Term
| What are the physical signs of atelactesis |
|
Definition
| "rapid shallow breathing due to decreased compliance, increased tactile fremitus over the effected area due to increase in density, dullness to percussion over the effected area due to the increase in density, fine/late inspiratory crackles or bronchial breath sounds and/or dereased breath sounds over the effected area; brochophony, egophony, or whispered pectoriloquy; tachycardia in the presence of hypoxemia; fever; hypoxemia and hypocapnia on the arterial blood gas and/or; desaturation on pulse oximetry" |
|
|
Term
| what type of medical history predisposes a pt to atelactesis |
|
Definition
| "upper abdominal surgery or thoracic surgery, chronic lung disease and/or smoking history following surgery or prolonged bed rest" |
|
|
Term
| How is respiratory rate affected by atelectasis |
|
Definition
| "it is directly proportional, as the atelectasis progresses, the respiratory rate increases" |
|
|
Term
| "With atelectasis, what does the chest radiograph reveal" |
|
Definition
| "increased opacity of the effected lung in a segmental, lobar, or whole lung field; plate atelectasis pattern in segmental or subsegmental atelecasis; displacement of the interlobar fissure towards the effected area; crowding of the pulmonary fasculature; air bronchograms; elevation of th eadjacent diaphragm; narrowing of rib interspaces; mediastinal or tracheal shift towards massive atelectasis and/or compensatory hyperexpansion of the surrounding lung" |
|
|
Term
| what is the cause/mechanism of resorption atelectasis |
|
Definition
| "A bronchus is obstructed by mucus plug, bronchial lesion, etc. o2 in obstructed segment or lobe diffuses into passing blood in pulmonary vasculature. this allows the alveoli to shrink beyond the point where surface tension can maintain normal alveolar geometry resulting in collapse." |
|
|
Term
| The alveolar shrinkage of resorption atelectasis is more pronounced in which type of pts |
|
Definition
| "patients on an increased Fio2, since a greater proportion of the alveolar volume is occupied by oxygen. Since nitrogen is not consumed, it remains in equilibrium in the alveoli, as does CO2, since there is no pressure gradient for it to leave the alveoli" |
|
|
Term
| How would resorption atelectasis caused by mucus plugging be treated |
|
Definition
| "It is releaved by deep breathing and coughing, adequate hydration, chest physical therapy, bronchoscopy with mucolytic lavage, intrapulmonary percussive ventilation and other bronchial hygiene maneuvers" |
|
|
Term
| "Generally, how is resorption atelectasis treated" |
|
Definition
| "by first determining the cause and then following the specific protocol for the specific cause (i.e., mucus plugging relieved by deep breathing and coughing, among other options for treatment)" |
|
|
Term
| How would resorption atelectasis caused by obstruction caused by a tumor treated |
|
Definition
| "may be mechanically removed or shrunk by antineoplastic therapy. in the meantime, the pts increased work of breathing may be relieved by heliox" |
|
|
Term
| How would resorption atelectasis caused by malpositioned ET tube be treated |
|
Definition
| the ET tube would be re-positioned |
|
|
Term
| How would resorption atelectasis caused by a foreign body be relieved |
|
Definition
|
|
Term
| What is the cause/mechanism of passive atelectasis |
|
Definition
| "when alveoli are not periodically stretched by yawning, sighing or other deep breathing they begin to shrink. susceptible patients rapidly and shallowly breath and eventually, the alveoli collapse when surface tension overcomes the elastic forces keeping them open." |
|
|
Term
| What type of patients are susceptible to passive atelectasis |
|
Definition
| "debilitated patients who remain motionless in bed, most commonly in dependent lung segments and lobes. Post op patients who do not actively engatge in deep breathing or sighing due to pain or depressive effects analgesics have on teh respiratory center in the brain" |
|
|
Term
| What is the treatment for passive atelectasis |
|
Definition
| "debilitated patients need to be moved periodically by rolling every two hours as an example. some hospitals have kinetic beds that continuously move the patients. post op pts must deep breathe. pts unable to voluntarily deep breathe may need IPPB and those who do, may benefit from IS" |
|
|
Term
| What are the indications for IS |
|
Definition
| "presence of conditions predisposing to the development of pulmonary atelectasis ( upper abdominal surgery, thoracic surgery, surgery in pts with COPD); presence of pulmonary atelectasis, presence of restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm" |
