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203 EXAM 2


advantages of aerosol drug therapy -Rapid (As fast as IV administration) -Target organ: Lungs -Very few side affects -No pain
disadvantages of aerosol drug therapy -You don't know how much medication the patient will get (only 10-20% of the does actually gets into the lungs) -SVN has a lot of drug waste -Too many delivery methods -Can be expensive $$$
How much medication gets into the target organ with proper technique? 10-20%
When done appropriately, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) deposits in the lungs? about 20%
What is the amount said that gets into your lungs with bad technique? 10%
What effects the medicine getting into the lungs? Technique and Breathing pattern
Inhaled Dose Amount of drug entering through inhalation (Can't Measure)
Respirable Dose Amount of inhaled dose deposited in the lungs/target organ
factors affecting pulmonary deposition of aerosol particle size Intertial Impaction diffusion gravity anatomy of the respiratory tract 2. Sedimentation 3. Diffusion 4. Aging
intertial impaction The particles colliding with the surface (larger than 5 um) *why we have different breathing patterns for different delivery of medications* Ex. when it hits the back of the throat, falls out of suspension, and doesn't get into the parenchyma
sedimentation The particles that settle onto tissue (when particles settle out of suspension and are deposited owing gravity) The greater the mass of the particle, the faster it settles *you need a breath hold for sedimentation*
Diffusion The primary mechanism causing deposition of the medications in the lung parenchyma (small particles < 3um) Diffusion happens when there is no longer any gas flow
Aging aerosol suspension changes overtime due to growing, shrinking, and falling out of suspension
Ways to deliver aerosol 1. Atomizer 2. MDI 3. DPI 4. SVN 5. LVN 6. USN
Hazards of aerosol drug therapy 1. Adverse reaction to med 2. Infections 3. Airway reactivity/bronchospasm 4. Eye irritation if wearing mask (Atrovent dilate pupils) 5. med concentrations 6. Second-hand exposure
what particle size range is deposited in upper airway 10-15 um Particle size: nose > 10um mouth > 15um
what particle size range is deposited in lower airway Particle size: 5-10 um
what particle size range is deposited in Parenchyma Particle size: around 1-5 um *gas exchange occurs*
What is the primary mechanism for deposition of large, high-mass particles (greater than 5 microns) in the respiratory tract? inertial impaction
Where do most aerosol particles in the 5-10 um range deposit? upper airways
Where do most aerosol particles that are less than 3 um deposit? parenchyma
Atomizer Does not include a baffling, used to deliver anti-inflammatories and anesthetics to the upper airway, produce particles with large MMADs
Which following statements about atomizers is FALSE? A. atomizer doesn't include baffling B. Atomizers used to deliver anti-inflammatories, anesthetics to upper airway C. Atomizers produce particles w/ large MMADs D. Atomizers useful for bronchospasm Atomizers are useful for bronchospasm
MDI stands for metered dose inhaler
Holding Chamber one way valve, whistles when breath in too fast
Priming- what does this mean getting the medication ready for the first use, or if it has not been used for a period of time
advantages of MDI -portable and compact -shorter treatment time than SVN -Reproducible can produce the same emitted dose every time
disadvantages of MDI -Coordination needs -proper technique needed -fixed drug concentration -reaction to propellants
What is the propellant called in an MDI? hydrofluoroalkane (HFA)
HFA -hydrofluoroalkane (HFA) -shake inhaler thoroughly -prime as directed -use close mouth technique or a holding chamber -clean actuator to assure proper dosing
clean actuator for proper dosing -weekly -flush for 30 seconds under warm running water-shake and air dry
MDI technique -Prime if needed -shake (15-30 seconds) -exhale away from the device -make a tight seal -inhale slowly and deeply then actuate -breath hold for 10 seconds
Actuate then inhale slowly and deeply only if you have a ____________________ holding chamber
When using a metered-dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point? Immediately after beginning a slow inspiration
What do you do if you are inhaling a steroid? rinse mouth to prevent thrush
why do you need to wait and shake for at least 30 seconds? you need time for the propellant and medication to mix
Which following are beneficial effects of using holding chamber w/ MDI? I. Usage of MDI adapted to children/elderly II. Decrease need for hand-breath coordination III. Elimination of need to do 10 sec breath hold IV. Improved deposition in oropharynx I and II
Respimat (delivers spriva and combivent) New type of MDI that doesn't require a holding chamber *delivers albuterol and atrovent* Soft plume
