Lesson 10: Lung Expansion Therapy Flashcards
What are the pulmonary complications seen in patients who have undergone thoracic or abdominal surgery?
Atelectasis, pneumonia, and acute respiratory failure.
List the most common modalities that are used to prevent or correct atelectasis:
Early pt mobilization, deep breathing/directed cough, IS, CPAP, PEP, IPPB, and HFNC
What are the two primary types of atelectasis
Gas absorption atelectasis and compression atelectasis
When does gas atelectasis occur?
Either when there is a complete interruption of ventilation to a section of the lung or when there is a significant shift in V/Q.
When does compression atelectasis occur?
When the trans thoracic pressure( pressure difference between the body surface and alveoli) exceeds the transalveolar pressure(the pressure difference between the Alveoli and pleural space)
What type of patients may have difficulty taking deep breaths?
Those whom are significantly obese, pts w/ neuromuscular disorders, patients under heavy sedation, and pts who have undergone upper abdominal or thoracic surgery.
What is the purpose of IS?
To coach the pt to take a sustained maximal Inspiratory effort resulting in a decrease in pAL and maintaining the latency of airways at risk for closure
What does the baseline assessment include before beginning therapy?
A general evaluation of pts clinical status and a specific assessment related to the chosen therapeutic goals.
Also measuring vitals, assessing the pt appearance and sensorium, assessing the breathing patterns through chest auscultation, and the pts level of motivation and their ability to follow instructions
Indications for incentive spirometer:
Presence of atelectasis and conditions predisposing atelectasis ( upper abdominal surgery , thoracic surgery, surgery In pts w/ COPD), and presence of a restrictive lung defect associated with quadriplegia or dysfunctional diaphragm
Contraindications to incentive spirometry:
Pt cannot be instructed or supervised to ensure appropriate use of device, pt cooperation is absent or patient is unable to understand or demonstrate proper use of device, and pt is unable to deep breathe effectively (VC < 10 ml/kg or IC < 1/3 of predicted)
Hazards and complications of IS:
Hyperventilation and respiratory alkalosis, discomfort secondary to inadequate pain control, pulmonary barotrauma, exacerbation of bronchospasm, and fatigue
What common problem occurs when the pt performs IS too rapidly or if the prescribed frequency of therapy is mismatched?
Acute respiratory alkalosis
While using a IS after the inspiratory target is met , hoe long should the pt hold their breath?
5-10 secs
Potential outcomes of incentive spirometry:
Decrease or elimination of atelectasis, improved breath sounds, normal or improved chest x-ray, increased Sp02, increased VC, improved inspiratory muscle performance and cough