Module 6: Lung Expansion Therapy

Question 1

Who is at high risk for developing atelectasis?

Answer 1

Obese Patients

Question 2

Who is at high risk for developing atelectasis?

Answer 2

Patients with neuromuscular disorders

Question 3

Who is at high risk for developing atelectasis?

Answer 3

A patient who has been heavily sedated

Question 4

Are you at high risk of developing atelectasis after having surgery near your diaphragm?

Answer 4

Yes you are at high risk for developing atelectasis

Question 5

Can excessive bed rest cause atelectasis?

Answer 5

Yes

Question 6

Is poor cough, history of lung disease, and restrictive lung chest wall abnormalities a high risk for developing atelectasis?

Answer 6

Yes you are at high risk for developing atelectasis

Question 7

What is a clinical sign of atelectasis?

Answer 7

History of recent major surgery. (Thoracic or abdominal surgery)

Question 8

Tachypnea and tachycardia are both __?

Answer 8

Clinical signs of atelectasis

Question 9

A pt has fine, late-inspiratory crackles on auscultation; this is a clinical sign of __?

Answer 9

Atelectasis

Question 10

A pt has bronchial or diminished breath sounds on auscultation this is a clinical sign of __?

Answer 10

Atelectasis

Question 11

Increased density and signs of volume loss show on a pt’s chest radiograph this is a clinical sign of ___?

Answer 11

Atelectasis

Question 12

What is the most physiologically the most normal lug expansion therapy?

Answer 12

Incentive spirometry

Question 13

Incentive spirometry has been proven to be ___?

Answer 13

Most effective in high risk patients

Question 14

Indications for incentive spirometry?

Answer 14

Presence of pulmonary atelectasis
Presence of conditions predisposing to atelectasis

Question 15

What are the three factors that show presence of conditions predisposing to atelectasis?

Answer 15

Upper abdominal surgery
Thoracic surgery
Surgery in patients with COPD

Question 16

Is presence of a restrictive lung defect associated with quadriplegia or dysfunctional diagram an indication of ___?

Answer 16

Incentive spirometry

Question 17

When a patient cannot be instructed or supervised to ensure appropriate use of device this is a __?

Answer 17

Contraindication for incentive spirometry

Question 18

When the patient’s cooperation is absent, or pt is unable to understand or demonstrate proper use of device this is a sign of ___?

Answer 18

Contraindication for incentive spirometry

Question 19

When a patient is unable to take a deep breathe effectively (VC is less than 10 ml/kg or IC less than predicted) this is a sign of __?

Answer 19

A contraindication for incentive spirometry

Question 20

When the patient is unconscious this is obviously a sign of __?

Answer 20

A contraindication for incentive spirometry

Question 21

What is a hazard or complication of incentive spirometry?

Answer 21

Hyperventilation and respiratory alkalosis

Question 22

Discomfort secondary to inadequate pain control is a __?

Answer 22

Hazard and/or complication of incentive spirometry

Question 23

Pulmonary barotrauma is a hazard of incentive spirometry?

Answer 23

Yes

Question 24

What are the two last possible hazards of incentive spirometry?

Answer 24

Exacerbation of bronchospasm
Fatigue

Question 25

Incentive spirometry devices are either ___?

Answer 25

Flow or volume oriented

Question 26

How do you teach a patient how to effectively use a IS device?

Answer 26

Demonstrate then observe the patient Patient instruction Follow-up

Question 27

What is the first step when instructing a patient?

Answer 27

Exhale normally

Question 28

What is the second step when instructing a patient?

Answer 28

Slow, deep inspiration to peak inspiration

Question 29

What is the third step when instructing a IS device/therapy?

Answer 29

Inspiratory hold for 5-10 seconds

Question 30

What is the last step when instructing a patient how to use IS device or therapy?

Answer 30

Passive exhale then rest

Question 31

What is an important tip you must let your patient know when instructing them how to use a IS device?

Answer 31

Patient should sustain his/her maximal inspiratory effort for 5-10 seconds (total time to perform)

Question 32

What is an indication for IPPB?

Answer 32

PT with atelectasis is not responsive to other modalities such as IS or other therapies

Question 33

A patient at high risk for atelectasis who cannot perform or cooperate with IS treatment is a a ___?

Answer 33

Indication for IPPB

Question 34

All obese patients who have undergone abdominal surgery is an indication to use?

Answer 34

Indication for IPPB

Question 35

What is an absolute contraindication or IPPB?

Answer 35

Untreated tension PNX

Question 36

When a IPPB device cycles off prematurely this means?

Answer 36

Airflow obstructed Kinked tubing Occluded mouthpiece Active resistance to inhalation

Question 37

When checking for leaks on a IPPB this means ?

Answer 37

Cycle off Most common leak is when pt is not sealing their lips around the mouthpiece If pt has a good lip seal then check circuit for leaks

Question 38

Airway clearance therapy uses __?

Answer 38

Noninvasive techniques designed to improve gas exchange

Question 39

Normal airway clearance requires __?

Answer 39

Patent airway Functional mucociliary escalator Adequate hydration

Question 40

Retention of secretions can result in __?

Answer 40

Full and Partial Obstruction

Question 41

Full obstruction ___?

Answer 41

Or mucous plugging can result in atelectasis, which causes hypoxemia due to shunting, and possible infection which could lead to pneumonia

Question 42

Partial obstruction __?

Answer 42

Restricts airflow, increasing WOB and possibly leading to air trapping, lung over distention and V/Q imbalances

Question 43

What causes impaired muccociliary clearance in intubated patients?

Answer 43

Endotracheal or tracheostomy tube

Question 44

Tracheobstructional causes?

Answer 44

Impaired mucociliary clearance in intubated patients

Question 45

Inadequate humidification causes ___?

Answer 45

Impaired mucociliary clearance in intubated patients

Question 46

High FiO2 values causes __?

Answer 46

Impaired mucociliary clearance in intubated patients

Question 47

Drugs, opiates, general anesthesia, and narcotics causes what?

Answer 47

Impaired mucociliary clearance in intubated patients

Question 48

Underlying pulmonary disease can cause what?

Answer 48

Impaired mucociliary clearance in intubated patients