Egan's 9th Edition Chapter 39
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| Key Term: Abnormal collapse of distal lung parenchyma. | show 🗑
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| 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. | show 🗑
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| show | Intermittent Positive-Pressure Breathing (IPPB)
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| Key Term: The process of encouraging the bedridden patient to take deep breaths to avoid atelectasis. | show 🗑
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| show | Lobar Atelectasis
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| Key Term: Collapse of distal lung units due to persistent ventilation with small tidal volumes. | show 🗑
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| 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. | show 🗑
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| show | Resorption Atelectasis
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| show | Thoracic/upper abdominal post-op patients. History of lung disease/heavy cigarette smoking.
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| show | 1. rapid shallow breathing 2. fine, late-inspiratory crackles 3. abnormalities on CXR
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| show | increasing the transpulmonary pressure gradient.
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| The most common problem associated with lung expansion therapy: | show 🗑
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| show | implement, monitor, and document results of the therapy
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| Rule of Thumb: What factor in abdominal surgery makes post-op atelectasis more likely? | show 🗑
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| Rule of Thumb: Typically, as the atelectasis progresses, the __ __ increases proportionally. | show 🗑
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| show | 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
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| 3 main contraindications for IS: | show 🗑
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| 5 main hazards/complications for IS: | show 🗑
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| show | sustained maximal inspiration; slow, deep inhalation from FRC to TLC, followed by a 5-10 second breath hold.
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| show | volume oriented, flow oriented
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| The purpose of the "resting period" after an IS maneuver: | show 🗑
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| show | 1. need for improvement of lung expansion 2. need for noninvasive ventilatory support in hypercapneic patients 3. need to deliver aerosol medication
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| show | 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.
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| show | bronchial hygiene therapy and humidity therapy
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| The 1 absolute contraindication of IPPB: | show 🗑
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| show | respiratory alkalosis (accompanied by arrhythmias in severe alkalosis)
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| show | Gas may pass directly into the esophagus when the pressure at which the esophagus opens exceeds 20 cm H2O.
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| show | 1. improved VC, CXR, breath sounds, improved cough and secretion clearance, & oxygenation 2. increased FEV1 or peak flow 3. favorable patient subjective response
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| What 3 general assessments must be made before IPPB therapy? | show 🗑
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| show | aseptically occlude the patient connector and manually trigger a breath at low-flow setting (machine should cycle off)
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| When explaining the purpose of IPPB therapy, what 4 points must be addressed? | show 🗑
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| show | semi-Fowler's (unless contraindicated; supine acceptable)
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| When applying IPPB, what is the general breathing pattern goal? | show 🗑
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| show | the volumes delivered exceed those volumes achieved through the patients spontaneous breathing
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| show | q 72 hrs or with any change in patient status
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