Hyperinflation Therapy Lab Flashcards
1
Q
Recruitment
A
Atelectasis resolving, using positive pressure
2
Q
Air follows path of
A
least resistance
3
Q
Who is at risk of atelectasis
A
- surgical, above the waist 2. Obese 3. Neuromuscular 4. Heavily Sedated 5. History of lung disease 6. Beddridden
4
Q
Why is surgical patients at risk
A
painful to breath.. not breathing deep enough
5
Q
Physcial signs of hypoxemia
A
RR, HR, CO, BP, Cyanosis
6
Q
Two types of atelectasis
A
Resorption- mucus plug/ secretions inhibit ventilation, Passive- Decrease in ventilation (decrease volume)
7
Q
Resorption
A
Mucus plug/ secretions inhibit ventilation (smokers- further inflammation of atelectasis- nitrogen washout)
8
Q
Passive
A
Decrease in ventilation (and volume)
9
Q
Why is heavily sedated people at risk of atelectasis
A
inhibited respiratory drive
10
Q
Why is patients with history of lung disease
A
stiff/ fluid filled- mucous/ inflammation. elasticity gone- tissue damage
11
Q
Physical signs of hypoxemia
A
RR, HR, CO, BP, Cyanosis
12
Q
Chest xray assessment of atelectasis
A
Increased density, increased opacity, decreased lung volumes= deep breaths -> normal Vt, Air Bronchograms
13
Q
Air bronchograms
A
Collapsed lung tissue (foggy looking, with black scribbles)
14
Q
Normal Tidal Volume
A
300-500ml
15
Q
Chest Assessment/ breath sounds
A
Bronchial, Crackles, Diminished
16
Q
Bronchial
A
Norm in trachea-> harsh insp/ exp. (dark vador). BAD in lower lungs (peripheral)= consolidation
17
Q
Crackles
A
Fine in atelectasis… at end of inspiration(Alveolar shearing)
18
Q
Tympanic=
A
tension pneumonia
19
Q
Can pleural effusion cause atelectasis
A
yes
20
Q
IS
A
Incentive Spirometry
21
Q
Incentive Spirometry
A
technique designed to mimic natural sighing or yawning maneuvers, also referred to as sustained maximal inspiration (SMI)
22
Q
What does IS mimic
A
natural sigh incorporating visual feedback to encourage adequate inflation for a minimum of 5-10 seconds
23
Q
How often to use IS
A
10x per hour while awake, has to be able to use on own
24
Q
Ways to avoid atelectasis (pulmonary toilet)
A
Keep pt mobile and hydrated
25
Contraindications of IS
Pt cannot be instructed or supervised to assure proper use of device-Awake alert and capable of taking deep breaths, pt unable to cooperate, VC less than about 10ml/ kg, Open stoma (adaptable)
26
Hazards of IS
Hyperventilation, Exacerbation of bronchospasm, Fatigue, Inedequate pain control, Barotrauma, Hypoxia with O2 delivery interruption
27
IBW/PBW equations
Male- 50 + 2.3 (H- 60)
| Female- 45.5 + 2.3 (H- 60)
28
Normal Tidal Volume
300-500
29
To get Vt from IBW x 5
then x RR to get Minute volume
30
Normal minute lung volumes
5-10 Lpm
31
Direct measurement or calibrated
Not direct measurement-> calibrated volume (Indirect measurement of volume)
32
Splinting
Helps pain - get better cough effort
33
How do we know IS is working
Record frequency of use, Record # of breaths per session, Document volumes achieved, Observe breath hold, Effort and motivation, Reinstruct when needed, Device within reach, INCREASE IN INSP VOLUMES, Vital signs, Bronchial breath sounds?, Vesicular breath sounds- normal, Opacity, Air bronchograms? INCREASE IN AERATION, Patient Strength, Airway, Ventilation, Oxygenation
34
IPPB
Intermittent Positive Pressure Breathing
35
Intermittent Positive Pressure Breathing
short term mechanical ventilation for assisting ventilation and providing short duration hyperinflation therapy ( not used in duluth regional area) -Pushes positive pressure in lungs
36
Does IPPB have a breath hold?
no
37
Target volumes of IPPB
15ml/kg
38
What is IPPB ideal for
patients with major head injury (bleed/ TB) or stroke... good for atelectais
39
IPPB manometer wings which direction during inspiration
negative, positive pressure= stop
40
Where is flow adjustment on IPPB
furthest end away from manometer
41
Patient has to be what kind of breathing for IPPB
Spontaneously breathing
42
How long does IPPB last
treatment lasts for 15-20 min
43
Delivers what on IPPB?
