RCp 120 Unit 4 Test Flashcards
-Lung Expansion Therapy Devices
-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!!
-Incentive Spirometry
-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
-Lung Expansion Therapy -Indications
-Any condition predisposing patient to development of atelectasis
-Presence of atelectasis
-Incentive Spirometry -Contradictions
-Patient who cannot follow directions/ coordinate treatment
-Incentive Spirometry
-Hazards/ complications
-Ineffective if not used correctly
-Hyperventilation in patients perform too fast
-Tingling fingers, numbness around mouth, have patients to slow their breathing down
-Incentive Spirometry
-Devices
-Volume or flow oriented using visual cue/ indicator
I.S. -Implementation
-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
-Intermittent Positive Pressure Breathing (IPPB)
-Gas pushed into alveoli by positive pressure, followed by passive exhalation (mask or mouthpiece)
IPPB -Indications
-May be useful for atelectasis if patient doesn’t respond to IS or other positive pressure therapies
IPPB -Contraindications
-Untreated pneumothorax, recently oral/ facial surgery
IPPB -Hazards and complications
-Patients with high resp rate (tachypnea) should not use IS or IPPB
-CPAP
-Continuous positive airway pressure- set pressure during both inhalation and exhalation
-recruitment of alveoli -Decreased WOB -Improved distribution of ventilation
-EZPAP
-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
-Lung expansion Therapy
-Selecting appropriate lung expansion
-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
-Effective cough 4 stages
-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)
-Diseases contributing to abnormal clearance
-Cystic fibrosis
-Acute conditions
-Copious secretions
-Determining the need
-Adequate patient assessment, CXR often a useful tool
Methods for Bronchial Hygiene
- 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
Postural Drainage Therapy
• Use of gravity and mechanical means to mobilize secretions
• Includes turning, percussion, and vibration (often referred to as CPT, PPD or pulmonary toileting)
Postural Drainage Therapy
absolute contraindication
• Unstable spine
• Relative contraindications of positioning
- Severe diarrhea, worsening dyspnea
• Proning belly down
- 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
Gravity
• Use of gravity to help move secretions from distal areas into central airways; remove by suction or cough
• Positions
- Held 5-10 minutes (per position)
• Most useful if patient is producing 25-30ml/day of sputum
PDT • Technique
- 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
PDT - Pre-treatment assessment
• Vital signs
• Pulse Oximetry- should be monitored throughout therapy
• Auscultation
Positions of PDT
- Support all joints and bony areas with pillows/towels
- Allow rest between positions
- Discourage strong coughing in head down positi
• Post treatment assessment
- See above plus subjective responses
- Breath sounds may worsen after therapy
• Documentation PDT
- All positions used
- Time in each position
- All assessment - pre and post
- Sputum production - amount, color, consistency
- Absolute contraindications
PDT
• Head and neck injury until stabilized
• Active hemorrhage or hemo-dynamically unstable
- Relative contraindications
PDT
active hemoptysis, pulmonary embolism, rib fracture
- NOTE: If negative patient response
stop therapy, return patient to original position, stay with patient until STABILIZED
• Manual percussion
- 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
• Modifications in technique of Coughing
- Splinting - place hand or pillow over incision site and apply gentle pressure while coughing
• Forced Expiratory Technique - Huff Cough
- Sharp exhalations from high to mid lung volumes through an open glottis
- To keep glottis open - patient says “huff” during expiration
• Mechanical Insufflation-Exsufflation (MIE)
- Known as the cough assist
- Device that inflates the lungs with positive pressure followed by a negative pressure to simulate a cough
Positive Expiratory Pressure (PEP)
• 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
PEP • Indications for treatment
- Reduce air trapping in asthma and COPD
- Mobilize retained secretions for CF and chronic bronchitis
- Optimize delivery of bronchodilators
PEP • Contraindications
recent surgery to mouth/face/skull, untreated pneumothorax
- Discontinue treatment if: sinusitis, epistaxis, or middle ear infection
• Technique for PEP
- 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
High Frequency Conpression/ Oscillation
• Two methods
- External-high frequency chest wall compression
(HFCWC)
- Applied to Airway
• HFCWC
- The Vest Airway Clearance
System
• IPV (Intrapulmonary percussive ventilation)
- 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
Airway Oscillating Devices
• Produce PEP with oscillations in the airway
• Flutter valve
- Heavy steel ball sits in the bowl of “pipe” like device
• Acapella “the pickle”
- Uses a counterweighted plug and magnet to create airflow oscillations during expiratory flow
