Management Of Volume Loss Flashcards
What are the signs and symptoms of pneumonia?
Fever, malaise, muscle ache, tactile Fremitus, dyponea(sob), loss of appetite and rapid heart rate
What are the risk factors of aspiration pneumonia?
Dysphagia (difficulty swallowing), impaired or absent gag reflex, dementia, intoxication from drugs/alcohol, reduced physical mobility
What is a NEWS score?
National early warning score
What might reduce the amount of air in the lungs?
Atelectasis/collapse- alveoli, segment, lobe and total lung
Others- consolidation, thoracic cage restriction, lung tissue restrictive disease will reduce lung volume
Pleural effusion, pneumothorax and abdominal distension compress the lung
What does loss of lung volume mean to a physio?
A decrease amount of aerated lung, it can only be used to directly manage some causes of reduced lung volume, only collapse can be directly treated by physio techniques. When lung volume is not amenable to physio, v/q matching can be optimised.
Breakdown loss of lung volume due to consolidation. What is the stages to improve lung function due to consolidation?
It can be prevented worsening by
- Mobilisation
- Hydration
- Positioning
- Education of breathing techniques
What is the problem with atelectasis regarding lung function?
Reduced amount of functioning lung. Reduces surface area of ventilated lung. Reduces SA for gas exchange - V/Q mismatch and decreased SaO2 Increased wob Increases airway resistance
How can you identify atelectasis in clinical practice?
CXR Decreased chest expansion Auscultation changes Pulse ox ABGS
What can atelectasis be caused by?
Immobility/ prolonged bed rest
Poor positioning
Pain
Shallow breathing pattern (narcotics or CNS)
Airway occlusion
Mucus plug, tremor in airway, foreign object, airway compression and high o2
Why should we increase lung volume?
Increase the amount of functioning lung
Increase surface area- improve v/q match
Increase SaO2
Increase lung compliance and decrease airway resistance
Decrease WOB
Decrease the risk of sputum retention and infection
What defines closing volume?
Lung volume, above residual volume, at which airway collapse occurs during expiration. The CV increases with age, smoking, lung disease and body position.
What is mobilisation?
Therapeutics and prescriptive application of low intensity exercise in the management of cardiopulmonary dysfunction in acutely Ill patients
What is benefit of doing abdominal breathing?
Decreases airways turbulence
Decreases dead space
Favours dependent regions
Relaxes shoulder girdle
What are Thoracic expansion exercises thought to do?
Increase lung volume Increase ventilation Decrease airway resistance Increase surfactant secretion Aid V/Q matching Decrease dead space Increase diffusion Increase o2 saturation
What is IPPB?
Intermittent positive pressure Breathing
How does IPPB ( the bird) work?
Intermittent positive pressure applied during inspiration, this pushes the patient into IRV. ( extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration) Greater volumes means improved gas exchange and decreased WOB. The patient triggers inspiration by taking a breath and then a sustained positive pressure is applied to the patients airway to a set pressure level. This is followed by a passive expiration and is therefore a pressure supported inspiration.
What are the indications for using IPPB or the Bird?
Atelectasis/ volume loss when the patient is tired, drowsy, weak or neurologically impaired. - unable to participate in more active treatments
May be used to aid secretion clearance
What are the contraindications for using IPPB?
Untrained pneumothorax Bronchospasm Recent lung surgery Hypoxic drive patients Nausea Flail chest Haemoptysis Bronchospasm
What is the NIPPY clear way?
Airway assisting device with two settings
Mechanical insufflation- exsufflariom machine
Insufflation- positive inspiratory pressure - pushes air in
Exsufflation- negative pressure applied at the mouth for secretion removal - sucks air out
For volume loss just set the insufflation to a desired pressure
Nippy clear way can be put on a cough assist mode as well
What can the NIPPY clear way be used for?
Due to its many modes the machine can be used to increase volumes, remove secretions and as a non invasive ventilator p
What does CPAP stand for?
Continuous Positive Airway pressure
What does CPAP involve?
It consists of positive pressure applied throughout the whole respiratory cycle ie inspiration and expiration.
It keeps the airway pressure higher than atmospheric throughout the whole respiratory cycle. It delivers a constant flow of gas which exceeds the patients demands.
This will increase FRC above CV thus recruiting collapsed alveoli and maintaining higher lung volumes
What is the percussion technique?
It is also referred to as cupping or clapping. The purpose of percussion is to intermittently apply kinetic energy to the chest wall and lungs. This is accomplished by rhythmically striking the thorax with a cupped hand (for more air) over the lung segment being drained
Resevoir
Normal o2 therapy plus the expired o2, the co2 is disposed off
What is the 3 important components of the bird that the physio can manipulate?
How fast the breath goes in
The pressure at which the breath goes in
Starting effort or sensitivity
What are the effects of a general anaesthetic in terms of treatments post op on the respiratory system?
Decreased mucocilliary clearance
Harder to inflate lungs
Less incentive to breath
Patient is drowsy and finds clearance more difficult
Sputum is drier and less mobile and hydrated so doesn’t move as well
FRC is lowered which affects closing volumes and decreases lung compliance and can cause atelectasis
What is the different types of collateral channels for collateral ventilation
The ones between bronchioles called inter bronchial channels of Martin
The ones between bronchioles and alveoli - lambert
The ones between alveoli and alveoli- kohn
What is incentive spirometry?
Patient is in relaxed sitting of side laying if extra volume is required in one lung due to v/q matching
Patient- tight seal around mouth piece and inhales deeply and slowly as they watch the mouth piece
If possible they create an end inspiratory hold- 3-4 seconds
Contraindications
People with severe dyspnoea
Fatigue
If they can’t use it properly
Indications for use- Presence of atelectasis Abdominal thoracic surgery Prolonged bed rest Surgery in patients with COPD Lack of pain control Restricted lung diseases
It is used to facilitate sustained slow breathes
How to measure the size of a catheter
Measure the size of the endotracheal tube and minus 2 and multiply by 2 and can add one if they have thick secretions
What is the NIPPY clear way technique (cough assist)
It is a mechanical insufflation exsufflation
It can be used with different interfaces- mouth pie, face mask or tracheostomy connector
Insufflation- the inspiratory pressure
Exsufflation- the pressure applied at the mouth for secretion removal
It can set the pressures and
For volume loss just set the insufflation to the correct pressure
What is bagging
Provides deep breaths in order to do increase lung volumes
Opens airways if atelectasis occurs
Facilitates secretion removal
Aids secretion removal as sputum clearance occurs during icu
What are respiratory Adjuncts?
Apply the pressure at the mouth and breath out against resistance. They can be use in conjunction with other interventions. They help to remove secretions by increasing functional residual capacity and enhancing collateral ventilation for removing secretions from collapsed airways as they get air behind the secretions.
Eg flutter, acapella, bubble pep, pep mask
What happens during bubble pep
Facilitates positive expiratory pressure which allows the patient to breath against resistance- facilitates collateral channels of ventilation
What is the difference between restrictive and obstructive
Restrictive- can’t get air in
Obstructive- can’t get air out
What is inspiratory reserve volume
The extra volume of air that can be inspired with maximal effort after reaching the end of a normal inspiratory volume
If they are in respiratory acidosis or alkalosis
Alkalosis- getting rid of too much co2
Acidosis- retaining too much co2
What does acapella do
Gives positive expiratory pressure, gives oscillations, helps splint the airways open, helps collateral ventilation, the oscillations also help to decrease the viscosity of the sputum
Acapella - prescription - puts pressure on the NHS
Flutter- patients have to buy their own- more cost effective
Don’t use adjuncts if they have had a previous tracheostomy