|
|
Term
| What are the contraindications for IS |
|
Definition
| "pt cannot be instructed or supervised to ensure appropriate use, pt cooperation is absent or unable to understand or demonstrate proper procedure; pts unable to deep breathe effectively (ie pts with VC less than 10 ml/kg or IC less than about 1/3 predicted); presence of open tracheal stoma is not a contraindication but requires adaptation of the spirometer" |
|
|
Term
| What are the hazards associated with IS |
|
Definition
| "ineffective unless closely supervised or performed as ordered, hyperventilation, exacerbation of bronchospasm, hypoxia due to break in mask O2 therapy, inappropriate as sole treatment for major lung collapse or consolidation, barotrauma (emphysematous lungs); fatigue; discomfort secondary to inadequate pain control" |
|
|
Term
| What is the reason for dizziness and numbness around the mouth during IS |
|
Definition
| acute respiratory alkalosis is the most common problem associated with IS and this causes dizziness and numbness of the mouth. |
|
|
Term
| How is dizziness and numbness of the mouth associated with IS treated? |
|
Definition
| careful instruction and monitoring of the patient. Encourage the patient to slow their efforts and slow inspiratory flow |
|
|
Term
| What are the potential positive outcomes of IS |
|
Definition
| "absence of or improvement in signs of atelectasis, decreased respiratory rate, normal pulse rate, resolution of abnormal breath sounds, normal or improved chest radiograph, improved PaO2 and decreased PaCO2, increased Spo2, increased VC and peak expiratory flows, restoration of preoperative FRC or VC, improved inspiratory muscle performance and cough, attainment of preoperative flow and volume levels, increased FVC" |
|
|
Term
| What is the appropriate time a high risk surgical patient should be oriented to IS |
|
Definition
| During the assessment/screening of patients undergoing abdominal surgery. assessment conducted at this point will help identify patients at high risk for postoperative complications and allow determinatin of their baseline lung volumes and capacities. It provides an opportunity to orient them to the procedures of IS thereby increasing the liklihood of success when IS is provided after surgery |
|
|
Term
| WHat are the instructions the practitioner gives to the patient prior to IS treatment |
|
Definition
| "Make sure to set an intial goal and that it is attainable, but not too low which results in little incentive and ineffective maneuver. Instruct the patient to inspire slowly and deeply to maximize the distribution of ventilation" |
|
|
Term
| What are the instructions the practioner gives while a patient is performing IS |
|
Definition
| instruct the patient to sustain his or her maximal inspiratory volume for 5 - 10 seconds. A normal exhalation should follow the breath-hold maneuver and rest as long as needed between maneuvers. PERFORM 5-10 MANEUVERS PER HOUR |
|
|
Term
|
Definition
| application of insiratory positive pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic modality. They usually last 15-20 minutes and may be given for a variety of reasons. |
|
|
Term
| WHat are the indications for IPPB |
|
Definition
| "need to improve lung expansion (atelactasis when other forms have been unsuccessful, uncooperative pt; inability to clear secretions b/c of pathology that limites the ability to ventilate or cough effectively and failure to respond to other modes of treatment); need for short-term noninvasive vent support to hypercapniec patients (alternative to intubation and continuous ventilatory support); the need to deliver aerosolized meds (some disagree, however with bronchospasm such as asthma that is unresponsive to MdI or nebulizer with close observation); deliver aerosol meds to pts with ventilatory muscle weakness or fatigue or chronic conditions in which intermittent noninvasive ventilatory support is indicated" |
|
|
Term
| what are the contraindications for IPPB |
|
Definition
| "the only absolute is tension pneumothorax and carefully evaluate the following: ICP>15 mmhg; hemodynamic instability; recent facial oral or skull surgery; tracheoesophageal fistula; recent esophageal surgery; active hemoptysis; nausea; air swallowing; active, untreated tuberculosis; radiographic evidence of bleb; singultus (hiccups)" |
|
|
Term
| What are the hazards associated with IPPB |
|
Definition
