Chapter 7 Flashcards
List 2 indications for IPPB?
- Need for delivery of medications to
patients who cannot take a deep breath (<
10 ml/kg IBW) - Atelectasis especially in sedated post-op
patients and patients recovering from
abdominal or chest surgery who are more
reluctant to breath deeply or cannot take
breaths on their own
List 5 hazards of IPPB?
Excessive ventilation
Gastric distention
Decreased cardiac output
Increased ICP
Pneumothorax
List 2 contraindications for IPPB?
Untreated pneumothorax
Pulmonary hemorrhage
The pulse rate must not exceed how many
beats/min before treatment must be terminated?
20 beats/min
What does an inc. Raw have on delivered tidal
volume on a pressure limited IPPB machine?
Dec. VT
What affect does an inc. CL have on the
delivered VT on IPPB machine?
Inc. Vt
How does lung compliance affect Ti?
Decreases Ti
How should IPPB be modified for a patient
w/closed head injury?
Place the patient in Fowlers position to avoid
increased ICP. High pressures should be avoided
and short inspiratory pressures should be used
by increasing inspiratory flow rate.
Incentive spirometry is indicated if a patient can
obtain a vital capacity of what level?
More than 10 ml/kg of body weight.
What is another word used for incentive
spirometry?
Sustained maximal inspiratory therapy
List 3 requirements necessary for incentive
spirometry?
Cooperative patient
Motivated patients
Patients respiratory rate should be less
than 25 breaths/min
What is IPPB?
A short-term 10-15 min breathing treatment in
which pressures above atmospheric pressure are
delivered to the patients lungs via a pressure
limited ventilator.
What are the 4 factors for effective IPPB?
- An RRT who has been well trained and has
the knowledge of the equipment,
medications used, reasons for therapy,
side effects and goals of therapy. - A relaxed informed, and cooperative
patient - A pressure limited IPPB machine with a
means of measuring Vt - Proper instruction of the patient on
breathing patterns
If there is decreased venous return and left
ventricular pressure during therapy what might
the patient experience?
Tachycardia and a decrease in systemic blood
pressure
What is normal ICP?
< 10 mmHg
Pneumothorax is most common in what
patients?
COPD patients with bollous disease or bleb
formation.
Patients who complain of sudden chest pain,
SOB, other breathing difficulties, or tachycardia
during IPPB must be suspected of what?
Pneumothrorax
If pneumothorax is suspected what should
happen?
Treatment should be stopped immediately.
What is gastric distention?
Swallowing air during the treatment
Gastric distention may cause the patient to
complain of what after?
Nausea during or after treatment
IPPB is safe for patients with a pneumothorax
that have a in place?
Chest tube
If IPPB is administered in a pulmonary
hemorrhage air may enter the blood vessel
resulting in what?
air embolism
What should you review the patients chart for?
- Last treatment given
- Latest chest film interpretation
- Latest ABG results
- Identify indications, potential hazards, and
contraindications for treatment
How much sensitivity does the patient need to
draw?
no more than -2 cm H2O
Increased airway resistance results in what?
Decreased Vt
Decreased Ti
Decreased airway resistance results in what?
Increased Vt
Increased Ti
Increased lung compliance results in what?
Increased Vt
Increased Ti
Decreased lung compliance results in what?
Decreased Vt
Decreased Ti
Increased inspiratory pressure results in what?
Increased Vt
Decreased inspiratory pressure results in what?
Decreased Vt
Increased flow results in what?
Decreased Vt
Decreased flow results in what?
Increased Vt
Increased Ti
WHAT DO YOU DO IF THE PATIENT IS HAVING
DIFFICULTY CYCLING IPPB INTO THE
INSPIRATORY PHASE?
Adjust sensitivty so that patient is
generating a pressure of -0.5 to - 2cm H2O
Make sure the machine is plugged into the
wall gas outlet
Ensure that the machine tubing
connections are all tight
Ensure that the patient has lips sealed
tightly around the mouthpiece or mask to
avoid leaks
WHAT DO YOU DO IF THE PATIENT COMPLAINS
OF DIZZINESS AND TINGLING IN THE
EXTREMITIES DURING THE TREATMENT BUT
HAS NO APPRECIABLE INCREASE?
Instruct the patient to breathe slower and to
pause longer between breaths
WHAT TO DO IF THE PATIENTS HEART RATE
INCREASES MORE THAN 20 BEATS PER/MIN
DURING TREATMENT?
Stop the treatment immediately and notify
the physician.
This is most likely the result of the
nebulized bronchodilating agent
stimulating the heart
WHAT TO DO IF THE PATIENT CANNOT CYCLE
THE IPPB MACHINE OFF?
Tighten all tubing connections
Ensure that there are no leaks around the
mouthpiece, mask, or nose. Nose clips
should be used if air is leaking out
Ensure that the ETT or trach cuff is inflated
and adequately to prevent leaks
Check the circuits of the expiratory valve
function
WHAT TO DO IF THE PATIENT INHALES BUT
THERE IS NO NEBULIZATION OF THE
MEDICATION?
Ensure that the capillary tube of the neb is
connected
Ensure that the neb drive line is connected
What do we do if during inspiration the needle
stays in the negative area for the first half of the
breath and then rises to the positive area in the
last half?
Increase the machine flow rate
What do we do if the IPPB machine repeatedly
cycles on shortly after the patient has begun the
expiratory phase.
Decrease machine sensitivity
Make sure control is off
Flow meter for EzPAP is set to what?
5-10 lpm
EzPAP is indicated for what patients?
Atelectasis
What is the VC for EzPAP?
> 10 ml of IBW
What are the indications for I.S.?
Presence of atelectasis
Patients prone to atelectasis such as
postoperative patient following upper
abdominal or thoracic surgery
Presence of restrictive lung condition
quadriplegia or impaired diaphragm
What are some complications of I.S.?
Hyperventilation: have patient pause
longer between deep breaths
Fatigue
Ineffective if not performed properly
I.S. is inappropriate if used as the only
treatment for atelectasis or consolidation
(Most effective when combined with
ambulation).
Discomfort secondary to inadequate pain
control
What are the requirements for effective I.S.?
- Cooperative patient.
- Motivated patient.
- Patient’s respiratory rate should be less
than 25 breaths/min.
