Ch. 43 Egans Flashcards
What are the indications for NIV?
Inc. WOB
COPD
DNI
What are the diff. types of atelectasis?
Gas absorption atelectasis
Lobar atelectasis
Compression atelectasis
What are the factors associated with atelectasis?
Obesity
Neuromuscular Disorders
Heavy sedation
Surgery near diaphragm
Bed rest
Restrictive chest wall abnormalities
Clinical signs of NIV?
Tachypnea
Fine late inspiratory crackles (alveoli are trying to pop back open but not all of them)
Inc. density and signs of volume loss on chest radiograph
Bronchial breath sounds
Tachycardia
Categories for NIV?
Positive pressure
Pt triggered
Pressure cycled
Pneumatically powered
Time, pressure, or manually triggered
Lung expansion tool
Time = machine
pressure = pt
manually = pressing button
How long does NIV tx last for?
15-20 mins
Every 4-6 hours based on tx time, severity, and disease.
Indications for IPPB?
I.S. pt dependent to other modalities
Pt w/pulmonary atelectasis not responsive
Pt. Inability to clear secretions
Pt with vent muscle weakness or fatigue w/aerosol delivery
Contradictions to IPPB/Tension pneumothorax?
What are some potential outcomes for IPPB?
What are some things to monitor for IPPB?
What are some hazards/complications for IPPB?
What are some equipments used for IPPB?
Mouthpiece and nose clip
Circuit
Tracheal adaptor
What is the best position for IPPB?
Semi-Fowler
Preliminary planning for IPPB?
Therapeutic outcomes set
Evaluate alternatives
Baseline assessment of pt
Implementation for IPPB?
-Equipment
-Pt orientation
-Pt positioning
-Initial application
•Sensitivity of 1-2cmH2O
•Initial pressure 10-15cmH2O
•Breathing pattern 6-8 bpm
•I:E ratio of 1:3 or 1:4
-Adjusting parameters
•Flow & pressure are adjusted to meet the goal
Control changes for IPPB (volume)?
⬆️ pressure = ⬆️ volume time
⬇️ flow = ⬇️ Ti
Ti is determined by pressure setting, flow rate, lung compliance, and airway resistance
Control changes in IPPB (I:E)?
⬆️ pressure = ⬆️ Ti
⬆️ flow = ⬇️ Ti
Lung status vs. volume
⬇️ compliance = ⬇️ volume
⬆️ compliance = ⬆️ volume
⬆️ Raw = ⬇️ volume
⬇️ Raw = ⬆️ volume
⬆️ compliance ⬇️ Raw (positive thing) = ⬆️ volume
What are the different parts of the IPPB Bird circuit?
Name the parts of the IPPB Bird Circuit
- Holder
- Nebulizer exhalation valve drive line
- Main flow tube
- Nebulizer
- Manifold
- Exhalation valve
- Mouthpiece
- Reservoir tube
- Exhalation valve drive line
What is IPPB sensitivity?
Pt effort control
⬆️ sensitivity means what?
Makes machine less sensitive to pt inspiratory trigger (machine makes it more difficult for pt to trigger machine on).
⬇️ sensitivity means what?
Will make machine more sensitive to pt inspiration
What can a ⬇️ in sensitivity cause?
Auto-triggering if set too low
What does ⬇️ the dial do?
Creates less magnetic pull on the diaphragm in the middle of machine
What does less sensitive mean?
More pressure needed to initiate inspiration phase (harder for pt).
More sensitive=
Easier for pt
Less sensitive=
Harder for pt
