lung expansion

Question 1

what complications can occur when a patient undergoes thoracic or abdominal surgery

Answer 1

atelectasis
leads to hypoxemia
increase risk of infection like pneumonia

Question 2

what is the purpose and goal of lung expansion therapy

Answer 2

increase pressure in lungs either by decreasing pressure outside lungs, or increasing pressure inside the lungs. increase transalveolar pressure gradient allowing alveoli to expand

Question 3

what is a gas absorption atelectasis caused by

Answer 3

complete interruption of ventilation to a section of the lung or significant shift of ventilation or prefussion

Question 4

what is compression atelectasis caused by

Answer 4

occurs when the transthoracic pressure exceeds the transalveolar pressure

Question 5

what is the difference b/w high and low V/Q rations

Answer 5

low-ventilation is limited: asthma, pneumonia, atelectasis

high-ventilation is present but blood flow is blocked: pulmonary embolism

Question 6

what are the factors associated with atelectasis

Answer 6

*obesity
*heavy sedation & recovery from thoracic surgery increase likelihood of atelectasis

Question 7

what are the clinical signs of your patient if you suspect atelectasis

Answer 7

*shallow breathing
*reduced breath sounds
*crackle on auscultation
*decreased oxygen saturation

Question 8

why is early mobilization important and what kind of movement does it included

Answer 8

prevent atelectasis&pneumonia
deeper breathes, lung expansion, better oxygen exchange

Question 9

what is the difference b/w volume-oriented and flow-oriented IS

Answer 9

Flow-measures the flow rate of air that the PT inhales, easy to use, provides immediate feed back/visual, doesn’t measure volume

Volume-measures the total volume of air PT inhales during deep breath, precise measure of lung expansion, more challenging for PT

Question 10

your patient is using a flow-oriented IS. That patient can raise the ball with 500 cc/s of flow and keep it elevated for 2 seconds. what is the pt IC?

Answer 10

500x2=1000

Question 11

when is the best time a patient should be instructed on how to use an IS

Answer 11

Prior to surgery, improves understanding & compliance

Question 12

what are the indications for IS

Answer 12

*post operative PT
*prolong bed rest& immobility
*chronic lung conditions
*restrictive lung diseases

Question 13

what are the contraindications for IS

Answer 13

*Pt unable to cooperate
*PT w/ severe respiratory muscle weakness
*inadequate vital capacity
*bronchoconstriction

Question 14

what are the hazards and complications for IS

Answer 14

*hyperventilation–>respiratory alkalosis
*dizziness
*lightheadeness
*tingling in exteremities

Question 15

how to instruct a patient to perform an IS maneuver

Answer 15

inhale slow & deep, hold for 5-10 seconds, exhale normal, allow to rest perform 10 times

Question 16

what are the contraindications for IPPB

Answer 16

*untreated pneumothorax
*increased intracranial pressure
*hemodynamic instability
*active pulmonary hemorrage
*air trapping in COPD PTs

Question 16

what outcome can be expected from IS

Answer 16

*prevent atelectasis
*improved IC
*improves V/Q mismatch
*improves post op complications

Question 17

what are the indications of IPPB

Answer 17

*PT w/ atelectasis Not responsive to other therapies
*neuromuscular disorder
*fatigue or muscle weakness
*severe pulmonary complication
*short term ventilation support

Question 18

what are the hazards and complications for IPPB

Answer 18

*barotrauma
*gastric distention
*hyperventilation & respiratory alkalosis
*decreased venous return&cardiac output

Question 19

what are the three main controls on an IPPB that are adjusted

Answer 19

sensitivity, flow rate, pressure

Question 20

what does the sensitivity trigger control

Answer 20

detects pt attempt to initiate a breathe

Question 21

what are the potential outcomes w/ IPPB

Answer 21

*improved lung expansion
*enhanced secretion clearance
*improved oxygenation
*decreased WOB

Question 22

troubleshooting
loss of pressure

Answer 22

leak or insufficient flow

Question 23

troubleshooting
excessive pressure

Answer 23

obstruction of excessive flow

Question 24

troubleshooting failed to cycle on inspiration

Answer 24

adjust sensitivity or tight seal around mouth piece

Question 25

troubleshooting failed to cycle off

Answer 25

fail to cycle of-cause by leak-->mouth piece/mask seal/cuff leaking/fenestrated trach tube open

Question 26

troubleshooting pressure reads in the negative

Answer 26

pressure does not rise normally--> insufficient flow

Question 27

what are the indications for CPAP

Answer 27

obstructive sleep apnea (OSA) *atelectasis prevention & treatment *congestive heart failure (CHF) w/pulmonary edema *post-extubation

Question 28

what are the contraindications for CPAP

Answer 28

*untreated pneumothorax *hemodynamic instability *facial trauma or burns *uncooperative or unconscious

Question 29

what does PEP therapy do for the lungs

Answer 29

*helps PT clear secretions *improve lung function *prevent post-op PT developing pneumonia *PT exhales against fixed pressure *back pressure helps maintain airway patency

Question 30

when using PEP, what pressure do you need to achieve FRC

Answer 30

10-20

Question 31

beable to identify which lung expansion therapy device will be needed based on PT scenarios. IS IPPB CPAP

Answer 31

IS-after surgery, alert/conscious, follow directions decreased breath sounds , bed ridden/immobile, post thoracic surgery IPPB- unconscious/conscious , unable to take deep breathes on their own ,shallow breathing patterns, respiratory weakness, neuromuscular disorder, severe pulmonary complications CPAP-Obstructive sleep apnea,pulmonary edema (heart)