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Egans > ch 39 atelectasis and overview of LET > Flashcards

ch 39 atelectasis and overview of LET Flashcards

1
Q

define atelectasis

A

alveolar collapse

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2
Q

what are 3 pulmonary complications seen with patients who undergo thoracic or abdominal surgery

A

atelectasis, pneumonia, acute respiratory failure

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3
Q

most common form of therapy used in high risk patients after surgery

A

lung expansion therapy

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4
Q

lung expansion therapy includes what 5 modalities that are designed to prevent or correct atelectasis

A
  1. intermittent positive airway pressure breathing (IPPB)
  2. positive expiratory pressure (PEP)
  3. continuous positive airway pressure (CPAP)
  4. incentive spirometry (IS)
  5. deep breathing/directed cough
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5
Q

the common purpose of all 5 lung expansion therapies is

A

guiding the patient into improving pulmonary function by maximizing alveolar recruitment and optimizing airway clearance

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6
Q

true or false: there is no precise method to apply in a given situation bc there has not been any one method proved superior to other methods of LET (lung expansion therapy)

A

true

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7
Q

what is the common factor that all the LET modalities share

A

they are all designed to increase functional residual capacity (FRC)

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8
Q

what 4 things should a RT assist the physician in

A
  1. identifying patients most likely to benefit from LET
  2. recommend/initiate the appropriate and most efficient therapeutic approach
  3. monitor the patients response
  4. alter the treatment regimen as needed
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9
Q

the 2 types of atelectasis associated with postoperative or bedridden patients who are breathing spontaneously w/o mechanical assistance are

A
  1. gas absorption atelectasis

2. compression atelectasis

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10
Q

when can gas absorption atelectasis occur

A

either when there is a complete interruption of ventilation to a section of the lung (or) when there is a significant shift in v/q (ventilation/perfusion)

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11
Q

during gas absorption atelectasis what causes the partial collapse of the alveoli

A

gas that is absorbed by the passing blood DISTAL to the obstruction, causing the partial collapse of the nonventilated alveoli

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12
Q

define lobar atelectasis

A

when ventilation is compromised to a larger airway or bronchus

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13
Q

what does transmural pressure do

A

distends and maintains the alveoli in an open state

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14
Q

when does compression atelectasis occur

A

when the forces within the chest wall and lung (pleural pressure) are exceeded by the transmural pressure

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15
Q

what causes compression atelectasis

A

persistent use of small tidal volumes by the patient and when the patient does not periodically take a deep breath in and expand the lungs fully

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16
Q

when is it common to find someone using small tidal volumes

A
  1. general anesthesia is given
  2. use of sedatives and bed rest
  3. when deep breathing is painful (after surgery)
  4. weakening or impairment of the diaphragm
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17
Q

what type of atelectasis is common in hospitalized patients

A

compression atelectasis

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18
Q

true or false compression atelectasis and gas absorption atelectasis can occur simultaneously and why

A

true – may occur in a patient with excessive airway secretions who breathes with small tidal volumes for extended period of time

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19
Q

when can atelectasis occur in a patient

A

when the patient does not or cannot take deep breaths periodically and in patients who are restricted to bed for any reason

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20
Q

patients who have difficulty taking deep breaths without assistance include

A
  1. patients with significant obesity
  2. neuromuscular disorders
  3. under heavy sedation
  4. patients who have undergone upper abdominal or thoracic surgery
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21
Q

what are the major contributors to the onset of atelectasis

A
  1. diaphragmatic position

2. function of the diaphragm

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22
Q

in an anesthetized patient what shift of the diaphragm occurs

A

cephalad (toward the head) shift

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23
Q

for patients who are supine what part of the diaphragm is used the most

A

the lower, dependent portion of the diaphragm performs the most movement

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24
Q

for patients who are paralyzed what part of the diaphragm is used the most

A

the upper portion of the diaphragm

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25
Q

patients undergoing lower abdominal surgery are at _____ risk for atelectasis than patients undergoing upper abdominal or thoracic surgery

A

lower

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26
Q

patients with spinal cord injuries are most prone to what type of respiratory complication

A

atelectasis

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27
Q

bedridden patients (recovering from trauma) are predisposed to what type of conditions (2)

A

lack of mobility and development of atelectasis

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28
Q

atelectasis is the biggest determinate to what post abdominal surgery

A

hypoxemia

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29
Q

_____ percentage of deaths occur from atelectasis within ____ days of surgery

A

24% and within 6 days of surgery

30
Q

impairment of the function of __________ ____________ also impacts the development of atelectasis

