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RSPT EQUIPMENT > Chapter 43 > Flashcards

Chapter 43 Flashcards

1
Q

What is Lung Expansion Therapy?

A

*used to keep the alveoli open
*often used with other therapies to keep the bronchi free of secretions and fully bronchodilated
*also called bronchopulmonary toilet or bronchial hygiene therapy

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2
Q

what are some Natural Lung Expansion Mechanisms?

A

1.Yawn or sigh
2.Coughing
3. Mucociliary escalator

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3
Q

Yawn or sigh

A

a large, deep breath which will pop open the alveoli to prevent -
Passive Atelectasis

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4
Q

Passive Atelectasis

A

alveoli have closed down because of a lack of deep breaths, you breathe with the same size tidal volume every breath

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5
Q

Coughing

A

keeps airway clear by moving secretions along (100ml mucus a day) helps prevent -
Reabsorption atelectasis

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6
Q

Reabsorption atelectasis

A

secretions plug the airway off; no fresh gas gets to the alveoli so the gas in the alveolus is also absorbed

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7
Q

Mucociliary escalator

A

the cilia move mucous of normal amounts and thickness.

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8
Q

How does atelectasis happen?

A

*when FRC is decreased, we develop a decreased lung compliance (lung is stiffer, not as stretchable)
*much easier to take frequent shallow breathes than to work at stretching a stiff lung
*Vicious Cycle
*Shallow breathing and not coughing leads to retained secretion and infection can result

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9
Q

Vicious Cycle

A

more shallow breaths lead to more atelectasis thus leading to a further decrease in FRC

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10
Q

Functional Residual Capacity (FRC)

A

the normal amount of gas left in your lungs at the end of a normal exhalation

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11
Q

Factors Associated with Atelectasis

A

*Obesity – post op comp
*Neuromuscular disorders
*Heavy sedation
*Surgery near diaphragm
*Bed rest
*Poor cough
*History of lung disease
*Restrictive chest-wall abnormalities – scoliosis

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12
Q

Clinical Signs of Atelectasis

A

*History of recent major surgery
*Tachypnea
*Fine, late-inspiratory crackles
*Bronchial or diminished breath sounds
*Tachycardia
*Increased density and signs of volume loss on chest radiograph

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13
Q

Types of Lung Expansion Therapy

A

PEP (Positive Expiratory Pressure)
IPPB (Intermittent Positive Pressure Breathing)
IPV (Interpulmonary Percussive Ventilation)
IS (Incentive Spirometry)
**These are the most common therapies used to maximize lung expansion and prevent atelectasis

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14
Q

PEP (Positive Expiratory Pressure)

A

-Traditional, Vibratory/Oscillatory – purse lip breathing with a devise or extra stuff (COPD – air trapping bc airways collapse)

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15
Q

IPPB (Intermittent Positive Pressure Breathing)

A

just lung expansion

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16
Q

IPV (Interpulmonary Percussive Ventilation)

A

breathe percussive breaths

17
Q

IS (Incentive Spirometry)

A

just lung expansion - Inhale Slowly
*mimics the natural sigh or yawn by encouraging slow, deep breaths
* the patient must do the work

18
Q

Indications for IS

A

-presence of or risk of developing atelectasis (thoracic or abdominal surgery)
o-patients with Neuromuscular disease (ALS)
-restrictive lung disease (quadriplegia)

19
Q

Guidelines for IS

A

**IC- inspiratory capacity (Vt +IR)
-IC> 80% of preoperative value—treatment not indicated
-IC < 2.5 L—IS is indicated
-Treatment goal for IS should be an initial IC of 2X the Vt.
-Increase the goal in 200 ml increments as tolerated
-FVC < 70% of predicted or VC < 10 ml/kg—IPPB is indicated
(forced vital capacity – everything but rv)

20
Q

Outcomes for IS

A

-increased lung volumes
-decreased RR and HR
-improved breath sounds
-decreased WOB
-increased PaO2
-improved chest x-rays

