| Flap 1 | Flap 2 |
| Indications for IS are | presence of atelectasis, predisposition for atelectasis ie: upper ab or thoracic surgery, or surgery to COPD pt, pt with restrictive lung defect ie: quad or diaphragm problem |
| Contraindications for IS | unconscious, uncooperative or uncoordinated pt, inadequate VC less than 10 mL per Kg or IC less than 70 percent |
| Hazards and complications of IS are | hyperventilation and resp alkalosis, pain, pulm barotraumas, exacerbation of bronchospasm, fatigue, ineffective unless performed as ordered, inappropriate as sole treatment for lung collapse or consolidation |
| The three types for Incentive spirometers are | flow dependent (ball), volume displacement (bellows), photoelectric (combined flow and vol displac) |
| Voldyne spirometers | flow dependent, 1 tube with float, slow deep breath, keep float in set range, range is 0 to 4000 mL |
| Triflow | three tubes with floats, flow dependent, highest of the three x seconds held equals total volume |
| Volurex | bellows volume displacement, range is to 4000 mL |
| Spirocare | photoelectric, must have electric source and gives read out, combination volume displacement and flow dependent |
| SMI is | sustained maximal inspiration aka incentive spirometry, mimics natural sigh, visual feedback to patient, increases pulm press and insp volume |
| The three phases of hyperinflation therapy are | planning, implementation and follow-up |
| Preliminary planning for IS includes | pt screening and baseline assessments, establishing explicit pt outcomes |
| Pt therapeutic outcomes for IS should include | absence or improved atelectasis, decreased RR, norm pulse, norm or improved BS, increased SPO2, VC and PEF, restoration of FRC or VC, improved cough, normal CXR, improved P(A-a)O2 |
| Implementation of IS includes | Attainable goals with moderate effort set by RT, observation of pt performance by RT, good pt instruction |
| Follow-up with IS should include | check to be sure pt is using IS correctly |
| What pt need to be screened for IS and given a baseline assessment | upper ab or thoracic surgery patients |
| IS hold is how long | 5 to 10 seconds |
| If pt has trouble holding 5 seconds in IS what should RT do | add one way valve |
| If pt does not rest between maneuvers during IS, what problem may develop | pt does not breath deep enough and can develop resp alkalosis |
| Pt monitoring during IS therapy should include | frequency of sessions, breaths per session, volume and flow achieved, breath hold time maintained, spot check pt compliance, device in reach of pt, increase volumes ea day, vitals and BS, pt motivation and effort |
| Lung expansion therapy includes | IPPB, IS, CPAP, PEP |
| The most common serious problems seen in pt after thoracic or abdomen surgery is | atelectasis, acute resp failure and pneumonia |
| The two primary types of atelectasis seen in post op are | reabsorption atelectasis and passive atelectasis |
| Reabsorption atelectasis is | mucus plugs prevent ventilation, air trapped gas is absorbed into blood and alveoli then collapse |
| Passive atelectasis is | persistent small VT causes distal alveoli to collapse from lack of ventilation |
| Lobar atelectasis is | severe form of atelectasis seen in about 5 percent of pt usually caused by a large mucus plug in pt with low VT and excessive secretions |
| What is the most common cause of atelectasis in the hospital | pt does not take periodic deep breath and fully expand lungs. |
| Indications for lung expansion therapy are | post op, neuromuscular, sedation, spinal cord injury, bedridden from major trauma |
| During the first 48 hours post op, what happens to the lungs | progressive decrease in FRC |
| Decreased FRC is associated with alveolar collapse in what area of the lung | basal or dependent |
| Atelectasis causes what to happen to V/Q | ventilation perfusion mismatch |
| What clinical signs does RT look for in pt history for atelectasis | recent surgery, history of lung disease, smoking |
| Physical signs of atelectasis are, | increased RR, fine late inspire crackles over region affected, bronchial BS, diminish BS tachycardia if hypoxemia present |
