2nd semester lung expansion therapy part one
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If a patients vital capacity is between 45-65 ml/kg what does that mean?
Patient is within normal limits :0)
If a patients vital capacity is 30 ml/kg what does that mean?
patient has a poor cough - secretions build
If a patients vital capacity is 25 ml/kg what does that mean?
Patients sigh is compramised, atelectasis begins/ hypoxemia
If a patients vital capacity is between 20-15ml/kg what does that mean?
Patients sigh is lost, shunting
If a patients vital capacity is 10 ml/kg what does that mean?
If a patients vital capacity is 5 ml/kg what does that mean?
What would you suggest if a patients vital capacity is above 15 ml/kg?
What would you suggest if a patients vital capacity is less than 10 ml/kg ?
What is I.S?
Low resistance training that empasizes sustained (hold) maximal inspiration
Its designed to mimic a natural sigh
What are the idications for I.S? (3)
1. Pulmonary atelectasis
2. Prevent atelectasis
3. Patients with restrictive atelectasis
Resisdual volume is the same as ___?
What does it mean if a pt has a low FRC?
They have decreased lung volumes. Most likely a restrictive disease
If a pt is air trapping, would they have a high or low FRC?
What are contraindication for using I.S? (3)
1. Unconscious pt
2. Pt cannot comply w/ instructions
3. VC < 10 cc/Kg or IC <about 1/3 of predicted normal
What are the hazards of using I.S? (5)
2. Discomfort w/ deep inspiration
4. Exacerbation of bronchospasm
What are some of the therapeutic outcomes of using I.S? (8)
- 1. Improved atelectasis
- 2. Prevention of atelectasis
- 3. Normal pulse rate
- 4. Return of normal BS
- 5. Return of normal X-ray
- 6. Improved ABGs
- 7. Increased VC, restored FRC
- 8. Improved cough
Why is it important to restore a patients FRC? and what can help with this ?
Because it is important to the work of breathing.
CPAP and I.S can help with this.
Explain the steps of how I.S should be used?
- 1. set goal (vc 30-65 ml/kg)
- 2. RT demonstrates for pt
- 3. pt returns demonstration
- 4. moderate to slow inspiration
- 5. 5-10 sec insp. hold
- 6. normal exhalation
- 7. 10-30 sec rest between attempts
- 8. 5-10 SMI per hour
what does I.S measure?
flow X time = volume
What is "Spontaneous breathing" ?
Negative transpulmonary pressure during inspiration secondary to more negative pleural pressure caused by muscle contraction
what is "Positive pressure breathing"?
Greater than atm pressure applied to the lung resulting in a positive transpulmonary pressure through out inspiration
what are the indications of IPPB? (4)
1. atelectasis unresponsive to other therapy
2. high risk patients unable to use IS or PEP
3. short-term ventilation
4. to deliver med if VC is less than 10 ml/kg
What are the contraindications of IPPB? (11)
- 1. tension pneumothorax
- 2. ICP greater than 15 mmHg
- 3. hemodynamically unstable
- 4. active hemoptysis
- 5. TE fistula
- 6. recent esophageal surgery
- 7. active untreated TB
- 8. blebs on X-ray
- 9. singulus (hiccups)
- 10. air swallowing
- 11. nausea
What are the hazards and complications of IPPB? (8)
- 1. increased airway resistance
- 2. pulmonary barotrauma
- 3. nosocomial infection
- 4. hyperoxia
- 5. impaired venous return
- 6. gastric distension
- 7. increased air-trapping
- 8. psychological dependence
What are the therapudic outcomes of using IPPB? (5)
1. Improved Vt
2. Improved chest x-ray
3. Improved breath sounds
4. Enhanced cough
5. Improved oxyenation
IPPB is used when pt needs a ____ _____.
when administering a IPPB treatment what are the first 5 things that need to be set?
- 1. eliminate leaks
- 2. set sensitivity
- 3. set pressure
- 4. set flow (for I:E ratio)
- 5. keep respiratory rate at 6
What is lung expansion therapy help prevent?
atelectasis ----> pneumonia ----> acute failure
What is "resorption" and what are three things that can commonly cause this ?
the result of mucus plugging with distal gas absorption
1. A ineffective cough
2. Hx of increased mucus production
3. Smoking history
when the pleural space contains large amount of air this is called a_______.
what can cause a pneumothorax? (2)
where does this push the lung?
what will you see on a xray?
1. rupture of a bleb
2. complication of positive pressure ventilation (barotrauma)
3. pushes the lung away from the chest wall
4. you will see a thin pleural line at the lung margin on a xray
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