Chapter 10 - Perform Airway Clearance and Lung Expansion Techniques Flashcards Preview

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Flashcards in Chapter 10 - Perform Airway Clearance and Lung Expansion Techniques Deck (22)
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1

While performing nasotracheal suctioning, you note that one of the patient's nostrils is obstructed and the other is becoming traumatized. You should:

  1. discontinue the procedure and tell the patient to cough
  2. obtain an order for postural drainage and percussion
  3. recommend inserting an endotracheal tube for suctioning
  4. recommend inserting a nasopharyngeal airway for suctioning

4

The insertion of a nasopharyngeal airway is an excellent way to minimize nasal trauma in patients requiring frequent nasotracheal suctioning.

2

Patients can control a flutter valve's pressure by changing:

  1. the weight of the ball
  2. their inspiratory flow
  3. the angle of the device
  4. the expired volume

3

The flutter valve combines the techniques of PEP with high frequency oscillations at the airway opening. The valve consists of a pipe-shaped device with a heavy steel ball sitting in an angled "bowl." The pipe bowl is covered by a perforated cap. When the patient exhales actively into the pipe, the ball creates a positive expiratory pressure of between 10-25 cm H2O. At the same time, the pipe angle causes the ball to flutter back and forth at about 15 Hz. When the valve is properly used, the oscillations it creates are transmitted down into the airways. Patients can control the pressure by either changing their expiratory flows (higher flows generate higher pressure) or by changing the angle of the device (raising the device above horizontal increases the pressure).

3

Which of the following cough methods would be best for helping a COPD patient clear secretions?

  1. cough with standard compression phase
  2. the forced expiratory technique/huff coughing
  3. abdominal thrust synchronize to explosive phase
  4. autogenic drainage plus standard coughing

2

The forced expiratory technique or "huff coughing" is best suited for post-op patients for whom explosive exhalation is very painful, and COPD patients prone to airway closure on forced exhalation. It consists of 2-3 forced exhalations or huffs with the glottis open, followed by a rest period. This process is repeated until the secretions have moved up into the pharynx, where they can be cleared by the patient via expectoration.

4

A 52-year-old patient with altered mental status requires nasotracheal suctioning. When you occlude the catheter's control port for 10 to15 seconds, you note that secretions aspirate slowly. The suction regulator is set to -75 mm Hg. To improve suctioning effectiveness, you should:

  1. lengthen the suction time
  2. insert a nasopharyngeal airway
  3. adjust the vacuum to -120 mm Hg
  4. preoxygenate the patient

3

Lengthening the suction time is not warranted. Insertion of a nasopharyngeal airway and/or preoxygenating the patient may contribute to safety but will not improve suctioning effectiveness. The problem is inadequate negative pressure/vacuum. Recommend vacuum pressure ranges are 60 to 80 mm Hg for neonates, 80 to 100 mm Hg for pediatric patients and 100 to 120 mm Hg for adult patients.

5

A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you select for this patient?

  1. head down, patient prone with a pillow under her abdomen
  2. head down, patient supine with a pillow under her knees
  3. head down, patient half-rotated to left, right lung up
  4. head down, patient half-rotated to right, left lung up

3

The proper position to drain the right middle lobe (lateral and medial segments) is a left-lying lateral Trendelenburg position (head down 25 degrees or more, patient half-rotated to left, right lung up).

6

A physician orders IPPB therapy for a post-op patient exhibiting clinical signs and symptoms of atelectasis. Which of the following baseline measures would be most critical for this patient?

  1. inspiratory or vital capacity
  2. arterial blood gas analysis
  3. forced expiratory flows
  4. chest percussion/auscultation

1

Different goals for IPPB require different baseline information. For a post-op patient exhibiting clinical signs and symptoms of atelectasis, you should obtain a baseline bedside measurement of either the patient's inspiratory capacity or vital capacity.

7

While performing a routine check on an intubated patient receiving pressure control SIMV, you feel course vibrations on his chest wall during both inspiration and expiration. You should do which of the following?

  1. perform endobronchial suctioning
  2. switch to volume control SIMV
  3. decrease the ventilator pressure limit
  4. recommend a bronchodilator treatment

1

Course vibrations that you can palpate through the chest wall during breathing are termed rhonchial fremitus. Rhonchial fremitus is most often associated with the presence of excess secretion in the large airways, which should be cleared by suctioning.

