Upgrade to remove ads
Ch 39 egans TEST 4
Lung Expansion Therapy Work Sheet
Terms in this set (82)
1. Persistent breathing at small tidal volumes can result in what?
Loss of lung capacity
2. What patient categories are at high risk for developing atelectasis?
Bed ridden and post operative (thoracic or abdominal)
3. The major contributing factor in the development of postoperative atelectasis is?
no taking deep breath because of pain,
lack of mobility,
closer the cut to the diaphragm greater the risk.
4. What groups of patients are at risk for developing postoperative atelectasis?
history of lung disease that causes increased mucus production, history of cigarette smoking
5. What clinical findings indicate the development of atelectasis?
opacified areas on the chest x-ray film,
diminished or bronchial breath sounds,
Fine late inspiratory crackles may be heard
6. All modes of lung expansion therapy aid lung expansion how?
IS enhances lung expansion via a spontaneous and sustained decrease in P pl.
Positive airway pressure techniques increase P alv in a effort to expand the lung.
positive end-expiration pressure therapy
intermittent positive-pressure breathing (IPPB)
expiratory positive airway pressure (EPAP)
7. How can the transpulmonary pressure gradient be increased?
decreasing pleural pressure (Ppl) or increasing alveolar pressure (p alv). a spontaneous deep inspiration increase the Pl gradient by decreasing the Ppl. the application of positive pressure to the lungs increase the Pl gradient by raising pressure in the lungs
8. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure are?
IS enhances lung expansion via a spontaneous and sustained decrease in Ppl. Positive airway pressure techniques increase P alv in an effort to expand the lungs. IPPB inspiration only, PEP expiratory positive airway pressure, EPEP,CPAP during both inspiration and expiration
9. What lung expansion therapy is physiologically most normal?
10. An alert and cooperative 24-year-old woman with no prior history of lung disease underwent cesarean section 10 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient? Know why
A. incentive spirometry
B/C lungs need to be expanded
11. What are the indications for incentive spirometry?
presence of restrictive lnng defect associated W/quadriplegia and or dysrunctional diaphragm, presence of pulmonary atelectasis, presence of conditions predisposing to atelectasis, upper abdominal surgery, thoracic surgery, surgery in PT w/COPD
12. What are the contraindication for incentive spirometry?
unconscious pt or those unable to cooperate, pt who cannot properly use is device after instruction, pt unable to generate adequate inspiration for example, VC <10 ml/KG or IC< 33% of predicted normal
13. What are potential hazard or complication of incentive spirometry?
hyperventilation and respiratory alkalosis
exacerbation of bronchospasm
14. A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms? Know why
Deep and Fast breathing leads to sharp drop in PCo2 and an equally marked increased in Arterial PH
15. Incentive spirometry devices are categorized as?
Volume or flow oriented
16. A flow-oriented incentive spirometry devices does what?
measure and visually indicate the degree of inspiratory flow. flow can be equated w/volume by assessing the duration of inspiration or time (flow*time=volume) a sustained maximal inspiratory effect to prevent or correct atelectasis
17. What would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry?
absence of or improvement
normal or improved chest radiograph
resolution of abnormal breath sounds
improved PaO2 and decreased PaCO2
Increase VC and peak expiratory flow
restoration of preoperative FCR or VC
Improved inspiratory muscle performance and cough
Attachment of preoperative flow and volume levels
18. Ideally, when should high-risk surgical patients be oriented to incentive spirometry?
Before undergoing surgery
19. Successful application of incentive spirometry depends on: Successful incentive spirometry requires effective patient teaching.
set a goal * slowly and deeply to maximize distillation of ventilation
20. In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would would you instruct the patient to do?
Diaphragmatic breathing @ slow to moderate inspiration flow pt to sustain maximal inspiration volume for 5 to 10 sec
21. In performing the sustained maximal inspiration maneuver during incentive spirometry, the patient should be instructed to sustain the breath for at least how long?
5 to 10 secs
22. In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min.What would you suggest to the patient and why?
take slower deeper breath to ensure that PT. is getting good use of IS and hold for 5 to 10 sec
23. For patients receiving incentive spirometry, what is the minimum number of sustained maximal inspirations (SMIs) per hour that you should recommend?