Dry Powder Inhaler (DPI) -Breath actuated -Rapidly (Fast and Deep) inhale -5 years old and over -Breath hold for at least 10 seconds
Advantages of DPI -small and portable -Built in dose counter -NO propellent -breath actuated -short prep and administration time
Disadvantages of DPI -High flows needed (40L/min minimum) -High oropharyngeal impaction can occur (you can hit back of throat causing thrush or dysphonia) -Humidity can clump up powder -Limited range of drugs
DPI technique Fast and deep inhalation -Exhale away from the device -hold upright -make tight seal -hold breath 5-10 secs -Rinse mouth to prevent thrush -Tap the DPI to see if there is leftover powder Keep dry
For which of the following patient groups is use of a DPI for bronchodilator administration recommended? I. Children > 5-6 years of age II. Patients suffering an acute bronchospastic episode III. Patients requiring maintenance therapy I and III
Other names for SVN -SVN -Acorn -Updraft -Med Neb -Hand Held Neb -Microneb
SVN technique 1. Pick source of oxygen: Air, O2, Compressor 2. Pick mask or mouthpiece 3. Pre-Assessment 4. Fill neb with proper medication 5. Set Flowrate 6. Monitor patient (HR) 7. Hear a sputter- Tap it 8. Post-Assessment 9. Clean up
Which of the following describes the output produced by a nebulizer? A. single dose B. emitted dose C. respirable dose D. output dose Emitted Dose
All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration EXCEPT which one? A. Steroids B. Albuterol C. Acetylcysteine (Mucomyst) D. Antibiotics Albuterol
SVN in mechanical ventilation 1. Insert neb in the inspiratory limb 2. Remove HME or place after HME 3. Adjust settings on vent (if not, use vent to power neb) 4. Set flowrate (6-8 lpm) 5. Tap 6. Reconnect HME 7. Return to original vent settings
Aerogen -A vibrating mesh neb -fine particles size improves deposition of medicine -put on dry side of the humidifier -mist on inspiration for 30min -doesn't confuse ventilator -more expensive -vibrates at 128,000 times per second
Advantages of SVN -many drugs -can mix drugs if compatible -breath normally -no breath hold -any age -can modify drug concentration -can do blow by
Disadvantages of SVN -cost money $$$ -wasted med -lengthy treatment time -power source needed -different brands -contamination (med cup) -mask causes face to get wet -can dilate pupils if gets into eyes
Problems of SVN -Infections if you don't clean it or change it -Poor delivery -Drug reconcentration towards the end -Mist room more than the patient
During aerosol drug delivery w/ SVN @ 8 L/min input flow, pt asks bed be lowered to semi-Fowler's position. Immediately after, large drop in SVN aerosol output, despite there being at least 3 ml of solution left in the reservoir. How to correct problem? Reposition the patient so that the SVN is more upright
patient suffering from acute asthma exacerbation, not responding to standard dose/frequency of aerosolized bronchodilator & is now receiving SVN therapy every 15-30 minutes. Which of the following would you recommend to the patient's doctor at this time? Consider continuous nebulization of the drug
Large Volume Nebulizers -continuous neb -hold >200 ml -lasts 1-2 hours -used to give babies ribavirin -aerosol tubing and aerosol mask
Problems of LVN -Tachycardia (use heart monitor) -medication reconstitution (dont know when giving medicine or saline)
What is the major problem with using large-volume nebulizers for continuous aerosol drug therapy Drug reconcentration and toxicity
USN advantages -BEST nebulizer -can use it in a car or battery operated -small particle size better deposition -small, fast, and quiet -nebulizing on inspiration, no wasted medication -For really sick asthmatics or bad airway disease
USN disadvantages -Not all drugs can be used with it -Expensive -cant put pulmicort in it will crystalize
Advantages of small-volume ultrasonic nebulizers for drug delivery include all of the following EXCEPT: A. greater respirable drug mass B. less dead space and waste C. quiet D. decreased cost D. decreased cost
Ultrasonic Nebulizer (USN) humidifier in which an electrical signal is used to produce high-frequency vibrations in a container of fluid. The vibrations break up the fluid into aerosol particles. Uses piezoelectric crystals
Guideline for selection of aerosol device -SVN neonates & up (Anyone) -MDI >5years (older than 5) -MDI with holding chamber/spacer >4years old (greater than 4) -MDI with holding chamber and mask <4years old (less than 4) -Breath acuated MDI >5years (older than 5) -DPI>5 years (older than 5)
PRIMARY way people mobilize secretions cough
Reasons that impair cough 1. Pain 2. CNS depression/problems 3. Neuromuscular problems 4. Drugs 5. Artificial airway 6. Surgery 7. Weakness 8. Inadequate lung recoil
