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
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
How can you prevent hyperventilaiton while admin. an IPPB treatment?
Instruction, BR 10-12, Pull out of mouth, talk between each treatment
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
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)
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
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 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
The IPPB is stuck in insp. position what could be the problem?
leak in the system, sticking valve, sensitivity not set
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)
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