therapeutic procedures Flashcards
1
Q
Patient position to enhance oxygenation
Prone
A
ARDS
2
Q
Patient position to enhance oxygenation
Fowler’s position
A
CHF
(30-35 degrees)
3
Q
Patient position to enhance oxygenation
Lateral Fowler’s
A
obese patient
with air hunger
4
Q
Patient position to enhance oxygenation
unilateral lung disease
A
good lung down
5
Q
Inspiratory muscle training (IMT)
Ventilatory muscle training benefits patients by
A
increaseing their muscle strength and endurance, decreasing dyspnea and need for medication and hospital visits
6
Q
Inspiratory muscle training (IMT)
progressive resistance
A
over time, greater resistance is imposed on the inspiratory muscles. to increase muscle strength and endurance
7
Q
incentive spirometry
POST-opeative goal should be ____of the Pre- operative insp. capasity
A
one-half
8
Q
incentive spirometry
if pt is unable to achieve targeted volume ….
A
check connection and pt mouth seal before reducing volume target
9
Q
contraindications for IPPB
A
- unskilled practitioners and users
- hypotension
- untreated pnuemo
- elevated IC pressure
10
Q
IS should be performed ___ while the pt is awake for approximately ___ breaths
A
- hourly
- 10 breaths
11
Q
Indications for IPPB
A
- prevent/ correct atelectasis
- Prevent/ decrease pulmonary edema
- decrease wob (assesory muscle use, pt it COPD)
- distribute aerosols more evenly
- improve and promote the cough mechanism
12
Q
Hazards of IPPB
Impening venous return - results in
A
decreased Cardica output ,
and incrased intracranial pressure
13
Q
classification: Bird Mark
A
- Pnumatically powered
- Pressure cycled
14
Q
How do we change the volume on a Bird Mark (IPPB)
A
change the pressure setting
15
Q
if IPPB sensitivity is set too much it will
A
self cycle
16
Q
Turning the knob higher on IPPB will cause
A
a greater flow ( decrease inspt time)
17
Q
IPPB
increase pressure will____volume
A
increase
18
Q
Bird Mark IPPB
decreasing the flow will
A
increase the volume
(increases inspiratory time)
19
Q
Bird Mark IPPB
increasing flow will
A
increase turbulence and decrease volume
decrease inspiratory time
20
Q
IPPB
fail to cycle off
cause
A
Leak
1. mouthpiece / mouth seal
2. cuff leak
3. fenestrated trach tube open
4. loose equpment connection
21
Q
IPPB
If pressure does not rise normally (neddle reads low or neg)
it means…
troubleshoot?
A
there’s insufficient flow
troubleshoot: raise the flow
22
Q
consider bronchial hygiene therapy for pt with
A
- Cystic Fibrosis
- Bronchiectasis
23
Q
Position
Fowlers, Semi-fowlers or reverse trendelenburg
is best for
A
- hypoxic pt,
- obese pt with dyspena,
- post-op abdominal surgery pt ,
- pt with pulmonary edema
24
Q
Body position
position for pt with low blood pressure or and obese pt with an order for bronchial hygiene therapy
A
trendelenburge
25
Body position
*Flat *
upper lobes
26
Body position
*down 15 degrees *
middle lobes
27
Body position
*down 30 degrees *
lower lobes
28
# cough control techniques
small breath and cough, larger breath and cough, then deep breath and hard cough
| this technique is called
Serial cough
29
# cough control technique
coughing with an open glottis
| this technique is called
Huff coughing
30
# cough control technique
more effective in pts with COPD or head trauma to prevent increased IC pressures
Huff cough
31
Postive expiratory pressure therapy
| PEP definition
application of expiratory positve airway pressure using a one-way insp. valve and one-way exp. flow resistor
32
# PEP therapy
the exp. flow resistor prevents
end-expiratory pressure from falling to zero
33
# PEP therapy
expiratory pressure
range
10-20 cmH2O at mid-exhalation
34
PEP tharapy is an
alterantaive airway clearance technique
| hlep improve secretion expectoration, improve airway maintenance
35
instruction for PEP therapy
inspire a longer than normal Vt and exhale actively but nor forcefully (exhalation is 2-3 times longer than inspiration)
36
High Frequency Chest wall Compression devices are for what kind of pt ?