Indications for Secretion Management 1. Mucous -Copious, Abnormal 2. Retained Secretions 3. Acute Lobar Atelectasis 4. V/Q Mismatch -unilateral lung disease 5. Prophylaxis -Immobility, CF
Other indications for Secretion Management -Anything that alters the airway potency -Mucociliary function -strength of inspiratory & expiratory muscles -thickness of secretions -the effectiveness of the cough reflex -artificial airways produce more mucus/can close the glottis
therapeutic outcomes of secretion management -get mucus out (improve breath sounds, amount, and patient) -improve V/Q (ABG, SATS) -improve CXRR
hypersecretion when you have excessive mucus production example: asthma, COPD, cystic fibrosis
mechanism for healthy individual to move mucus (the one that is not coughing..) the mucocillary escalator is the mechanism of mucus clearance from the lungs
In individuals with Acute Airway Disease -ciliary dysfunction and/or mucus hyper secretion -cough is the primary mechanism for mucus clearance
Methods of airway clearance 1. Cough 2. Forced Expiratory Technique (FET) 3. Manually assisted cough 4. Active cycle of breathing 5. Autogenic drainage 6. Mechanical insufflation exsufflation
Who is airway clearance therapy mostly for cystic fibrosis, bronchiectasis, chronic bronchitis
most therapies get ______ behind secretions so that they can move up and out volume of air
Before cough what should you do take a deep breath first, hold for a sec, and use abdominal muscles to cough
Four stages of cough 1. Irritation 2. Inspiration 3. Compression 4. Expulsion
4 types of irritation 1. inflammation- from infection 2. mechanical- from foreign bodies 3. chemical- from irritating gasses 4. thermal- cold temperature
Three things that impair the ability to cough -anesthesia -narcotics -CNS depression
irritation anything abnormal that provokes sensory fibers in your airways example: inflammation, foreign body, and chemical such as cold air
things that impair inspiration -pain -neuromuscular dysfunction -pulmonary restriction -abdominal restriction
duration of compression (during cough reflex) 0.2 seconds, then the glottis closes
Things that impair compression (0.2 sec) -laryngeal nerve damage -artificial airways -abdominal muscle weakness -abdominal surgeries
during expulsion, the glottis opens, and air comes out at _____ mph 500
ways to impair expulsion -airway compression -airway obstruction -abdominal muscle weakness -inadequate lung recoil (in COPD and emphysema patients)
what opens during expulsion/what closes during compression glottis
Type of forced expiratory technique huff cough
manually assisted cough AKA "QUAD cough" Apply pressure to the upper abdominal area during the compression and expiratory phase of the cough (for neuromuscular patients)
active cycle of breathing a combination of breathing control, thoracic expansion control, and forced expiration technique (used in home care settings)
autogenic drainage (AD) aims to achieve highest possible airflow in the different generations of bronchi to move secretions without forced expirations (aerobika with a aerobika)
Mechanical insufflation-exsufflation (MIE) AKA "cough assist machine" applies positive pressure to the lungs followed by a negative pressure to stimulate a cough (adds pressure then sucks it out) for neuromuscular problems
types of secretion management techniques CPT PD PDPV PEP Flutter PEP and Flutter (combo) Suctioning IPV Vests AD Cough Mucolytics (mucomyst)
What kind of medications can irritate the airways Antibiotics, mucolytics, and steroids
Contraindications for CPT/PD -unstabilize neck injury -active hemorrhage w/unstable hemodynamics -empyema/TB -rib fx -large pleural effusions -ICP>20 mmHg -recent neck injury/surgery -active hemoptysis -aspiration -osteoporosis -PE -BPF -pulm. edema
What is an airway clearance? anything you can put in the lungs behind secretions to bring it up to cough it out
advantages of PEP -self administration -easy to teach -mouthpiece or mask -patient upright -trach patient -inexpensive -combo of SM and LI
combo of SM and LI -utilized for post op atelectasis -decreases use of antibiotics and mucolytics -decreases exacerbations
Positive Expiratory Pressure (PEP) Acapella Aerobika EzPap
Contraindications for PEP -ICP >20 mmHg -hemodynamically unstable -acute sinusitis -hemoptysis, epistaxis -unresolved ptx -surgery (face, oral) -middle ear problem -unable
HFCWC (high frequency chest wall compression) generates neg. changes in transrespiratory pressure difference by compressing the chest externally to cause short, rapid expiratory flow pulses, relies on chest wall elastic recoil to return the lungs to functional residual capacity. (vests or jacket)
intrapulmonary percussive ventilation (IPV) creates positive changes in transrespiratory difference by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall elastic recoil or passive exhalation.
