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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?

Decrease

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?

Chest pain/SOB

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?

dizziness, paresthesia

Can IPPB cause air trapping in COPD patients?

Yes

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?

Atelectasis, CHF

Signs of Atelectasis

Decreased SpO2 and BS
Increased RR,HR

The positive pressure of the CPAP is maintained through what?

Inspiration and Expiration

Does the CPAP give ventilation?

No

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?

Low

How do you determine that initial settings on the CPAP?

Hunch

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?

Hyperventilation

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?

FRC

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?

Wright Spirometer

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?

kgx10x2
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

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