5 to 10 SMI each hour
average person sighs 6 times per hour
24. What should the monitoring of patients using incentive spirometry include?
frequency of session
vital signs / breath sounds
number of session
number of breaths /sessions
volume / flow goals achieved
breath hold maintained
periodic observation of pt compliance W/additional instruction as need
device within reach of Pt and Pt encouraged to perform independently
new and increasing inspiratory volumes established each day
25. The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines?
as an intermittent or short term therapeutic modality usually last 15 to 20 min
26. What is true about intermittent positive-pressure breathing?
from the alveoli to the pleural space during the inspiratory phase of an IPPB treatment causing Ppl to rise somewhat during inspiration. depending on the mechanical properties of the ling, Ppl may actually exceed atmospheric pressure during a portion of Inspiration
27. What patients should be considered for lung expansion therapy using intermittent positive- pressure breathing (IPPB)?
W/clinically diagnosed atelectasis not responsive to other therapies such as IS and chest physiotherapy
28. IPPB intermittent positive-pressure breathing is best defined as and used to treat? REF:
episodic mechanical ventialtion treats postoperative atelectesis
29. What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis?
slow deep breathing that are sustained or held @ end inspiration increased the distribution of inspired gas to areas of the lungs w/low compliance
30. What are potential contraindications for the use of intermittent positive-pressure breathing?
ICP >15 mmhg
recent esopnageal surgery
active untreated tubercles
radiographic evidence of bless
recent facial, oral or skull surgery
31. What is an absolute contraindication for using intermittent positive-pressure breathing?
32. What is the most common complication associated with intermittent positive-pressure breathing (IPPB)?
the inducement of respiratory alkalosis. this occurs when pt breath too rapidly during treatment
33. What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach?
20 cm H2) had been reached therefore gastric distention represents the greatest risk in Pt receiving IPPB @ high pressures
34. What is the potential of gastric distention with intermittent positive-pressure breathing (IPPB)?
the inducement of respiration alkalosis. this occurs when pt breath too rapidly during treatment.
Deep fast breathing leads to sharp drop in PcO2 and increased PH
35. What are the potential hazards of intermittent positive-pressure breathing?
increased airway resistance
Impaired venous return
air trapping auto- peep, over distention* psychological dependence
36. Preliminary planning for the use of intermittent positive-pressure breathing (IPPB) should include?
Effective IPPB requires careful preliminary planning, individualized patient assessment and implementation, and thoughtful follow-up. In all three phases of the process, the respiratory therapist should work closely with the prescribing physician to determine patient need, select the appropriate therapeutic approach, and assess patient progress toward predefined clinical outcomes. REF: 912
37. What are the desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy? Box 39-8 lists potential accepted and desired outcomes of IPPB therapy.
Increased FEV or peak flow
enhanced cough and secretion clearance
improved chest radiograph
improved breath sounds
improved oxygenation * favorable pt. subjective response
38. The general assessment, common to all patients when intermittent positive-pressure breathing (IPPB) is ordered, should include?
1) measurement of vital signs
2) observation assement of the pt. appearance and sensorium
3) breathing pattern and chest ausclration
39. When checking a patient's intermittent positive-pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What is the problem?
there is a leak and the pressure is not rising due to the leak out
40. What should explained to the patient about intermittent positive-pressure breathing (IPPB) prior to beginning an new treatment?
(1) Why the physician ordered the treatment, (2) what the treatment does, (3) how it will feel, and (4) what are the expected results should be explained to the patient.
41. What position is ideal for intermittent positive-pressure breathing therapy?
the best is semi flowers position
42. In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, what adjuncts should be tried first?
To eliminate airway leaks in the alert patient, an initial trial of nose clips may be needed until the technique is understood and the treatment can be performed without them.
43. When adjusting the sensitivity control on an intermittent positive-pressure breathing device, what parameters are you changing?