8

A patient is receiving IPPB therapy via pressure-cycled ventilator with a mouthpiece. You observe that the patient is exhaling, but after triggering on the ventilator fails to cycle off. Which of the following should be done to correct this problem?

  1. Use a flanged mouthpiece or mask
  2. Increase the sensitivity
  3. Use the expiratory timer
  4. Ask the patient to exhale more forcefully

1

This patient appears to be having difficulty obtaining a good lip seal. As a result, you should consider using either a flanged mouthpiece or mask to overcome the leak.

9

The normal range of negative pressure to use when suctioning children is:

  1. -80 to -100 mm Hg
  2. -60 to -80 mm Hg
  3. -100 to -120 mm Hg
  4. -150 to -200 mm Hg

1

Using the proper amount of negative pressure can help avoid atelectasis and airway trauma. Suction pressure is limited to -100 to -120 cm H2O for adults, -80 to -100 cm H2O for children, and -60 to -80 cm H2O for infants. These setting may need to be altered depending on the consistency of the secretions. Thicker secretions may require more negative pressure, and thinner secretions less.

10

A doctor has ordered inspiratory resistive exercises for a COPD patient being discharged to home care. In addition to the general assessment of this patient, which of the following information is needed to establish an effective inspiratory resistive exercise program?

  1. The patient's forced vital capacity (FVC)
  2. The patient's maximum voluntary ventilation (MVV)
  3. The patient's resting oxygen saturation (SaO2)
  4. The patient's maximum inspiratory pressure (MIP)

4

In planning an inspiratory resistive exercise program the therapist should initially measure the patient's maximum inspiratory pressure (PImax) using a calibrated pressure manometer. The initial PImax is then compared to established norms and used to set initial loads. Subsequently, this measure can provide the basis for monitoring patient progress.

11

A postop patient receiving incentive spirometry treatments complains of dizziness and tingling in the extremities following therapy. Which of the following is the most likely cause of these symptoms?

  1. The patient is hypoxemic
  2. The patient is inhaling too rapidly
  3. The patient is hyperventilating
  4. The patient is breathing too slow

3

Dizziness and tingling in the extremities (paresthesia) are symptoms of respiratory alkalosis (hyperventilation). This is a common complication of incentive spirometry treatments when the patient breathes too fast. To avoid hyperventilation during incentive spirometry, patients should be taught to take six or fewer breaths per minute through the device.

12

You would select the semi-Fowler's position to drain which of the following lobes/segments?

  1. Middle lobe of the right lung
  2. Posterior segments of the upper lobes
  3. Apical segments of the upper lobes
  4. Superior segments of the lower lobes

3

You would select the semi-Fowler's position to drain the apical segments of a patient's upper lobes. This position is not commonly used for postural drainage since it is the normal position most bed-ridden respiratory patients assume (therefore drainage occurs without special positioning).

13

During the administration of chest percussion, you observe the patient producing sputum containing a moderate amount of fresh red blood when coughing. You should:

  1. continue treatment but soften the percussion strokes
  2. discontinue the treatment and notify the physician
  3. wait 10 minutes and then continue the treatment
  4. turn the patient to perform percussion on the opposite lung

2

Fresh red blood in coughed-up secretions indicates that the patient is actively bleeding, perhaps as a result of the therapy administered. In such an instance, the therapy should be stopped, the patient monitored and the physician immediately notified.

14

While performing nasotracheal suctioning, you note that one of the patient's nostrils is obstructed and the other is becoming traumatized. You should:

  1. discontinue the procedure and tell the patient to cough
  2. obtain an order for postural drainage and percussion
  3. recommend inserting an endotracheal tube for suctioning
  4. recommend inserting a nasopharyngeal airway for suctioning

4

The insertion of a nasopharyngeal airway is an excellent way to minimize nasal trauma in patients requiring frequent suctioning.

15

Advantages of the flutter valve over other bronchial hygiene methods include all of the following except:

  1. good patient acceptance
  2. greater effectiveness
  3. full portability
  4. independent use

2

The flutter valve is readily accepted by patients, inexpensive, fully portable, and (once instruction is provided) does not require caregiver assistance. However, there is no current evidence that it is more or less effective than other positive airway pressure modailites.