Metaneb LI and SM CPEP - cont positive expiratory pressure CHFO - aerosol pulses of positive pressure and high-frequency oscillations
sputum collection -cough -induced sputum -tracheal aspiration -bronchoscopy -mini bronchoalveolar lavage -transtracheal aspiration
what is responsible for normal clearance of secretions from the lower respiratory tract? mucocilliary transport
what is responsible for secretion clearance in acute and chronic respiratory disease? cough
conventional chest physiotherapy consists of postural drainage, percussion, and vibration
advantages of CPT/PD can perform on patients with artificial airways
disadvantages of CPT/PD - time-consuming - need a caregiver to perform - not always tolerated well - tube feeding must be off for 30 minutes prior to the start of therapy - increases hypertension - increases dyspnea - pain
active cycle of breathing techniques consist of ________, _______, and _______. breathing control, thoracic expansion control, and forced expiratory technique
autogenic drainage -trying to get behind the secretion, trying to get a mucus rattle -doing diaphramatic breathing
percussion and vibration -cupping hands makes an air pocket pop -used to move secretions in the larger airways -also have handheld processor -vibration (hands) only done on exhalation -do 4-5 min segments
techniques that can be used for airway clearance -positive expiratory pressure -oscillating positie expiratory pressure -intrapulmonary percussive ventilation -external chest wall compression
what are used to mechanically clear secretions from the lower respiratory tract -airway suctioning -nasotracheal suctioning -bronchoscopy
acapella device -dial at the bottom to change the pressure -comes in blue and green -blue is for someone who can't breathe well <15 lpm severe COPD, neuromuscular problems -green is for normal breather flow rate 15 lpm over 3 seconds
advantages of acapella, aerobika, VPep -mouthpiece or mask -use inline with svn -any position -self admin -easy to teach -easy to clean -Inexpensive
VPEP use (cycles? breaths? what else?) 4 cycles of 10-20 breaths Huff cough between cycles
VPEP therapy Patient -alert, cooperative -Cough/intact airway -also for lung inflation
Aerobika -gives better vibration and lower flows -only one approved to use with SVN
Flutter -alert cooperative patient -can't use a mask -more vibration then exhale with greater effort -change angle to the floor/ + vibe
Goals for Lung Inflation Therapy -INCREASE FRC! but also.. -it prevents or reverse atelectasis -improves gas exchange (V/Q mismatch) -increases FRC and VC -aids in secretion removal
atelectasis is detrimental in _______ movement is detrimental in _________ gas exchange, circulation
preventing or correcting atelectasis eliminates areas of collapse which affects your? V/Q mismatch
what does atelectasis sound like? snap, crackle, and pop (rales)
outcome assessment for Lung Inflation -reverse of atelectasis decrease rr -improved breath sounds -if hear less sounds beginning to end you've recruited alveoli -slower deeper breathing -if recruited Sa02 should improve, more gas exchange, better V/Q match -Increased volume & lung cl
How does lung inflation therapy help to remove secretion? If you get enough volume behind secretions it can help to remove them
how does lung Inflation work? increasing pulmonary pressure
transpulmonary pressure palv-ppl=pl
2 ways to increase pulmonary pressure 1. generate negative pressure -Incentive spirometer 2. generate positive pressure -IPPB on inspiration -PEP on expiration -CPAP and EzPAP on I and E
what is the breathing pattern for atelectasis? shallow and fast
what do you see on a CXR of a person with atelectasis? -opacity -air bronchograms
where does the trachea deviate with a person who has atelectasis? towards the affected side
what happens to the ribs of someone with atelectasis when they have a loss in lung volume? the ribs come closer together
what happens to the diaphragm of a person with atelectasis? the diaphragm will elevate
Post operative complications can cause? -atelectasis general anesthesia decreases FRC causes shallow breathing causes V/Q mismatch causes hypoxemia -Pain "splinting" -Infection -Thrombosis -functional issues
Who is at risk for atelectasis? -lung (chest) disease and surgery -upper abdominal surgery -lower abdominal surgery -obesity and surgery -may be pre/post op
The sigh mechanism -sigh 6-10 times per hour -1.5 to 2.0 times normaal Vt -Reinflates lung bases (dependent) -Surgery (reduces sighs) -Anesthesia -Pain -post op meds
