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RT test 3

wwall RT 2 test 3

QuestionAnswer
Indications for IS are presence of atelectasis, predisposition for atelectasis ie: upper ab or thoracic surgery, or surgery to COPD pt, pt with restrictive lung defect ie: quad or diaphragm problem
Contraindications for IS unconscious, uncooperative or uncoordinated pt, inadequate VC less than 10 mL per Kg or IC less than 70 percent
Hazards and complications of IS are hyperventilation and resp alkalosis, pain, pulm barotraumas, exacerbation of bronchospasm, fatigue, ineffective unless performed as ordered, inappropriate as sole treatment for lung collapse or consolidation
The three types for Incentive spirometers are flow dependent (ball), volume displacement (bellows), photoelectric (combined flow and vol displac)
Voldyne spirometers flow dependent, 1 tube with float, slow deep breath, keep float in set range, range is 0 to 4000 mL
Triflow three tubes with floats, flow dependent, highest of the three x seconds held equals total volume
Volurex bellows volume displacement, range is to 4000 mL
Spirocare photoelectric, must have electric source and gives read out, combination volume displacement and flow dependent
SMI is sustained maximal inspiration aka incentive spirometry, mimics natural sigh, visual feedback to patient, increases pulm press and insp volume
The three phases of hyperinflation therapy are planning, implementation and follow-up
Preliminary planning for IS includes pt screening and baseline assessments, establishing explicit pt outcomes
Pt therapeutic outcomes for IS should include absence or improved atelectasis, decreased RR, norm pulse, norm or improved BS, increased SPO2, VC and PEF, restoration of FRC or VC, improved cough, normal CXR, improved P(A-a)O2
Implementation of IS includes Attainable goals with moderate effort set by RT, observation of pt performance by RT, good pt instruction
Follow-up with IS should include check to be sure pt is using IS correctly
What pt need to be screened for IS and given a baseline assessment upper ab or thoracic surgery patients
IS hold is how long 5 to 10 seconds
If pt has trouble holding 5 seconds in IS what should RT do add one way valve
If pt does not rest between maneuvers during IS, what problem may develop pt does not breath deep enough and can develop resp alkalosis
Pt monitoring during IS therapy should include frequency of sessions, breaths per session, volume and flow achieved, breath hold time maintained, spot check pt compliance, device in reach of pt, increase volumes ea day, vitals and BS, pt motivation and effort
Lung expansion therapy includes IPPB, IS, CPAP, PEP
The most common serious problems seen in pt after thoracic or abdomen surgery is atelectasis, acute resp failure and pneumonia
The two primary types of atelectasis seen in post op are reabsorption atelectasis and passive atelectasis
Reabsorption atelectasis is mucus plugs prevent ventilation, air trapped gas is absorbed into blood and alveoli then collapse
Passive atelectasis is persistent small VT causes distal alveoli to collapse from lack of ventilation
Lobar atelectasis is severe form of atelectasis seen in about 5 percent of pt usually caused by a large mucus plug in pt with low VT and excessive secretions
What is the most common cause of atelectasis in the hospital pt does not take periodic deep breath and fully expand lungs.
