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Principles and Practices of Resp Therapy 1 > Hyperinflation Therapy Lab > Flashcards

Hyperinflation Therapy Lab Flashcards

1
Q

Recruitment

A

Atelectasis resolving, using positive pressure

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2
Q

Air follows path of

A

least resistance

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3
Q

Who is at risk of atelectasis

A
  1. surgical, above the waist 2. Obese 3. Neuromuscular 4. Heavily Sedated 5. History of lung disease 6. Beddridden
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4
Q

Why is surgical patients at risk

A

painful to breath.. not breathing deep enough

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5
Q

Physcial signs of hypoxemia

A

RR, HR, CO, BP, Cyanosis

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6
Q

Two types of atelectasis

A

Resorption- mucus plug/ secretions inhibit ventilation, Passive- Decrease in ventilation (decrease volume)

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7
Q

Resorption

A

Mucus plug/ secretions inhibit ventilation (smokers- further inflammation of atelectasis- nitrogen washout)

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8
Q

Passive

A

Decrease in ventilation (and volume)

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9
Q

Why is heavily sedated people at risk of atelectasis

A

inhibited respiratory drive

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10
Q

Why is patients with history of lung disease

A

stiff/ fluid filled- mucous/ inflammation. elasticity gone- tissue damage

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11
Q

Physical signs of hypoxemia

A

RR, HR, CO, BP, Cyanosis

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12
Q

Chest xray assessment of atelectasis

A

Increased density, increased opacity, decreased lung volumes= deep breaths -> normal Vt, Air Bronchograms

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13
Q

Air bronchograms

A

Collapsed lung tissue (foggy looking, with black scribbles)

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14
Q

Normal Tidal Volume

A

300-500ml

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15
Q

Chest Assessment/ breath sounds

A

Bronchial, Crackles, Diminished

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16
Q

Bronchial

A

Norm in trachea-> harsh insp/ exp. (dark vador). BAD in lower lungs (peripheral)= consolidation

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17
Q

Crackles

A

Fine in atelectasis… at end of inspiration(Alveolar shearing)

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18
Q

Tympanic=

A

tension pneumonia

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19
Q

Can pleural effusion cause atelectasis

A

yes

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20
Q

IS

A

Incentive Spirometry

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21
Q

Incentive Spirometry

A

technique designed to mimic natural sighing or yawning maneuvers, also referred to as sustained maximal inspiration (SMI)

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22
Q

What does IS mimic

A

natural sigh incorporating visual feedback to encourage adequate inflation for a minimum of 5-10 seconds

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23
Q

How often to use IS

A

10x per hour while awake, has to be able to use on own

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24
Q

Ways to avoid atelectasis (pulmonary toilet)

A

Keep pt mobile and hydrated

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25
Q

Contraindications of IS

A

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)

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26
Q

Hazards of IS

A

Hyperventilation, Exacerbation of bronchospasm, Fatigue, Inedequate pain control, Barotrauma, Hypoxia with O2 delivery interruption

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27
Q

IBW/PBW equations

A

Male- 50 + 2.3 (H- 60)

Female- 45.5 + 2.3 (H- 60)

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28
Q

Normal Tidal Volume

A

300-500

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29
Q

To get Vt from IBW x 5

A

then x RR to get Minute volume

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30
Q

Normal minute lung volumes

A

5-10 Lpm

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31
Q

Direct measurement or calibrated

A

Not direct measurement-> calibrated volume (Indirect measurement of volume)

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32
Q

Splinting

A

Helps pain - get better cough effort

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33
Q

How do we know IS is working

A

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

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34
Q

IPPB

A

Intermittent Positive Pressure Breathing

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35
Q

Intermittent Positive Pressure Breathing

A

short term mechanical ventilation for assisting ventilation and providing short duration hyperinflation therapy ( not used in duluth regional area) -Pushes positive pressure in lungs

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36
Q

Does IPPB have a breath hold?

A

no

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37
Q

Target volumes of IPPB

A

15ml/kg

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38
Q

What is IPPB ideal for

A

patients with major head injury (bleed/ TB) or stroke… good for atelectais

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39
Q

IPPB manometer wings which direction during inspiration

A

negative, positive pressure= stop

40
Q

Where is flow adjustment on IPPB

A

furthest end away from manometer

41
Q

Patient has to be what kind of breathing for IPPB

A

Spontaneously breathing

42
Q

How long does IPPB last

A

treatment lasts for 15-20 min

43
Q

Delivers what on IPPB?