| "increased a/w resistence; barotrauma; pneumothorax; nosocomial infection; hyperventilation/hypocapnia; hemoptysis; hyperoxia when oxygen is the gas source; gastric distention; secretion impaction (inadequate humidity); psychological dependence; impedance of venous return; exacerbation of hypoxemia; hypoventilation; increased v/q mismatch; air trapping, auto-PEEP, overdistended alveoli" |
|
|
Term
| What are the hazards associated with IPPB specific to bullous emphysema |
|
Definition
| "pulmonary barotrauma in the form of a pneumothorax may occur in patients with bullous emphysema. In the event tht a bulla is hyperinflated., it may rupture. " |
|
|
Term
| What is the baseline assessment conducted prior to beginning IPPB therapy? |
|
Definition
| "It includes both a general evaluation of the pt clinical status and specific assessment related to the chosen therapeutic goals. The general assessment includes: measurement of vital signs, observational assessment of the pt appearance and sensorium, breathing pattern and chest auscultation." |
|
|
Term
| What is the purpose of a baseline assessment conducted prior to IPPB treatment |
|
Definition
| helps individualize the treatment and allows objective evaluation of the patient's subsequent response to therapy. together with the pt medical history it alerts the RT to possible problems or hazards associated with administering IPPB to a specific pt. |
|
|
Term
| What are the troubleshooting steps if an IPPB won't cycle off or end inspiration |
|
Definition
| "check the patency of the pt breathing circuit by occluding the pt connector and manually trigger a breath at a low-flow setting because leaks are what cause the IPPB not to cycle off or end inspiration. If you do this and the system pressure rises and the machine cycles off, the circuit is free of any major leak" |
|
|
Term
| describe the initial settings on an IPPB machine |
|
Definition
| "sensitivity or trigger of about 1-2 cm H2O, system pressure initially set to 10-15 cmH2O (resulting volumes measured and pressure adjusted accordingly), low-to-moderate flow control and adjust to pt breathing pattern. The goal is to establish a breathing pattern consisting of about 6 breaths per minute, with an expiratory time of at least 3 to 4 times longer (I:E ratio of 1:3 to 1:4 or lower) - all adjusted to pt need" |
|
|
Term
| What are the volume goals of IPPB |
|
Definition
| "IPPB treatment is volume oriented when treating for atelectasis: strive for a volume of 10 - 15 ml/kg of body weight or at least 30% of predicted IC. If initial volumes fall short and pt can tolerate, pressure should be gradually increased until this goal is reached. pressure as high as 30-35 cm H2O may be needed to achieve this end when lung compliance is reduced. To ensure the greatest volume, pt should be encouraged to actively breathe during positive pressure breath" |
|
|
Term
| What are the indications for CPAP |
|
Definition
| "CPAP treatment in the post op pt population is used, but the book states should be used on a continuous basis until the pt condition improves; used to treat cardiogenic pulmonary edema which reduced venous return and cardiac filling time" |
|
|
Term
| what are the contraindications for CPAP |
|
Definition
| "hemodynamically unstable; hypoventilation ( machine does not ensure ventilation); nausea, facial deformities, untreated pneumothorax, elevated intracranial pressure" |
|
|
Term
| What are some of the hazards/complications of CPAP |
|
Definition
| increases work of breathing therefore it can lead to hypoventilation and hypercapnia; does not augment spontaneous ventilation and pts with ventilatory insufficiency may hypoventilate; barotrauma; gastric distention at pressures above 15 cm H2O - which leads to vomiting and aspiration |
|
|
Term
| what are the components of a CPAP machine |
|
Definition
| "breathing gas mixture from oxygen blender; into inspiratory limb of of a breathing circuit; a reservoir bag; provides reserve volume if the patient's inspiratory flow exceeds that of the system, pt breathes in and out of a simple valveless t-piece connector, pressure alarm system with manometer, monitors the CPAP pressure at the pt airway, alarm sysgem warns of either low or high system pressure, expiratory limb, , connected to threshold resister, in this case a water column, emergency inlet valve" |
|
|
Term
| what are the initial flow settings of a CPAP |
|
Definition
| initially set to 2 to 3 times he pts minute ventilation and adjusted therafterby carefully observing airway pressure. flow is adequate when the system pressure drops no more than 1-2 cm H2O during inspiration |
|
|
Term
| What are the conditions most likely to predispose a pt to atelectasis |
|
Definition
