ch 39 atelectasis and overview of LET

Question 1

define atelectasis

Answer 1

alveolar collapse

Question 2

what are 3 pulmonary complications seen with patients who undergo thoracic or abdominal surgery

Answer 2

atelectasis, pneumonia, acute respiratory failure

Question 3

most common form of therapy used in high risk patients after surgery

Answer 3

lung expansion therapy

Question 4

lung expansion therapy includes what 5 modalities that are designed to prevent or correct atelectasis

Answer 4

1. intermittent positive airway pressure breathing (IPPB)
2. positive expiratory pressure (PEP)
3. continuous positive airway pressure (CPAP)
4. incentive spirometry (IS)
5. deep breathing/directed cough

Question 5

the common purpose of all 5 lung expansion therapies is

Answer 5

guiding the patient into improving pulmonary function by maximizing alveolar recruitment and optimizing airway clearance

Question 6

true or false: there is no precise method to apply in a given situation bc there has not been any one method proved superior to other methods of LET (lung expansion therapy)

Answer 6

true

Question 7

what is the common factor that all the LET modalities share

Answer 7

they are all designed to increase functional residual capacity (FRC)

Question 8

what 4 things should a RT assist the physician in

Answer 8

1. identifying patients most likely to benefit from LET
2. recommend/initiate the appropriate and most efficient therapeutic approach
3. monitor the patients response
4. alter the treatment regimen as needed

Question 9

the 2 types of atelectasis associated with postoperative or bedridden patients who are breathing spontaneously w/o mechanical assistance are

Answer 9

1. gas absorption atelectasis

2. compression atelectasis

Question 10

when can gas absorption atelectasis occur

Answer 10

either when there is a complete interruption of ventilation to a section of the lung (or) when there is a significant shift in v/q (ventilation/perfusion)

Question 11

during gas absorption atelectasis what causes the partial collapse of the alveoli

Answer 11

gas that is absorbed by the passing blood DISTAL to the obstruction, causing the partial collapse of the nonventilated alveoli

Question 12

define lobar atelectasis

Answer 12

when ventilation is compromised to a larger airway or bronchus

Question 13

what does transmural pressure do

Answer 13

distends and maintains the alveoli in an open state

Question 14

when does compression atelectasis occur

Answer 14

when the forces within the chest wall and lung (pleural pressure) are exceeded by the transmural pressure

Question 15

what causes compression atelectasis

Answer 15

persistent use of small tidal volumes by the patient and when the patient does not periodically take a deep breath in and expand the lungs fully

Question 16

when is it common to find someone using small tidal volumes

Answer 16

1. general anesthesia is given
2. use of sedatives and bed rest
3. when deep breathing is painful (after surgery)
4. weakening or impairment of the diaphragm

Question 17

what type of atelectasis is common in hospitalized patients

Answer 17

compression atelectasis

Question 18

true or false compression atelectasis and gas absorption atelectasis can occur simultaneously and why

Answer 18

true – may occur in a patient with excessive airway secretions who breathes with small tidal volumes for extended period of time

Question 19

when can atelectasis occur in a patient

Answer 19

when the patient does not or cannot take deep breaths periodically and in patients who are restricted to bed for any reason

Question 20

patients who have difficulty taking deep breaths without assistance include

Answer 20

1. patients with significant obesity
2. neuromuscular disorders
3. under heavy sedation
4. patients who have undergone upper abdominal or thoracic surgery

Question 21

what are the major contributors to the onset of atelectasis

Answer 21

1. diaphragmatic position

2. function of the diaphragm

Question 22

in an anesthetized patient what shift of the diaphragm occurs

Answer 22

cephalad (toward the head) shift

Question 23

for patients who are supine what part of the diaphragm is used the most

Answer 23

the lower, dependent portion of the diaphragm performs the most movement

Question 24

for patients who are paralyzed what part of the diaphragm is used the most

Answer 24

the upper portion of the diaphragm

Question 25

patients undergoing lower abdominal surgery are at _____ risk for atelectasis than patients undergoing upper abdominal or thoracic surgery

Answer 25

lower

Question 26

patients with spinal cord injuries are most prone to what type of respiratory complication

Answer 26

atelectasis

Question 27

bedridden patients (recovering from trauma) are predisposed to what type of conditions (2)

Answer 27

lack of mobility and development of atelectasis

Question 28

atelectasis is the biggest determinate to what post abdominal surgery

Answer 28

hypoxemia

Question 29

_____ percentage of deaths occur from atelectasis within ____ days of surgery

Answer 29

24% and within 6 days of surgery

Question 30

impairment of the function of __________ ____________ also impacts the development of atelectasis

Answer 30

pulmonary surfactant

Question 31

what do surfactants do in the lungs

Answer 31

decrease the surface tension of the walls of the alveoli

Question 32

when there is deterioration of surfactant function what occurs

Answer 32

the relative increase in surface tension can cause the walls of the alveoli to collapse

