What is positive pressure ventilation?
Power source forces air into lings developing a positive intrapulmonary pressure that expands lungs (movement of air though a gradient)
Indications for IPPB
1. Improve lung expansion: treat atelectsis when a patient is unable to generate an IC>33% or ineffective cough>70% VC
2. Improve short term ventilator therapy: treat acute hypercapnic, resp. failure, COPD (which can prevent intubation/mech vent
3. To deliver aerosolized medication: SVN
Increased VT increases or decreases PaCO2 levels?
Hazards/Complications associated with IPPB therapy?
Elevated ICP, Decreased Cardiac Output, Gastric Distension, Airway Resistance, Airway Entrapment, Infection, Barrel Trama, Hyperventilation
Ways to avoid IPPB hazards?
Avoid escessive airway pressure, Appropriate I:E ratio, upright position
Symptoms of elevated intra-thoracic pressure?
Increased HR, Decreased BP, Anxiousness, Headache, Hypotention
Symptoms of pneumothorax?
What kind of pressure can cause Gastric Dis? Prevent?
20-25 cm H2O prevented by NG tube
How can you prevent hyperventilaiton while admin. an IPPB treatment?
Instruction, BR 10-12, Pull out of mouth, talk between each treatment
Symptoms of hyperventilation?
Can IPPB cause air trapping in COPD patients?
What are the absolute contraindications for administering an IPPB treatment?
Tension pneumothorax w/o chest tube
Eight relative contra. for IPPB?
Facial surgery, actively coughing up blood, increased ICP, active TB, nausea (air swallowing), acute MI, subcutanous emphysema
What is respiratory failure?
Inadequate gas exchange, increased CO2
What is PaCO2? Range?
Partial pressure of CO2 dissolved in arterial blood range is 80-100 mmhg
What is PaO2? Range?
Partial pressure of O2 dissolved in arterial blood range 35-45 mmhg
When would the IS be perferred over IPPB?
If the patient is unable to generate an IC<than 33%, no change with IS, patient requires O2, post op, neuro disorder, ex. asthma
If the IPPB machine's pressure rises at the end of inspiration what should you tell the patient to do?
Allow the machine to give the patient a deep breath (relax)
The patient is having difficulty initiating a breath on the IPPB what should be changed on the machine?
Sensitivity (-1 cm H2O)
What control is used to increase the vol. delivered by IPPB machine?
Pressure Limit (15 cm H2O)
An IPPB machine cycles on with patient but wont turn off why?
Leak in system
What does CPAP stand for?
Continuous Positive Airway Pressure
When is CPAP indicated?
Signs of Atelectasis
Decreased SpO2 and BS
The positive pressure of the CPAP is maintained through what?
Inspiration and Expiration
Does the CPAP give ventilation?
What are signs of CHF?
pedal edema, rales,SOB, pink sputum
What kind of pressure are used when administering CPAP?
5-25 cm H2O
What does OSA stand for?
Obstruction Sleep Apnea
Benefits of CPAP?
Increased FRC, Increased compliance (decrease WOB), improved ventilation, secretion removal
Contraindications for CPAP?
Hemodynamic stability, Hypoventilation, Nausea, Increased ICP, Facial Trama, Decreased Venous Return
Patients must be observed carefullu when admin a CPAP what should be watched?
HR, BS, RR, SpO2, Consciousness, Nausea, Pressure
Three clinical assessments that can be observed to determine that the CPAP is working?
Increased BS/SpO2, Decreased HR/WOB, Better CXR
What alarm is on the CPAP high or low?
How do you determine that initial settings on the CPAP?
How do you determine if you are giving enough flow to the CPAP?
Hook up manometer, have patient inhale on peak inspiratory flow if the drops 1-2 cm H2O then increase flow
Patient is dizzy/tingling sensation in fingers means?
Patient is SOB, blue and has chest pain during treatment what do you do?
stop treatment, give O2, get doc/nurse, dont leave patient
How can you determine if the IPPB or EZPAP?
Increased BS/SpO2/cough, Decreased HR/RR, normal ABG, better CXR
CPAP is used to increase what?
The IPPB is stuck in insp. position what could be the problem?
leak in the system, sticking valve, sensitivity not set
When is the EZPAP perferred over the IPPB?
child, lack of cordnation, more tolerable
How would you instruct a patient to use the EZPAP?
Aerosol treatment w/22 adaptor, set flow to 5 L/min, patient breathes easily vs. device, inhale/exhale normally, if the patient is having difficulty increase flow
The patient will not take an effective IPPB what do you do?
nose clips, bennet seal, ambu mask, demonstrate again, threaten (worse things can be done)
How do you determine VT when using IPPB?
When administer IPPB via mask what do you watch for?
chest rise, excessive pressure, NG in, facial trama, vomitting
How do you get IBW?
female 5 feet=105
5lbs per inch after that
male 5 feet=106
6lbs per inch after that
How do you get volume of IS?
first get IBW convert to kg multipy by 10 (highest VT) then double
Male 6'2"=190 lbs/2.2=86.3(10)(2)=1.7 L or 1700 ml for IS
When is IS done?
10x every hr awake