| How does rt confirm atelectasis | CXR opacity, displaced interlobal fissures, crowded pulm vessels, air bronchograms, elevated diaphragm, tracheal shift |
| Lung expansion therapy increase lung volume by what | increasing transpulmonary press gradient |
| Proper use of IPPB requires | careful pt selection, indications be specifically defined, treatment porpertly administered and monitored by trained RT |
| IPPB is | the application of inspiratory positive pressure to spontaneously breathing patients as an intermittent short term modality never as a prophylactic |
| How long does an IPPB treatment last | 15 to 20 minutes |
| During an IPPB treatment, positive pressure is transmitted from the alveoli to where | pleural space |
| Indications for IPPB | need to improve lung expansion, atelectasis when IS or CPT not working, high risk for atelectasis but unable to cooperate, pt who only needs 1 therapy instead of multiple modalities, inability to clear secretions and other modes fail, short term vent |
| Contraindications for IPPB | pneumothorax, ICP greater 15, unstable hemodynamics, active hemoptysis, tacheoesophageal fistula, recent esphogeal surgery, TB, CXR with blebs, recent surgery to face or head, hiccups, air swallowing nausea |
| Hazards to IPPB | increased airway resistance, barotraumas, nosocomial infection, resp alkalosis (most common) pco2 down ph up, hyperoxia, impaired venous return, gastric destention if pt not alert, airtrapping psychological dependence |
| 4 steps to administering IPPB includes | 1 planning, 2 evaluating alternatives, 3 baseline assessments, 4 implementation |
| Preliminary planning for IPPB therapy includes | determining need, base therapeutic outcome on diagnostic information and as explicit and measurable as possible, significant atelectasis, reduced VC less than 10 mL/kg,at risk pts who need assistance breathing but not mech vent |
| Potential outcome to IPPB therapy are | improved VC, increased FEV1 or peak flow, enhanced cough, improved CXR, BS and oxygenation, favorable subjective pt response |
| What does RTT look for when evaluating alternatives to IPPB | cheaper method available, if not, document, if so, document and change method |
| Baseline assessment in IPPB should include what | vitals, auscultations, observation of pt appearance sensorium (LOC), include specific assessment to individual identified clinical goals |
| Implementation of IPPB should include what 6 steps | 1 infections control, 2 equipment prep, 3 patient orientation, 4 pt position, 5 initial application, 6 adjusting parameters |
| An example of IPPB outcome set for a pt with post op atelectasis would be | spontaneous IC of 70 percent of predicted, improved CXR, decreased late inspire crackles, reduced RR under 25 per min |
| Infection control in IPPB includes | hand washing, CDC universal precautions (gloves), CDC TB airborne gloves gown hepamask, pt infection control posted, only sterile dilutes and meds, disinfect reusables, change nebs or disinfect 24 hrs on continuous, rinse in sterile water only |
| Equipment preparation for IPPB when and for what | before taking to pt room, for leaks |
| Patient orientation in IPPB should include | explain dr order, what IPPB does, how it feels, what to expect |
| Patient position in IPPB is | semi fowler with no slouching supine if pt unable to semi fowler |
| Initial application of IPPB includes | insert past teeth, lips seal, set machine so breath can initiate with minimal pt effort, adjust to -1 t -2 (system check) system press at 10 move slowly to 15, 6 to 8 breaths per min, 2 to 4 times longer exp than insp |
| What happens to IPPB if there is a leak | it shuts off |
| 99 percent of the time a leak can be fixed in IPPB with what | nose clips |
| What should RTT do if mouth wont seal in IPPB | use CPAP mask |
| When a CPAP mask is used in IPPB why does an NG tube need to be installed | so air does not enter stomach |
| Post treatment assessment of IPPB includes | repeat pt assessment, vitals, BS, sensorium, untoward effects and specific clinical follow up, did pt meet goals, frequency based on response to therapy |