Question 33

why do most postoperative patients have trouble coughing

Answer 33

because of their reduced ability to take deep breaths

Question 34

ineffective cough impairs ______ which leads to increased retain of ________

Answer 34

impairs normal clearance mechanism leading to increases in retained secretions

Question 35

what type of atelectasis does an increase in retained secretions lead too and why

Answer 35

development of gas absorption atelectasis in a patient with excessive mucus production

Question 36

what type of patients are more prone to develop increased retained secretions

Answer 36

patients with preexisting lung disease with increased mucus production like chronic bronchitis or chronic smokers

Question 37

lung expansion therapy and chest physical therapy in the postoperative period help improve what

Answer 37

clearance of secretions by improving the effectiveness of coughing and secretion removal

Question 38

if the incision is close to the diaphragm the chances of _______ goes up

Answer 38

greater risk of postoperative atelectasis

Question 39

how does inadequate nutrition increase the risk for postoperative atelectasis

Answer 39

most likely due to inadequate strength of the inspiratory muscles to maintain a normal FRC and VC

Question 40

what levels show inadequate nutrition that could lead to increased risk for pulmonary complications

Answer 40

albumin level less than 3.2 mg/dL

Question 41

what provides the first clue in identifying atelectasis

Answer 41

patients medical history

Question 42

if the patient has minimal atelectasis then the signs may be

Answer 42

absent or very subtle

Question 43

when atelectasis involves a more significant portion of the lungs the patients respiratory is related how

Answer 43

the patients respiratory rate increases proportionally

Question 44

what sounds may be heard over the region of the atelectasis

Answer 44

fine, late-inspiratory crackles

Question 45

what produces the crackles heard

Answer 45

sudden opening of distal airways with deep breathing

Question 46

what breath sounds may be heard as the lung becomes more consolidated with atelectasis

Answer 46

bronchial type breath sounds

Question 47

diminished breath sounds are common when

Answer 47

excessive secretions block the airways and prevent transmission of breath sounds

Question 48

__________ heart rate may be present if atelectasis leads to significant ________

Answer 48

tachycardia , hypoxemia

Question 49

patients with preexisting lung disease often present with significant abnormalities in __________ and _________ rates; even when atelectasis is not _________

Answer 49

respiratory heart severe

Question 50

direct relationship between the ______________ respiratory rate and the ___________ of atelectasis present

Answer 50

spontaneous degree (directly related)

Question 51

what is often done to confirm the presence of atelectasis

Answer 51

chest radiograph

Question 52

in a x-ray the atelectatic region shows as

Answer 52

increased opacity

Question 53

evidence of __________ _________ is present in patients with significant atelectasis

Answer 53

volume loss

Question 54

direct signs of volume loss on the chest film include (3)

Answer 54

1. displacement of interlobar fissures 2. crowding of pulmonary fissures 3. air bronchograms

Question 55

indirect signs of volume loss on the chest film include (5)

Answer 55

1. elevation of the diaphragm 2. shift of the trachea, heart, or mediastinum towards side of atelectasis 3. pulmonary opacification 4. narrowing of the space b/w the ribs 5. compensatory hyperextension of the surrounding lung

Question 56

how do all modes of lung expansion therapy work

Answer 56

they increase lung volume by increasing the transpulmonary pressure (PL) gradient

Question 57

what does the transpulmonary pressure gradient represent

Answer 57

the difference between the alveolar pressure (Palv) and the pleural pressure (Ppl)

Question 58

what is the formula for the PL gradient

Answer 58

PL = Palv - Ppl

Question 59

with all else being constant, the greater the PL gradient, the more that the alveoli will...

Answer 59

expand -- directly related

Question 60

how can the PL gradient be increased

Answer 60

1. decrease the surrounding Ppl | 2. increase the Palv

Question 61

how does a spontaneous deep inspiration increase the PL gradient

Answer 61

by decreasing the Ppl

Question 62

how does the application of positive pressure to the lungs increase the PL gradient

Answer 62

increasing the pressure inside the lungs

Question 63

how does incentive spirometry work

Answer 63

it enhances lung expansion via a spontaneous and sustained decrease in Ppl

Question 64

how does positive airway pressure techniques work

Answer 64

increases Palv in an effort to expand the lung

Question 65

what method decreases Ppl

Answer 65

incentive spirometry

Question 66

methods that decrease Ppl have a more ______ effect than the methods that increase Palv and often are most ________

Answer 66

physiologic | effective

Question 67

what should the goal of any lung expansion therapy

Answer 67

implement a plan that provides an effective strategy in the most efficient manner

Question 68

what two major issues are related to efficiency

Answer 68

staff time and equipment

Question 69

what does positive pressure therapy require significantly more of

Answer 69

staff time and equipment

Question 70

who is positive pressure therapy reserved for

Answer 70

high-risk patients who cannot perform IS techniques