Lesson 10: Lung Expansion Therapy

Question 1

What are the pulmonary complications seen in patients who have undergone thoracic or abdominal surgery?

Answer 1

Atelectasis, pneumonia, and acute respiratory failure.

Question 2

List the most common modalities that are used to prevent or correct atelectasis:

Answer 2

Early pt mobilization, deep breathing/directed cough, IS, CPAP, PEP, IPPB, and HFNC

Question 3

What are the two primary types of atelectasis

Answer 3

Gas absorption atelectasis and compression atelectasis

Question 4

When does gas atelectasis occur?

Answer 4

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.

Question 5

When does compression atelectasis occur?

Answer 5

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)

Question 6

What type of patients may have difficulty taking deep breaths?

Answer 6

Those whom are significantly obese, pts w/ neuromuscular disorders, patients under heavy sedation, and pts who have undergone upper abdominal or thoracic surgery.

Question 7

What is the purpose of IS?

Answer 7

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

Question 8

What does the baseline assessment include before beginning therapy?

Answer 8

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

Question 9

Indications for incentive spirometer:

Answer 9

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

Question 10

Contraindications to incentive spirometry:

Answer 10

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)

Question 11

Hazards and complications of IS:

Answer 11

Hyperventilation and respiratory alkalosis, discomfort secondary to inadequate pain control, pulmonary barotrauma, exacerbation of bronchospasm, and fatigue

Question 12

What common problem occurs when the pt performs IS too rapidly or if the prescribed frequency of therapy is mismatched?

Answer 12

Acute respiratory alkalosis

Question 13

While using a IS after the inspiratory target is met , hoe long should the pt hold their breath?

Answer 13

5-10 secs

Question 14

Potential outcomes of incentive spirometry:

Answer 14

Decrease or elimination of atelectasis, improved breath sounds, normal or improved chest x-ray, increased Sp02, increased VC, improved inspiratory muscle performance and cough