator is difficult for some individuals to adjust to because of a longer time without ventilator support but once mastered it is more comfortable. These devices for individuals with paralysis are quite expensive but you can work with your healthcare professional and insurance case manager to obtain one. Many insurances allow this device. The less expensive models most likely will not be sufficient for your needs.

For everyone, periodically, deep breathe and cough. Remember, there are three requirements for effective breathing, the diaphragm, intercostal muscles and abdominal muscles. Often individuals with lower level injury do not feel that they have respiratory compromise because they have diaphragm and intercostal function. The abdominal muscles play a key part in breathing as well. Everyone benefits from three slow, deep breaths and a cough to clean out and open up those tiny little sacs in the lungs. When you take three really deep breaths, you will probably stimulate a cough. Breathe deeply enough to really feel your lungs open up. The breath should include use of stomach muscles if you can activate them. Practice this but do not make yourself dizzy. You might start with just one deep breath and a cough, building up over time. Three deep breaths and a cough every two hours while awake works well as a prevention exercise. More frequently like every hour, if you have a respiratory infection.

Deep breathing and coughing is activity. Providing movement to your body is important for your overall health including your ability to fight a cold or flu. Movement to your body will improve the ability of your respiratory system as well as your overall general health.

Eating a healthy diet and hydrating is another way to maintain your health. Keep your resistance up by eating vegetables and whole grains. Drinking water is the best way to maintain hydration and keep your mouth and mucous membranes moist. Avoid sugary drinks as they are just what bacteria need to thrive and grow. Caffeine tends to dehydrate your body which includes drying out of your mouth, nasal passages and mucous membranes.

One more thing to think about if you think you have a respiratory infection, cold or flu is medication. Antibiotics will work to kill bacteria but they do not work on viruses. Taking too many antibiotics over time lead to resistance in treatment. Then you have to keep upping the level of antibiotic taken until eventually, there are no more that will be affective in your body. Each time you take an antibiotic, the bacteria in your body learn how to resist that particular antibiotic. Check with your healthcare provider to see if you need an antibiotic for a bacteria and which antibiotic to take. Different antibiotics treat different bacteria.

Viruses are not affected by antibiotics. There are some antiviral medications available by prescription and over the counter that will reduce the length of time for a viral infection such as the flu. These should be taken only with consultation with your healthcare provider to assess if you have a bacteria or a virus and to make sure they do not conflict with your personal health or other medications.

Bacteria and viruses are spread in the air by droplets that you cannot even see, by contact with another person or object. You cannot completely avoid getting a cold or flu but you can do a lot to prevent it from happening and if it does, you can shorten your infection time with some general health hygiene. Stay healthy! Nurse Linda

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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