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Lung Expansion Ther.

Lunch Expansion Therapy RCP 111

QuestionAnswer
The respiratory group is located in which areas of the brain? The Pons and Medulla Oblongata
The Dorsal Respiratory group is located in the posterior medulla. Inspiratory Center Neurons Responsible for the rythem of breathing.
The Ventral Respiratory Group is located in various areas of the medulla. Controlls inspiration and expiration. In active during normal breathing. Active during exercise/stress. Inspiratory and experiatory neurons.
What are included in the pontine respiratory centers? Apneustic/pneumotaxic (homeostatic mechanism)
Apneustic lower portion of the pons. sends impulses to activate inspiration. Takes over if pneumotaxic is damaged.
Pneumotaxic located bilaterally upper 1/3 of pons. Restrains apneustic/cuts off the inspiration. Innervated by the vagus nerve
What are the respiratory monitoring system chemoreceptors? Central chemoreceptors peripheral chemoreceptors
Central chemoreceptors respond to an increas in hydrogen ions in CSF. Hydrogen ions porportional to co2.
Peripheral chemoreceptors special 02 sensitive cells that react to a decrease in oxygen levels. Stimulate an increased respiratory rate. Located in cotoid and aortic arch.
Lung expansion therapy is designed to treat and prevent atelectasis
What are the two types of atelectasis? passive resorption
Passive atelectasis is the result of shallow breathing. Caused by persistent use of small tidal volume.
Passive atelectasis can occur with the following surgery medications (CNS depressents) Neurolgical disorder neuromuscular weakness bed rest immobility
Resorption atelectasis is the result of an airway obstruction. Muscus plugs are present in the airway and block ventilation. Capillaries/blood flow absorb gas
What is lobar atelectasis An entire lobe of atelectasis; a large plug can also be caused by tumors.
what are factors causing atelectasis? obesity neuromuscular disease sedation surgery spinal injury bedridden immobility decreased cough
What are clinical signs of atelectasis? breath sounds: decreased/crackles tachycardia, tachypnea,cyanosis; secondary to hypoxemia. CXR: increased opacity
Normal breathing physics Transpulmonary Pressure (Ptp)
Transpulmonary Pressure (Ptp) (Palv)-(Ppl) alveolar pressure-pleural pressure creates a gradient
Lung expansion therapy increases lung volume by increasing the transpulmonary pressure gradient.
The greater the transpulmonary pressure gradient the more the lung expands.
What are the types of lung expansion therapy? Incentive Spirometry Intermittent Positive Pressure Breathing.
Incentive Spirometry (IS) increases the transpulmonary pressure gradient by lowering pleural pressure. Most effective b/c mimics normal physiology of breathing.
IPPB increases the transpulmonary pressure gradient by increasing alveolar pressure. (increased risk of damaging lung)
How do you know what to choose? Needed equipment Personnel Risk Cost
Incentive spirometry can be done with mothpiece or a trache.
Incentive spirometry mimics natural sighing by encouraging a slow, deep breathing.
The therapist determines the volume and repetitions during IS
Icentive Spirometry Procedure Slow, deep breath in from resting exhalation, followed by a 3-5 second breath hold. Repeat every hour; 5 to 10 reps
Vital Capaicity 65-75 ml/kg (-10 ml/kg) not an effective therapy
THe indications of incentive spirometry. Treat and prevent atelectasis presence of restrictive lung disease
What are the contraindications of IS? patients unable to take a deep breath lack of consciousness/cooperation
What are the hazards/complications of IS? hyperventilation barotrauma discomfort due to pain hypoxia due to interrupted 02 therapy bronchospasm fatigue
What are the three IS devices? indirect volume measuring device volume oriented flow oriented
Indirect volume measuring device flow through a fixed orifice over time displaces volume
Volume oriented not used anymore. measures volume via bellows bulky/large
Flow oriented indirectly measures volume
What should you Chart after Incentive Spirometry? Vitals Volume Achieved Repetitions Good breath hold or not If they understood. Assessment of cough Effort/motivation set goal
IPPB invented by forest bird in 1947. aka hyperinflation therapy used for a broad range of clinical conditions. 1st ventilator
IPPB is used short term or long term? Short term
IPPB csn be administered several times a day or as frequently as once every hour.