Pressure and flow
44. What are appropriate initial settings for intermittent positive-pressure breathing given to a new patient?
A sensitivity or trigger level of 1 to 2 cm H2O is adequate for most patients. Initially, system pressure is set to between 10 and 15 cm H2O. REF: 914
45. In administering intermittent positive-pressure breathing therapy, what breathing pattern is most desirable?
6 breath per min w/an expiratory time of @ least 3 to 4 times longer than inspiration
I:E ration or 1:3 to 1:4 or lower
46. What are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy?
Most clinical centers strive to achieve an IPPB tidal volume of 10 to 15 ml/kg of body weight or at least 30% of the patient's predicted IC. If the initial volumes fall short of this goal and the patient can tolerate it, the pressure is gradually raised until the goal is achieved. Pressures as high as 30 to 35 cm H2O may be needed to achieve this end when lung compliance is reduced. REF: 914
IPPD last 15 to 20 min
47. What should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment?
a succinct account of treatment session, including the prassessment and postassment results any untoward pt response must also be reported
48. What are the machine performance characteristics that should be monitored during intermittent positive-pressure breathing therapy?
Sensitivity, peak pressure, flow setting, FIO2, I:E ration
49. In terms of machine performance, what does large negative pressure swings early in inspiration indicate?
In terms of machine performance, large negative pressure swings early in inspiration indicate an incorrect sensitivity or trigger setting. REF: 914
50. What will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely?
Alternatively, an IPPB device may cycle off prematurely when airflow is obstructed. Kinked tubing, an occluded mouthpiece, and active resistance to inhalation by the patient are the most common causes of this problem. REF: 915
51. What mechanisms contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
Exactly how CPAP helps resolve atelectasis is unknown. However, the following factors probably contribute to its beneficial effects: (1) the recruitment of collapsed alveoli via an increase in FRC, (2) a decreased work of breathing due to increased compliance or elimination of autopositive end-expiratory pressure (PEEP), (3) an improved distribution of ventilation through collateral channels (e.g., Kohn pores), and (4) an increase in the efficiency of secretion removal. REF: 916
52. What are contraindications for continuous positive airway pressure (CPAP) therapy? REF:
does not ensure ventilation ( no good for PT w/hypoventilation
nausea, facial trauma, untreated pneumorthorax, and elevated intracranial pressure (ICP)
53. What are the potential complications of continuous positive airway pressure (CPAP) therapy?
caused by increased pressure or apparatus
hypoventilation and hypercabnia b/c cpap doesn't augment spontaneous ventilation pt w/ accompanying ventilatory insufficiency may hyperventilate
barotraume pt w/emphysema and blebs * gastric distension lead to vomiting and aspiration w/ pt w/ gag reflex
54. What are the essential components of a continuous positive airway pressure (CPAP) flow system?
A breathing gas mixture from an oxygen blender flows continuously through a humidifier into the inspiratory limb of a breathing circuit. A reservoir bag provides reserve volume if the patient's inspiratory flow exceeds that of the system. The patient breathes in and out through a simple valveless T-piece connector. A pressure alarm system with manometer monitors the CPAP pressure at the patient's airway. The alarm system can warn of either low (usually due to a disconnection) or high system pressure. The expiratory limb of the circuit is connected to a threshold resistor, in this case a water column (H). REF: 916-917
55. During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. What is the explanation?
The most common problem with positive airway pressure therapies is system leaks.
56. What initial flow settings would you select when setting up a continuous positive airway pressure flow-mask system for a patient with atelectasis?
2 to 3 times the pt min ventilation
57. While monitoring a patient receiving +12 cm H2O flow-mask continuous positive airway pressure, you note that the pressure drops to +6 cm H2O during inspiration, but returns to +12 cm H2O during exhalation. What is most likely the problem?
The flow is not adequate and need to be adjusted to met pt flow needs
58. A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has undergone lower abdominal surgery. In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44% predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secretions. What lung expansion treatment would you recommend? REF: 917 know why you made this choice.
VC exceeds 15 ml/kg lean body weight
IC is greater than 33% @ 44%
IS is given if VC and IC are less, IPPB should be given and delivered @ least 15 ml/kg
59. A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. What lung expansion treatment would you recommend? know why you made this choice.
IPPB @ 10 to 15 ml/kg
PT is obtunded (mental blunting)
The Exam will also cover information already learned. It is implied that you already under- stand the material of past exams. To help you review this material the following are the chap- ter worksheets you should review as will:
Chapter 38 Medical Gas Therapy
Chapter 37 Storage and Delivery of Medical Gases (Duration Formulas, cylinder factors, cubic ft liquid O2, and how to figure for a cylinder factor using 28.3 and the cubic feet ) Chapter 4 Principles of infection Control
The test will be 50 questions. The bulk of the test 40 questions will be on Chapter 39 the rest will come from the other chapters noted above plus the one matching. The test will be given as noted on the courses schedule.