| "those who cannot take a deep breath: those with significant obesity, those with neuromuscular disorders, those under heavy sedation, those who have undergone abdominal (especially UPPER abdominal) surgery or thoracic surgery, spinal cord injury , bedridden patients, especially due to truama." |
|
|
Term
| What does lung expansion therapy accomplish |
|
Definition
| increases lung volume by increasing the transpulmonary pressure gradient. This gradient represents the difference between the alveolar pressure and the pleural pressure |
|
|
Term
| "With all things being constant, the greater the what gradient, the more that the alveoli expand?" |
|
Definition
| the greater the PL(transpulmonary ) |
|
|
Term
| How can the PL (transpulmonary) gradient be increased |
|
Definition
| by either decreasing the surrounding Ppl (pleural pressure) or increasing the Palv (alveolar pressure) |
|
|
Term
| How does a spontaneous deep inspiration increase the PL (transpulmonary) gradient |
|
Definition
| by decreasing the Ppl (pleural pressure) |
|
|
Term
| How does positive airway pressure increase the PL (transpulmonary gradient) |
|
Definition
| by raising the pressure inside the lung |
|
|
Term
| How does IS enhance lung expansion |
|
Definition
| vi spontaneous and sustained decrease in Ppl (pleural) pressure |
|
|
Term
| Which method has a more physiologic effect and are most effective |
|
Definition
| those that decrease Ppl (i.e. IS) however they require an alert and cooperative patient |
|
|
Term
| what is the goal of any lung expansion therapy |
|
Definition
| to implement a plan that provides an effective strategy in the most efficient manner. |
|
|
Term
| Describe the basic maneuver of IS |
|
Definition
| "it is designed to mimic a slow, deep breath. A sustained maiximal inspiration (SMI). SMI is a slow, deep inhalation from the FRC up to (ideally) the total lung capcity, followed by a 5-10 second breath hold. An SMI is thus functionally equivalent to peforming an inspiratory capcity (IC) maneuver, followed by a breath hold." |
|
|
Term
| How does CPAP work to treat pulmonary edema |
|
Definition
| "reduced venous return and cardiac filling pressures, which is helpful in reducing pulmonary vascular congestion" |
|
|
Term
| How is the inhaled volume from a flow-oriented IS device calculated |
|
Definition
| equated with volume by assessing the duration of inspiration or time (flow x time = volume) |
|
|
Term
| Describe the airway pressure change seen during CPAP |
|
Definition
| "CPAP maintains a positive airway pressure throughout both inspiration and expiration. CPAP elevates and maintains high alveolar and airway pressures thoughout the full breathing cycle. This increases PL gradient throughout both inspiration and expiration.The patient on CPAP breathes through a pressurized circuit against a threshold resistor, with pressures maintained between 5 and 20 cm H2O. To maintain system pressure throughout the breathing cycle, CPAP requires a source of pressurized gas." |
|
|
Term
| what factors contribute to CPAPs beneficial effects |
|
Definition
| "the recruitment of collapsed alveoli via an increase in FRC, decreased work of breathing due to increased compliance or elimination of autopositive end-expiratory pressure (PEEP), an improved distribution of ventilation through collateral channels (khrones pores) and an increase in teh efficiency of scretion removal." |
|
|
Term
| Explain the standard precautions associated with patient equipment |
|
Definition
| "handle used patient care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. do not use reusable equipment to care for another patient unless it has been cleaned and reporcessed appropriately. properly discard single-use items. hand washing, the use of a high-efficiency particulate air filter distal to the IPPB ventilator, and daily circuit changing contribute to this goal" |
|
|
Term
| What does postural drainage therapy involve the use of? |
|
Definition
| "gravity and mechanical energy to help mobilize secretions, improve V/Q balance, and normalize the functional residual capacity (FRC)." |
|
|
Term
| What does postural drainage therapy include |
|
Definition
| "turning, postural drainage, and percussion and vibration; cough methods are used with postural drainage also" |
|
|
Term
| What is the rotation of the body around the longitudinal axis |
|
Definition
|
|
Term
| What is the primary purpose of turning |
|
Definition
| "to promote lung expansion, improve oxygenation, and prevent retention of secretions; other benefits include a reduction in venostasis and prevention of skin ulcers" |
|
|
Term
| WHat are the two absolute contraindications to turning: |
|
Definition
| unstable spinal cord injuries and traction of arm abductors |
