Management Of Volume Loss

Question 1

What are the signs and symptoms of pneumonia?

Answer 1

Fever, malaise, muscle ache, tactile Fremitus, dyponea(sob), loss of appetite and rapid heart rate

Question 2

What are the risk factors of aspiration pneumonia?

Answer 2

Dysphagia (difficulty swallowing), impaired or absent gag reflex, dementia, intoxication from drugs/alcohol, reduced physical mobility

Question 3

What is a NEWS score?

Answer 3

National early warning score

Question 4

What might reduce the amount of air in the lungs?

Answer 4

Atelectasis/collapse- alveoli, segment, lobe and total lung
Others- consolidation, thoracic cage restriction, lung tissue restrictive disease will reduce lung volume
Pleural effusion, pneumothorax and abdominal distension compress the lung

Question 5

What does loss of lung volume mean to a physio?

Answer 5

A decrease amount of aerated lung, it can only be used to directly manage some causes of reduced lung volume, only collapse can be directly treated by physio techniques. When lung volume is not amenable to physio, v/q matching can be optimised.

Question 6

Breakdown loss of lung volume due to consolidation. What is the stages to improve lung function due to consolidation?

Answer 6

It can be prevented worsening by

1. Mobilisation
2. Hydration
3. Positioning
4. Education of breathing techniques

Question 7

What is the problem with atelectasis regarding lung function?

Answer 7

Reduced amount of functioning lung.
Reduces surface area of ventilated lung.
Reduces SA for gas exchange - V/Q mismatch and decreased SaO2
Increased wob 
Increases airway resistance

Question 8

How can you identify atelectasis in clinical practice?

Answer 8

CXR
Decreased chest expansion
Auscultation changes
Pulse ox
ABGS

Question 9

What can atelectasis be caused by?

Answer 9

Immobility/ prolonged bed rest
Poor positioning
Pain
Shallow breathing pattern (narcotics or CNS)
Airway occlusion
Mucus plug, tremor in airway, foreign object, airway compression and high o2

Question 10

Why should we increase lung volume?

Answer 10

Increase the amount of functioning lung
Increase surface area- improve v/q match
Increase SaO2
Increase lung compliance and decrease airway resistance
Decrease WOB
Decrease the risk of sputum retention and infection

Question 11

What defines closing volume?

Answer 11

Lung volume, above residual volume, at which airway collapse occurs during expiration. The CV increases with age, smoking, lung disease and body position.

Question 12

What is mobilisation?

Answer 12

Therapeutics and prescriptive application of low intensity exercise in the management of cardiopulmonary dysfunction in acutely Ill patients

Question 13

What is benefit of doing abdominal breathing?

Answer 13

Decreases airways turbulence
Decreases dead space
Favours dependent regions
Relaxes shoulder girdle

Question 14

What are Thoracic expansion exercises thought to do?

Answer 14

Increase lung volume
Increase ventilation
Decrease airway resistance
Increase surfactant secretion
Aid V/Q matching 
Decrease dead space
Increase diffusion 
Increase o2 saturation

Question 15

What is IPPB?

Answer 15

Intermittent positive pressure Breathing

Question 16

How does IPPB ( the bird) work?

Answer 16

Intermittent positive pressure applied during inspiration, this pushes the patient into IRV. ( extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration) Greater volumes means improved gas exchange and decreased WOB. The patient triggers inspiration by taking a breath and then a sustained positive pressure is applied to the patients airway to a set pressure level. This is followed by a passive expiration and is therefore a pressure supported inspiration.

Question 17

What are the indications for using IPPB or the Bird?

Answer 17

Atelectasis/ volume loss when the patient is tired, drowsy, weak or neurologically impaired. - unable to participate in more active treatments
May be used to aid secretion clearance

Question 18

What are the contraindications for using IPPB?

Answer 18

Untrained pneumothorax 
Bronchospasm
Recent lung surgery
Hypoxic drive patients
Nausea
Flail chest
Haemoptysis
Bronchospasm

Question 19

What is the NIPPY clear way?

Answer 19

Airway assisting device with two settings
Mechanical insufflation- exsufflariom machine
Insufflation- positive inspiratory pressure - pushes air in
Exsufflation- negative pressure applied at the mouth for secretion removal - sucks air out
For volume loss just set the insufflation to a desired pressure
Nippy clear way can be put on a cough assist mode as well

Question 20

What can the NIPPY clear way be used for?

