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Egan's 9th Edition Chapter 39

Key Term: Abnormal collapse of distal lung parenchyma. Atelectasis
Key Term: Ventilatory support where the patient breathes spontaneously without mechanical assistance against threshold resistance, with pressure above atmospheric maintained at the airway throughout breathing. Continuous Postitive Airway Pressure (CPAP)
Key Term: Application of positive pressure breaths to a patient for a relatively short period of time (10-20 minutes). Intermittent Positive-Pressure Breathing (IPPB)
Key Term: The process of encouraging the bedridden patient to take deep breaths to avoid atelectasis. Incentive Spirometry
Key Term: Alveolar collapse involving a specific lobe of the lung. Lobar Atelectasis
Key Term: Collapse of distal lung units due to persistent ventilation with small tidal volumes. Passive Atelectasis
Key Term: Airway clearance technique in which the patient exhales against a fixed orifice flow resistor in order to help move secretions into the larger airways for expectoration via coughing or swallowing. Positive Expiratory Pressure (PEP)
Key Term: Collapse of distal lung units due to mucus plugging of airways. Resorption Atelectasis
Which patients are at greatest risk for developing atelectasis? What other factors increase this risk? Thoracic/upper abdominal post-op patients. History of lung disease/heavy cigarette smoking.
What 3 signs indicate atelectasis? 1. rapid shallow breathing 2. fine, late-inspiratory crackles 3. abnormalities on CXR
Lung expansion therapy corrects atelectasis by: increasing the transpulmonary pressure gradient.
The most common problem associated with lung expansion therapy: respiratory alkalosis (patient breathes too fast)
RT's role in lung expansion therapy: implement, monitor, and document results of the therapy
Rule of Thumb: What factor in abdominal surgery makes post-op atelectasis more likely? The closer the incision is to the diaphragm, the greater the risk.
Rule of Thumb: Typically, as the atelectasis progresses, the __ __ increases proportionally. respiratory rate
3 main indications for IS: 1. pulmonary atelectasis 2. conditions predisposing to atelectasis (surgery of upper abdominal, thoracic, or in patients with COPD) 3. restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm
3 main contraindications for IS: 1. unconscious patients or those unable to cooperate 2. patients who can't properly use IS device after instruction 3. Patients unable to generate adequate inspiration
5 main hazards/complications for IS: 1. hyperventilation/respiratory alkalosis 2. discomfort secondary to inadequate pain control 3. pulmonary barotrauma 4. exacerbation of bronchospasm 5. fatigue
What is an SMI? sustained maximal inspiration; slow, deep inhalation from FRC to TLC, followed by a 5-10 second breath hold.
2 categories of IS devices: volume oriented, flow oriented
The purpose of the "resting period" after an IS maneuver: to help patients avoid repeating the maneuver at a rapid rate, which can cause respiratory alkalosis.
IPPB indications: 1. need for improvement of lung expansion 2. need for noninvasive ventilatory support in hypercapneic patients 3. need to deliver aerosol medication
What happens when IPPB is the only modality used for resorption atelectasis due to excess airway secretions? The positive pressure is likely to cause overinflation of the lung regions not affected by secretions and minimal/no expansion of the affected lung segments.
What 2 treatment modalities are added to IPPB therapy when treating resorption atelectasis? bronchial hygiene therapy and humidity therapy
The 1 absolute contraindication of IPPB: tension pneumothorax
Most common complication/hazard of IPPB: respiratory alkalosis (accompanied by arrhythmias in severe alkalosis)
Why is gastric distention a complication/hazard of IPPB? Gas may pass directly into the esophagus when the pressure at which the esophagus opens exceeds 20 cm H2O.
Potential outcomes for IPPB: 1. improved VC, CXR, breath sounds, improved cough and secretion clearance, & oxygenation 2. increased FEV1 or peak flow 3. favorable patient subjective response
What 3 general assessments must be made before IPPB therapy? 1. vital signs 2. observation of patient's appearance & sensorium 3. breathing pattern & chest auscultation
What step can be done to ensure the pressure-cycled IPPB has no leaks? aseptically occlude the patient connector and manually trigger a breath at low-flow setting (machine should cycle off)
When explaining the purpose of IPPB therapy, what 4 points must be addressed? 1. why the Dr. ordered treatment 2. what treatment does 3. how treatment feels 4. expected results
What position provides the best results in IPPB therapy? semi-Fowler's (unless contraindicated; supine acceptable)
When applying IPPB, what is the general breathing pattern goal? 6 breaths/minute; I:E ratio 1:3 or 1:4
IPPB is only useful in the treatment of atelectasis if: the volumes delivered exceed those volumes achieved through the patients spontaneous breathing
Treatment frequency for acute care patients: q 72 hrs or with any change in patient status
Troubleshooting IPPB; Machine Performance: Large negative pressure swing early in inspiration
Created by: debbiesaurus