Chapter 43 Egans

Question 1

What is atelectasis?

Answer 1

Alveoli collapse

Question 2

What causes atelectasis?

Answer 2

persistent ventilation with small tidal volumes or by resorption of gas distal to obstructed airways

Question 3

What patients are at more risk for developing atelectasis?

Answer 3

Patients who have undergone upper abdominal or thoracic surgery

Question 4

What are 3 signs of atelectasis?

Answer 4

-Rapid, shallow breathing
-Fine late inspiratory crackles
-abnormalities on chest radiograph

Question 5

3 types of atelectasis

Answer 5

Gas absorption
Lobar
Compression

Question 6

Gas absorption atelectasis

Answer 6

-Complete interruption of ventilation to a section of the lung
or
-Significant shift in V/Q
~ Elevated FiO2

Question 7

Lobar atelectasis

Answer 7

Complete or partial collapse of the entire lung or area (lobe) of the lung

Question 8

Compression atelectasis

Answer 8

When the transthoracic pressure exceeds the trans alveolar pressure

Question 9

What is transthoracic pressure

Answer 9

Pressure difference between the body surface and the alveoli

Question 10

What is trans alveolar pressure

Answer 10

The pressure difference between the alveoli and pleural space

Question 11

Supine patients Vs. Paralized

Answer 11

Supine: Lower, dependent portion of the diaphragm performs most movement
Paralyzed: Upper portion of diaphragm performs most movement

Question 12

Moderate atelectasis

Answer 12

Increased RR and consistently lower SpO2
Breathe sounds with crackles and possibly faint bronchial breath sounds

Question 13

Severe atelectasis

Answer 13

Dyspnea, need more O2, absent breath sounds over affected area with distinct brachial sounds in surrounding area

Question 14

Chest X-ray with atelectasis

Answer 14

increased opacity

Question 15

Pal gradient

Answer 15

Difference between alveolar and pleural pressure pal= Palv-Ppl

Question 16

How to increase Pal gradient

Answer 16

1) decreasing surrounding Ppl
2) Increasing Palv
3) Deep breath in

Question 17

Goal of any lung expansion therapy

Answer 17

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

Question 18

Two major issues related to efficiency

Answer 18

Staff time, equipment

Question 19

4 parts of general assessment

Answer 19

1) Measuring vital signs
2) Assessing the patient’s appearance and sensorium
3) Assessing breathing patterns through chest auscultation
4) Patients level of motivation and their ability to follow instructions

Question 20

Pulmonary complications of immobility

Answer 20

Development of atelectasis, pneumonia, and pulmonary emboli (PE)

Question 21

Complications of prolonged bed rest

Answer 21

Cardiovascular, pulmonary, gastrointestinal, skin integrity issues

Question 22

Purpose of IS (Incentive Spirometry)

Answer 22

• treat existing atelectasis
• Also helps coach the patient to take a sustained maximal inspiratory (SMI) effort resulting in a decrease in Pal and maintaining the patency of airways at risk for closure

Question 23

Most common problem of IS?

Answer 23

Respiratory alkalosis

Question 24

Volume oriented IS devices:

Answer 24

Measure and visually indicate the volume achieved by SMI

Question 25

Flow oriented IS Devices:

Answer 25

Measure and indicate degree of inspiratory flow (Flow x time = volume)

Question 26

Phases of IS application

Answer 26

Preliminary planning- identify needs/risks
Implementation- The patient should be instructed to inspire slowly and deeply to maximize the distribution of ventilation
~ Correct technique calls for diaphragmatic breathing at slow to moderate inspiratory flows
~ Goal is an intermittent, maximal inspiration
~ 5-10 SMI maneuvers each hour
Follow up- Assessing patients performance

Question 27

NIV (Noninvasive Ventilation)

Answer 27

Provides breathing support to patients with inadequate ability to ventilate

Question 28

IPPB

Answer 28

Proved machine-assisted deep breathes assisting the patient to breathe deeply and stimulate a cough
~ Lung volumes are increased because Palv>Ppl
~ Should provide the patient with augmented Vt, achieved with minimal effort

Question 29

Gastric distention

Answer 29

Gas from IPPB device passes directly into the esophagus

Question 30

CPAP

Answer 30

Provides distending pressure to reinflate the collapsed airways thus improving V/Q
~ Pressure maintained between 5cm H2O- 20cm H2O
~ Should be used continuously until patient recovers
~ Reduces venous return and cardiac filling pressures

Question 31

HFNC (High flow nasal cannula)

Answer 31

Flow rate of 40-50L/min
~ Provide a more stable FiO2
~ Reduces anatomic dead space by approximately 1/3, reducing PCO2 by 3-5mm Hg and decreasing WOB
~ 1 cm H2O PEEP is established for every 10L/min flow through the HFNC

Question 32

PAP therapy factors(PEP, Flutter, CPAP)

Answer 32

1) recruitment of collapsed alveoli through an increase in FRC
2) decreased WOB due to increased compliance or elimination of intrinsic bution of ventilation through collateral channels
4) Increase in the efficiency of secretion removal

Question 33

Extra Facts

Answer 33

~ If the VC exceeds 15mL/kg of lean body weight or the IC is greater than 33% of predicted, IS is given
~ If either VC or the IC is less than these threshold levels, IPPB is initiated with the pressure gradually manipulated from the initial setting to deliver at least 15mL/kg
~ If excessive sputum production is a compounding factor, a trial of PEP therapy is substituted for IS