|
|
Term
| What are relative contraindications to turning |
|
Definition
| "diarrhea, marked agitation, a rise in intracranial pressure, large drops in blood pressure (greater than 10%), worsening dyspnea, hypoxia, and cardiac arrhythmias" |
|
|
Term
| What are some hazards and complications associated with postural drainage therapy (AARC) |
|
Definition
| "hypoxemia, increased ICP, Acute hypotension during procedure, Pulmonary hemorrhage, pain or injury to muscles, ribs or spine, vomiting and aspiration, bronchospasm, arrhythmias" |
|
|
Term
| "Besides the AARC hazards and complications associated with postural drainage, what are some plumbing problems associated with turning" |
|
Definition
| "ventilator disconnections, accidental extubation, accidental aspiration of ventilator circuit condensate, and disconnection of vascular lines or urinary catheters" |
|
|
Term
| Proning the patient is a strategy most often applied to the treatment of patients with what? |
|
Definition
|
|
Term
| what has proning in the patient with ALI (acute lung injury) been shown to improve |
|
Definition
| oxygenation without negative effects on hemodynamics |
|
|
Term
| What two factors account for improvement in oxygenation when proning patients with ALI (aute lung injury) |
|
Definition
| "transpulmonary pressure generated in the prone position probably exceeds the airway opening pressure in dorsal lung regions; the prone position probably shifts blood flow away from shunt regions, thus increasing areas with normal V/Q balance. This redistribution of blood flow is most likely caused by gravity-induced recruitment of previously atelectactic but healthy areas" |
|
|
Term
| what does the prone position decrease the liklihood of |
|
Definition
| further lung injury associated with positive-pressure ventilatin of patients with ARDS |
|
|
Term
| what does postural drainage involve the use of |
|
Definition
| "gravity to help move respiratory tract secretions from distal lung lobes or segments into the central airways, where they can be removed by cough or suctioning" |
|
|
Term
| How is postural drainage done |
|
Definition
| by placing the segmental bronchus to be drained in a vertical position relative to gravity |
|
|
Term
| How long are positions used in postural drainage held for |
|
Definition
| 3-15 minutes and modified as the patient's condition and tolerance warrant |
|
|
Term
| What involves positioning the patient so gravity will assist the drainage of secretions |
|
Definition
| postural drainage therapy |
|
|
Term
| "WHat are some added benefits, beside drainage of secretions, to postural drainage therapy" |
|
Definition
| improved distribution of ventilation and an improvement in ventilation and perfusion |
|
|
Term
| WHat assists gravity in postural drainage therapy |
|
Definition
| mechanical energy in the form of percussion and vibration |
|
|
Term
| Postural drainage is most effective in conditions characterized by what? |
|
Definition
| excessive sputum production (greater than 25-30 ml/day) |
|
|
Term
| "For maximum effect in postural drainage, head-down positions should not exceed what?" |
|
Definition
| 25 degrees below horizontal |
|
|
Term
| Postural drainage is not likely to succeed until what |
|
Definition
| adequate systemic and airway hydration is ensured |
|
|
Term
| "in critical care patients, including those on mechanical ventilation, postural drainage should be performed how often" |
|
Definition
|
|
Term
| "In spontaneously breathing patients, frequency should be determined how" |
|
Definition
| by assessing patient response to therapy |
|
|
Term
| When would a clinician need to modify head-down positions |
|
Definition
| "in patients with unstable cardiovascular status, hypertension, cerebrovascular disorders, or dyspnea related to changes in postion" |
|
|
Term
| How long should the postural drainage positions be held |
|
Definition
| 3-15 minutes if tolerated and longer if good sputum production results |
|
|
Term
| AARC assessment of outcome in postural drainage |
|
Definition
| "change in sputum production, change in breath sounds of lung fields being drained, patient subjective response to therapy, change in vital signs, change in chest radiograph, change in ABG values or oxygen saturation, change in ventilator variables" |
|
|
Term
| What is secretion clearance enhanced by |
|
Definition
| hydration; clinician may need to wait 24 hours after optimal systemic hydration has been achieved to see any evidence of increased sputum production |
|
|
Term
| what can tracheobronchial clearance be enhanced by |
|
Definition
