Therapeutic Procedures Flashcards
To enhance a patient’s oxygenation, what are the positions you would recommend for the following patient diagnosis or conditions?
ARDS-CHF-obesity-unilatleral lung disease
Prone
Fowlers
Lateral Fowlers
Good lung down
What procedure benefits patients by increasing their muscle, strength and endurance, decreases dyspnea, the need for medication and hospital visits
Inspiratory muscle training or IMT
You should instruct a patient to use an inspiratory muscle training device twice per day for 10 to 15 minutes per session, building up to 30 minutes. You want to increase the resistance until their results are what percentage of their measured MIP?
30%
What is the therapeutic procedure you would recommend for the prevention of atelectasis
Sustained maximal inspiration (SMI)
Compared to preoperative inspiratory capacity, what is the postoperative goal in incentive spirometry?
1/2
What are the five indications for IPPB therapy?
Prevention, or correction, of atelectasis in a patient, unable to take a deep breath
Prevention or correction of pulmonary edema.
Decrease the work of breathing (accessory muscles in COPD)
Distribute aerosols more evenly
Improved and promote the cough mechanism
What are contraindications for IPPB?
Hypotension
Elevated intracranial pressures
Untreated pneumothorax
What are five hazards of IPPB?
Hyperventilation
Impede venous return
Gastric distention
Pneumothorax
Excessive oxygenation and increased air trapping in patients with COPD
You should adjust the IPPB sensitivity setting to be in what range
1.0 to 2.0 cm of H2O
Decreasing the flow in IPPB will have what impact on the volume
It will increase the volume as the flow becomes more laminar 
What is the three reasons to provide bronchial hygiene therapy?
Improve mobilization of secretions
Prevent accumulation of secretions
Improve ventilation
What does ciliary dyskinesia mean and what would be a therapy you could recommend?
Dysfunction of normal movement of the cilia
Bronchial hygiene therapy
What are the four hazards or contraindications to bronchial hygiene therapy?
Unstable cardiovascular system
Unstable pulmonary system
Unstable, postoperative status
untreated tuberculosis
What position would you recommend in bronchial hygiene therapy for the following? Patient conditions: hypoxic patients, obese patients with dyspnea, postop, abdominal surgery, patients, and patients with pulmonary edema.
Reverse trendelenburg or semi-fowlers
What position in bronchial hygiene therapy would you recommend for a patient with very low blood pressure or who are obese and don’t have dyspnea
Trendelenburg’s
Why would you use lateral Fowlers in bronchial hygiene therapy?
Very obese patients with air hunger
What is the best position to prevent aspiration in bronchial hygiene therapy?
Lateral flat
What is the position of the bed during bronchial hygiene therapy in patients with lingular or middle lobe consolidation?
Incline 12 to 14 inches or 15%
What incline and positions should the patient be for postural drainage of the upper lobes?
Flat
Apical-semi fowlers with bed flat
Anterior-supine with pillow under butt
Posterior-sitting but leaning forward
How high should you raise the bed for postural drainage of the lower lobes?
18 to 20 inches or 30%
Please describe the patient position with respect to the bed for drainage of the superior segment to the lower lobes
Head of bed flat and patient prone with a pillow under their midsection
What are hazards and contraindications to chest percussion?
Metastatic conditions
Pulmonary emboli
Tuberculosis
untreated pneumothorax
Pleural effusion
Hemolysis/pulmonary hemorrhage
Rib, fractures
soft tissue trauma
If a patient does not tolerate manual percussion, what should be considered?
Mechanical percussion or vibration devices
Vibration techniques can be used instead of just percussion, but I have the following associated contradictions?
Rib fracture or trauma
soft tissue trauma
What type of cough is it when the therapist applies pressure on a patient’s abdomen during exhalation
Quad cough
What is the type of coughing with an open glottis and who is it recommended for?
Huff cough
More effective impatience with COPD or head trauma to prevent increased intracranial pressures
What are some cough control techniques a respiratory therapist could recommend
Position
relax between efforts
Volume building -multiple inhalations
Multiple cough with single exhalation
Serial coughs-incremental depth and force
Splitting over incision site
During pep therapy, what should exploratory pressures range from at mid exhalation?
10-20 cm H2O
What are the potential benefits of pep therapy?
Improve secretion expectoration
Reduce residual volume
Improve airway maintenance with cystic fibrosis pneumonia
What are the hazards to pep therapy that would cause you to discontinue the treatment
Sinusitis
Epitaxis
Middle ear infection
Breathing exercise utilized to improve mucus clearance, primarily in patients with cystic fibrosis and bronchiectasis, where a patient takes small breaths, then middle volume breast and then large breaths mobilize creations in the corresponding airways
Autogenic drainage
External percussive devices are indicated for patients who cannot tolerate other procedures. What is the Hertz you would order the treatment for and how long?
5-25 Hz for 30 minutes (1-6 times a day)
What is interapulmonary percussive ventilation?
Combination of high frequency, pulse deliveries of 100 to 250 cycles:minute of a sub-tidal volume and an aerosol to improve ventilation past obstructions for a better aerosol delivery and cough effectiveness
What is the recommended starting source pressure for most patients during intrapulmonary percussive ventilation
30 psi
What are the two names for the device that delivers a deep inspiration by positive pressure, followed by a one to 2 second breath hold and then negative pressure exsufflation to create a cough?
