Lung Expansion Therapy

Question 1

What is the goal of lung expansion therapy?

Answer 1

to prevent or correct atelectasis

Question 2

What are the 4 types of lung expansion therapy?

Answer 2

IPPB, IS, CPAP, PEP

Question 3

What is absorption atelectasis?

Answer 3

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

Question 4

What is passive atelectasis

Answer 4

caused by persistant small tidal volumes

Question 5

Who needs lung expansion therapy?

Answer 5

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

Question 6

Who is at the most risk to develop atelectasis?

Answer 6

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

Question 7

Clinical signs of atelectasis

Answer 7

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

Question 8

What is the relationship between RR and atelectasis?

Answer 8

the more atelectasis the faster the respiratory rate

Question 9

Clinical signs on CXR

Answer 9

increased radiopacity, mediastinal shift

Question 10

How does lung expansion therapy work?

Answer 10

by increasing transpulmonary pressure gradient

Question 11

What is transpulmonar pressure?

Answer 11

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

Question 12

Which therapy is the most physiological?

Answer 12

IS (SMI)

Question 13

What is compliance?

Answer 13

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

Question 14

What is elasticity?

Answer 14

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

Question 15

Average intrapleural pressure

Answer 15

-4 to -5 cwp below atmospheric

Question 16

Intrapleural pressure with stron inspiratory effort

Answer 16

Up to -50 cwp

Question 17

Intrapleural pressure with forced expiration

Answer 17

+70 cwp

Question 18

Transairway pressure

Answer 18

P mouth-P alveolar

Question 19

Transpulmonary pressure

Answer 19

P mouth-P intrapleural

Question 20

alveolar distending pressure

Answer 20

P alveolar-P intrapleural

Question 21

Spontaneous breath before inspiration

Answer 21

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

Question 22

When inspiration begins…

Answer 22

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

Question 23

During expiration

Answer 23

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

Question 24

What is resting position of lungs and chest

Answer 24

FRC

Question 25

When is alveolar pressure 0?

Answer 25

pre inspiration, end inspiration and end exhalation

Question 26

Objective of SMI

Answer 26

increase transpulmonary pressure and inspiratory volumes, improve inspiratory muscle performance

Question 27

Advantages of SMI over IPPB

Answer 27

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

Question 28

Goals of IS

Answer 28

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

Question 29

Indications for IS

Answer 29

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

Question 30

Contraindications for IS

Answer 30

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

Question 31

Hazards and Complications of IS

Answer 31

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

Question 32

2 types of IS devices

Answer 32

flow oriented, volume oriented

Question 33

3 phases for administering IS or IPPB

Answer 33

planning , implementation, follow up

Question 34

Criteria for SMI

Answer 34

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

Question 35

Potential outcomes of IS

Answer 35

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

Question 36

Administering IS

Answer 36

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

Question 37

IPPB requries

Answer 37

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

Question 38

IPPB definition

Answer 38

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

Question 39

Indications for IPPB

Answer 39

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

Question 40

Contraindications for IPPB

Answer 40

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

Question 41

Signs of pneumothorax

Answer 41

increased HR, decrease BP, absent BS, hyperresonate percussion

Question 42

Hazards and Complications of IPPB

Answer 42

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

Question 43

Adverse effects positive pressure

Answer 43

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

Question 44

GI effects of postive pressure

Answer 44

gastric insuflation- esp with mask tx, abd distention

Question 45

Expiratory retard

Answer 45

modification of pursed lip breating

Question 46

Implementation of IPPB

Answer 46

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

Question 47

Settings on IPPB

Answer 47

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

Question 48

Any problems with therapy

Answer 48

Stop, stay and stabilize

Question 49

CPAP

Answer 49

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

Question 50

Benifits of CPAP

Answer 50

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

Question 51

CPAP indications

Answer 51

postop atelectasis,

Question 52

Contraindications of CPAP

Answer 52

hypoventilation, hemodynamic unstability, facial trauma, untreated pneumothorax

Question 53

CPAP hazards and complications

Answer 53

increased work of breathing, barotrauma, gastric distention