| bland aerosol therapy with an unheated jet nebulizer |
|
|
Term
| What should the clinician identify on the basis of preliminary assessment of the patient and review of the physician's order for postural drainage |
|
Definition
| "Identify the appropriate lobe and segments for drainage; also it should be determined if the position chosen needs to be modified since the clinician may need to modify head-down positions in patients with unstable cardiovascular disorders, or dyspnea related to changes in position" |
|
|
Term
| When should the clinician shcedule ppostural drainage treatment times to avoid gastroesophageal reflus and the possibility of aspiration |
|
Definition
| before or at least 1 1/2 to 2 hours after meals or tube feedings |
|
|
Term
| When should the clinician schedule postural drainage treatments if the patient assessment indicates tha tpain may hinder treatment implementation |
|
Definition
| consider coordinating the treatment regimen with prescribed pain medication |
|
|
Term
| "Before postural drainage procedure positioning, what should be done?" |
|
Definition
| "The procedure should be explained to the patient; and as necessary, clothing around the waist and neck should be loosened. Also, the clinician should inspect any monitoring leads, intravenous tubing, and oxygen therapy equipment connected to the patient and make adjustments to ensure continued function during the procedure" |
|
|
Term
| What does postural drainage predispose the patient to and what should be considered a routine component of monitoring during postural drainage |
|
Definition
| "postural drainage positioning predisposes patients to arterial desaturation, pulse oximetry shoudl be conisidered a routine component of monitoring. also measure pt vital signs and auscultate the chest. serve as baseline for monitoring response and assessing outcome" |
|
|
Term
| "For postural drainage, to obtain proper head-down position, the clinician must lower th ehead of the bed by what and what angle" |
|
Definition
| lower the head of the bed by at least 16 - 18 inches to achieve the desired 25-degree angle |
|
|
Term
|
Definition
| "in the ambulatory care setting, a tilt tabel can be used in lieu of a hospital bed. It allows precise positioning at head-down angles up to 45 degrees; with this large of angles, shoulddr supports must be provided to prevent the patient from sliding off the table" |
|
|
Term
| What does the clinician do once the patient is in the appropriate postural drainage position |
|
Definition
| confirm his or her comfort and ensure proper support of all joints and bony areas with pillows or towels. |
|
|
Term
| How long should the postural drainage position be held |
|
Definition
| "3 - 15 minutes if tolerated, and longer if good sputum production results. Between positions, pauses for relaxation and breathing control are useful and can help prvent hypoxemia. " |
|
|
Term
| Why do clinicians recommend 100% oxygen to critically ill patients receiving postural drainage therapy |
|
Definition
| Because postural drainage therapy can increase oxygen consumption |
|
|
Term
| What is the clinician's role during postural drainage therapy; while the patient is in position |
|
Definition
| "continually observe the patient for complications, expect moderate changes in vital signs but significant problems may require immediate intervention" |
|
|
Term
| "Besides observing the patient, what else should be ensured " |
|
Definition
| "ensure appropriate coughing technique both during and after positioning. When using the head-down position the patient should avoid strenuous coughing, because this will markedly raise intracranial pressure. - Have the pt use the forced expiration technique . total treatment time should not exceed 30 - 40 minutes " |
|
|
Term
| Does postural drainage result in the immediate production of secretions |
|
Definition
| "no, secretions are more often simply mobilized toward the trachea for easier removal by coughing. If the procedure causes vigorous coughing have th pt sit up until th ecough subsides" |
|
|
Term
| What shoule the clinician do after the postural drainage treatment is over |
|
Definition
| "restore the pt to the pre treatment position, and ensure his or her stability and comfort. Immediate post-treatment assessment includes repeat vital signs, confirmation of satisfactory arterial saturation, chest auscultation, and patient questioning regarding his ro her subjective response to the procedure" |
|
|
Term
| What action should be taken if the patient experiences hypoxemia during postural drainage therapy |
|
Definition
