-
What is resorption atelectasis, how does it occur?
- Occurs when mucus plugs block ventilation to selected regions of the lung
- Gas distal to the obstruction is absorbed by the passing blood
-
What is passive atelectasis caused?
Caused by persistent breathing with small tidal volumes
-
Can both types of atelectasis' happen at the same time?
Yes
-
What is it called when a large mucus plug blocks ventilation of a single lobe?
Lobar atelectasis
-
What are some factors associated with causing atelectasis?
- Obesity
- Neuromuscular disorders
- Heavy sedation
- Surgery near the diaphragm
- Bed rest
- Poor cough
- History of lung disease such as COPD
-
What are some clinical signs of atelectasis?
- History of recent majory surgery
- Tachypnea
- Fine, late inspiratory crackles
- Bronchial or diminished breath sounds
- Tachycardia
- Increased density and signs of volume loss on the chest radiograph
-
The closer the incision to the __________, the greater the risk of ______________ atelectasis.
-
What are the 3 types of Lung expansion therapies?
- Incentive Spirometry (IS)
- Intermittent Positive Pressure Breathing (IPPB)
- Positive Airway Pressure Therapy
-
How does the incentive spirometry device work?
Mimics natural sighing by encouraging PTs to take slow, deep breaths
-
The incentive spirometry uses _______ ____ to the PT when an inspiratory volume of flow is reached
Visual cues
-
What are some indications for Incentive Spirometry?
- Presence of pulmonary atelectasis
- Presence of conditions predisposing to atelectasis
- -Upper abdominal surgery
- -Thoracic surgery
- -Surgery in PTs with COPD
- Presence of restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm
-
Why is Incentive Spirometry one of the main mainstay devices used? What are the 2 types of IS devices?
- Simple, portable and inexpensive
- Flow oriented - more popular because they are smaller
- Volume oriented
-
What is a basic maneuver for PTs using an IS device?
- SMI - sustained maximal inspiration
- Slow deep inhalation from FRC followed by a 5-10 second breath hold
-
What is an effective way for PT teaching maneuvers? How many maneuvers should be done in an hour?
- Demonstrate it by doing it yourself then observe how the PT does it
- PT should sustain maximal inspiratory effort for 5-10 seconds
- Aim for 5-10 maneuvers an hour
-
What are AARC guidelines for indications of Incentive Spirometry?
- To improve atelectasis
- To prevent atelectasis (post-op, COPD, other pulmonary complications)
- Mobilize secretions
-
What are some contraindications for Incentive Spirometry?
- PT unable to coordinate
- PT cant be instructed
- PT is unable to breath deeply (VC < 10ml/kg)
- Prescence of open tracheal stoma requires modification
-
.What are some hazards and complications with Incentive Spirometry?
- Hyperventilation/Respiratory alkalosis is #1
- Ineffective unless performed correctly
- Barotrauma
- Discomfort secondary to pain
- Fatigue
-
How does Intermittent Positive Pressure Breathing work? How long do treatments last? (IPPB)
- Uses positive airway pressure to expand the lung
- Treatments last 15-20 mins
-
What is the absolute contraindication for IPPB machines?
Tension pneumothorax
-
What range must PTs be in to be treated with an IPPB machine? mL/kg, %?
- <10mL/kg = VC vital capacity
- <33% = IC inspiratory capacity
-
What are some contraindications for Intermittent Positive Pressure Breathing (IPPB)?
- Tension pneumothorax
- ICP > 15mmHg
- Hemodynamic instability
- Active hemoptysis
- Tracheoesophageal fistula
- Recent esophageal surgery
- Active, untreated tuberculosis
- Radiographic evidence of blebs
- Recent facial, oral or skull surgery
- Singultus (hiccups)
- Air swallowing
- Nausea
-
What are some hazards and complications of Intermittent Positive Pressure Breathing (IPPB)?
- Increased airway resistance
- Pulmonary barotrauma
- Nosocomial infection
- Respiratory alkalosis
- Hyperoxia (with O2 as source gas)
- Impaired venous return
- Gastric distension
- Air trapping, auto-PEEP, overdistension
- Psychological dependence
-
What are the 3 things you should do for Intermittent Positive Pressure Breathing preliminary planning?
- Therapeutic outcomes
- Evaulate alternatives
- Baseline assessment
-
What are some potential outcomes of Intermittent Positive Pressure Breathing>
- Improved VC
- Increased FEV, or peak flow
- Enhanced cough and secretion clearance
- Improved chest radiograph
- Improved breath sounds
- Improved oxygenation
- Favorable PT subjective response
-
What is the best position for a PT getting Intermittent Positive Pressure Breathing? Another effective position?
- Semi-fowler
- Supine is also acceptable
-
What is a positive pressure ventilator?
Bird Mark 7 - pushes air into lungs
-
How is the Bird Mark 7 powered? What source?
Pneumatically powered - runs on a gas source, does not require electricity
-
How many circuits does a Bird Mark 7 have?
Single circuit - the same gas supply goes to the PT that powers machine
-
What does pressure cycled or cycling mean? When does the machine end inspiration?
- Cyciling is what ends inspiration
- When pressure is reached, machine ends inspiration
-
At what sensitvity setting is good for a PT taking in a breath? Where is the sensitivty settings located?
- 1-2 below ambient
- Left side of the machine
-
At what pressure is good to set for a PT and where is the pressure settings located?
- Initially set 10-15 cmH2O
- Located on the right side of the machine
-
An increase in ________ means increases in _________.
-
Where is the flow rate located on the Bird Mark 7? What is it initially set at?
- Located on the front of the machine
- Initially set to 15LPM (low to moderate)
-
What is the max flow rate on a Bird Mark 7?
80LPM
-
The _______ the flow, the ________ the breath is delivered resulting in a short 'I' time and a long 'E' time
-
What are the 3 different PAP machines? definitions? which one is the most effective?
- PEP= Positive Expiratory Pressure
- EPAP= Expiratory Postive Airway Pressure
- CPAP= Continuous Positive Airway Pressure
- They are all just as effective
-
What are the 2 indications for CPAP?
- Treatment of atelectasis
- Treatment of cardiogenic pulmonary edema
-
What are 2 contraindications of CPAP?
- Hemodynamic instability #1
- Hypoventilation
-
What are 3 hazards and complications with CPAP?
- Hypoventilation
- Barotrauma
- Gastric Distention
-
What is the most common problem with CPAP machines?
System leaks
|
|
