Lunch Expansion Therapy RCP 111
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| The respiratory group is located in which areas of the brain? | The Pons and Medulla Oblongata
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| The Dorsal Respiratory group | is located in the posterior medulla.
Inspiratory Center Neurons
Responsible for the rythem of breathing.
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| 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.
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| What are included in the pontine respiratory centers? | Apneustic/pneumotaxic
(homeostatic mechanism)
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| Apneustic | lower portion of the pons.
sends impulses to activate inspiration.
Takes over if pneumotaxic is damaged.
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| Pneumotaxic | located bilaterally upper 1/3 of pons.
Restrains apneustic/cuts off the inspiration.
Innervated by the vagus nerve
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| What are the respiratory monitoring system chemoreceptors? | Central chemoreceptors
peripheral chemoreceptors
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| Central chemoreceptors | respond to an increas in hydrogen ions in CSF. Hydrogen ions porportional to co2.
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| 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.
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| Lung expansion therapy is designed to treat and prevent | atelectasis
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| What are the two types of atelectasis? | passive
resorption
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| Passive atelectasis is | the result of shallow breathing. Caused by persistent use of small tidal volume.
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| Passive atelectasis can occur with the following | surgery
medications (CNS depressents)
Neurolgical disorder
neuromuscular weakness
bed rest
immobility
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| Resorption atelectasis is the result of | an airway obstruction.
Muscus plugs are present in the airway and block ventilation.
Capillaries/blood flow absorb gas
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| What is lobar atelectasis | An entire lobe of atelectasis; a large plug
can also be caused by tumors.
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| what are factors causing atelectasis? | obesity
neuromuscular disease
sedation
surgery
spinal injury
bedridden
immobility
decreased cough
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| What are clinical signs of atelectasis? | breath sounds: decreased/crackles
tachycardia, tachypnea,cyanosis; secondary to hypoxemia.
CXR: increased opacity
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| Normal breathing physics | Transpulmonary Pressure (Ptp)
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| Transpulmonary Pressure (Ptp) | (Palv)-(Ppl)
alveolar pressure-pleural pressure
creates a gradient
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| Lung expansion therapy | increases lung volume by increasing the transpulmonary pressure gradient.
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| The greater the transpulmonary pressure gradient | the more the lung expands.
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| What are the types of lung expansion therapy? | Incentive Spirometry
Intermittent Positive Pressure Breathing.
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| Incentive Spirometry (IS) | increases the transpulmonary pressure gradient by lowering pleural pressure. Most effective b/c mimics normal physiology of breathing.
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| IPPB | increases the transpulmonary pressure gradient by increasing alveolar pressure.
(increased risk of damaging lung)
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| How do you know what to choose? | Needed equipment
Personnel
Risk
Cost
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| Incentive spirometry can be done with | mothpiece or a trache.
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| Incentive spirometry | mimics natural sighing by encouraging a slow, deep breathing.
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| The therapist determines | the volume and repetitions during IS
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| 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
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| Vital Capaicity | 65-75 ml/kg
(-10 ml/kg) not an effective therapy
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| THe indications of incentive spirometry. | Treat and prevent atelectasis
presence of restrictive lung disease
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| What are the contraindications of IS? | patients unable to take a deep breath
lack of consciousness/cooperation
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| What are the hazards/complications of IS? | hyperventilation
barotrauma
discomfort due to pain
hypoxia due to interrupted 02 therapy
bronchospasm
fatigue
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| What are the three IS devices? | indirect volume measuring device
volume oriented
flow oriented
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| Indirect volume measuring device | flow through a fixed orifice over time displaces volume
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| Volume oriented | not used anymore.
measures volume via bellows
bulky/large
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| Flow oriented | indirectly measures volume
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| 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
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| IPPB | invented by forest bird in 1947.
aka hyperinflation therapy
used for a broad range of clinical conditions.
1st ventilator
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| IPPB is used short term or long term? | Short term
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| IPPB csn be administered | several times a day or as frequently as once every hour.
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| What does IPPB require | spontaneously breathing patient
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| How can IPPB be given | with a mouthpiece or a mask
(Requires a tight seal)
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| IPPB is administered with a | pneumatic machine
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| Usually IPPB therapy is given accompanying | aerosol
32% less effective than hand held nebulizer.
3cc normal saline if ordered w/out treatment
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| IPPB Therapy lasts | 15 minutes
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| IPPB Requires a what? | 50 PSI sources
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| IPPB Indications | Prevent/Treat atelectasis
Inability to clear secretions due to inneffective ventilation and coughing.
short-term ventilatory support
Deliver aerosol medication.
