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Theory and Principles of Respiratory Care > RCp 120 Unit 4 Test > Flashcards

RCp 120 Unit 4 Test Flashcards

1
Q

-Lung Expansion Therapy Devices

A

-Incentive spirometry (I.S.)

-Continuous Positive Airway Pressure (CPAP)

-Intermittent Positive Pressure Breathing (IPPN)

-EZPAP

-Best choice is what will accomplish what is needed at least cost!!

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2
Q

-Incentive Spirometry

A

-Designed to mimic natural sighing, performed using devices which provide a visual cue.

-Basaic maneuver-SMI- sustained maximal inspiration

	-Slow deep inspiration from FRC to total lung capacity, followed by 3-5 second breath hold
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3
Q

-Lung Expansion Therapy -Indications

A

-Any condition predisposing patient to development of atelectasis

-Presence of atelectasis

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4
Q

-Incentive Spirometry -Contradictions

A

-Patient who cannot follow directions/ coordinate treatment

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5
Q

-Incentive Spirometry

-Hazards/ complications

A

-Ineffective if not used correctly

-Hyperventilation in patients perform too fast

		-Tingling fingers, numbness around mouth, have patients to slow their breathing down
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6
Q

-Incentive Spirometry

-Devices

A

-Volume or flow oriented using visual cue/ indicator

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7
Q

I.S. -Implementation

A

-Effective patient teaching

-RT set initial effort and correct technique as required

-instruct in breath hold, very important

-Rest between breaths

-5-10 maneuvers per hour

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8
Q

-Intermittent Positive Pressure Breathing (IPPB)

A

-Gas pushed into alveoli by positive pressure, followed by passive exhalation (mask or mouthpiece)

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9
Q

IPPB -Indications

A

-May be useful for atelectasis if patient doesn’t respond to IS or other positive pressure therapies

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10
Q

IPPB -Contraindications

A

-Untreated pneumothorax, recently oral/ facial surgery

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11
Q

IPPB -Hazards and complications

A

-Patients with high resp rate (tachypnea) should not use IS or IPPB

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12
Q

-CPAP

A

-Continuous positive airway pressure- set pressure during both inhalation and exhalation

      -recruitment of alveoli

		-Decreased WOB

		-Improved distribution of ventilation
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13
Q

-EZPAP

A

-Its connected to a flowmeter (ait of O2) adjusted to a flow of 5-10 LPM

-EZPAP amplifies the input of air or oxygen by approximately four times by taking advantage of thee Coanda effect
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14
Q

-Lung expansion Therapy

-Selecting appropriate lung expansion

A

-For IS- Patient must be alert or will need to do IPPB

	-If patient has excess secretions , use PEP therapy

	-Last resort, intermittent CPAP therapy
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15
Q

-Effective cough 4 stages

A

-Phase one, irritation (inflammatory, mechanical, chemical, or thermal)

	-Phase two- inspiratory (normally 1-2L in adult)

	-Phase three, compression (glottic closure and forceful contraction of respiratory muscles)

	-Phase four- expulsion release as glottis opens (Cough)
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16
Q

-Diseases contributing to abnormal clearance

A

-Cystic fibrosis

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17
Q

-Acute conditions

A

-Copious secretions

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18
Q

-Determining the need

A

-Adequate patient assessment, CXR often a useful tool

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19
Q

Methods for Bronchial Hygiene

A
  • 1) Postural drainage therapy (turning, percussion, and vibration), 2)coughing, 3)positive airway pressure therapy, 4)high-frequency compression/oscillation, IPV, 5)mobilization and exercise
20
Q

Postural Drainage Therapy

A

• Use of gravity and mechanical means to mobilize secretions

• Includes turning, percussion, and vibration (often referred to as CPT, PPD or pulmonary toileting)

21
Q

Postural Drainage Therapy

absolute contraindication

A

• Unstable spine

22
Q

• Relative contraindications of positioning

A
  • Severe diarrhea, worsening dyspnea
23
Q

• Proning belly down

A
  • Used in treatment of patients with ALI (acute lung injury)
  • Improvement in blood flow/recruitment of atelectatic areas
  • Good lung down phenomenon- gravity takes blood to area of best ventilation
24
Q

