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RT test 3
wwall RT 2 test 3
| Question | Answer |
|---|---|
| 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 |
| Mark bird machines are | pneumatically powered pressure controller for IPPB therapy, can be pressure cycled or on 7A and 8 can be time controlled or press cycled |
| The pressure chamber on the mark is | located on the right side, gas press from the gas source builds and pressurizes pt circuit for delivery |
| The center body of the mark is | the narrow casting of aluminum alloy that seperates the ambient and press chambers, gas source on top |
| sensitivity control on the mark is | is located on the far left and controls pt effort, range is 0 to 10 below ambient press, ideal adjustment at -1 to -2, initiates inspiration |
| The flow rate control on the mark is | the large dial in front on the center body, controls the flow of gas, high flow is 80 L per min |
| The expiratory timer control on the mark is | the bottom dial on the center body and is used only in apnea pts. |
| The inspiratory pressure control of the mark | is located on the far right side and sets the insp pressure |
| The expiratory flow control on the mark is | FOUND ONLY ON THE MARK 8,a negative press control used to vent neonates, creates peep and neep |
| Time press trigger control on the mark is | ONLY FOUND ON THE 7A AND 8, pneumatic switch that determines if the machine operates in pressure or timed |
| The air mix control on the mark is | unique to the 7 and is the middle knob in the center body, pulling it out is the on off switch for the venturi venturi and controls FIO2 |
| The steps to assembling the mark IPPB ventilator circuit are | after explaining to pt and taking vitals, set up nebulizer, adjust press to sensitivity 10, flow 15, insp 10, pull air mix, increase insp to 15 during exp breaths only, take BS at 15, vitals, cough and BS when done |
| If a mark cycles prematurely during an IPPB what is usually the cause | pt obstructing mouthpiece with tongue or flow to low or to high |
| Autocycling in the mark during IPPB usually is caused by | setting is to sensitive, adjust |
| Inspiratory time is to long in the mark during IPPB | increase flow, check for leaks, decrease press, give pt better instructions |
| Manometer in mark during IPPB indicates high neg pressure during inspiration | adjust sensitivity |
| Manometer hesitates or jumps during inspiration in mark during IPPB | increase flow |
| What is a PR2 | Pneumatic power ventilator for hospital use, needs 50 psi gas source |
| What is the function of the Bennet valve on the PR2 | on off switch, needs only .5 cmh2o to on |
| What is the AP5 | electric powered home use pressure triggered, flow cycled machine |
| On off switch for the AP5 is | toggle switch located under the manometer |
| Pressure control on the AP5 is | located on the top right and uses a spring loaded disk and is limited to 30, but augmented by venturi |
| With help from the venturi, the AP5 can produce press of | 75 to 90 liters per min |
| The nebulizer control on the AP5 is | on the bottom right side, it operates contiuously and is controlled by a needle valve |
| How does RTT set the volume on the PR2? | cannot set volume, only pressure |
| The inspiratory pressure control in a PR2 is | the center knob between the monometers and sets the pressure, it reduces the incoming 50 psi to a safe working press, single stage reducer can be set 0-45 |
| Air dilution control in the PR2 is | located on the right side, top middle knob, and determines the FIO2 |
| A pt with a VT of 700 is put on IPPB and 1 day has PIP of 30 two weeks later PIP is 50￢ﾀﾙs, what is happening to his lungs | lungs are getting stiff |
| The negative press control on the PR2 is | never used during IPPB, it ventilates neonates and evacuates gas from pt circuit, located on the side, bottom of the middle two knobs |
| What are the accumulators on the PR2 | on the top, direct the path of gas, left determines length of exp, right determines length of insp, middle phases insp and expir |
| Expiration timer on the PR2 is | on the front right is never used in IPPB, lengthens the expiration time when used as ventilator |
| Inspiration nebulizer control on the PR2 is | located on the bottom right side (on the side), and nebulizes meds, adjust to half open |
| The expiration nebulizer control on the PR2 is | located on the bottom left (on the side) and is for exhalation of meds, adjust open just enough to mist nebulizer |
| Sensitivity control in the PR2 is | located on the side, top right knob, controls patient effort to cycle on machine, uses needle valve |
| Terminal flow control on the PR2 is | found only on the Bennet, located on the side, top left knob, helps cycle vet of when leaks are present, can compensate up to 15 liters, dilutes FIO2 |
| Peak flow control on the PR2 is | located on the bottom shaft and delivers pressure, vent clockwise, IPPB counter clock |
| System Pressure manometer on the PR2 | is the meter on the left and reads the pt press in circuit |
| The control press manometer on the PR2 | is the meter on the right and reads the press in the machine or the set press |
| What is the significance of the PR2 having 2 manometers | both control and system manometers should match, if not, adjust pressures to match by turning insp press control up or down |
| Factors to consider that decrease VT when using pressure limited IPPB | increased RAW, decreased CL, decreased insp press, increased flow like in COPD |
