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Respiratory Care Seminar‼️ > Ch. 7: Hyperinflation Therapy > Flashcards

Ch. 7: Hyperinflation Therapy Flashcards

1
Q

A short term (10-15 minute) breathing treatment in which pressures above atmospheric pressure are delivered to the patient’s lungs via a pressure-limited ventilator.

A

Intermittent positive pressure breathing (IPPB)

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2
Q

Effectiveness of IPPB depends on what four factors?

A
  • Relaxed and cooperative patient
  • A pressure-limited IPPB machine with a means of measuring VT
  • Proper instructions
  • Well-trained RT that has knowledge of the equipment, reasons for therapy, side effects and goals
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3
Q

What are some indications for IPPB? (4)

A
  • Need for delivery of medication to a patient who cannot take a deep breath. (<10 mL/kg IBW)
  • Atelectasis
  • Sedated postoperative patients
  • Patients recovering from chest or abdominal surgery who are reluctant to breath deeply
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4
Q

What are some hazards of IPPB? (5)

A
  1. Excessive ventilation
  2. Decreased cardiac output
  3. Increased ICP
  4. Pneumothorax
  5. Gastric distention
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5
Q

What is normal ICP levels?

A

Less than 10 mm Hg

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6
Q

Intermittent positive pressure breathing (IPPB)

To avoid increasing ICP, what position should the patient be placed in during treatment?

A

Fowler position

High inspiratory pressures should be avoided and short inspiratory times should be used by increasing the inspiratory flow rate

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7
Q

Hazards of Intermittent positive pressure breathing (IPPB)

Excessive ventilation

A
  • Leads to decreased PaCO2, causing cerebral vasocontriction and results in dizziness
  • Patient should be instructed not to stand or walk immediately after treatment.
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8
Q

Hazards of Intermittent positive pressure breathing (IPPB)

Decreased cardiac output

If there is a decreased venous return and decreased left ventricular filling pressure during the therapy, the patient may experience _____________.

A
  • Tachycardia
  • Decrease in systemic blood pressure
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9
Q

Hazards of Intermittent positive pressure breathing (IPPB)

What may minimize the hazard of decreasing cardiac output?

A

Avoiding high inspiratory pressure and long inspiratory times

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10
Q

Hazards of Intermittent positive pressure breathing (IPPB)

Patients who complain of sudden chest pain, SOB, or other breathing difficulties and who have tachycardia during IPPB must be suspected of having a _________.

A

Pneumothorax

If a pnemothorax is suspected, STOP TREATMENT IMMEDIATELY

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11
Q

Hazards of Intermittent positive pressure breathing (IPPB)

How is gastric distention caused?

A

By swallowing air during treatment

May cause the patient to complain of nausea during or after treatment.

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12
Q

Hazards of Intermittent positive pressure breathing (IPPB)

Pneumothorax during IPPB is most common for that type of patients?

A

COPD patients with bullous disease or bleb formation

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13
Q

Contraindications of IPPB therapy

IPPB should not be administered under any circumstance with this condition because it only worsens the problem.

A

Untreated pneumothorax

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14
Q

Contraindications of IPPB therapy

IPPB is only safe for pneumothorax patients if ____________.

A

They have a chest tube in place

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15
Q

Contraindications of IPPB therapy

What would happen if a patient with a pulmonary hemorrhage was administered IPPB?

A

Air may enter a blood vessel, resulting in an air embolism

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16
Q

PROPER ADMINISTRATION OF IPPB

To better distribute the medication and improve gas exchange, what would you instruct the patient to do?

A

Tell the patient to hold his or her breath for a count of 3 before exhaling. Tell the patient to pause before the next breath.

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17
Q

During IPPB, if the pulse rate rises more than ____ beats/min, stop treatment and notify the doctor.

A

20

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18
Q

IPPB

Ater 10 minutes or when the medication is completely nebulizer, what should you encourage the patient to do?

A

Cough

19
Q

What are the set machine variables for IPPB?

A
  • Inspiratory pressure: Start lower than desired pressure than gradually increase as treatment continues
  • Flow rate
  • Sensitivity: Adjust so the patient has to draw no more than -2 cmH2O
20
Q

Increased flow results in ________ tidal volume.

A

Decreased

21
Q

Decreased flow results in ________ tidal volume.

A

Increased

22
Q

Decreased inspiratory pressure results in ________ tidal volume.

A

Decreased

23
Q

Increased inspiratory pressure results in ________ tidal volume.

A

Increased

24
Q

Increased airway resistance = ________ inspiratory time.