Patients who cannot use or tolerate other procedures
37
combination of high frequency pulse delivery of a sub-tidal volume and a dense aerosol
| (100 -250 cycles/min)
intrapulmonary percussive ventilation
| IPV
38
cought assit devices is also called
Insufflation/Exsufflation devices
| Manual assited coughing (MAC)
39
indicated for patiens with neurologic problems or muscle weakness
Insufflation/Exsufflation devices
40
how does a cough assist device work
deliver deep inspiration by positive pressure, followed by 1-2 sec breath hold, then negative pressure exsufflation to create a cough
41
Goals of humidity therapy
1. prevention of mucosal crusting
2. compensate for a humidity defict
42
Proper humidity to maintain
44 mg/L at 37 °C
or 47 mmhg
43
# humidifier
Used on low-flow oxygen delivery devices
bubble humidifier
44
Proper function of bubble humidifier should be checked by
occluding or pinching the connecting tubing and listening for the whistling sound
| if no sound occurs, there is a leak
45
with bubble humidifiers, if whistling sound occurs without intentional occlusion then that means...
oxygen flow is excessively high
obstruction or kinking of tubing
46
other names for Heat moisture exchanger
* hydroscopic condenser humidifier
* artificial nose
47
HME is located
between the wye and the patient
48
Replace the HME if
airway pressure increases
49
Can deliver 100% body humidity
Wick humidifier
50
Wick Humidifiers have low risk of cross contamination (nosocomial infection ) because
no particles are being produced
51
Goals of Aerosol therapy
1. relieve bronchospasm and mucosal edema
2. to thin secretions
3. to humidify
4. administer drugs
52
Medications that can be admistered by a hand held or small volume neb
short acting beta agonist
Anticholinergic agent
inhaled corticosteroids
Mucolytic agents
Antibiotics
53
SVN vs. LVN
SVN - for small doses of medication
LVN - are utilized to deliver bland aerosols to upper airway to reduce chances of edema of humidity deficit
54
# TROUBLESHOOTING
LVN not misting enough due to clogged capillary tube
get new one
55
Small particle aerosol generator (SPAG)
| designed for?
designed to deliver Ribavrin (Virazole)
for treating RSV
56
Can you use SPAG with another drug
no just Ribavrin
57
# Nebulizers
Recomended for thick tenacious secretions
Ultrasonic neb
58
Ultrasonic neb
has the highest output range of all neb without heating
59
Vribrating Mesh Neb
electrically powered neb which produces aerosols with small particles
60
IS indication
prevention or treatment of atelectasis for pt who are able to spontanously take a breath
61
# Hazards of IPPB
Hyperventilation
| patient will complain of ...
1. Dizziness
2. tingling of fingers (excessive elimination of CO2)
| instruct to breath slower
62
Bird Mark 7 (IPPB) sensitivity setting
1.0-2.0 cmH2O
63
What happends on the Bird Mark 7 (IPPB) if setting is set too sensitive
self cycling will occur
64
On Bird Mark 7(IPPB) leaks in the circuit will prevent
normal cycling to exhalation
65
# Bird Mark 7 (IPPB)
Purpose of bronchial hygiene therapy
improve mobilization of secretions
66
# IPV
recommended starting pressure
30 psi
67
# IPV
the percussive effect of gas improves___past obstruction in the airway thereby delivering ___ aerosol to the ____
* ventilation
* more
* distal airways
68
What type of pathology would benefit from PEP therapy
Cystic Fibrosis
Pneumonia
69
Discontinue PEP therapy if ...