A

pulmonary surfactant

31
Q

what do surfactants do in the lungs

A

decrease the surface tension of the walls of the alveoli

32
Q

when there is deterioration of surfactant function what occurs

A

the relative increase in surface tension can cause the walls of the alveoli to collapse

33
Q

why do most postoperative patients have trouble coughing

A

because of their reduced ability to take deep breaths

34
Q

ineffective cough impairs ______ which leads to increased retain of ________

A

impairs normal clearance mechanism leading to increases in retained secretions

35
Q

what type of atelectasis does an increase in retained secretions lead too and why

A

development of gas absorption atelectasis in a patient with excessive mucus production

36
Q

what type of patients are more prone to develop increased retained secretions

A

patients with preexisting lung disease with increased mucus production like chronic bronchitis or chronic smokers

37
Q

lung expansion therapy and chest physical therapy in the postoperative period help improve what

A

clearance of secretions by improving the effectiveness of coughing and secretion removal

38
Q

if the incision is close to the diaphragm the chances of _______ goes up

A

greater risk of postoperative atelectasis

39
Q

how does inadequate nutrition increase the risk for postoperative atelectasis

A

most likely due to inadequate strength of the inspiratory muscles to maintain a normal FRC and VC

40
Q

what levels show inadequate nutrition that could lead to increased risk for pulmonary complications

A

albumin level less than 3.2 mg/dL

41
Q

what provides the first clue in identifying atelectasis

A

patients medical history

42
Q

if the patient has minimal atelectasis then the signs may be

A

absent or very subtle

43
Q

when atelectasis involves a more significant portion of the lungs the patients respiratory is related how

A

the patients respiratory rate increases proportionally

44
Q

what sounds may be heard over the region of the atelectasis

A

fine, late-inspiratory crackles

45
Q

what produces the crackles heard

A

sudden opening of distal airways with deep breathing

46
Q

what breath sounds may be heard as the lung becomes more consolidated with atelectasis

A

bronchial type breath sounds

47
Q

diminished breath sounds are common when

A

excessive secretions block the airways and prevent transmission of breath sounds

48
Q

__________ heart rate may be present if atelectasis leads to significant ________

A

tachycardia , hypoxemia

49
Q

patients with preexisting lung disease often present with significant abnormalities in __________ and _________ rates; even when atelectasis is not _________

A

respiratory
heart
severe

50
Q

direct relationship between the ______________ respiratory rate and the ___________ of atelectasis present

A

spontaneous
degree
(directly related)

51
Q

what is often done to confirm the presence of atelectasis

A

chest radiograph

52
Q

in a x-ray the atelectatic region shows as

A

increased opacity

53
Q

evidence of __________ _________ is present in patients with significant atelectasis

A

volume loss

54
Q

direct signs of volume loss on the chest film include (3)

A
  1. displacement of interlobar fissures
  2. crowding of pulmonary fissures
  3. air bronchograms
55
Q

indirect signs of volume loss on the chest film include (5)

A
  1. elevation of the diaphragm
  2. shift of the trachea, heart, or mediastinum towards side of atelectasis
  3. pulmonary opacification
  4. narrowing of the space b/w the ribs
  5. compensatory hyperextension of the surrounding lung
56
Q

how do all modes of lung expansion therapy work

A

they increase lung volume by increasing the transpulmonary pressure (PL) gradient

57
Q

what does the transpulmonary pressure gradient represent

A

the difference between the alveolar pressure (Palv) and the pleural pressure (Ppl)

58
Q

what is the formula for the PL gradient

A

PL = Palv - Ppl

59
Q

with all else being constant, the greater the PL gradient, the more that the alveoli will…

A

expand – directly related

60
Q

how can the PL gradient be increased

A
  1. decrease the surrounding Ppl

2. increase the Palv

61
Q

how does a spontaneous deep inspiration increase the PL gradient

A

by decreasing the Ppl

62
Q

how does the application of positive pressure to the lungs increase the PL gradient

A

increasing the pressure inside the lungs

63
Q

how does incentive spirometry work

A

it enhances lung expansion via a spontaneous and sustained decrease in Ppl

64
Q

how does positive airway pressure techniques work

A

increases Palv in an effort to expand the lung

65
Q

what method decreases Ppl

A

incentive spirometry

66
Q

methods that decrease Ppl have a more ______ effect than the methods that increase Palv and often are most ________

A

physiologic

effective

67
Q

what should the goal of any lung expansion therapy

A

implement a plan that provides an effective strategy in the most efficient manner

68
Q

what two major issues are related to efficiency

A

staff time and equipment

69
Q

what does positive pressure therapy require significantly more of

A

staff time and equipment

70
Q

who is positive pressure therapy reserved for

A

high-risk patients who cannot perform IS techniques

Egans (2 decks)

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