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Lung expansion > Lung expansion > Flashcards

Lung expansion Flashcards

1
Q

Lung expansion therapy encompasses a variety of respiratory care modalities designed to prevent or correct atelectasis

A

deep breathing/directed cough, incentive spirometry (IS),
continuous positive airway pressure (CPAP), positive
expiratory pressure (PEP), and intermittent positive
airway pressure breathing (IPPB)

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2
Q

The common purpose that all of these techniques share is to

A

improving pulmonary function by maximizing alveolar recruitment and optimizing airway clearance.

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3
Q

If all of the following therapies were to be compared,
the common factor they share is that they all are designed
to

A

increase functional residual capacity (FRC)

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4
Q

What are the two types of atelectasis

A

gas absorption and compression

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5
Q

can occur either when
there is a complete interruption of ventilation to a section
of the lung or when there is a significant shift in ventilation/
perfusion (V Q ).

A

Gas Absorption

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6
Q

When ventilation is compromised to a larger airway or bronchus,

A

lobar atelectasis

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7
Q

results when the forces within the chest wall and lung—specifically, the pleural pressure—are exceeded by the transmural pressure, which is what
distends and maintains the alveoli in an open state.2

A

Compression atelectasis

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8
Q

Compression atelectasis is primarily caused by

A

persistent use of small tidal volumes by the patient

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9
Q

Compression atelectasis results when

the patient does not periodically

A

take a deep breath and

expand the lungs fully

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10
Q

Atelectasis can occur in any patient who cannot or does

not

A

take deep breaths periodically and in patients who are

restricted to bed rest for any reason

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11
Q

It is the major

contributor to the onset of atelectasis.

A
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12
Q

It is the major contributor to the onset of atelectasis.

A

Diaphragmatic position and function

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13
Q

Anesthetized patient

A

there is a cephalad (toward the head) shift of the

diaphragm

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14
Q

Atelectasis is one of the most important determinants
of________after abdominal surgery and may account
for ____ of deaths within 6 days of surgery

A

hypoxemia,24%

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15
Q

It often provides the first clue in identifying atelectasis.

A

Patient medical history

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16
Q

When the
atelectasis involves a more significant portion of the lungs,
the patient’s. (signs)

A

increases proportionally. Fine, late-inspiratory crackles may be heard over the
affected lung region. Bronchial-type breath sounds. Diminished
breath sounds, Tachycardia

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17
Q

It is often used to confirm the presence of atelectasis.

A

Chest radiograph

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18
Q

The atelectatic region of the lung has

increased

A

Opacity

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19
Q

Direct signs of volume

loss on the chest film include

A

displacement of the interlobar fissures, crowding of the pulmonary vessels, and air bronchograms

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20
Q

Indirect signs includes

A

elevation of the diaphragm; shift of the trachea, heart, or mediastinum; pulmonary opacification; narrowing of the space between the ribs; and compensatory hyperexpansion of the surrounding lung

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21
Q

All modes of lung expansion therapy increase lung volume

by

A

increasing the transpulmonary pressure (PL) gradient.

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22
Q 
gradient represents the difference between the alveolar pressure (Palv) and the 
pleural pressure (Ppl):
A

PL gradient

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23
Q

The purpose of IS is to guide the patient to take a sustained maximal inspiratory effort resulting in a decrease in ___________

A

Ppl and maintain the patency of airways at risk for closure

24
Q

IS devices are designed to mimic _____ by encouraging patients to take slow, deep breaths.

A

natural sighing

25
Q

The inspired volume goal is set on the basis of__________. The true benefit of IS is best achieved by _________.

A

predicted values or observation of initial performance, repeated use and proper technique

26
Q

The basic maneuver of IS is a ________. An SMI is a slow, deep inhalation from the _________, followed by a ______second breath-hold.

A

sustained maximal inspiration (SMI), functional residual capacity (FRC) up to (ideally) the total lung capacity, 5- to 10

27
Q

Indications for Incentive Spirometry

A
  • Presence of pulmonary atelectasis
  • Presence of conditions predisposing to atelectasis
  • Upper abdominal surgery
  • Thoracic surgery
  • Surgery in patients with COPD
  • Presence of a restrictive lung defect associated with quadriplegia or dysfunctional diaphragm
28
Q

Contraindications for Incentive Spirometry

A

• Patient cannot be instructed or supervised to ensure
appropriate use of the device
• Patient cooperation is absent, or the patient is unable to understand or demonstrate proper use of the device
• Patients unable to deep breathe effectively (VC < 10 ml/
kg or IC < 13 predicted)

29
Q

Hazards and Complications of Incentive Spirometry

A
  • Hyperventilation and respiratory alkalosis
  • Discomfort secondary to inadequate pain control
  • Pulmonary barotrauma
  • Exacerbation of bronchospasm
  • Fatigue
30
Q

_________ are the most frequently reported symptoms associated with respiratory alkalosis.

A

Dizziness and numbness around the mouth

31
Q

_______ devices measure and visually indicate the volume achieved during an SMI. The most popular true volume-oriented IS devices employ a _____ that rises according to the inhaled volume

A

True volume-oriented, bellows

32
Q

_______ devices measure and visually indicate the

degree of inspiratory flow

A

Flow-oriented

33
Q

Successful IS requires effective ______.