What can a sigh do? helps to prevent atelectasis and keeps lung expanded -deep breathing are sometimes sighs
how do you increase transpulmonary pressure? decrease pleural pressure or increase alveolar pressure
incentive spirometer is also known as sustained maximal inspiration
Goals of Incentive Spirometry -promote cough -reduce retained mucus
Hazards of Incentive Spirometry -hyperventilation -barotrauma -fatigue -discomfort secondary to pain
how does IPPB work -positive pressure on INSPIRATION ONLY -pressure aids in deep breath (decrease WOB) -better if patient assisted -nebulize medications -goal is same as IS (10-15 ml/kg IBW)
indications for IPPB lung inflation
what type of patients need IPPB spontaneously breathing
conditions for IPPB atelectasis and neuromuscular
contraindications of IPPB -tension ptx -increase ICP -UGI surgery -active hemoptysis -nausea
hazards of IPPB dizziness gastric inflation pneumothorax decrease BP air trapping
IPPB machine wont start check if plugged in sensitivity to low
inadequate flow, active inhalation -Large negative pressure swings at early inspiration -Large negative pressure swings after machine turns on
premature cycling off -flow is too high -airflow obstruction (tongue in mouth piece) -pressure is set too low
auto triggering too sensitive, rate control on
won't cycle off system leak, sticking breathing valve
prolonged inspiration leaks, flow rate too low, pressure too high
no mist from neb check gas flow adequate solution nebulizer properly positioned
CPAP meaning continuous positive airway pressure on inhalation and exhalation
indications for CPAP prevent and treat atelectasis hypoxemia
contraindications of CPAP -untreated pneumo -claustrophobia -unstable BP -GI surgery -Nausea -Facial trauma -Increase ICP -hypoventilation
hazards of CPAP hypoventilation barotrauma gastric distention
Monitoring CPAP alarm system (disconnect or low pressure) gas source failure (emergency inlet valve available)
Conditions of CPAP atelectasis CHF refractory hypoxemia sleep apnea
What is used to facilitate deep breathing in post op patients? incentive spirometry
What is used for short-term hyperinflation therapy? Intermittent positive pressure breathing
What is used to increase FRC to improve oxygenation, treat OSA, patient spontaneously breathing CPAP (continuous positive airway pressure)
Persistent breathing at small tidal volumes can result in which of the following? a. reabsormption atelectasis b. spontaneous pneumothorax c. compression atelectasis d. respiratory alkalosis Compression atelectasis
Which of the following patient categories are at high risk for developing atelectasis? 1. those who are heavily sedated 2. those with abdominal or thoracic pain 3. those with neuromuscular disorders A. 1 and 2 B 2 and 3 C. 1 and 3 D. 1, 2, and 3 D. 1, 2, and 3
What is the major contributing factor in the development of postoperative atelectasis? repetitive, shallow breathing
Which of following groups of patients is not at risk for developing postoperative atelectasis? a. pt.w/ chronic obstructive pulmonary disease b. pt.w/ significant history of cigarette smoking c. pt.w/ impaired mucocilliary clearance d. pt. w/ pneumonia d. those with pneumonia
Which of the following clinical findings indicate the development of atelectasis? 1. opacified areas on the chest x-ray film 2. inspiratory and expiratory wheezing 3. tachypnea 4. diminished or bronchial breath sounds 1, 3, 4
How do all modes of lung expansion therapy aid lung expansion? a. increasing the transpulmonary pressure gradient b. decreasing the transthoracic pressure gradient c. increasing the pressure in the pleural space d. decreasing the pressure in the alveoli a. increasing the transpulmonary pressure gradient
How can the transpulmonary pressure gradient be increased? 1. increasing the alveolar pressure 2. decreasing pleural pressure 3. decreasing transthoracic pressure 1 and 2
Lung expansion methods that increase transpulmonary pressure gradients by increasing alveolar pressure include? 1. IS 2. positive and end-expiration pressure therapy 3. IPPB 4. expiratory positive airway pressure (EPAP) 2, 3, 4
Which of the following is not a potential hazard or complication of incentive spirometry? a. pulmonary barotrauma b. decreased cardiac output c. respiratory alkaloxis d. fatigue b. decreased cardiac output
