what is passive atelectasis? name four things that can cause this?
the result of persistent use of small Vt
1. general anesthesia
2. shallow breathing
3. reduced surfactant production
4. inadequate nutrition
atelectasis in a hospitalized patient can be the result of what? (6)
1. neuromuscular disorders
2. heavy sedation
3. upper or lower abdominal or thoracic surgery
4. bed ridden patients
5. spinal cord injury
6. hx of malnutrition
what types of lung diseases can lead to atelectasis? name 5 (ABCCE)
those w/ increased mucus production
2. chronic bronchitis
what are some symptoms of atelectasis? (7)
1. increased RR
2. inspiratory rales
3. bronchial BS
4. reduced BS
5. hypoxemia (due to shunt)
6. tachycadia (heart tries to compensate for hypoxemia)
7. fever (if pneumonia develops)
What might you see on a x-ray for a patient with atelectasis?
2. signs of volume loss
due to: displacement of interlobar lung fissures, crowding of blood vessels, air bronchospasms, elevated diaphragm, shift of trachea, heart or diaphragm (shift towards it, pneumothorax would push it away)
there would be white solid figures
What are 4 different types of lung expansion therapies?
what happens to flow when transpulmonary pressure is equal to atmospheric pressure?
flow is zero
For PEEP to work airways pressures are kept ____ atm pressure at all times. how is this accomplised?
ABOVE atm pressures.
PEEP device that allows air out of the circuit only until some set pressure above atm is reached.
1. what happens when the pressure in the PEEP circuit decreases to its new baseline?
2. what happens as the next breath is inhaled?
1. exhalation ends and the volume in the lung (FRC) is larger than it was prior to application.
2. the end inspiratory volume will be higher, because the same volume will be inhaled but there was a larger volume in the lungs at the beginning of the inhalation.
how does PEEP help the alveoli?
because the alveoli that were likely to collapse due to a lack of surfactant are not allowed to do so because the added pressure at the end of exhalation splints or holds them open
PEEP and CPAP are normally used with what type of patients?
PEEP- pt normally on mechanical vent
CPAP- pt is spontaneously breathing
*they both are changing your baseline to maintain openess at the end of exhalation
what are the two types of PEEP devices ?
Orificial resistors - (has continuous flow) generates PEEP by obstructing gas flow. dependent on expiratory flow rate
threshold resistors - creates PEEP by the use of a spring that keeps preset level of pressure on exhalation valve w/in a specific flow rate . able to maintain PEEP at a constant level.
what are 5 types of threshold resistors that provide PEEP ?
inflated balloon, emerson water seal, weighted ball, spring loaded, or a magnet
what are the normal PEEP pressures?
a patient on CPAP needs to maintain ______.
what do flow resistors on PEEP do?
increase the flow rate past the point where the resistance of the exhalation vavle can allow gas to leave. because the flow fills up the circuit faster than it is vented out, back pressure creates positive pressure.
During PEP therapy the patient exhales against a ____-_____ flow resistor.
what happens when the pt exhales against the fixed-orifice flow resistor?
pressure in the airways is raised, which shifts the gas from those alveoli that were easily inflated during inhalation to those that are atelectatic.
Is PEP or PEEP continuous?
PEP is NOT. PEEP is continuous.
how would you instruct a pt to use PEP ?
when are the alveoli opened up with PEP therapy?
pt takes a moderatly deep inhalation through their nose and then exhales against the fixed orifice resistor.
atelectatic alveoli are inflated during the EXHALATION phase. NOT INHALATION!!
does PEP or PEEP therapy require a pressurized external gas source?
PEP - NO
PEEP - YES
does EPAP produce the same mechanical or pressure effect as PEP when a fixed orifice resistor is used?
how does EPAP increase the work of breathing?
draws negative during inspiration and can increase the work of breathing because there is a larger gap from expiratory pressure to inspiration