| "administer higher FIO2 if potential for or observed hypoxemia exists; if hypoxemic during treatment administer 100% O2, stop therapy immediately return patient to original position and consult a physician" |
|
|
Term
| What action should be taken if the patient experiences increased intracranial pressure during postural drainage therapy |
|
Definition
| "stop therapy, return patient to original resting position, and consult physician" |
|
|
Term
| What action should be taken if the patient experiences acute hypotension during postural drainage therapy |
|
Definition
| "stop therpay, reutrn patient to original resting position, consult physician" |
|
|
Term
| What action should be taken if the patient experiences pulmonary hemorrhage during postural drainage therapy |
|
Definition
| "stop therapy, return patient to original resting position, call phusican immediately. Administer o2 and maintain an airway until physican responds" |
|
|
Term
| "What action should be taken if the patient experiences pain or injury to muscles, ribs or spine during postural drainage therapy" |
|
Definition
| "stop therapy that appears directly associated with pain or problem, exercise care in moving patient, and consult physican" |
|
|
Term
| What action should be taken if the patient experiences vomiting and aspiration during postural drainage therapy |
|
Definition
| "stop therapy, clear airway and suction as needed, administer oxygen, maintain airway, return patient to previous resting position, and contact physican immediately" |
|
|
Term
| What action should be taken if the patient experiences bronchospasm during postural drainage therapy |
|
Definition
| "stop therapy, return patient to previous resting position, and adminster or increase oxygen delivery while contactin physican. adminster physician-ordered bronchodilators" |
|
|
Term
| What action should be taken if the patient experiences arrythmias during postural drainage therapy |
|
Definition
| "stop therapy, return patient to previous resting postion, and adminster or increase oxygen delivery while contacting physican" |
|
|
Term
| How do you position a patient for postural drainage when the anterior upper segment needs draining |
|
Definition
| Semi-Fowler's with pillow under knees[image] Semi-fowler’s with pillow under knees |
|
|
Term
| How do you position a patient for postural drainage when nposterio apical segment needs draining |
|
Definition
| "sitting up, leaning forward with pillow under knees" |
|
|
Term
| How do you position a patient for postural drainage when the anterior segments needs draining |
|
Definition
| "lying flat, pillow under knees" |
|
|
Term
| How do you position a patient for postural drainage when the right posterior segment needs draining |
|
Definition
| "lying on left side left arm behind, left leg behing, right side of body angled to the right" |
|
|
Term
| How do you position a patient for postural drainage when the left posterior segment needs draining |
|
Definition
| "lying on stomach, bed raised to an angle, pillow under left arm/abdomen" |
|
|
Term
| How do you position a patient for postural drainage when the right middle lobe needs draining |
|
Definition
| "head down, legs raised 12 inches, leaning to the right" |
|
|
Term
| How do you position a patient for postural drainage when the left lingular needs draining |
|
Definition
| "head down, feet raised 12 inches leaning to the left" |
|
|
Term
| How do you position a patient for postural drainage when the anterior upper segment needs draining |
|
Definition
| "head down leaning to the left, legs raised 18 inches, pillow supporting arm/abdomen" |
|
|
Term
| How do you position a patient for postural drainage when the posterior segments needs draining |
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Definition
| "lying on stomach legs raised 18 inches, pillow under feet, pillow under abdomen" |
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Term
| How do you position a patient for postural drainage when the superior segment needs draining |
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Definition
| "lying flat, pillow under stomach, pillow under legs" |
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Term
| what is the rule of thumb when an untoward patient response is observed during postural drainage |
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Definition
| "TRIPLE S RULE - stop therapy, (return patient to original position), stay with the patient until he/she is stabalized" |
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Term
| what are the absolute contraindications of postural drainage therapy |
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Definition