A postop pt using incentive spirometry complains of dizziness & numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms? a. gastric insufflation b. hyperventilation c. pulmonary barotrauma d. respiratory acidosis b. hyperventilation
Which outcomes would indicate improvement in patient previously diagnosed with atelectasis who has been receiving incentive spirometry? 1. improved PaO2 2. decreased RR 3. improved chest radiograph 4. decreased forced vital capacity (FVC) 5. tachycardia 1, 2, 3
Ideally, when should high-risk surgical pt be oriented to IS? a. postop, after full recovery from anesthesia b. preop, before undergoing the surgical procedure c. postop, while still in recovery room d. postop, but no sooner than 24 hours after surgery b. preoperatively, before undergoing the surgical procedure
Successful application of incentive spirometry depends on: a. the use of a true volume-oriented incentive spirometry system b. the type of surgery previously peformed c. the effectiveness of patient teaching d. setting an easily achieved initial goal c. the effectiveness of pt. teaching
In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say? ""exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds."
In performing the sustained maximal inspiration maneuver during incentive spirometry, the patient should be instructed to sustain the breath for at least how long? 5-10 seconds
The short-term application of inspiratory positive pressure to a spontaneously breathing patient best defines which of the following? intermittent positive-pressure breathing
Which following is false about IPPB? a. during insp., pressure in alveoli decreases b. pressure gradients of normal breathing reversed c. During insp., alveolar pressure may exceed pleural pressure d. energy stored during insp. causes passive exhalation a. During inspiration, pressure in the alveoli decreases
Intermittent positive-pressure breathing is associated with a passive exhalation. a true b. false true
pt groups considered for lung expansion therapy using IPPB? 1. pts w/ clinically diagnosed atelectasis,unresponsive to other therapies 2. pts at high risk for atelectasis who cannot cooperate w/ other methods 3.obese patients undergoing abdominal surgery 1 and 2
What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis? slow, deep breaths held at end-inspiration
Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing? a. hemodynamic instability b. recent esophageal surgery c. tension pneumothorax d. neuromuscular disorders d. neuromuscular disorders
Which of the following is an absolute contraindication for using intermittent positive-pressure breathing? a. hemodynamic instability b. active untreated tuberculosis c. tension pneumothorax d. recent esophageal surgery c. tension pneumothorax
What is the most common complication associated with intermittent positive-pressure breathing (IPPB)? a. air trapping b. oral bleeding c. respiratory alkalosis d. gastric distention c. respiratory alkalosis
Which false about gastric distention w/IPPB? a.Gastric distention uncommon in alert/cooperative pt b.Gastric distention most likely@ highairwaypressures c.gastric distention significantrisk w/obtunded pt d.gastric distention relatively harmless effectIPPB d. gastric distention relatively harmless effect of IPPB
Which of the following is not a potential hazard of intermittent positive-pressure breathing? a. increased cardiac output b. respiratory alkalosis c. pulmonary barotrauma d. gastric distention increased cardiac output
Which of the following are potential hazards of intermittent positive-pressure breathing (IPPB)? 1. air-trapping, auto-PEEP 2. hyperventilation 3. nosocomial infection 4. increased airway resistance 1, 2, 3, 4
Preliminary planning for IPPB should include which of the following? 1. evaluation the alternative approaches to the patient's problem 2. setting specific, individual clincial goals or objectives 3. conducting a baseline assessment of the pt 1, 2, 3
Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy? 1. improved oxygenation 2. increased cough and secretion clearance 3. improved breath sounds 4. reduced dyspnea 1, 2, 3, 4
The general assessment, common to all patients for whom IPPB is ordered, should include which of the following? 1. vital signs 2. appearance/sensorium 3. chest auscultation 4. ABG analysis 5. peak expiratory flow rates 1, 2, 3
When checking a patient's intermittent positive-pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case? check the circuit for leaks