A

Decreased

25
Q

Decreased airway resistance = ________ inspiratory time.

A

Increased

26
Q

Increased lung compliance = ________ inspiratory time.

A

Increased

27
Q

Decreased lung compliance = ________ inspiratory time.

A

Decreased

28
Q

Increased flow results = ________ inspiratory time.

A

Decreased

29
Q

The patient is having difficulty cycling the IPPB machine into the inspiratory phase?

List some corrective actions.

A
  • Adjust sensitivity so that patient has to generate pressure of 0.5 to -2 cmH2O to start inspiration
  • Make sure machine is plugged into the wall.
  • Ensure tube connections are tight
  • Ensure patient lips are sealed tightly around the mouthpiece or no leaks around mask
30
Q

Instruct your patient on the proper administration of IPPB.

A

Encourage patient to keep lips sealed tight around the mouthpiece and to breathe only through their mouth. Instruct the patient to “sip” on the mouthpiece and allow the machine to fill the lungs until it cycles off. Tell the patient to hold their breath for a count of 3 before exhaling. Tell them to pause before the next breath.

31
Q

The patient complains of dizziness and tingling in the extremities during the treatment but has no appreciable increase in heart rate.

What is the corrective action?

A

Instruct patient to take slower breaths and pause in between breaths

32
Q

The patient’s heart rate increases more than 20 beats/min during the treatment.

What is the corrective action?

A

Stop treatment. Notify MD.

This is most likely the result of the bronchodilator stimulating the 🫀.

33
Q

The patient cannot cycle the IPPB machine off.

What is the corrective action?

A
  • Tighten all tubing connections
  • Ensure no leaks around mouthpiece, mask or nose
  • Check circuit’s expiratory valve function
  • Ensure that the ET tube or tracheostomy tube is inflated adequately to prevent leaks
34
Q

As the patient inhales, there is no nebulization of the medication.

What is the corrective action?

A
  • Ensure the capillary tube of the nebulizer is connected
  • Ensure the nebulizer drive line is connected
  • Ensure medication is in the neb
  • Ensure the neb is in upright position
35
Q

When is EzPAP indicated?

A

Prevention or treatment of atelectasis for patients who don’t meet guidelines for incentive spirometry, a VC of >10mL/kg of IBW.

36
Q

The IPPB machine repeatedly cycles on shortly after the patient has begun the expiratory phase.

How do you fix this?

A
  • Decrease sensitivity
  • Make sure rate control is off
37
Q

What are the indications for incentive spirometry?

A
  • Atelectasis
  • Patients prone to atelectasis (postoperative patients following upper abdominal or thoracic surgery)
  • Presence of restrictive lung condition with quadriplegia or impaired diaphragm
38
Q

Complications of Incentive Spirometry (IS)

A
  • Hyperventilation
  • Fatigue
  • Improper use
  • Inappropriate if used as the only treatment for atelectasis or consolidation
  • Discomfort secondary to inadequate pain control
39
Q

Decrease or increase?

Dead space added by HMEs means the tidal volume must ____________ to compensate.

A

Increase

40
Q

What are the requirements for effective incentive spirometry?

A
  1. Cooperative patient.
  2. Motivated patient.
  3. Patient’s respiratory rate should be less than
    25 breaths/min.
  4. Patient’s vital capacity should be more than 10
    mL/kg of body weight;     IPPB or EzPAP may be indicated if vital capacity is less than 10 mL/kg or IC ,1/3 of predicted value.
41
Q

EzPAP POSITIVE AIRWAY PRESSURE SYSTEM

The patient exhales against an adjustable spring- loaded valve, resulting in positive expiratory pressure. Inspiratory pressure is generated from the high inspiratory flow rate that is four times the flow rate set on the flowmeter. The flowmeter is generally set at _____.

A

5 to 10 L/min.

42
Q

What type of INCENTIVE SPIROMETRY is this?

These devices indicate inspiratory volume
achieved by moving a bellows or piston upward, lining up with a volume scale on the side of the spirometer.

A

Volume-displacement incentive spirometer

43
Q

What type of INCENTIVE SPIROMETRY is this?

These devices require the patient to generate a specific inspiratory flow to raise 1 to 3 plastic balls (depending on the model). As the patient inhales, creating a negative pressure inside the device, the balls begin to rise.

A

Flow-dependent incentive spirometer

44
Q

Post-chapter question

How should an IPPB treatment be modified for a patient with a closed head injury?

A

Increased inspiratory flow, decreased peak inspiratory pressure

Respiratory Care Seminar‼️ (19 decks)

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