Test 1 Ch. 43 Eagans Intermittent Positive Pressure Breathing (IPPB) Flashcards

1
Q

What are the 3 types of Atelectasis?

A
  • Gas Absorption
  • Lobar
  • Compression
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2
Q

Gas absorption atelectasis can occur when mucus plugs block _________________ to selected regions of lungs, which causes ______ mismatch

A

ventilation;
V/q

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3
Q

Lobar atelectaisis happens when ________________ is compromised in a……..

A

ventilation;
larger airway or bronchus

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4
Q

Compression atelectasis occurs when the

A

transthoracic pressure exceeds the transalveolar pressure (PAL)

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5
Q

Factors Associated w/ Atelectasis (5)

A
  • Obesity
  • Neuromuscular disorders
  • heavy sedation
  • surgery near the diaphragm
  • restrictive chest wall abnormalities
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6
Q

Clinical signs of Atelectasis (5)

A
  • Tachypnea
  • Fine, late-inspiratory crackles
  • Increased density and signs of volume on chest xray
  • Bronchial breath sounds
  • Tachycardia
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7
Q

What is the main indication for hyperinflation therapy?

A

To prevent or treat atlectasis

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8
Q

What are some indications of NPPV? (3)

A
  • Increased WOB
  • DNI pts
  • Acute exacerbation of COPD
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9
Q

IPPB is positive pressure on inspiration; the pt is getting positive pressure into

A

their lungs to inflate them

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10
Q

IPPB can be…. (3)

A
  • pt, time, pressure or manually triggered
  • pressure cycled
  • pneumatically powered
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11
Q

IPPB is considered a _______ ____________ tool b/c ___________ pressure is given to the airway during _______________

A

lung expansion;
positive;
inspiration

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12
Q

IPPB tx last about (range)

A

15- 20 minutes

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13
Q

IS is ____% pt effort

A

100%

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14
Q

IPPB can be modified to adjust the….

A

pressure that the pt is getting

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15
Q

Pts do not have to be cooperative while doing IPPB, as long as a pt can

A

take a deep breath it can be done

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16
Q

Contraindications for IPPB

A
  • Hemothorax
  • Pneumothorax (b/c will cause a tension pneumothorax)
  • Tension Pneumothorax
  • Active hemoptysis
  • ICP>15 mm Hg
  • Tracheoesophageal fistula
  • Hemodynamic instability
  • Recent facial, oral, or skull surgery
  • Nausea
  • Singultus (hiccups)
  • Surgery near eosphogeal
17
Q

Pressure builds up until it shifts the mediastinum, once that is shifted, it then causes cardiac instability. What is this describing?

A

Tension Pneumothorax

18
Q

Hazards and Complications of IPPB (5)

A
  • Hypoventilation and respiratory alkalosis
  • Discomfort secondary to inadequate pain control
  • Pulmonary barotrauma
  • Exacerbation or bronchospasm
  • Fatigue
19
Q

Potential outcomes of IPPB (6)

A
  • Decrease or elimination
  • Improved breath sounds
  • Normal or improved chest x-ray
  • Increased SpO2
  • Increased VC
  • Improved inspiratory muscle performance and cough
20
Q

What is the best position for IPPB

A

Semi-Fowlers

21
Q

What are some equipment needed for IPPB

A
  • mouthpiece
  • circuit
  • Tracheal adapter (can be added to ETT/TT)
22
Q

Prior to initiating IPPB what most be done first?

A

A baseline assessment

23
Q

Monitoring IPPB:
Machine performance (4)
Patient response (8)

A

Machine Performance
- Sensitivity
- Peak pressure
- Flow setting
- FiO2

Patient Response
- Breathing rate and expired volume
- Peak flow or FEV1/FVC%
- Mental function
- Skin color
- BP
- SPO2
- ICP
- Chest x-ray

24
Q

Initial settings for IPPB (ranges)
Sensitivity
Pressure
RR
I:E

A
  • Sensitivity: -1 to -2
  • Pressure: 10 to 15 cm H2O
  • RR: 6 to 8 breaths/min (low rate to provide full expansion of lungs)
  • I:E ratio: 1:3 to 1:4
25
Q

Both ______and __________ can be adjusted to reach the goal pressures

A

flow and pressure

26
Q

What is inspiratory time determined by? (4)

A
  • Pressure setting
  • Flow rate
  • Lung compliance
  • Airway resistance
27
Q

Airway resistance can affect the inspiratory time b/c increased resistance takes

A

time to get in and get it out

28
Q

Decreased compliance, __________ volume.

A

decreases

29
Q

Increased compliance __________ volume.

A

Increases

30
Q

Decreased airway resistance ____________ volume.

A

Increases

31
Q

Increased airway resistance __________ volume.

A

Decreases

32
Q

With IPPV, exhalation is

A

Passive

33
Q

What is the optimal breathing pattern for IPPB?

A

Slow, and deep