1. a/A ratio
the ratio of arterial-to-alveolar oxygen partial pressures (Pao2/PA02); a measure of the efficiency of oxygen transfer across the lung
2. absolute humidity
the actual mass or content of water in a measured volume of air. It is usually expressed in grams per cubic meter or pounds
3. absorption atelectasis
atelectasis due to the absorption of oxygen from obstructed or partially obstructed alveoli with high oxygen concentrations
4. adventitious lung sounds
abnormal lung sounds superimposed on the basic underlying breath sounds
the act of inhaling, especially in reference to the pathological aspiration of vomitus or material foreign to the respiratory tract (see aspiration pneumonia); also the process of withdrawing fluid by negative pressure
6. aspiration pneumonia
an inflammatory condition of the lungs and bronchi caused by the inhalation of foreign ma- terial or vomitus containing acid gastric contents
abnormal collapse of distal lung parenchyma atherosclerosis an arterial disorder characterized by the de- posit of plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls or arteries
injury sustained as a result of exposure to ambient pressures above normal, most commonly secondary to positive pressure ventilation, for example, pneumothorax, pneumomediastinum
9. barrel chest
an abnormal increase in the anterior-posterior diameter of the chest due to hyperinflation of the lungs
10. Biot's respiration
breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken
11. body humidity
the absolute humidity in a volume of gas saturated at a body temperature of 370 C; equivalent to 43.8 mg/L
12. bronchovesicular breath sounds
sharing the characteristics of those heard over the trachea (bronchial sounds) and those arising from the more distal alveolar region (vesicular sounds)
13. canals of Lambert
intercommunicating channels between terminal bronchioles and the alveoli that are about 30 pm in size and appear to remain open even when bronchiolar smooth muscle is contracted
14. Cheyne-Stokes respiration
an abnormal, repeating pattern of breathing characterized by alternating progressive hy- popnea and hypoventilation, ending in a brief apnea
15. chronic bronchitis
a very common debilitating pulmonary disease, characterized by greatly increased production of mucus by the glands of the trachea and bronchi and resulting in a cough with expectoration for at least 3 months of the year for more than 2 consecutive years
16. Coanda effect
a phenomenon in hydrodynamics whereby a fluid in motion may be attracted or held to a wall
17. congestive heart failure (CHF)
an abnormal condition that reflects impaired cardiac pumping. It is caused by myocardial infarction, ischemic heart disease, or cardiomyopathy
18. cor pulmonale
right ventricular hypertrophy/failure and pulmonary hypertension due to certain parenchymal or vascular lung disorders
19. costopbrenic angle
the acute angle where the costal pleura meets the diaphragm
a discontinuous type of adventitious lung sound creatinine a substance formed from the metabolism of cre- atine, commonly found in blood, urine, and muscle tissue
Direct signs of volume loss on the chest film
displacement of the interlobar fissures, crowding of the pulmonary vessels, and air bronchograms. Indirect signs include elevation of the diaphragm, shift of the trachea, heart, or mediastinum, pulmonary opacification, narrowing of the space between the ribs, and compensatory hyperexpansion of the surrounding lung.
THIS SET IS OFTEN IN FOLDERS WITH...
Mechanical Ventilation Formulas and Norms
Respiratory Therapy Equations
Respiratory Therapy-Egans 2012 7
IPPB & Lung Expansion Therapy
YOU MIGHT ALSO LIKE...
Egan's 11th Edition Chapter 42: Lung Expansion The…
Lung Expansion Therapy proc 2 test #2
Ch.39 Egan's Lung Expansion Therapy
OTHER SETS BY THIS CREATOR
antiinfactives, diuretis, xantines, and NM agents
Delivery Aerosol to upper airway
OTHER QUIZLET SETS
Chapter 25 HW: The History of Life on Earth
economic loss + negligent misstatement
Ch. 17 Functional Organization of Endocrine System
Biology chapter 7 vocabulary