A

patient teaching

34
Q

Some patients in the early postoperative stage may need to rest for _______ between maneuvers.

A

30 seconds to 1 minute

35
Q

healthy individuals average about sighs per hour, an IS regimen should probably aim to ensure a minimum of ______ SMI maneuvers each hour

A

6, 5 to 10

36
Q

________ provides breathing support to patients with inadequate ability to ventilate.

A

Noninvasive ventilation (NIV)

37
Q

_____ is a specialized form of NIV used for relatively short treatment periods (approximately __minutes per treatment). The intent of IPPB is not to provide full ventilatory support as with some other forms of NIV but to provide some ______ assisting the patient to deep breathe and stimulating cough.

A

IPPB, 15, machine-assisted deep breaths

38
Q

Airways clearance with humidity therapy should be considered in conjunction with IPPB for optimizing results in patients with
______.

A

retained secretions

39
Q

Normally, the esophagus does not open until a pressure of about ______ has been reached. _____ represents the greatest risk in patients receiving IPPB at high pressures.

A

20 to 25 cm H2O, Gastric distention

40
Q

IPPB therapy best resulting position

A

semi-Fowlers position

41
Q

The goal of IPPB therapy is to establish a breathing pattern consisting of about ____ per minute, with an expiratory time of at _______ than inspiration (inspiratory-to-expiratory [I:E] ratio of ≤1:3 to 1:4).

A

6 breaths, least three to four times longer

42
Q

There are various ways of determining these volume goals. Most clinical centers strive to achieve an IPPB tidal volume of _________

A

10 to 15 ml/kg of body weight or at least 30%

of the patient’s predicted IC

43
Q

PEP and EPAP create _______ only, whereas CPAP maintains a _______throughout both inspiration and expiration

A

expiratory positive pressure, positive airway pressure

44
Q

____ elevates and maintains high alveolar and airway pressures throughout the full breathing cycle; this increases ______throughout both inspiration and expiration. Typically, a patient on CPAP breathes through a _______, with pressures maintained between __________. To maintain system pressure throughout the breathing cycle, CPAP requires a source of _____.

A

CPAP, PL gradient , pressurized circuit against a threshold resistor,5 cm H2O and 20 cm H2O, pressurized gas

45
Q

The following factors involving PAP, EPAP, and CPAP therapy contribute to the beneficial effects:

A

(1) recruitment of collapsed alveoli via an increase in FRC,
(2) decreased work of breathing secondary to increased compliance or elimination of intrinsic positive end-expiratory pressure (PEEP),
(3) improved distribution of ventilation through collateral channels (e.g., Kohn pores),
(4) increase in the efficiency of secretion removal.

46
Q

The corresponding increase in FRC may be lost within _____ after the end of the treatment. For this reason, it has been suggested that CPAP should be used on a continuous basis until the patient recovers.

A

10 minutes

47
Q

CPAP by mask also has been used to treat _________. In such patients, CPAP reduces _________, which is helpful in reducing pulmonary vascular congestion. Lung compliance is improved, and the work of breathing is decreased.

A

cardiogenic pulmonary edema, venous return and cardiac filling pressures

48
Q

Contraindication of CPAP

A

hemodynamically unstable, hypoventilation, nausea, facial trauma, untreated pneumothorax, and elevated intracranial pressure (ICP).

49
Q

Most hazards and complications associated with CPAP are caused by either the ______

A

increased pressure or the apparatus.

50
Q

The increased work of breathing caused by the apparatus can lead to ________

A

hypoventilation and hypercapnia.

51
Q

The most common problem with PAP therapies is ______

A

system leaks.

52
Q

As with IPPB by mask, this potential hazard can be eliminated by use of a _________, although this increases the risk of a leak

A

nasogastric tube at higher pressure requirements

53
Q

For a patient having no difficulty with secretions, if the VC exceeds 15 ml/kg of lean body weight or the IC is greater than 33% of predicted, ______ is given.

A

IS

54
Q

If either the VC or the IC is less than these threshold levels, IPPB is initiated, with the pressure gradually manipulated from the
initial setting to deliver at least ____

A

15 ml/kg

55
Q

If excessive sputum production is a compounding factor, a trial of _____ therapy is substituted for IS. Based on patient response, _______ measures may be added to this regimen.

A

PEP, bronchodilator therapy and bronchial hygiene

Lung expansion (2 decks)

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