| Factors to consider that increase VT when using pressure limited IPPB | decreased Raw, increased CL, increased insp press, decreased flow or increased press |
| Factors that increase inspiratory time in IPPB | decreased flow, increased CL, decreased raw |
| Factors that decrease inspiratory time in IPPB | increased flow, decreased CL, increased raw |
| Factors to consider when using a pressure limited IPPB vent effects on fio2 | using terminal |
| CPAP is | continuous positive airway press, elevates and maintains high alveolar and airway press through out a full breathing cycle |
| CPAP increases PL gradient in inspiration or expiration? | both |
| Pressure during CPAP is | 5 to 20 cmH20, pt must be breathing spontaneously |
| How does CPAP help resolve atelectasis | unknown |
| Although it is unknown how CPAP helps resolve atelectasis, what factors probably contribute or have beneficial effects | recruit collapsed alveoli via increase in FRC, decreased WOB due to increased CL, improved ventilation, increased secretion removal |
| Indications for CPAP are | decreased FRC, decreased CL, cardiogenic pulm edema, atelectasis should be continuous because FRC will be lost after treatment ended, PAO2 less than 60 on FIO2 greater than 60 |
| Hazards and complications of CPAP are | barotraumas aka pneumothorax, decreased CO, Venous return or urinary output, or hypoventiltation, nausea, increased ICP |
| Patient circuit for CPAP includes | gas source, flow meter 60 to 90 L per min, humidifier, reservoir bag to increase flow, mask or t tube, high and low press alarm, end press cap |
| What kind of a gas source does CPAP use | usually an O2 blender |
| A pt on a CPAP for a couple of days and suddenly his high press alarm goes off, what is the most common reason? | obstruction |
| What is the most common reason for a low pressure alarm in CPAP | disconnect |
| During the planning stage of CPAP, what are the desired outcomes of the therapy | improved BS, improved vitals, lover RR, resolution of abnormal CXR and restoration of normal oxygenation via SPO2 or ABG |
| Why is a CPAP pt in danger of hypoventilation | pt must be able to spontaneously breath and blow off CO2 |
| If an infant has been doing well on CPAP but suddenly his stats are falling what might the problem be | mask is loose or out of place |
| What is the high and low press monitored in CPAP | 2 and -2 |
| What is the most common problem in CPAP | a leak in the circuit causing a loss in pressure usually the mask |
| What can be done to eliminate the problem of gastric insufflations and aspiration in CPAP | NG tube |
| What is the flow for CPAP | 3 to 4 times a patients minute volume, should drop to 1 to 2 on inspiration |
| Bilevel positive pressure or BiPAP is | another type of press ventilation that can be used on incubated or non intubated |
| Why is BiPAP popular for COPD pts | copd￢ﾀﾙer are hard to wean off mechanical vents, BiPAP is 1st choice, |
| Indications for BiPAP are | home vent for neuromuscular, sleep apnea, COPD in ventilation crisis |
| What are the cycle settings for apnea pts | time cycled in central sleep apnea, pt cycled in obstructive sleep apnea |
| Pressure settings for bipap are | 10 and 5 or 10 and 4, can be remembered by ￢ﾀﾜI am greater￢ﾀﾝ IPAP is always the greater number |
| IPAP is what | pressure support in CPAP, augments tidal volume, calculation is 7 to 10 mL per KG of body weight |
| EPAP is what | CPAP |
| Criteria for BiPAP is | stable hemodynamics, cooperative pt, minimal airway secretions, no need for airway protection |
| What is the indication the Pt has reached optimal lung volumes in IPPB | listen at lung base, if you hear aeration, you hear optimal lung volume |
| State two parameters on the IPPB that will affect VT | pressure (best) and flow |
| If IPPB auto cycles, what is most likely cause | sensitivity needs adjusting or rate control may be on |
| Why do COPD do well on BiPAP | it helps blow off CO2 |
| If pt has hard time cycling off machine what are steps to fix | 1. lips-use flange or mask with NG tube, 2. Nose clip, 3. Flow |
| IPPB machine hesitates before cycles into inspiration what is most likely cause | flow is to low |
| Dr Margo asks you your opinion about giving IPPB to a pt with air bronchograms what to tell her | air bronchograms indicate mucus plugging aka secretion problem, pt needs bronchial hygiene and humidity with IPPB |
| Hyperventilation causes | resp alkalosis |
| What is the most common problem associated with lung expansion therapy | resp alkalosis |
| Dr Chris asks your opinion for lung expansion on a post op pt on FIO2 of 60% and PaO2 of 58, what do you suggest | CPAP |
| Dr Gails asks your opinion for lung expansion on post op pt whit 67% PaO2 and PaCO2 of 58, what do you suggest | BiPAP , pt needs help blowing off co2 |
| Pt needs lung expansion but is not alert or is unable to cooperate, what do you suggest | IPPB at 10-15 with monitoring, why-need alert pt for IS, PEP or CPAP |
| Alert pt, no secretion problems, VC greater than 15mL/kg or IC greater than 70% of expected, what should RTT choose | IS |
| Alert pt with secretion problem RTT should choose | PEP unless atelectasis persists, then add CPAP |
| What is primary difference in choosing a pt for CPAP or BiPAP | CPAP for pt with decreased PaO2 but normal CO2 and BiPAP for pt wit trouble blowing of CO2 |
Created by:
williamwallace
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