21
Q

Hazards and Complications for IS

A

-Hyperventilation and respiratory alkalosis – dizzy and tingling fingers
-Discomfort secondary to inadequate pain control
-Pulmonary barotrauma – pneumothorax
-Exacerbation of bronchospasm
-Fatigue

22
Q

Contraindications for IS

A

-confused, uncooperative patients
-unable to take deep breathes (Vital capacity < 10ml/kg)

23
Q

Advantages for IS

A

-easy, inexpensive therapy with very few side effects
-patient gets visual feedback on their progress
-can be done without the therapist

24
Q

Volume Displacement IS

A

-as the patient inhales through a mouthpiece, a volume is displaced
-at maximal volume, the patient should hold the breath for 3-5 seconds
before exhaling
-should do 5-10 breaths every hour while awake – IS q1
-some devices have a flow indicator to encourage the patient to take a slow, deep breath

25
Flow Dependent IS
-contains a manifold of 3 tubes each containing a lightweight ball -negative pressure in the tubes causes the balls to rise -the number of balls that rise and the level to which they rise measures the flow achieved -smaller devices, but more difficult to perform
26
other important notes for IS
*the breath hold allows the pressure in the lungs to equilibrate *as the patient achieves more volume for the same effort, they are getting better
27
Intermittent Positive Pressure Breathing
foundation of mechanical ventilation *delivery of positive inspiratory pressure to a spontaneously breathing patient (the opposite of how we normally breathe) *beneficial to patients for whom IS, CPT, and deep breathing have not been effective; the machine does the work for the patient
28
Indications for IPPB
-lung expansion therapy, especially for those unable to do IS -aerosolized medication
29
IPPB Operation
*machine requires a 45-55 psi pressure source *inspiration begins when the patient creates a negative pressure and ends when a preset pressure is reached *the amount of negative pressure the patient must generate to start the breath (trigger) depends on the sensitivity set on the machine (set by the therapist) *the pressure that must be reached to end inspiration (limit) and allow exhalation to occur (cycle) is also set on the machine (set by the therapist) *the goal of IPPB is to deliver a volume, not a pressure to the patient *the amount of volume the patient gets for a pressure depends on the condition of the lungs; less compliant lungs get less volume for the same pressure *treatment should last 15-20 minutes
30
Contradictions of IPPB
*ICP greater than 15 mm Hg *Hemodynamic instability *Active hemoptysis *Tracheoesophageal fistula *Recent esophageal surgery *Active, untreated tuberculosis *Radiographic evidence of blebs *Recent facial, oral, or skull surgery *Singultus (hiccups)
31
Side Effects of IPPB
-barotrauma (pushing air into a weak lung can pop it) (a stiff lung) Volutrauma (over compliant lung) -hyperventilation (gives big breaths, removes more CO2) -Cardiovascular effects—IPPB can decrease Venous Return to the heart, this will cause a drop-in blood pressure *E time should be twice as long as I time, this allows blood to return to the heart between breaths
32
Bird IPPB Machine
*pneumatically powered *time, pressure (preferred), or manually triggered *time or pressure cycled machine must be cleaned, line is disposable
33
Gas Flows in Bird IPPB Machine
-gas leaving the compartment travels to a Venturi jet, a nebulizer power line, and the exhalation valve -the Venturi jet entrains air and the gas moves to the patient -as pressure builds, the Venturi jet closes; the gas flow to the exhalation valve stops, so the valve opens to allow the patient to exhale
34
Air Mix Control in Bird IPPB Machine
-On: gas is directed to the Venturi jet. *Delivered gas comes from the Venturi jet, the air it entrains, and the nebulizer. *has a decelerating flow pattern, good for obstructed patients (COPD, asthma) -Off: gas never goes to the Venturi jet, no air in entrained, FiO2=100% *has a constant, square wave flow
35
Flow Control on Bird IPPB Machine
-increasing the flow will decrease the time for the breath -high flow is more turbulent, pressure builds faster, so breath is shorter – flow control -obstructed patients will not get a good volume if the flow is too fast

RSPT EQUIPMENT (2 decks)

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