16

Which of the following settings are appropriate when applying mechanical insufflation-exsufflation to a patient with a neurologic problem causing a weak cough?

  1. inhalation pressure +30 cm H2O, exhalation pressure – 40 cm H2O
  2. inhalation pressure +10 cm H2O, exhalation pressure – 40 cm H2O
  3. inhalation pressure +15 cm H2O, exhalation pressure – 15 cm H2O
  4. inhalation pressure +30 cm H2O, exhalation pressure – 10 cm H2O

1

When initiating mechanical insufflation-exsufflation (MI-E) you should start out at low pressures (inhalation and exhalation pressures between 10 and 15 cm H2O). After the patient adapts to the technique, you should adjust inhalation pressures to between 15- 40 cm H2O and exhalation pressures to between 35–45 cm H2O, always using lowest pressures needed to provide effective secretion clearance.

17

When suctioning a mechanically ventilated adult patient with an appropriately sized oral endotracheal tube, suctioning should be done:

  1. quickly, taking no longer than 10-15 sec
  2. until all of the secretions are removed
  3. quickly, taking no longer than 20-30 sec
  4. until his SpO2 level drops below 90%

1

In general, endotracheal suctioning of an adult should be done only after pre-oxygenating the patient for 30-60 seconds and as quickly as possible, so as not to exceed a total of 10-15 seconds. This will limit the amount of desaturation/hypoxemia that would otherwise occur.

18

When instructing a patient after abdominal surgery in coughing techniques, you should recommend which of the following?

  1. "Lie flat, inhale quickly, hold your breath, and try to clear your throat"
  2. "Sit upright, inhale fully, hold your breath, and then exhale forcefully"
  3. "Sit in a semi-Fowler's position, inhale rapidly, and huff several times"
  4. "Sit upright with your feet on the floor and huff several times"

2

When instructing a patient on coughing techniques, you should instruct the patient to sit upright, inhale fully, hold his/her breath, and then exhale forcefully. Helping a postop patient splint the incision site with a pillow also can be helpful. Huff coughing is used primarily with COPD patients.

19

A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you select for this patient?

  1. head down, patient prone with a pillow under her abdomen
  2. head down, patient supine with a pillow under her knees
  3. head down, patient half-rotated to left, right lung up
  4. head down, patient half-rotated to right, left lung up

3

The proper position to drain the right middle lobe (lateral and medial segments) is a left-lying lateral Trendelenburg position, i.e., head down 25° or more, patient half-rotated to left, right lung up.

20

An adult patient with cystic fibrosis cares for himself at home. The patient's doctor has ordered postural drainage, percussion and vibration. Which of the following would your recommend to assist this patient in clearing his retained secretions during postural drainage?

  1. a pneumatically powered percussor/vibrator
  2. a high frequency chest wall oscillation vest
  3. an electrically powered percussor/vibrator
  4. properly sized percussion cups or wand

2

For care of adults requiring postural drainage, percussion and vibration in the home who do not have caregiver support, you could recommend either a high frequency chest wall oscillation vest system or an electrically powered intrapulmonary percussive ventilation device.

21

When suctioning a newborn infant using a DISS wall-mounted regulator system with collection bottle, you would initially set the vacuum pressure at:

  1. -12 to -15 in Hg
  2. -60 to -80 mm Hg
  3. -5 to -7 in Hg
  4. -80 to -100 mm Hg

2

DISS wall-mounted regulator suction systems are calibrated in mm Hg. When suctioning an infant with a bedside regulator suction system, you would initially set the vacuum pressure at -60 to -80 mm Hg. Always use the lowest amount of vacuum needed to effectively remove the secretions.

22

You are about to suction a female patient who has an 8.0 mm (ID) endotracheal tube in place. What is the MAXIMUM size catheter you would use in this case?

  1. 8 Fr
  2. 10 Fr
  3. 12 Fr
  4. 14 Fr

4

Too large a suction catheter can cause atelectasis and worsen hypoxemia. To help avoid this problem, the external diameter of catheters generally should never exceed 1/2 the internal diameter of the airway (2/3rd in infants). To quickly estimate the correct size, double the internal diameter (ID) of the ET tube and select the next smallest catheter size. In this case 2 x 8 = 16.