Prior to starting IPPB on a new patient, what should the practitioner explain? 1. why the physician ordered the treatment 2. what the IPPB treatment will do 3. how the IPPB treatment will feel 4. what the expected results are 1, 3, 4
Which of the following positions is ideal for intermittent positive-pressure breathing therapy? Semi-Fowlers
In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try? a. flanged moutpiece b. form-fitting mask c. nasopharyngeal airway d. nose clips d. nose clips
When adjust sensitivity on IPPB, which parameters change? a. vol. of gas delivered to pt during inhal. b. effort required to cycle device "off (end inspir.) c. effort required to cycle device "on"(begin inspir.) d. max.pressure deliver to pt during inhal. effort required to cycle the device "on" (begin inspiration)
Which of the following are appropirate initial settings for intermittent positive-pressure breathing given to a new patient? sensitivity -1 to -2cm H20; pressure 10to 15cmH2O; moderate flow
Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy? 1. 10 to 15 ml/kg ideal body weight 2. at least 30% of the inspiratory capacity (IC) 3. pressure level as high as 30 to 35 cmH2O 1 and 2
All of the following parameters should be evaluated after intermittent positive-pressure breathing therapy except: a. vital signs b. sensorium c. breath sounds d. temperature d. temperature
Which of the following should be charted in the patient's medical record after completion of an intermittent positive-pressure breathing treatment? 1. results of pre and post treatment assessment 2. any side effects 3. duration of therapeutic session 1, 2 and 3
All of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy except: a. flow setting b. sensitivity c. humidity output d. peak pressure humidity output
In terms of machine performance, what large negative pressure swings early in inspiration indicate? a. inadequate flow setting b. incorrect sensitivity c. inadequate pressure setting d. inadequate humidity incorrect sensitivity
Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely? 1. airflow obstructed 2. kinked tubing 3. occluded mouthpiece 4. active resistance to inhalation 1, 2, 3, 4
Which mechanisms probably contribute to the beneficial effects of CPAP in treating atelectasis? 1. recruitment of collapsed alveoli 2. decreased work of breathing 3. improved distribution of ventilation 4. increased efficiency of secretion removal 1, 2, 3, 4
Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy? 1. hemodynamic instability 2. hypoventilation 3. facial trauma 4. low intracranial pressures 2 and 3
Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy? 1. barotrauma 2. hyperventilation 3. gastric distention 4. hypercapnia 1, 3, 4
Which following are essential components of a continuous positive airway pressure (CPAP) flow system? 1. blended source of pressurized gas 2. nonrebreathing circuit with reservoir bag 3. low-pressure or disconnect alarm 4. expiratory threshold resistor 1, 2, 3, 4
During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation? system or mask leaks
Which of the following has a direct relationship between the degree to which atelectasis can present itself with a post-operative patient? a. spontaneous respiratory rate b. bradycardia c. hypocapnia d. hypothermia a. spontaneous respiratory rate
Which of the following are the hazards and complications of incentive spirometry? 1. hyperventilation 2. fatigue 3. discomfort secondary to inadequate pain control 4. barotrauma 1, 2, 3, 4
59 year old COPD pt comes to hospital w/ upper abdominal surgery. The physician diagnoses the pt w/ pulmonary atelectasis. The pt has a vital capacity of 25 ml/kg. Which of following lung expansion therapy will you recommend to assist pt's atelectasis? a. incentive spirometry
USN is used for _____ ______ (MAIN USE!) sputum induction
When do you actuate the MDI right before inhalation (slow and deep)
What do we use instead of USN now? Aerogen (Mesh nebulizer)
Minimum inspiratory flow for DPI.. why? 40 L/min; patient needs to generate this flow because there is no propellant behind medication
While using MDI, medication should deposit into ______; and ____% enters, ____% does not parenchyma; 20%, 80%
Primary factors affecting aerosol delivery deposition inertia gravity diffusion
geometric size of particles commonly expressed as mass median aerodynamic diameter (MMAD)
Ultrasonic nebulizers generate aerosols using a high-frequency vibrating _________ _________ piezoelectric crystal