What does IPPB require spontaneously breathing patient
How can IPPB be given with a mouthpiece or a mask (Requires a tight seal)
IPPB is administered with a pneumatic machine
Usually IPPB therapy is given accompanying aerosol 32% less effective than hand held nebulizer. 3cc normal saline if ordered w/out treatment
IPPB Therapy lasts 15 minutes
IPPB Requires a what? 50 PSI sources
IPPB Indications Prevent/Treat atelectasis Inability to clear secretions due to inneffective ventilation and coughing. short-term ventilatory support Deliver aerosol medication.
Condraindications for IPPB untreated pneumothorax hemodynamic instability increased ICP Recent facial or esophageal surgery tracheosophageal fistula Acive hemoptisis
More contraindications for IPPB Active/untreated TB Evidence of blebs (over distension) Singulations Air swallowing nausea
One important fact... Increased thorax pressure clamps down on the great vessels and drops the blood pressure.
Hazards and complications of IPPB barotrauma hemodynamic instability increased ICP (clamping of great vessels) Air trapping Nosocomial infection Hemoptysis Hypocarbia Hyperoxia or hypoxemia
more hazards and complications of IPPB Gastric distension/aspiration Increased airway resistance increased V/Q mismatch Physchologic dependence bronchospasm
Facts about the Bird Mark 7 pneumatically powered requires a closed circuit with exhalation valve and nebulizer
The machine incorporates a venturi or air entrainment jet to enhance flow capabilities and decrease Fi02
What are the IPPB controls? Pressure, Flow, Sensitivity, Air mix control and apnea timer.
Pressure directly controls tidal volume. Indirectly affects inspiratory time
Patients lung characteristics also affect tidal volume lung compliance/tidal volume directly proportional. Airway resistance/tidal volume indirectly proportional
Flow directly controls speed (i time) indirectly affects tidal volume
Sensitivity controls patient effort needed to trigger machine
Air mix control when used increases flow output and decreases Fi02
Apnea Timer backup rate
Ventilator Class (Bird Mark 7) Pressure controller Pressure does not change as a result of compliance and resistance changes
Volume Controller Volume does not change as a result of compliance and resistance changes -measures volume directly
Flow controller volume does not change as a result of compliance and resistance changes -measures volume indirectly by measuring flow
Phase 1 change from exhalation to inspiration
Phase 2 Inhalation
Phase 3 Change from inhalation to exhalation
Phase 4 Exhalation
Trigger: Phase 1 Variable that triggers (starts) breath delivery. Pressure (patient), manual or time. Other trigger variables flow
Limit:Phase 2 Variable not eexceeded above the preset value during inspiration. Inspiration does not end when the variable reaches the preset value. Flow, other limit variables (pressure)
Cycle: Phase 3 Variable that cycles (stops) breath delivery. Pressure. Other cycle variables: volume, flow or time.
Phase 4 Exhalation is passive
The circuit Pressure drive line- powers nebulizer/ exhalation valve
Exhalation valve close on inspiration/ opens on exhalation Mushroom type valve
The IPPB can have a mouthpiece or a mask must have a tight seal
The left side of the IPPB machine is the ambient side- atmospheric pressure
The right side is the pressure side
The pressure control toggle 10-40 cm H20
If pressure increases tidal volume increases
If pressure decreases Tidal Volume decreases
This is a pressure cycle machine and pressure indirectly affects inspiratory time
TLC Trigger, Limit, Cycle
Pressure Cycles the machine off
Patient lung characteristics affect tidal volume
Overly compliant lungs take longer to reach pressure (longer i time)
Stiff lungs Take less time to reach pressure, shorter i time
The longer its on the more volume
lung compliance and tidal volume are directly proportional
Airway resistance and tidal volume are indirectly porportional
Flow control 5-40 liters per minute
Flow control directly controls speed The higher the speed the less time
Flow indirectly affects tidal volume More flow less tidal volume less flow more tidal volume
Sensitivity (trigger) Controls patient effort need to trigger machine one
The trigger variable initiates the machine
Manual trigger is red
Patient trigger based on their effort
time trigger black (apnea)
Patient effort for sensitivity 5-40 5 easier to trigger 40 more difficult to trigger
Apnea makes machine trigger by itself
The closer the magnets the more difficult to trigger machine
The farther away the magnets are the easier it is to trigger machine
The initial setting on the Bird Mark 7 is 15/15/15
The Air max control in 100% Fi02 out 40-60% FI02
Limit variable Flow Can't get more or less flow than set
Manomometer Green +, Pink (-)
How can you measure volume Wrights respirometer Flows over time to give volume measurement Hooks on exhalation valve.
Created by: kparkerlehman