Gravity

A

• Use of gravity to help move secretions from distal areas into central airways; remove by suction or cough

25
Q

• Positions

A
  • Held 5-10 minutes (per position)

• Most useful if patient is producing 25-30ml/day of sputum

26
Q

PDT • Technique

A
  • Identify proper lobes/segments

• Physician order, CXR, breath sounds, may need to modify position

  • Schedule before or 1-2 hours after eating
        - Monitor all lines attached to patient for pulling/disconnection
27
Q

PDT - Pre-treatment assessment

A

• Vital signs

• Pulse Oximetry- should be monitored throughout therapy

• Auscultation

28
Q

Positions of PDT

A
  • Support all joints and bony areas with pillows/towels
  • Allow rest between positions
  • Discourage strong coughing in head down positi
29
Q

• Post treatment assessment

A
  • See above plus subjective responses
  • Breath sounds may worsen after therapy
30
Q

• Documentation PDT

A
  • All positions used
  • Time in each position
  • All assessment - pre and post
  • Sputum production - amount, color, consistency
31
Q
  • Absolute contraindications

PDT

A

• Head and neck injury until stabilized

• Active hemorrhage or hemo-dynamically unstable

32
Q
  • Relative contraindications

PDT

A

active hemoptysis, pulmonary embolism, rib fracture

33
Q
  • NOTE: If negative patient response
A

stop therapy, return patient to original position, stay with patient until STABILIZED

34
Q

• Manual percussion

A
  • Cupped hands with fingers and thumb closed
  • Traps cushion of air between chest and hands
  • Rhythmically strike in a waving motion, alternating both hands with elbows partially flexed and wrists loose
35
Q

• Modifications in technique of Coughing

A
  • Splinting - place hand or pillow over incision site and apply gentle pressure while coughing
36
Q

• Forced Expiratory Technique - Huff Cough

A
  • Sharp exhalations from high to mid lung volumes through an open glottis
  • To keep glottis open - patient says “huff” during expiration
37
Q

• Mechanical Insufflation-Exsufflation (MIE)

A
  • Known as the cough assist
  • Device that inflates the lungs with positive pressure followed by a negative pressure to simulate a cough
38
Q

Positive Expiratory Pressure (PEP)

A

• Active exhalation against a variable flow resistance

  • Positive Pressure during exhalation using a one-way expiratory flow resistor…using a mask or mouthpiece
  • Expiratory pressures range from 5 -20cm
39
Q

PEP • Indications for treatment

A
  • Reduce air trapping in asthma and COPD
  • Mobilize retained secretions for CF and chronic bronchitis
  • Optimize delivery of bronchodilators
40
Q

PEP • Contraindications

A

recent surgery to mouth/face/skull, untreated pneumothorax

  • Discontinue treatment if: sinusitis, epistaxis, or middle ear infection
41
Q

• Technique for PEP

A
  • Patient sitting comfortably upright
  • Adjust the expiratory resistor to the prescribed setting
  • Using a tight seal, exhale gently (not forcefully) to a pressure of 5-20 cmH2O (mask or mouthpiece)
  • Exhalation should be three times longer than inhalation
42
Q

High Frequency Conpression/ Oscillation

A

• Two methods

  • External-high frequency chest wall compression

(HFCWC)

  • Applied to Airway
43
Q

• HFCWC

A
  • The Vest Airway Clearance

System

44
Q

• IPV (Intrapulmonary percussive ventilation)

A
  • Creates positive changes by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall recoil for passive exhalation
  • 300-400 cycles per minute
45
Q

Airway Oscillating Devices

A

• Produce PEP with oscillations in the airway

46
Q

• Flutter valve

A
  • Heavy steel ball sits in the bowl of “pipe” like device
47
Q

• Acapella “the pickle”

A
  • Uses a counterweighted plug and magnet to create airflow oscillations during expiratory flow

Theory and Principles of Respiratory Care (5 decks)

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