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RET 2934 > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

List 2 indications for IPPB?

A
  1. Need for delivery of medications to
    patients who cannot take a deep breath (<
    10 ml/kg IBW)
  2. 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
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2
Q

List 5 hazards of IPPB?

A

Excessive ventilation
Gastric distention
Decreased cardiac output
Increased ICP
Pneumothorax

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3
Q

List 2 contraindications for IPPB?

A

Untreated pneumothorax
Pulmonary hemorrhage

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4
Q

The pulse rate must not exceed how many
beats/min before treatment must be terminated?

A

20 beats/min

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5
Q

What does an inc. Raw have on delivered tidal
volume on a pressure limited IPPB machine?

A

Dec. VT

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6
Q

What affect does an inc. CL have on the
delivered VT on IPPB machine?

A

Inc. Vt

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7
Q

How does lung compliance affect Ti?

A

Decreases Ti

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8
Q

How should IPPB be modified for a patient
w/closed head injury?

A

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.

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9
Q

Incentive spirometry is indicated if a patient can
obtain a vital capacity of what level?

A

More than 10 ml/kg of body weight.

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10
Q

What is another word used for incentive
spirometry?

A

Sustained maximal inspiratory therapy

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11
Q

List 3 requirements necessary for incentive
spirometry?

A

Cooperative patient
Motivated patients
Patients respiratory rate should be less
than 25 breaths/min

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12
Q

What is IPPB?

A

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.

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13
Q

What are the 4 factors for effective IPPB?

A
  1. 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.
  2. A relaxed informed, and cooperative
    patient
  3. A pressure limited IPPB machine with a
    means of measuring Vt
  4. Proper instruction of the patient on
    breathing patterns
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14
Q

If there is decreased venous return and left
ventricular pressure during therapy what might
the patient experience?

A

Tachycardia and a decrease in systemic blood
pressure

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15
Q

What is normal ICP?

A

< 10 mmHg

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16
Q

Pneumothorax is most common in what
patients?

A

COPD patients with bollous disease or bleb
formation.

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17
Q

Patients who complain of sudden chest pain,
SOB, other breathing difficulties, or tachycardia
during IPPB must be suspected of what?

A

Pneumothrorax

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18
Q

If pneumothorax is suspected what should
happen?

A

Treatment should be stopped immediately.

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19
Q

What is gastric distention?

A

Swallowing air during the treatment

20
Q

Gastric distention may cause the patient to
complain of what after?

A

Nausea during or after treatment

21
Q

IPPB is safe for patients with a pneumothorax
that have a in place?

A

Chest tube

22
Q

If IPPB is administered in a pulmonary
hemorrhage air may enter the blood vessel
resulting in what?

A

air embolism

23
Q

What should you review the patients chart for?

A
  1. Last treatment given
  2. Latest chest film interpretation
  3. Latest ABG results
  4. Identify indications, potential hazards, and
    contraindications for treatment
24
Q

How much sensitivity does the patient need to
draw?

A

no more than -2 cm H2O

25
Q

Increased airway resistance results in what?

A

Decreased Vt
Decreased Ti

26
Q

Decreased airway resistance results in what?

A

Increased Vt
Increased Ti

27
Q

Increased lung compliance results in what?

A

Increased Vt
Increased Ti

28
Q

Decreased lung compliance results in what?

A

Decreased Vt
Decreased Ti

29
Q

Increased inspiratory pressure results in what?

A

Increased Vt

30
Q

Decreased inspiratory pressure results in what?

A

Decreased Vt

31
Q

Increased flow results in what?

A

Decreased Vt

32
Q

Decreased flow results in what?

A

Increased Vt
Increased Ti

33
Q

WHAT DO YOU DO IF THE PATIENT IS HAVING
DIFFICULTY CYCLING IPPB INTO THE
INSPIRATORY PHASE?

A

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

34
Q

WHAT DO YOU DO IF THE PATIENT COMPLAINS
OF DIZZINESS AND TINGLING IN THE
EXTREMITIES DURING THE TREATMENT BUT
HAS NO APPRECIABLE INCREASE?

A

Instruct the patient to breathe slower and to
pause longer between breaths

35
Q

WHAT TO DO IF THE PATIENTS HEART RATE
INCREASES MORE THAN 20 BEATS PER/MIN
DURING TREATMENT?

A

Stop the treatment immediately and notify
the physician.
This is most likely the result of the
nebulized bronchodilating agent
stimulating the heart

36
Q

WHAT TO DO IF THE PATIENT CANNOT CYCLE
THE IPPB MACHINE OFF?

A

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

37
Q

WHAT TO DO IF THE PATIENT INHALES BUT
THERE IS NO NEBULIZATION OF THE
MEDICATION?

A

Ensure that the capillary tube of the neb is
connected
Ensure that the neb drive line is connected

38
Q

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?

A

Increase the machine flow rate

39
Q

What do we do if the IPPB machine repeatedly
cycles on shortly after the patient has begun the
expiratory phase.

A

Decrease machine sensitivity
Make sure control is off

40
Q

Flow meter for EzPAP is set to what?

A

5-10 lpm

41
Q

EzPAP is indicated for what patients?

A

Atelectasis

42
Q

What is the VC for EzPAP?

A

> 10 ml of IBW

43
Q

What are the indications for I.S.?

A

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

44
Q

What are some complications of I.S.?

A

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

45
Q

What are the requirements for effective I.S.?

A
  1. Cooperative patient.
  2. Motivated patient.
  3. Patient’s respiratory rate should be less
    than 25 breaths/min.

RET 2934 (13 decks)

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