Indications for lung expansion therapy are post op, neuromuscular, sedation, spinal cord injury, bedridden from major trauma
During the first 48 hours post op, what happens to the lungs progressive decrease in FRC
Decreased FRC is associated with alveolar collapse in what area of the lung basal or dependent
Atelectasis causes what to happen to V/Q ventilation perfusion mismatch
What clinical signs does RT look for in pt history for atelectasis recent surgery, history of lung disease, smoking
Physical signs of atelectasis are, increased RR, fine late inspire crackles over region affected, bronchial BS, diminish BS tachycardia if hypoxemia present
How does rt confirm atelectasis CXR opacity, displaced interlobal fissures, crowded pulm vessels, air bronchograms, elevated diaphragm, tracheal shift
Lung expansion therapy increase lung volume by what increasing transpulmonary press gradient
Proper use of IPPB requires careful pt selection, indications be specifically defined, treatment porpertly administered and monitored by trained RT
IPPB is the application of inspiratory positive pressure to spontaneously breathing patients as an intermittent short term modality never as a prophylactic
How long does an IPPB treatment last 15 to 20 minutes
During an IPPB treatment, positive pressure is transmitted from the alveoli to where pleural space
Indications for IPPB need to improve lung expansion, atelectasis when IS or CPT not working, high risk for atelectasis but unable to cooperate, pt who only needs 1 therapy instead of multiple modalities, inability to clear secretions and other modes fail, short term vent
Contraindications for IPPB pneumothorax, ICP greater 15, unstable hemodynamics, active hemoptysis, tacheoesophageal fistula, recent esphogeal surgery, TB, CXR with blebs, recent surgery to face or head, hiccups, air swallowing nausea
Hazards to IPPB increased airway resistance, barotraumas, nosocomial infection, resp alkalosis (most common) pco2 down ph up, hyperoxia, impaired venous return, gastric destention if pt not alert, airtrapping psychological dependence
4 steps to administering IPPB includes 1 planning, 2 evaluating alternatives, 3 baseline assessments, 4 implementation
Preliminary planning for IPPB therapy includes determining need, base therapeutic outcome on diagnostic information and as explicit and measurable as possible, significant atelectasis, reduced VC less than 10 mL/kg,at risk pts who need assistance breathing but not mech vent
Potential outcome to IPPB therapy are improved VC, increased FEV1 or peak flow, enhanced cough, improved CXR, BS and oxygenation, favorable subjective pt response
What does RTT look for when evaluating alternatives to IPPB cheaper method available, if not, document, if so, document and change method
Baseline assessment in IPPB should include what vitals, auscultations, observation of pt appearance sensorium (LOC), include specific assessment to individual identified clinical goals
Implementation of IPPB should include what 6 steps 1 infections control, 2 equipment prep, 3 patient orientation, 4 pt position, 5 initial application, 6 adjusting parameters
An example of IPPB outcome set for a pt with post op atelectasis would be spontaneous IC of 70 percent of predicted, improved CXR, decreased late inspire crackles, reduced RR under 25 per min
Infection control in IPPB includes hand washing, CDC universal precautions (gloves), CDC TB airborne gloves gown hepamask, pt infection control posted, only sterile dilutes and meds, disinfect reusables, change nebs or disinfect 24 hrs on continuous, rinse in sterile water only
Equipment preparation for IPPB when and for what before taking to pt room, for leaks
Patient orientation in IPPB should include explain dr order, what IPPB does, how it feels, what to expect
Patient position in IPPB is semi fowler with no slouching supine if pt unable to semi fowler
Initial application of IPPB includes insert past teeth, lips seal, set machine so breath can initiate with minimal pt effort, adjust to -1 t -2 (system check) system press at 10 move slowly to 15, 6 to 8 breaths per min, 2 to 4 times longer exp than insp
What happens to IPPB if there is a leak it shuts off
99 percent of the time a leak can be fixed in IPPB with what nose clips
What should RTT do if mouth wont seal in IPPB use CPAP mask
When a CPAP mask is used in IPPB why does an NG tube need to be installed so air does not enter stomach
Post treatment assessment of IPPB includes repeat pt assessment, vitals, BS, sensorium, untoward effects and specific clinical follow up, did pt meet goals, frequency based on response to therapy
How often should acute care pt be reevaluated for IPPB on dr orders, based on pt response to therapy, every 72 hours or with any change in status
Record keeping when discontinuing IPPB should be sucking but complete, include pre and post assessment, untoward effects need to notify dr, nurse and noted
The 5 things to monitor on the machine during IPPB are 1sensitivity, 2 peak pressure, 3 flow settings, 4 fio2 and 5 I:E ratio
The 12 things to monitor on a pt during IPPB therapy are RR and VE, peak flow or FEV1/FVC, pulse and rhythm, sputum quantity, color, consistency, odor, mental function, skin color, BS, BP, SPO2 if hypoxia, ICP, CXP, subjective pt response
What do large negative pressure swings early in inspiration indicate in IPPB sensitivity or trigger setting to low, RTT should increase sensitivity
in what pt settings would IS be found critical care, acute care inpatient, extedned care and skilled nursing home, home care
Bird machine cycles prematurely 1. Most common is pt obstructing mouthpiece with tongue, 2. flow to high, 3. pressure to low
Bird machine cycles on and off rapidly aka auto cycling 1. most common is sensitivity 2. Coach pt about breathing
Bird machine aspiratory tie is to long 1. Flow is to low, 2. Leak in circuit probably pt mouthpiece or pt needs nose clips, 3. Pressure to high, 4 coach pt to take exp pause of 3 seconds at the end of each breath, this will help extend expiration
Pressure manometer indicates high negative pressure prior to inspiration adjust sensitivity
Pressure manometer hesitates or rises erratically during inspiration flow is to low
Bennet cycles prematurely pt abstracting mouthpiece or pressure set to low
Bennet cycles on and off rapidly coach pt how machine works…only cycles when it senses a breath, obstruction or kinked tube, senility to high, Rate control on? Turn off rate control.
