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Respiratory Spring 13 > Lung Expansion Therapy > Flashcards

Lung Expansion Therapy Flashcards

1
Q

What is the goal of lung expansion therapy?

A

to prevent or correct atelectasis

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2
Q

What are the 4 types of lung expansion therapy?

A

IPPB, IS, CPAP, PEP

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3
Q

What is absorption atelectasis?

A

Due to lesions or mucus plugs blocking ventilation, gas distal to obstruction is absorbed by blood causing alveolar collapse

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4
Q

What is passive atelectasis

A

caused by persistant small tidal volumes

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5
Q

Who needs lung expansion therapy?

A

Any patient that cannot take a deep breath on their own.

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6
Q

Who is at the most risk to develop atelectasis?

A

Post op pt, especially upper abdominal, history of chronic lung disease, smoker

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7
Q

Clinical signs of atelectasis

A

increased RR, fine late inspiratory crackles, bronchial breath sounds, tachycardia

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8
Q

What is the relationship between RR and atelectasis?

A

the more atelectasis the faster the respiratory rate

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9
Q

Clinical signs on CXR

A

increased radiopacity, mediastinal shift

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10
Q

How does lung expansion therapy work?

A

by increasing transpulmonary pressure gradient

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11
Q

What is transpulmonar pressure?

A

alveolar pressure -pleural pressure; the greater pressure gradient, greater alveolar volume

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12
Q

Which therapy is the most physiological?

A

IS (SMI)

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13
Q

What is compliance?

A

the change in volume per unit of pressure change; chg in V/chg in P

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14
Q

What is elasticity?

A

the property of matter causing it to return to its original state after deformation by some external force; chg in P/chg in V

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15
Q

Average intrapleural pressure

A

-4 to -5 cwp below atmospheric

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16
Q

Intrapleural pressure with stron inspiratory effort

A

Up to -50 cwp

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17
Q

Intrapleural pressure with forced expiration

A

+70 cwp

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18
Q

Transairway pressure

A

P mouth-P alveolar

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19
Q

Transpulmonary pressure

A

P mouth-P intrapleural

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20
Q

alveolar distending pressure

A

P alveolar-P intrapleural

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21
Q

Spontaneous breath before inspiration

A

Flow=0, Ppl = -5, PA =0

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22
Q

When inspiration begins…

A

diaphragm contracts and descends; thoracic volume increases, Ppl becomes neg, alveolar volume increases and PA becomes neg, the change in Ppl cause change in PA

23
Q

During expiration

A

the sequence is reversed, muscles relax, lung recoils, diaphragm ascends

24
Q

What is resting position of lungs and chest

A

FRC

25
Q

When is alveolar pressure 0?

A

pre inspiration, end inspiration and end exhalation

26
Q

Objective of SMI

A

increase transpulmonary pressure and inspiratory volumes, improve inspiratory muscle performance

27
Q

Advantages of SMI over IPPB

A

NO POSITIVE PRESSURE, more effective as prophylactic, time and cost minimized

28
Q

Goals of IS

A

optimize lung inflation, optimize cough mechanism, early detection of acute lung disease

29
Q

Indications for IS

A

Presence of atelectasis; presence of conditions predisposing to atelectasis (abd surg), presence of a restrictive lung defect associate with quadriplegic or dysfunctional diagphragm

30
Q

Contraindications for IS

A

unable to cooperate; cannot follow instructions; unable to generate adequate inspiration;

31
Q

Hazards and Complications of IS

A

hyperventilation, discomfort(from pain), pulmonary barotrauma, hypoxemia, exacerbation of bronchospasm, fatigue

32
Q

2 types of IS devices

A

flow oriented, volume oriented

33
Q

3 phases for administering IS or IPPB

A

planning , implementation, follow up

34
Q

Criteria for SMI

A 
cooperative patient
VC> 10ml/kg IBW
IC>1/3 predicted
f<25 bpm
no acute lung disease
35
Q

Potential outcomes of IS

A

decreased RR. normal pulse, resolution of abn breaths sounds, improved CXR

36
Q

Administering IS

A

Set attainable goal; slow and deep; breath hold 5-10 seconds, normal exhalation, rest, repeat 5-10 times/hour

37
Q

IPPB requries

A

patients carefully chosen; indications be specifically defined, goals understood, properly administered

38
Q

IPPB definition

A

application of inspiratory positive pressure to a spontaneously breathing patient as an intermittent or short term therapeutic modality

39
Q

Indications for IPPB

A

need to improve lung expansion, need to deliver aerosol, not responsive to cheaper techniques

40
Q

Contraindications for IPPB

A

tension pneumo(absolute), ICP>15mmHg, blebs, hemodynamic instability, active hemoptysis, TE fistula, active untreated Tb, facial surgery

41
Q

Signs of pneumothorax

A

increased HR, decrease BP, absent BS, hyperresonate percussion

42
Q

Hazards and Complications of IPPB

A

pulmonary barotrauma, respiratory alkalosis, increased RAW, give with bronchodialator

43
Q

Adverse effects positive pressure

A

hyperinflation with air trapping, pulmonary edema, decreased venous return, increased ICP, arrhythmias, fluid retention

44
Q

GI effects of postive pressure

A

gastric insuflation- esp with mask tx, abd distention

45
Q

Expiratory retard

A

modification of pursed lip breating

46
Q

Implementation of IPPB

A

why ordered, what does it do, how will it feel, expected results, demonstration

47
Q

Settings on IPPB

A

sensitivity-1-2 cwp, initial pressure 10-15 cwp, flow mod to low, rate 6 bpm, I:E 1:3 or 1:4

48
Q

Any problems with therapy

A

Stop, stay and stabilize

49
Q

CPAP

A

elevates and maintains positive airway pressure throughout both inspiration and expiration; PEP and EPAP are positive on expiration only

50
Q

Benifits of CPAP

A

Recruitment of collapsed alveoli, decrease WOB, improved distribution of ventilation, increased secretion removal

51
Q

CPAP indications

A

postop atelectasis,

52
Q

Contraindications of CPAP

A

hypoventilation, hemodynamic unstability, facial trauma, untreated pneumothorax

53
Q

CPAP hazards and complications

A

increased work of breathing, barotrauma, gastric distention

Respiratory Spring 13 (2 decks)

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