Deliver bland aerosol (norm saline) or medication (bronchodilator) (neb cup)
44
IPPB delivers a flow
to meet a pressure to produce a volume (increase aeration)
45
Hyperinflation therapy=
increase aeration
46
Indications of IPPB
Atelectasis that isnt responsive to IS, Pt unable to use IS effectively, Unable to clear secretions bc of chronic disease process
47
Unable to clear secretions bc of chronic disease process
ALS, Quad/ paralegic, Muscular dystrophy/ multiple sclerosis, stroke/ TBI, Guillain- Barre/ Myasthenia gravis
48
Contraindications of IPPB
Absolute: Tension pneumothorax
49
Tension pneumothorax
Absolutes- need to get air out
50
ICP>
15 mmHg- bolt in brain (normal= 0-15) ex.. Intracranial pressure
51
Hemodynamic instability
unstable Cardiac Output (BP, Conduction, bleeding)
52
Tracheoesophageal fistula
tube connecting 2 (stomach/ esophageal fistula- acid burns esophagus)
53
Relative contraindications of IPPB
ICP> 15 mmHg, Hemodynamic instability, Actively bleeding, Tracheoesophageal fistula, Recent Esophageal surgery, Blebs, Facial/ Oral/ Skull trauma, Hiccups, Air Swallowing, Nausea
54
Bleb
Weakening of tissue= COPD, Outerlining of lung
55
Hazards of IPPB
Increased airway resistance, Pulmonary barotrauma, Nosocomial infection, Respiratory Alkalosis, Hyperoxia, Impaired venous return, Gastric distention, Air trapping, Auto PEEP, overdistention
56
Impaired Venous return
Less blood to right of heart, positive pressure into mediastinal
57
Mediastinal consists of
heart, esophageal, trachea, spinal
58
Hyperoxia
100% O2
59
Respiratory Alkalosis
Blowing of more CO2= hyperventilation
60
Nosocomial infection
Hospital acquired
61
Trigger the IPPB how
Begin breathing= 2cm of water (neg pressure)
62
Ez-PAP
Positive airway pressure
63
Who is the risk of applying positive pressure to the resp system
barotrauma or pneumothorax
64
Bronchial hygiene
Make sure airways are clear (secretions)
65
Hyperinflation therapy
Increase aeration (atelectasis)
66
both bronchial hygiene and hyperinflation therapy
reestablish lung volume by taking deep breaths
67
Ez- PAP flow amplified by
4x- positive pressure therapy (restores norm lung volumes and clears secretions )
68
What kind of pt uses Ez-PAP
Post cardiac/ surgical patients (open thoracic) every 4 hours
69
Inspiration on Ez-PAP=
feel flow/ inspiratory assist helps take bigger breaths
70
Ez-PAP pressure
maintains consistant pressure - expiratory resistance, stabilizes pressure in lungs
71
liter flow range for therapeutic pressure
5-7
72
what are therapeutic PAP pressure
10-20 ( only have to measure the first couple times done)
73
Ez-PAP can have how many sources
2, set up neb first at 10LPM, then ez-pap
74
Vacuum side of manometer
negative side
75
Ez-PAP Expiratory breathing effort
staying between 10-20 on positive side
76
Pressure is measured in
cm H2O
77
Continuous Positive Airway pressure breaths from a
pressurized circuit against a threshold resistor (not used during hyperinflation therapy)
78
CPAP constant pressure maintained
5-20 cm H2O
79
What is sufficient to maintain positive pressure during inspiration on a CPAP
Gas flow
80
Ways to use a CPAP
intermittent and continuous
81
Factors of resolving atelectasis on a CPAP are
Increased FRC recruits collapsed alveoli, decrease WOB, Improves collateral channel ventilation (Kohns pores)
82
CPAP does what
Increases FRC, helps atelectasis, Increases efficiency of secretion removal
83
indications CPAP isnt working
atelectasis= heart not working well, Cardiogenic Pulmonary Edema
84
Cardiogenic pulmonary edema
decreases venous return= decreased filling pressure= reduces pulmonary vasculature congestion, improves lung compliance (increase) and decreases WOB
85
Contraindications of CPAP
hemodynamic instability- poor BP, HYPOVENTILATION, nausea, facial trauma, untreated pneumothorax, elevated ICP
86
When to wear CPAP
for sleep apnea, and cardiogenic pulmonary edema- worn until fluid is subsided
87
List three at risk patients with potential to easily acquire atelectasis
Surgical, above the waist. Neuromuscular. History of lung disease (smoking history)
88
Worst breath sound to have
bronchial-sign of injury
89
Describe how O2 therapy can contribute to the development of atelectasis
Giving too high of an FiO2 for a long period of time (nitrogen washout) and secretions
90
How often will you intrust a patient to use IS
Series of breaths (10) once each hour while awake
91
How do we set volume goals for the patient
Nomagram chart in instructions, Do IS to find best of 3, or just have them do it and go from there.
92
Goal on IS
250-500 ml higher than best
93
List one specific acute / chronic process that would lead to contraindication for IS therapy
Cant do it/ follow instructions (lip seal)
94
Of the hazards associated with IS, which one do you think is most common and how can you ensure it does not happen
hyperventilation
95
besides deep breaths what else does a pt need to do to reduce the risk of pulmonary complications
stay hydrated, mobile