Bennet inspiratory time to long check peak flow control is fully clockwise, check for leaks , pressure to high, coach pt to take exp pause
Bennet ventilator fails to cycle off flow to low or leak in pt circuit
The most accurate way t measure inspired volumes is volume displacement
Three methods of volume measurement used in IS are timing the duration of flow, volume displacement and photoelectric
Gas pressure is regulated in the bird vent by magnetic attraction opposing gas pressure
Gas pressure in the Bennet vent is regulated by a low-pressure reducing valve
Needle valves are an effective way to control gas flow
Which incentive spirometer operates using volume displacement volurex
Which incentive spirometer operates using photoelectric sensor spirocare
A pt using a flow-dependent IS reaches a goal of 600 mL per second and holds for 3 seconds, what would the inspired volume be 1800 mL
An IPPB ventilator fails to cycle off, you suspect a leak, what would you check first pt ability to seal mouthpiece, pt nose, all circuit connections, exhalation valve
You are using a Bennett PR2 to give an IPPB, and want to increase the delivered tidal volume what should you do increase the pressure
When giving an IPPB treatment on a Bennet the vent triggers on and off rapidly, what do you do adjust sensitivity
Your attempting an IPPB with a Mark 7 and the circuit is assembled correctly but will still not trigger on, what do you suspect is the problem? flow rate has been turned off
What controls the FIO2 delivered in a Bennett PR2 operating in the source gas setting terminal flow control
When giving IPPB therapy using a Mark 7, changes in delivered FIO2 can be attributed to what venturi gate and pressure
If an IPPB ventilator fails to cycle in exhalation (off) the problem is ALWAYS a leak
A control on the Bennett PR2 that is designed to compensate for leaks is what terminal flow control
Which IPPB vent is designed primarily for home use Bennett AP5
Which IPPB vents can be used with apneic pts PR2, Mark 7, Mark 7A, Mark 8
When a pt attempts to trigger the IPPB ventilator on, a -8 cmH2O is recorded on the press manometer, what should the RTT should do adjust the sensitivity
Mark bird machines are pneumatically powered pressure controller for IPPB therapy, can be pressure cycled or on 7A and 8 can be time controlled or press cycled
The pressure chamber on the mark is located on the right side, gas press from the gas source builds and pressurizes pt circuit for delivery
The center body of the mark is the narrow casting of aluminum alloy that seperates the ambient and press chambers, gas source on top
sensitivity control on the mark is is located on the far left and controls pt effort, range is 0 to 10 below ambient press, ideal adjustment at -1 to -2, initiates inspiration
The flow rate control on the mark is the large dial in front on the center body, controls the flow of gas, high flow is 80 L per min
The expiratory timer control on the mark is the bottom dial on the center body and is used only in apnea pts.
