Module 6: Lung Expansion Therapy Flashcards
Who is at high risk for developing atelectasis?
Obese Patients
Who is at high risk for developing atelectasis?
Patients with neuromuscular disorders
Who is at high risk for developing atelectasis?
A patient who has been heavily sedated
Are you at high risk of developing atelectasis after having surgery near your diaphragm?
Yes you are at high risk for developing atelectasis
Can excessive bed rest cause atelectasis?
Yes
Is poor cough, history of lung disease, and restrictive lung chest wall abnormalities a high risk for developing atelectasis?
Yes you are at high risk for developing atelectasis
What is a clinical sign of atelectasis?
History of recent major surgery. (Thoracic or abdominal surgery)
Tachypnea and tachycardia are both __?
Clinical signs of atelectasis
A pt has fine, late-inspiratory crackles on auscultation; this is a clinical sign of __?
Atelectasis
A pt has bronchial or diminished breath sounds on auscultation this is a clinical sign of __?
Atelectasis
Increased density and signs of volume loss show on a pt’s chest radiograph this is a clinical sign of ___?
Atelectasis
What is the most physiologically the most normal lug expansion therapy?
Incentive spirometry
Incentive spirometry has been proven to be ___?
Most effective in high risk patients
Indications for incentive spirometry?
Presence of pulmonary atelectasis
Presence of conditions predisposing to atelectasis
What are the three factors that show presence of conditions predisposing to atelectasis?
Upper abdominal surgery
Thoracic surgery
Surgery in patients with COPD
Is presence of a restrictive lung defect associated with quadriplegia or dysfunctional diagram an indication of ___?
Incentive spirometry
When a patient cannot be instructed or supervised to ensure appropriate use of device this is a __?
Contraindication for incentive spirometry
When the patient’s cooperation is absent, or pt is unable to understand or demonstrate proper use of device this is a sign of ___?
Contraindication for incentive spirometry
When a patient is unable to take a deep breathe effectively (VC is less than 10 ml/kg or IC less than predicted) this is a sign of __?
A contraindication for incentive spirometry
When the patient is unconscious this is obviously a sign of __?
A contraindication for incentive spirometry
What is a hazard or complication of incentive spirometry?
Hyperventilation and respiratory alkalosis
Discomfort secondary to inadequate pain control is a __?
Hazard and/or complication of incentive spirometry
Pulmonary barotrauma is a hazard of incentive spirometry?
Yes
What are the two last possible hazards of incentive spirometry?
Exacerbation of bronchospasm
Fatigue
Incentive spirometry devices are either ___?
Flow or volume oriented
How do you teach a patient how to effectively use a IS device?
Demonstrate then observe the patient
Patient instruction
Follow-up
What is the first step when instructing a patient?
Exhale normally
What is the second step when instructing a patient?
Slow, deep inspiration to peak inspiration
What is the third step when instructing a IS device/therapy?
Inspiratory hold for 5-10 seconds
What is the last step when instructing a patient how to use IS device or therapy?
Passive exhale then rest
What is an important tip you must let your patient know when instructing them how to use a IS device?
Patient should sustain his/her maximal inspiratory effort for 5-10 seconds (total time to perform)
What is an indication for IPPB?
PT with atelectasis is not responsive to other modalities such as IS or other therapies
A patient at high risk for atelectasis who cannot perform or cooperate with IS treatment is a a ___?
Indication for IPPB
All obese patients who have undergone abdominal surgery is an indication to use?
Indication for IPPB
What is an absolute contraindication or IPPB?
Untreated tension PNX
When a IPPB device cycles off prematurely this means?
Airflow obstructed
Kinked tubing
Occluded mouthpiece
Active resistance to inhalation
When checking for leaks on a IPPB this means ?
Cycle off
Most common leak is when pt is not sealing their lips around the mouthpiece
If pt has a good lip seal then check circuit for leaks
Airway clearance therapy uses __?
Noninvasive techniques designed to improve gas exchange
Normal airway clearance requires __?
Patent airway
Functional mucociliary escalator
Adequate hydration
Retention of secretions can result in __?
Full and Partial Obstruction
Full obstruction ___?
Or mucous plugging can result in atelectasis, which causes hypoxemia due to shunting, and possible infection which could lead to pneumonia
Partial obstruction __?
Restricts airflow, increasing WOB and possibly leading to air trapping, lung over distention and V/Q imbalances
What causes impaired muccociliary clearance in intubated patients?
Endotracheal or tracheostomy tube
Tracheobstructional causes?
Impaired mucociliary clearance in intubated patients
Inadequate humidification causes ___?
Impaired mucociliary clearance in intubated patients
High FiO2 values causes __?
Impaired mucociliary clearance in intubated patients
Drugs, opiates, general anesthesia, and narcotics causes what?
Impaired mucociliary clearance in intubated patients
Underlying pulmonary disease can cause what?
Impaired mucociliary clearance in intubated patients
