| Question | Answer |
| 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. |
