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Key Term: Abnormal collapse of distal lung parenchyma.
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Key Term: Ventilatory support where the patient breathes spontaneously without mechanical assistance against threshold resistance, with pressure above atmospheric maintained at the airway throughout breathing.
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LungExpansionTherapy
Egan's 9th Edition Chapter 39
| Question | Answer |
|---|---|
| Key Term: Abnormal collapse of distal lung parenchyma. | Atelectasis |
| Key Term: Ventilatory support where the patient breathes spontaneously without mechanical assistance against threshold resistance, with pressure above atmospheric maintained at the airway throughout breathing. | Continuous Postitive Airway Pressure (CPAP) |
| Key Term: Application of positive pressure breaths to a patient for a relatively short period of time (10-20 minutes). | Intermittent Positive-Pressure Breathing (IPPB) |
| Key Term: The process of encouraging the bedridden patient to take deep breaths to avoid atelectasis. | Incentive Spirometry |
| Key Term: Alveolar collapse involving a specific lobe of the lung. | Lobar Atelectasis |
| Key Term: Collapse of distal lung units due to persistent ventilation with small tidal volumes. | Passive Atelectasis |
| Key Term: Airway clearance technique in which the patient exhales against a fixed orifice flow resistor in order to help move secretions into the larger airways for expectoration via coughing or swallowing. | Positive Expiratory Pressure (PEP) |
| Key Term: Collapse of distal lung units due to mucus plugging of airways. | Resorption Atelectasis |
| Which patients are at greatest risk for developing atelectasis? What other factors increase this risk? | Thoracic/upper abdominal post-op patients. History of lung disease/heavy cigarette smoking. |
| What 3 signs indicate atelectasis? | 1. rapid shallow breathing 2. fine, late-inspiratory crackles 3. abnormalities on CXR |
| Lung expansion therapy corrects atelectasis by: | increasing the transpulmonary pressure gradient. |
| The most common problem associated with lung expansion therapy: | respiratory alkalosis (patient breathes too fast) |
| RT's role in lung expansion therapy: | implement, monitor, and document results of the therapy |
| Rule of Thumb: What factor in abdominal surgery makes post-op atelectasis more likely? | The closer the incision is to the diaphragm, the greater the risk. |
| Rule of Thumb: Typically, as the atelectasis progresses, the __ __ increases proportionally. | respiratory rate |
| 3 main indications for IS: | 1. pulmonary atelectasis 2. conditions predisposing to atelectasis (surgery of upper abdominal, thoracic, or in patients with COPD) 3. restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm |
| 3 main contraindications for IS: | 1. unconscious patients or those unable to cooperate 2. patients who can't properly use IS device after instruction 3. Patients unable to generate adequate inspiration |
| 5 main hazards/complications for IS: | 1. hyperventilation/respiratory alkalosis 2. discomfort secondary to inadequate pain control 3. pulmonary barotrauma 4. exacerbation of bronchospasm 5. fatigue |
| What is an SMI? | sustained maximal inspiration; slow, deep inhalation from FRC to TLC, followed by a 5-10 second breath hold. |
| 2 categories of IS devices: | volume oriented, flow oriented |
| The purpose of the "resting period" after an IS maneuver: | to help patients avoid repeating the maneuver at a rapid rate, which can cause respiratory alkalosis. |
| IPPB indications: | 1. need for improvement of lung expansion 2. need for noninvasive ventilatory support in hypercapneic patients 3. need to deliver aerosol medication |
| What happens when IPPB is the only modality used for resorption atelectasis due to excess airway secretions? | The positive pressure is likely to cause overinflation of the lung regions not affected by secretions and minimal/no expansion of the affected lung segments. |
| What 2 treatment modalities are added to IPPB therapy when treating resorption atelectasis? | bronchial hygiene therapy and humidity therapy |
| The 1 absolute contraindication of IPPB: | tension pneumothorax |
| Most common complication/hazard of IPPB: | respiratory alkalosis (accompanied by arrhythmias in severe alkalosis) |
| Why is gastric distention a complication/hazard of IPPB? | Gas may pass directly into the esophagus when the pressure at which the esophagus opens exceeds 20 cm H2O. |
| Potential outcomes for IPPB: | 1. improved VC, CXR, breath sounds, improved cough and secretion clearance, & oxygenation 2. increased FEV1 or peak flow 3. favorable patient subjective response |
| What 3 general assessments must be made before IPPB therapy? | 1. vital signs 2. observation of patient's appearance & sensorium 3. breathing pattern & chest auscultation |
| What step can be done to ensure the pressure-cycled IPPB has no leaks? | aseptically occlude the patient connector and manually trigger a breath at low-flow setting (machine should cycle off) |
| When explaining the purpose of IPPB therapy, what 4 points must be addressed? | 1. why the Dr. ordered treatment 2. what treatment does 3. how treatment feels 4. expected results |
| What position provides the best results in IPPB therapy? | semi-Fowler's (unless contraindicated; supine acceptable) |
| When applying IPPB, what is the general breathing pattern goal? | 6 breaths/minute; I:E ratio 1:3 or 1:4 |
| IPPB is only useful in the treatment of atelectasis if: | the volumes delivered exceed those volumes achieved through the patients spontaneous breathing |
| Treatment frequency for acute care patients: | q 72 hrs or with any change in patient status |
| Troubleshooting IPPB; Machine Performance: Large negative pressure swing early in inspiration |
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