| How often should acute care pt be reevaluated for IPPB | on dr orders, based on pt response to therapy, every 72 hours or with any change in status |
| Record keeping when discontinuing IPPB should be | sucking but complete, include pre and post assessment, untoward effects need to notify dr, nurse and noted |
| The 5 things to monitor on the machine during IPPB are | 1sensitivity, 2 peak pressure, 3 flow settings, 4 fio2 and 5 I:E ratio |
| The 12 things to monitor on a pt during IPPB therapy are | RR and VE, peak flow or FEV1/FVC, pulse and rhythm, sputum quantity, color, consistency, odor, mental function, skin color, BS, BP, SPO2 if hypoxia, ICP, CXP, subjective pt response |
| What do large negative pressure swings early in inspiration indicate in IPPB | sensitivity or trigger setting to low, RTT should increase sensitivity |
| in what pt settings would IS be found | critical care, acute care inpatient, extedned care and skilled nursing home, home care |
| Bird machine cycles prematurely | 1. Most common is pt obstructing mouthpiece with tongue, 2. flow to high, 3. pressure to low |
| Bird machine cycles on and off rapidly aka auto cycling | 1. most common is sensitivity 2. Coach pt about breathing |
| Bird machine aspiratory tie is to long | 1. Flow is to low, 2. Leak in circuit probably pt mouthpiece or pt needs nose clips, 3. Pressure to high, 4 coach pt to take exp pause of 3 seconds at the end of each breath, this will help extend expiration |
| Pressure manometer indicates high negative pressure prior to inspiration | adjust sensitivity |
| Pressure manometer hesitates or rises erratically during inspiration | flow is to low |
| Bennet cycles prematurely | pt abstracting mouthpiece or pressure set to low |
| Bennet cycles on and off rapidly | coach pt how machine works…only cycles when it senses a breath, obstruction or kinked tube, senility to high, Rate control on? Turn off rate control. |
| Bennet inspiratory time to long | check peak flow control is fully clockwise, check for leaks , pressure to high, coach pt to take exp pause |
| Bennet ventilator fails to cycle off | flow to low or leak in pt circuit |
| The most accurate way t measure inspired volumes is | volume displacement |
| Three methods of volume measurement used in IS are | timing the duration of flow, volume displacement and photoelectric |
| Gas pressure is regulated in the bird vent by | magnetic attraction opposing gas pressure |
| Gas pressure in the Bennet vent is regulated by | a low-pressure reducing valve |
| Needle valves are an effective way to | control gas flow |
| Which incentive spirometer operates using volume displacement | volurex |
| Which incentive spirometer operates using photoelectric sensor | spirocare |
| A pt using a flow-dependent IS reaches a goal of 600 mL per second and holds for 3 seconds, what would the inspired volume be | 1800 mL |
| An IPPB ventilator fails to cycle off, you suspect a leak, what would you check first | pt ability to seal mouthpiece, pt nose, all circuit connections, exhalation valve |
| You are using a Bennett PR2 to give an IPPB, and want to increase the delivered tidal volume what should you do | increase the pressure |
| When giving an IPPB treatment on a Bennet the vent triggers on and off rapidly, what do you do | adjust sensitivity |
| Your attempting an IPPB with a Mark 7 and the circuit is assembled correctly but will still not trigger on, what do you suspect is the problem? | flow rate has been turned off |
| What controls the FIO2 delivered in a Bennett PR2 operating in the source gas setting | terminal flow control |
| When giving IPPB therapy using a Mark 7, changes in delivered FIO2 can be attributed to what | venturi gate and pressure |
| If an IPPB ventilator fails to cycle in exhalation (off) the problem is ALWAYS | a leak |
| A control on the Bennett PR2 that is designed to compensate for leaks is what | terminal flow control |
| Which IPPB vent is designed primarily for home use | Bennett AP5 |
| Which IPPB vents can be used with apneic pts | PR2, Mark 7, Mark 7A, Mark 8 |
| When a pt attempts to trigger the IPPB ventilator on, a -8 cmH2O is recorded on the press manometer, what should the RTT should do | adjust the sensitivity |