The inspiratory pressure control of the mark is located on the far right side and sets the insp pressure
The expiratory flow control on the mark is FOUND ONLY ON THE MARK 8,a negative press control used to vent neonates, creates peep and neep
Time press trigger control on the mark is ONLY FOUND ON THE 7A AND 8, pneumatic switch that determines if the machine operates in pressure or timed
The air mix control on the mark is unique to the 7 and is the middle knob in the center body, pulling it out is the on off switch for the venturi venturi and controls FIO2
The steps to assembling the mark IPPB ventilator circuit are after explaining to pt and taking vitals, set up nebulizer, adjust press to sensitivity 10, flow 15, insp 10, pull air mix, increase insp to 15 during exp breaths only, take BS at 15, vitals, cough and BS when done
If a mark cycles prematurely during an IPPB what is usually the cause pt obstructing mouthpiece with tongue or flow to low or to high
Autocycling in the mark during IPPB usually is caused by setting is to sensitive, adjust
Inspiratory time is to long in the mark during IPPB increase flow, check for leaks, decrease press, give pt better instructions
Manometer in mark during IPPB indicates high neg pressure during inspiration adjust sensitivity
Manometer hesitates or jumps during inspiration in mark during IPPB increase flow
What is a PR2 Pneumatic power ventilator for hospital use, needs 50 psi gas source
What is the function of the Bennet valve on the PR2 on off switch, needs only .5 cmh2o to on
What is the AP5 electric powered home use pressure triggered, flow cycled machine
On off switch for the AP5 is toggle switch located under the manometer
Pressure control on the AP5 is located on the top right and uses a spring loaded disk and is limited to 30, but augmented by venturi
With help from the venturi, the AP5 can produce press of 75 to 90 liters per min
The nebulizer control on the AP5 is on the bottom right side, it operates contiuously and is controlled by a needle valve
How does RTT set the volume on the PR2? cannot set volume, only pressure
The inspiratory pressure control in a PR2 is the center knob between the monometers and sets the pressure, it reduces the incoming 50 psi to a safe working press, single stage reducer can be set 0-45
Air dilution control in the PR2 is located on the right side, top middle knob, and determines the FIO2
A pt with a VT of 700 is put on IPPB and 1 day has PIP of 30 two weeks later PIP is 50¬タルs, what is happening to his lungs lungs are getting stiff
The negative press control on the PR2 is never used during IPPB, it ventilates neonates and evacuates gas from pt circuit, located on the side, bottom of the middle two knobs
What are the accumulators on the PR2 on the top, direct the path of gas, left determines length of exp, right determines length of insp, middle phases insp and expir
Expiration timer on the PR2 is on the front right is never used in IPPB, lengthens the expiration time when used as ventilator
Inspiration nebulizer control on the PR2 is located on the bottom right side (on the side), and nebulizes meds, adjust to half open
The expiration nebulizer control on the PR2 is located on the bottom left (on the side) and is for exhalation of meds, adjust open just enough to mist nebulizer
Sensitivity control in the PR2 is located on the side, top right knob, controls patient effort to cycle on machine, uses needle valve
Terminal flow control on the PR2 is found only on the Bennet, located on the side, top left knob, helps cycle vet of when leaks are present, can compensate up to 15 liters, dilutes FIO2
Peak flow control on the PR2 is located on the bottom shaft and delivers pressure, vent clockwise, IPPB counter clock
System Pressure manometer on the PR2 is the meter on the left and reads the pt press in circuit
The control press manometer on the PR2 is the meter on the right and reads the press in the machine or the set press
What is the significance of the PR2 having 2 manometers both control and system manometers should match, if not, adjust pressures to match by turning insp press control up or down
Factors to consider that decrease VT when using pressure limited IPPB increased RAW, decreased CL, decreased insp press, increased flow like in COPD
Factors to consider that increase VT when using pressure limited IPPB decreased Raw, increased CL, increased insp press, decreased flow or increased press
Factors that increase inspiratory time in IPPB decreased flow, increased CL, decreased raw
Factors that decrease inspiratory time in IPPB increased flow, decreased CL, increased raw
Factors to consider when using a pressure limited IPPB vent effects on fio2 using terminal