Insufflation/exsufflation device or Manually Assisted Coughing (MAC)
What are the reasons you would discontinue bronchial hygiene for complications or because therapy goals were met
Hazards occur-dizziness, SOB, cyanosis,etc
Patient is ambulating well with clear breath sounds and x-ray has a strong cough and is afebrile for 24 hours
How would you check proper function of a bubble humidifier?
Including or pinching the connecting tubing and listening to the whistling sound as t he he pop off alarm is activated, at 2 psi or 40 mm Hg
What are goals of aerosol therapy?
Relieve bronchospasm and mucosal edema
Thin secretions
Humidification
Deliver drugs
What are four hazards of aerosol therapy and how would you treat each?
Broncospasm-treat with bronchodilator
Secretion, swelling, the airway-suction
Fluid overlord with CHF, renal failure, and infants -monitor and output and weight
Cross-contamination- antibiotics
What is important to remember when using a blender with a large volume nebulizer?
Set the blender at the desired FiO2
Close the air entrainment port on the LVN
What is a small particle aerosol generator or SPAG, unit used for?
To deliver Ribavirin (I.e. Virazole) for treating RSV
What type of nebulizer has the highest aerosol output and what is it used for?
Ultrasonic nebulizer
Sputum inductions
What are the advantages to an vibrating mesh nebulizer (aerogen)
Very small particles
Low residual volume
No flow is added, if used with mechanical ventilation
What are two drugs delivered by meter dose inhaler, they’re not typically delivered by small volume nebulizer
Long acting beta agonist (salmeterol and formoterol)
Mast cell stabilizer (cromolyn sodium, nedocromil sodium)
Why are dry powder inhalers, or DPI’s, easier to use the MDI’s?
Coronation and timing is not as important
What are the two types of drugs delivered by DPI?
Long acting, beta agonists
Inhaled corticosteroids
What oxygen flow is necessary to flush out exhale CO2 in simple and partial rebreather masks
6-10 LPM
What is FO two delivery of a simple mass, partial, rebreather, mask, and nonrebreather mask
Simple mask = 40 to 55
Partial rebreather mask = 60 to 65
Non-mask = 21 to 100%
What are some indications for a nonrebreather mask?
Pneumothorax
CO poisoning
CHF
Burns
Mixed gas therapy
What is the flow range needed with an oxygen hood to prevent CO2 buildup and maintain FiO2?
7 to 14 L per minute
What are the associated risks with an oxygen hood?
Overheating can cause dehydration and apnea.
Under heating can increase O2 consumption.
can amplify sounds
What are hazards of an isolate or incubator?
Thermal burns
Electrical shock
Oxygen toxicity
Fire
Toxic inhalation
Hearing damage
What is the purpose of a radiant warmer?
Provides a neutral thermal environment that will not negatively impact insensible water, loss and premature infants because of evaporation
2. ideal for unstable newborns who require constant care
What is the advantage of a bourdon gauge?
The position of the tank is not a factor
What is the formula for duration of cylinder flow?
Gauge pressure in psi X tank factor/liter flow
Change to hours

E cylinder= 0.3
H cylinder= 3.0
What is the total flow and oxygen percentage calculations and what are the ratios and factors for 28% and 40% oxygen?
Total Flow=Flowmeter setting X Factor
28%= Ratio of 10:1, factor of 11
40%=Ratio of 3:1, factor of 4
On a blender, the low pressure alarm would indicate inlet pressures below what level
Below 40 PSI
What is the accuracy or precision with an air-oxygen proportioning blender?
Plus or minus 3%
What are the two types of oxygen analyzers?
Galvanic fuel cell-electron flows result of the oxidation/reduction of O2
Polarographic-similar to galvanic fuel needs a battery to polarize the electrodes
What is the accuracy requirement for an oxygen analyzer and how would you troubleshoot if it’s not reading correctly?
+/- 2%
Ensure there’s no water I’m sensor, pressure changes and recalibrate
What is the purpose of CPAP?
Improve oxygenation
Support oxygenation at lower FiO2’s
Why would you recommend sputum induction?
Patient with suspected pneumonia who don’t have a productive cough
What are the steps to a sputum induction?
Collect specimen early in the morning
Have patients remove dentures.
Have patient rinse or gargle with water.
Administer prescribed bland aerosol therapy
Have patient, cough and specimen
What is an adverse reaction to sputum induction?
Wheezing due to Broncospasm
How do you screen a sputum sample to verify that came from the lower respiratory tract and is not saliva?
Count the number of squamous epithelial cells. It should be less than 25 squamous cells per low power microscope field
What are the five medication types that can be delivered by small volume nebulizer?
SABA-abuterol
Anticholinergic-ipatroptium bromide
Corticosteroids-budesonide
Mucolytic-pulmozyme
Antibiotic-tobramycin
How does an anticholinergic work
by blocking the action of acetylcholine on muscarinic receptors in the airway smooth muscles. This leads to bronchodilation, reducing bronchospasm and airway resistance, which helps improve airflow and ease of breathing
 when utilizing an inspiratory muscle training device, the respiratory therapist will set the resistor at what level?
The lowest available resistance setting