Bronchodilator contraindication- when do you NOT start a bronchodilator tx patient has tachycardia >130 BPM
When do you STOP a bronchodilator tx? if HR increase by 20%, stop treatment
Delivery mechanism for Tobramycin (TOBI) Pari LC (ONLY WAY TO NEBULIZE THIS MED)
Delivery mechanism for Ribavirin (Virazole) Small Particle Aerosol Generator (SPAG) (ONLY WAY TO NEBULIZE THIS MED)
Delivery mechanism for Trepostinol (Tyvaso) Optineb (ONLY WAY TO NEBULIZE THIS MED)
hazards to oxygen therapy absorption atelectasis ROP can lead to blindness for babies O2 induced hypoventilation O2 toxicity
What is absorption atelectasis from high levels of oxygen, causes nitrogen washout in the lungs causes smaller tidal volumes, smaller shallow breaths
patient supine with pillow under knees flat bed, what position? anterior segment
Cystic Fibrosis patient- what tx is used most commonly HFCWO (High Frequency Chest Wall Oscillation) Vest
all modes of lung inflation aid in: main function: INCREASE FRC prevents atelectasis helps with increasing transpulmonary pressure gradient
dyspnea Difficulty breathing perceived by the patient
orthopnea difficulty breathing while lying down
Platypnea shortness of breath in upright position
hypoxic hypoxia -Insufficient pressure of O2 in the air; e.g. flying at altitude -diffusion defects -V/Q mismatch
An RCP enters a patient room to find the woman in distress. She has hyperresonance and decreased motion on the left side of the chest, dyspnea, and tracheal deviation to the right. Based on these findings, the most likely cause is: pneumothorax on left
What breathing pattern is associated with metabolic acidosis or diabetic ketoacidosis? Kussmaul
tracheal deviation towards the affected side = atelectasis on that side; ex. atelectasis on right means tracheal deviation to the right atelectasis pulls trach to affected side pneumothorax pushes trach away from the affected side
Relative Humidity The amount of water vapor in the air at any given time is usually less than that required to saturate the air. (Expressed as a percentage)
Chest pain is the cardinal symptom of which of the following diseases? Heart Disease
ROP can lead to ______ and is caused by _______ blindness in babies too high concentrations of O2 retinopathy of maturity
Water has accumulated in the delivery tubing of an aerosol system. This will result in? -Increased FIO2 -Decreased aerosol output -Increased back-pressure in the system
Bland aerosol therapy is potentially hazardous to which of the following patients? asthma
For which of the following patients would you NOT recommend goals aerosol therapy administration? I. patient with a bypassed upper airway II. patient with active bronchoconstriction III. a patient with a history of airway hyperresponsiveness II and III
Would you start breathing treatment if patient HR is over 140? NO!
Nurse calls you and tells you doctor put in order for treatment. What do you do FIRST? Check patient's chart to verify
Breath sound resulting from bronchoconstriction Wheezing
How would you describe a patient who is difficult to arouse but responds appropriately when asked questions? obtunded
While observing a patient's breathing, you note a regular pattern: the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation? Cheyne-Stokes
Missy Jones, a premature newborn female, in on 80% oxygen, Her SpO2 is 97%. As an RCP, which of the following would you be most concerned about? Retinopathy of prematurity
Mouth breather on nasal cannula still satting low, what mask would you switch to? first choice is air entrainment mask, with precise FIO2 second choice is oxymask
Goals of Bland Aerosol Therapy humidification of medical gases mobilization of pulmonary secretions sputum induction
Contraindications for Bland Aerosol Therapy bronchoconstriction history of airway hyper-responsiveness
What type of patient is commonly sent home with High Frequency Chest Wall Oscillation Vest Cystic Fibrosis- lots of secretions
humidity and bland aerosol therapy for burn patient... what type of mask used to administer face tent
A patient that came into the ER with RR 38. Shows signs of Respiratory Distress. What device would you recommend for this patient? CPAP
What are the goals of Humidity and Aerosol Therapy? provide heat and moisture, treat hypothermia, prevent airway response to cold air, and help removal of thick secretions
Created by: ekalahik
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