CPAP is continuous positive airway press, elevates and maintains high alveolar and airway press through out a full breathing cycle
CPAP increases PL gradient in inspiration or expiration? both
Pressure during CPAP is 5 to 20 cmH20, pt must be breathing spontaneously
How does CPAP help resolve atelectasis unknown
Although it is unknown how CPAP helps resolve atelectasis, what factors probably contribute or have beneficial effects recruit collapsed alveoli via increase in FRC, decreased WOB due to increased CL, improved ventilation, increased secretion removal
Indications for CPAP are decreased FRC, decreased CL, cardiogenic pulm edema, atelectasis should be continuous because FRC will be lost after treatment ended, PAO2 less than 60 on FIO2 greater than 60
Hazards and complications of CPAP are barotraumas aka pneumothorax, decreased CO, Venous return or urinary output, or hypoventiltation, nausea, increased ICP
Patient circuit for CPAP includes gas source, flow meter 60 to 90 L per min, humidifier, reservoir bag to increase flow, mask or t tube, high and low press alarm, end press cap
What kind of a gas source does CPAP use usually an O2 blender
A pt on a CPAP for a couple of days and suddenly his high press alarm goes off, what is the most common reason? obstruction
What is the most common reason for a low pressure alarm in CPAP disconnect
During the planning stage of CPAP, what are the desired outcomes of the therapy improved BS, improved vitals, lover RR, resolution of abnormal CXR and restoration of normal oxygenation via SPO2 or ABG
Why is a CPAP pt in danger of hypoventilation pt must be able to spontaneously breath and blow off CO2
If an infant has been doing well on CPAP but suddenly his stats are falling what might the problem be mask is loose or out of place
What is the high and low press monitored in CPAP 2 and -2
What is the most common problem in CPAP a leak in the circuit causing a loss in pressure usually the mask
What can be done to eliminate the problem of gastric insufflations and aspiration in CPAP NG tube
What is the flow for CPAP 3 to 4 times a patients minute volume, should drop to 1 to 2 on inspiration
Bilevel positive pressure or BiPAP is another type of press ventilation that can be used on incubated or non intubated
Why is BiPAP popular for COPD pts copd¬タルer are hard to wean off mechanical vents, BiPAP is 1st choice,
Indications for BiPAP are home vent for neuromuscular, sleep apnea, COPD in ventilation crisis
What are the cycle settings for apnea pts time cycled in central sleep apnea, pt cycled in obstructive sleep apnea
Pressure settings for bipap are 10 and 5 or 10 and 4, can be remembered by ¬タワI am greater¬タン IPAP is always the greater number
IPAP is what pressure support in CPAP, augments tidal volume, calculation is 7 to 10 mL per KG of body weight
EPAP is what CPAP
Criteria for BiPAP is stable hemodynamics, cooperative pt, minimal airway secretions, no need for airway protection
What is the indication the Pt has reached optimal lung volumes in IPPB listen at lung base, if you hear aeration, you hear optimal lung volume
State two parameters on the IPPB that will affect VT pressure (best) and flow
If IPPB auto cycles, what is most likely cause sensitivity needs adjusting or rate control may be on
Why do COPD do well on BiPAP it helps blow off CO2
If pt has hard time cycling off machine what are steps to fix 1. lips-use flange or mask with NG tube, 2. Nose clip, 3. Flow
IPPB machine hesitates before cycles into inspiration what is most likely cause flow is to low
Dr Margo asks you your opinion about giving IPPB to a pt with air bronchograms what to tell her air bronchograms indicate mucus plugging aka secretion problem, pt needs bronchial hygiene and humidity with IPPB
Hyperventilation causes resp alkalosis
What is the most common problem associated with lung expansion therapy resp alkalosis
Dr Chris asks your opinion for lung expansion on a post op pt on FIO2 of 60% and PaO2 of 58, what do you suggest CPAP
Dr Gails asks your opinion for lung expansion on post op pt whit 67% PaO2 and PaCO2 of 58, what do you suggest BiPAP , pt needs help blowing off co2
Pt needs lung expansion but is not alert or is unable to cooperate, what do you suggest IPPB at 10-15 with monitoring, why-need alert pt for IS, PEP or CPAP
Alert pt, no secretion problems, VC greater than 15mL/kg or IC greater than 70% of expected, what should RTT choose IS
Alert pt with secretion problem RTT should choose PEP unless atelectasis persists, then add CPAP
What is primary difference in choosing a pt for CPAP or BiPAP CPAP for pt with decreased PaO2 but normal CO2 and BiPAP for pt wit trouble blowing of CO2
Created by: williamwallace