A

Deliver bland aerosol (norm saline) or medication (bronchodilator) (neb cup)

44
Q

IPPB delivers a flow

A

to meet a pressure to produce a volume (increase aeration)

45
Q

Hyperinflation therapy=

A

increase aeration

46
Q

Indications of IPPB

A

Atelectasis that isnt responsive to IS, Pt unable to use IS effectively, Unable to clear secretions bc of chronic disease process

47
Q

Unable to clear secretions bc of chronic disease process

A

ALS, Quad/ paralegic, Muscular dystrophy/ multiple sclerosis, stroke/ TBI, Guillain- Barre/ Myasthenia gravis

48
Q

Contraindications of IPPB

A

Absolute: Tension pneumothorax

49
Q

Tension pneumothorax

A

Absolutes- need to get air out

50
Q

ICP>

A

15 mmHg- bolt in brain (normal= 0-15) ex.. Intracranial pressure

51
Q

Hemodynamic instability

A

unstable Cardiac Output (BP, Conduction, bleeding)

52
Q

Tracheoesophageal fistula

A

tube connecting 2 (stomach/ esophageal fistula- acid burns esophagus)

53
Q

Relative contraindications of IPPB

A

ICP> 15 mmHg, Hemodynamic instability, Actively bleeding, Tracheoesophageal fistula, Recent Esophageal surgery, Blebs, Facial/ Oral/ Skull trauma, Hiccups, Air Swallowing, Nausea

54
Q

Bleb

A

Weakening of tissue= COPD, Outerlining of lung

55
Q

Hazards of IPPB

A

Increased airway resistance, Pulmonary barotrauma, Nosocomial infection, Respiratory Alkalosis, Hyperoxia, Impaired venous return, Gastric distention, Air trapping, Auto PEEP, overdistention

56
Q

Impaired Venous return

A

Less blood to right of heart, positive pressure into mediastinal

57
Q

Mediastinal consists of

A

heart, esophageal, trachea, spinal

58
Q

Hyperoxia

A

100% O2

59
Q

Respiratory Alkalosis

A

Blowing of more CO2= hyperventilation

60
Q

Nosocomial infection

A

Hospital acquired

61
Q

Trigger the IPPB how

A

Begin breathing= 2cm of water (neg pressure)

62
Q

Ez-PAP

A

Positive airway pressure

63
Q

Who is the risk of applying positive pressure to the resp system

A

barotrauma or pneumothorax

64
Q

Bronchial hygiene

A

Make sure airways are clear (secretions)

65
Q

Hyperinflation therapy

A

Increase aeration (atelectasis)

66
Q

both bronchial hygiene and hyperinflation therapy

A

reestablish lung volume by taking deep breaths

67
Q

Ez- PAP flow amplified by

A

4x- positive pressure therapy (restores norm lung volumes and clears secretions )

68
Q

What kind of pt uses Ez-PAP

A

Post cardiac/ surgical patients (open thoracic) every 4 hours

69
Q

Inspiration on Ez-PAP=

A

feel flow/ inspiratory assist helps take bigger breaths

70
Q

Ez-PAP pressure

A

maintains consistant pressure - expiratory resistance, stabilizes pressure in lungs

71
Q

liter flow range for therapeutic pressure

A

5-7

72
Q

what are therapeutic PAP pressure

A

10-20 ( only have to measure the first couple times done)

73
Q

Ez-PAP can have how many sources

A

2, set up neb first at 10LPM, then ez-pap

74
Q

Vacuum side of manometer

A

negative side

75
Q

Ez-PAP Expiratory breathing effort

A

staying between 10-20 on positive side

76
Q

Pressure is measured in

A

cm H2O

77
Q

Continuous Positive Airway pressure breaths from a

A

pressurized circuit against a threshold resistor (not used during hyperinflation therapy)

78
Q

CPAP constant pressure maintained

A

5-20 cm H2O

79
Q

What is sufficient to maintain positive pressure during inspiration on a CPAP

A

Gas flow

80
Q

Ways to use a CPAP

A

intermittent and continuous

81
Q

Factors of resolving atelectasis on a CPAP are

A

Increased FRC recruits collapsed alveoli, decrease WOB, Improves collateral channel ventilation (Kohns pores)

82
Q

CPAP does what

A

Increases FRC, helps atelectasis, Increases efficiency of secretion removal

83
Q

indications CPAP isnt working

A

atelectasis= heart not working well, Cardiogenic Pulmonary Edema

84
Q

Cardiogenic pulmonary edema

A

decreases venous return= decreased filling pressure= reduces pulmonary vasculature congestion, improves lung compliance (increase) and decreases WOB

85
Q

Contraindications of CPAP

A

hemodynamic instability- poor BP, HYPOVENTILATION, nausea, facial trauma, untreated pneumothorax, elevated ICP

86
Q

When to wear CPAP

A

for sleep apnea, and cardiogenic pulmonary edema- worn until fluid is subsided

87
Q

List three at risk patients with potential to easily acquire atelectasis

A

Surgical, above the waist. Neuromuscular. History of lung disease (smoking history)

88
Q

Worst breath sound to have

A

bronchial-sign of injury

89
Q

Describe how O2 therapy can contribute to the development of atelectasis

A

Giving too high of an FiO2 for a long period of time (nitrogen washout) and secretions

90
Q

How often will you intrust a patient to use IS

A

Series of breaths (10) once each hour while awake

91
Q

How do we set volume goals for the patient

A

Nomagram chart in instructions, Do IS to find best of 3, or just have them do it and go from there.

92
Q

Goal on IS

A

250-500 ml higher than best

93
Q

List one specific acute / chronic process that would lead to contraindication for IS therapy

A

Cant do it/ follow instructions (lip seal)

94
Q

Of the hazards associated with IS, which one do you think is most common and how can you ensure it does not happen

A

hyperventilation

95
Q

besides deep breaths what else does a pt need to do to reduce the risk of pulmonary complications

A

stay hydrated, mobile

Principles and Practices of Resp Therapy 1 (4 decks)

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