Clinical Skills Practical Flashcards
Indications for IPPB
Indications:
Need to improve lung expansion,
Aid in delivery of medication
Short-term ventilatory support
Presence of atelectasis when others therapies have (like IS) have failed
Pathology limiting ventilation/cough causing inability to clear secretions
Aid in delivery of medication
Contraindications for IPPB
Tension Pneumothorax (ABSOLUTE)
RELATIVE: ICP>15mmHg, Hemodynamic instability, Hiccups, Active hemoptysis, TB Recent facial, skull surgery, Nausea
Indications for IS
Presence of atelectasis
Predisposition to developing atelectasis (UA/Thoracic, COPD Surgery)
Presence of restrictive lung defect (quadriplegia, dysfunctional diaphragm).
Contraindications for IS
Pt. cannot be instructed or supervised properly
Pt. will not cooperate, unable to demonstrate proper use of device
Pt. unable to breath deeply (VC<1/3 predicted)
Hazards and Complications associated with IS
Hyperventilation (respiratory alkalosis) Discomfort from inadequate pain control Barotrauma Bronchospasm Fatigue
Hazards/Complications of IPPB
Increases airway resistance (WOB) Barotrauma (pneumothorax) Nosocomial infection Hypocarbia (low CO2) Hypo/Hyperventilation Gastric Distention Decreased venous return Air-trapping, Auto-PEEP
Indications for Postural Drainage
Pt. needs to be turned, unwilling to change position on own
Poor oxygenation associated with position (unilateral lung disease)
Presence or potential of atelectasis (caused by mucus plugging)
Presence of artificial airway
Difficulty with secretion clearance, production more than 25-30ml/day
CF, bronchiectasis
During percussive ventilation
Contraindications to Postural Drainage
ABSOLUTE
Unstable head or neck injury
Active Hemorrhage, hemodynamic instability
RELATIVE ICP greater than 20 Recent spinal surgery, healing wound or tissue Active hemoptysis Pulmonary edema (CHF)
Hazards/Complications to Postural Drainage
Hypoxemia Increased IP Acute hypotension pulmonary hemorrhage Vomiting (aspiration) Arrhythmias
Indications for ABG
Need to evaluate ventilation, acid-base balance, oxygenation status and oxygen carrying capacity of the blood.
Assess response to therapy
Monitor severity or progression of disease
Contraindications for ABG
Abnormal modified Alan’s test results
Through a lesion or distal to a surgical shunt
Femoral puncture outside of the hospital
Coagulopathy or medium dose anticoagulation therapy
Possible complications of ABG sampling
Arteriospasm Hemorrhage Air or clotted blood emboli Vessel trauma Pain contamination