Answer 20

Due to its many modes the machine can be used to increase volumes, remove secretions and as a non invasive ventilator p

Question 21

What does CPAP stand for?

Answer 21

Continuous Positive Airway pressure

Question 22

What does CPAP involve?

Answer 22

It consists of positive pressure applied throughout the whole respiratory cycle ie inspiration and expiration.
It keeps the airway pressure higher than atmospheric throughout the whole respiratory cycle. It delivers a constant flow of gas which exceeds the patients demands.
This will increase FRC above CV thus recruiting collapsed alveoli and maintaining higher lung volumes

Question 23

What is the percussion technique?

Answer 23

It is also referred to as cupping or clapping. The purpose of percussion is to intermittently apply kinetic energy to the chest wall and lungs. This is accomplished by rhythmically striking the thorax with a cupped hand (for more air) over the lung segment being drained

Question 24

Resevoir

Answer 24

Normal o2 therapy plus the expired o2, the co2 is disposed off

Question 25

What is the 3 important components of the bird that the physio can manipulate?

Answer 25

How fast the breath goes in The pressure at which the breath goes in Starting effort or sensitivity

Question 26

What are the effects of a general anaesthetic in terms of treatments post op on the respiratory system?

Answer 26

Decreased mucocilliary clearance Harder to inflate lungs Less incentive to breath Patient is drowsy and finds clearance more difficult Sputum is drier and less mobile and hydrated so doesn’t move as well FRC is lowered which affects closing volumes and decreases lung compliance and can cause atelectasis

Question 27

What is the different types of collateral channels for collateral ventilation

Answer 27

The ones between bronchioles called inter bronchial channels of Martin The ones between bronchioles and alveoli - lambert The ones between alveoli and alveoli- kohn

Question 28

What is incentive spirometry?

Answer 28

Patient is in relaxed sitting of side laying if extra volume is required in one lung due to v/q matching Patient- tight seal around mouth piece and inhales deeply and slowly as they watch the mouth piece If possible they create an end inspiratory hold- 3-4 seconds Contraindications People with severe dyspnoea Fatigue If they can’t use it properly ``` Indications for use- Presence of atelectasis Abdominal thoracic surgery Prolonged bed rest Surgery in patients with COPD Lack of pain control Restricted lung diseases ``` It is used to facilitate sustained slow breathes

Question 29

How to measure the size of a catheter

Answer 29

Measure the size of the endotracheal tube and minus 2 and multiply by 2 and can add one if they have thick secretions

Question 30

What is the NIPPY clear way technique (cough assist)

Answer 30

It is a mechanical insufflation exsufflation It can be used with different interfaces- mouth pie, face mask or tracheostomy connector Insufflation- the inspiratory pressure Exsufflation- the pressure applied at the mouth for secretion removal It can set the pressures and For volume loss just set the insufflation to the correct pressure

Question 31

What is bagging

Answer 31

Provides deep breaths in order to do increase lung volumes Opens airways if atelectasis occurs Facilitates secretion removal Aids secretion removal as sputum clearance occurs during icu

Question 32

What are respiratory Adjuncts?

Answer 32

Apply the pressure at the mouth and breath out against resistance. They can be use in conjunction with other interventions. They help to remove secretions by increasing functional residual capacity and enhancing collateral ventilation for removing secretions from collapsed airways as they get air behind the secretions. Eg flutter, acapella, bubble pep, pep mask

Question 33

What happens during bubble pep

Answer 33

Facilitates positive expiratory pressure which allows the patient to breath against resistance- facilitates collateral channels of ventilation

Question 34

What is the difference between restrictive and obstructive

Answer 34

Restrictive- can’t get air in | Obstructive- can’t get air out

Question 35

What is inspiratory reserve volume

Answer 35

The extra volume of air that can be inspired with maximal effort after reaching the end of a normal inspiratory volume

Question 36

If they are in respiratory acidosis or alkalosis

Answer 36

Alkalosis- getting rid of too much co2 | Acidosis- retaining too much co2

Question 37

What does acapella do

Answer 37

Gives positive expiratory pressure, gives oscillations, helps splint the airways open, helps collateral ventilation, the oscillations also help to decrease the viscosity of the sputum Acapella - prescription - puts pressure on the NHS Flutter- patients have to buy their own- more cost effective Don’t use adjuncts if they have had a previous tracheostomy