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| Condraindications for IPPB | untreated pneumothorax
hemodynamic instability
increased ICP
Recent facial or esophageal surgery
tracheosophageal fistula
Acive hemoptisis
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| More contraindications for IPPB | Active/untreated TB
Evidence of blebs (over distension)
Singulations
Air swallowing
nausea
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| One important fact... | Increased thorax pressure clamps down on the great vessels and drops the blood pressure.
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| Hazards and complications of IPPB | barotrauma
hemodynamic instability
increased ICP (clamping of great vessels)
Air trapping
Nosocomial infection
Hemoptysis
Hypocarbia
Hyperoxia or hypoxemia
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| more hazards and complications of IPPB | Gastric distension/aspiration
Increased airway resistance
increased V/Q mismatch
Physchologic dependence
bronchospasm
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| Facts about the Bird Mark 7 | pneumatically powered
requires a closed circuit with exhalation valve and nebulizer
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| The machine incorporates a venturi or air entrainment jet to | enhance flow capabilities and decrease Fi02
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| What are the IPPB controls? | Pressure, Flow, Sensitivity, Air mix control and apnea timer.
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| Pressure | directly controls tidal volume.
Indirectly affects inspiratory time
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| Patients lung characteristics also affect tidal volume | lung compliance/tidal volume directly proportional.
Airway resistance/tidal volume indirectly proportional
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| Flow | directly controls speed (i time)
indirectly affects tidal volume
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| Sensitivity | controls patient effort needed to trigger machine
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| Air mix control | when used increases flow output and decreases Fi02
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| Apnea Timer | backup rate
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| Ventilator Class (Bird Mark 7) Pressure controller | Pressure does not change as a result of compliance and resistance changes
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| Volume Controller | Volume does not change as a result of compliance and resistance changes
-measures volume directly
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| Flow controller | volume does not change as a result of compliance and resistance changes
-measures volume indirectly by measuring flow
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| Phase 1 | change from exhalation to inspiration
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| Phase 2 | Inhalation
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| Phase 3 | Change from inhalation to exhalation
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| Phase 4 | Exhalation
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| Trigger: Phase 1 | Variable that triggers (starts) breath delivery.
Pressure (patient), manual or time.
Other trigger variables flow
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| 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)
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| Cycle: Phase 3 | Variable that cycles (stops) breath delivery.
Pressure.
Other cycle variables: volume, flow or time.
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| Phase 4 | Exhalation is passive
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| The circuit | Pressure drive line- powers nebulizer/ exhalation valve
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| Exhalation valve | close on inspiration/ opens on exhalation
Mushroom type valve
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| The IPPB can have a | mouthpiece or a mask
must have a tight seal
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| The left side of the IPPB machine is | the ambient side- atmospheric pressure
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| The right side is the | pressure side
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| The pressure control toggle | 10-40 cm H20
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| If pressure increases | tidal volume increases
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| If pressure decreases | Tidal Volume decreases
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| This is a pressure cycle machine and pressure | indirectly affects inspiratory time
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| TLC | Trigger, Limit, Cycle
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| Pressure Cycles the machine | off
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| Patient lung characteristics affect | tidal volume
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| Overly compliant lungs take | longer to reach pressure (longer i time)
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| Stiff lungs | Take less time to reach pressure, shorter i time
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| The longer its on | the more volume
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| lung compliance and tidal volume | are directly proportional
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| Airway resistance | and tidal volume are indirectly porportional
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| Flow control | 5-40 liters per minute
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| Flow control | directly controls speed
The higher the speed the less time
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| Flow indirectly affects tidal volume | More flow less tidal volume
less flow more tidal volume
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| Sensitivity (trigger) | Controls patient effort need to trigger machine one
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| The trigger variable | initiates the machine
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| Manual trigger | is red
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| Patient trigger | based on their effort
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| time trigger | black (apnea)
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| Patient effort for sensitivity | 5-40
5 easier to trigger
40 more difficult to trigger
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| Apnea | makes machine trigger by itself
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| The closer the magnets | the more difficult to trigger machine
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| The farther away the magnets are | the easier it is to trigger machine
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| The initial setting on the Bird Mark 7 | is 15/15/15
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| The Air max control | in 100% Fi02
out 40-60% FI02
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| Limit variable | Flow
Can't get more or less flow than set
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| Manomometer | Green +, Pink (-)
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| How can you measure volume | Wrights respirometer
Flows over time to give volume measurement
Hooks on exhalation valve.
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