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

Question 1

What are the 3 types of Atelectasis?

Answer 1

• Gas Absorption
• Lobar
• Compression

Question 2

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

Answer 2

ventilation;
V/q

Question 3

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

Answer 3

ventilation;
larger airway or bronchus

Question 4

Compression atelectasis occurs when the

Answer 4

transthoracic pressure exceeds the transalveolar pressure (PAL)

Question 5

Factors Associated w/ Atelectasis (5)

Answer 5

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

Question 6

Clinical signs of Atelectasis (5)

Answer 6

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

Question 7

What is the main indication for hyperinflation therapy?

Answer 7

To prevent or treat atlectasis

Question 8

What are some indications of NPPV? (3)

Answer 8

• Increased WOB
• DNI pts
• Acute exacerbation of COPD

Question 9

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

Answer 9

their lungs to inflate them

Question 10

IPPB can be…. (3)

Answer 10

• pt, time, pressure or manually triggered
• pressure cycled
• pneumatically powered

Question 11

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

Answer 11

lung expansion;
positive;
inspiration

Question 12

IPPB tx last about (range)

Answer 12

15- 20 minutes

Question 13

IS is ____% pt effort

Answer 13

100%

Question 14

IPPB can be modified to adjust the….

Answer 14

pressure that the pt is getting

Question 15

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

Answer 15

take a deep breath it can be done

Question 16

Contraindications for IPPB

Answer 16

• 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

Question 17

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

Answer 17

Tension Pneumothorax

Question 18

Hazards and Complications of IPPB (5)

Answer 18

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

Question 19

Potential outcomes of IPPB (6)

Answer 19

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

Question 20

What is the best position for IPPB

Answer 20

Semi-Fowlers

Question 21

What are some equipment needed for IPPB

Answer 21

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

Question 22

Prior to initiating IPPB what most be done first?

Answer 22

A baseline assessment

Question 23

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

Answer 23

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

Question 24

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

Answer 24

• 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

Question 25

Both ______and __________ can be adjusted to reach the goal pressures

Answer 25

flow and pressure

Question 26

What is inspiratory time determined by? (4)

Answer 26

• Pressure setting
• Flow rate
• Lung compliance
• Airway resistance

Question 27

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

Answer 27

time to get in and get it out

Question 28

Decreased compliance, __________ volume.

Answer 28

decreases

Question 29

Increased compliance __________ volume.

Answer 29

Increases

Question 30

Decreased airway resistance ____________ volume.

Answer 30

Increases

Question 31

Increased airway resistance __________ volume.

Answer 31

Decreases

Question 32

With IPPV, exhalation is

Answer 32

Passive

Question 33

What is the optimal breathing pattern for IPPB?

Answer 33

Slow, and deep