sinusitis, epistaxis or middle ear infection occurs
70
Most humidifiers incroporate ___ set at approximately ___
* pop-off valves
* 2psig or 40 mmhg
71
HME ideal use
patient transport and short term ventilation
72
Two ways insufflation/exsufflation device is attached to pt
* oralnasal interface
* endotraacheal
* tracheostomy tubes
73
Hazards of aerosol therapy
* Bronchospasm
* secretion swelling and airway obstruction
* Fuid overload
74
how are SVN powered
by pressurized gas source
75
Medications that can be deliverd by meter dose inhaler
1. short acting beta agonis
2. Long acting beta agosnis
3. Anticholinergics
4. Inhaled corticosteroids
5. Mast cell stabilizers
76
Spacer and Holding chambers
improves the efficacy of MDI by allowing. larger particles to attach to the walls of the device and decrease oral deposition
77
provide only a portion of total inspired volume
low flow devices
(nasal canula, simple mask, partial-rebreather)
78
Nasal Canula Flow
1-6 L/min
79
How to estimate FiO2 for NC (low flow)
Start 24%
add 4% for every 1 l/min
| 2 L/min= 28% , 3L/min=32%
80
Simple mask
Delivered FiO2 :
Flow :
Delivered FiO2 : 0.40-0.55
Flow :6-10 L/min
81
Simple Mask: Flow must be at least___ to flush out __
* 6L/min
* exhaled CO2
82
Partial rebreather mask
Delivered FiO2 :
Flow :
Delivered FiO2 : 0.60-0.65
Flow :6-10 l/min
83
difference between partial-rebreather and non-rebreather mask
Partial: has no flap valves
NON: has three one way valves
| Partial is a low flow, Non is a high flow
84
provide patient's entire inspired volume
| examples
high flow devices
(non-rebreather mask, air entrainment mask , High flow nasal canula, T-piece)
85
Non-rebrether mask
Delivered FiO2 :
Flow :
Delivered FiO2 : 0.21-1.00
Flow : must be sufficient to keep the bag from collapsing
86
# oxygen administration devices
used to deliver 100% O2 in an emergency
non-rebreather mask
87
# oxygen administration devices
What emergency requires 100% O2
Pneumothorax,
CO poisoning
CHF
Burns
88
Non-rebreather: if bag does not slightly contract:
* mask is not tight
* nonrebreathing valve is stuck
REPLACE MASK
89
Can a non-rebreather be used for mixed gas therapy
yes
90
delivers percise FiO2 concentrations
Air entrainment mas (venturi mask)
| ideal for COPD
91
# HIgh Flow devices
ideal for patients with irregular VT, rates and breathing patters
Venturi mask
92
# High Flow devices
Should see aerosol from reservoir tubing during inspiration
T-peice
93
# troubleshoot
T- piece : if aerosol disappears
1. increase the flow
2. add more reservoir tubing
3. set up a device to provide more flow (blender)
94
T-pece should utilize reservoir to
maintain proper FiO2
95
when do you use a Face Tent
Facial injury
Surgical treatment (mandible)
96
High Flow Nasal Cannula
| decribe
* a humidification system that can heat and humidify oxygen at flow rates up to 40 L/min
* O2 can be deliver by nasal cannula
97
Can deliver 100% body humidity
HFNC
98
Oxygen Hood
Flow range
7-14 L/min
99
Reason for Flow range of oxygen hood
to prevent CO2 buildup and maintain FiO2 without sealing the infant's neck around the hood
100
# OXY HOOD
what is the effect on the patient if the inspired air is overheating
can cause dehydration and apnea
101
# OXY HOOD
what is the effect on the patient if the inspired air is underheating
can increase O2 consumption
102
Duratin of Cylinder Flow:
| Formula
(Gauge presure (psi) x tank factor) / liter flow
103
Total Flow
equation
= O2 flow x Factor
104
Can be used with a non-rebrether mask to achieve a precise FiO2
Air-oxygen blender
105
Air - oxygen blender need ____psi
at least 40 psi
106
air compressor
| description
provides a compressed gas source without using an air cylinder
107
Can be used to power a hand-held neb for a pt with COPD in the home setting
air compressor
108
CPAP
| Purpose
1. improve oxygenation
2. support oxygenation at lower FiO2
109
Nasal CPAP is useful for what type of pt
Neonates since they are obligated nose breathers
110
What happends to the CPAP if infant begins to cry
can loose CPAP
111
CPAP is not _____, its for _______
* ventilation
* oxygenation
112
CPAP, EPAP, PEEP are pressures that
are maintain during exhalation
113
CPAP: loss of pressure indicates
* leak
* insufficient flow
114
CPAP: incresed pressure indicates
* obstruction
* with excessive flow, a continuous venting of the pop-off valve will occur
115
Sputum induction is indicated for patients with
suspected pneumonia who do not have a productive cough
116
Procedure for Sputum induction
1. collect speciment early in the morning
2. have pt remove dentures
3. have pt rinse or gargle with water
4. administer aerosol therapy
5. instruct pt to cough deeply and expectorate into the speciment container
117
IPPV is
| pressure or volume cycled?
Pressure cycle
118
Reasons IPPV does not reach the preset pressure
1. leak
2. not enough flow
119
Vibrating Mesh Neb
used to diliver small amoutn of medication
120
Therapy for atelectasis
CPAP