| head and neck injury; active hemorrhage with hemodynamic instability; |
|
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Term
| what are the relative contraindications of postural drainage therapy |
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Definition
| ICP > 20 mmhg; recent spinal injury; hemoptysis; empyema; bronchopleural fistula; pulmonary edema with CHF; aged/confused/anxious; pulmonary embolism; rib fracture; surgical/healing tissue/wounds; large pleural effusions |
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Term
| what are contraindications for trendelenburg position during postural drainage therapy |
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Definition
| hemoptysis; icp > 20 mmhg; hypertension; distended abdomen; pt needing to avoid increased ICP (aneurysms); uncontrolled airway at risk for aspiration; esophageal surgery |
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Term
| What are contraindications to external manipulation of the thorax (postural drainage AARC) |
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Definition
| "subcutaneous emphysema, recent epidural spinal infusion or spinal anesthesia; recently placed transvenous pacemaker or subcutaneous pacemaker; lung contusion; osteomyelitis of the ribs; coagulopathy; skin grafts/flaps on thorax; suspected pulmonary TB; bronchospasm; osteoporosis; complaint of chest wall pain" |
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Term
| what are the hazards and complication associated with postural drainage |
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Definition
| "hypoxemia; increased ICP; acute hypotension during procedure; pumonary hemorrhage, pain or injury to muscles/ribs/spine, vomiting and aspiration, bronchospasm, arrhythmias" |
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Term
| Is obtaining all the assessment outcome criteria required for continuing postural drainage therapy? |
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Definition
| "not all criteria are required, to justify continuing..usually one or more is an indication that therapy is working" |
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Term
| What is secretion clearance affected by? |
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Definition
| "affected by patient hydration, clinician may need to wait for at least 24 hours after optimal systemic hydration ahs been achieved to see any evidence of incrased sputum production." |
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Term
| "If a clinician is waiting for optimal systemic hydration in order to determine if there is evidence of increased sputum production with regard to postural drainage, what can tracheobronchial clearance be enhanced by" |
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Definition
| providion of bland aerosol therapy with an unheated jet nebulizer |
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Term
| "Following postural drainage therapy the clinician may note diminished breath sounds and crackles that change to course crackles after, what is this due to" |
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Definition
| "loosening of secretions and their mmovement into the larger airways, an intended purpose of the therapy. these course crackles should clear after coughing or suctioning" |
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Term
| "On the basis of assessment results, the postural drainage order should be re-evaluated how often?" |
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Definition
| At least every 48 hours for critical care patients and at least every 3 days for other hospitalized patients. Home care patients should be reevaluated at least every 3 months or whenever their status changes |
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Term
| What should the chart entry of postural drainage therapy include |
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Definition
| "the positions used, time in position, patient tolerance, subjective and objective indicators of treatmetn effectiveness 9including amount, color, and consistency of sputum produced) and any untoward effects observed" |
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Term
| "Why should a clinician make a return visit to a patient who had postural drainage therapy, within 1 to 2 hours after treatment" |
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Definition
| because the effects of the procedure may not bve immediately evident |
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Term
| What are the four mechanisms impairing the cough reflex |
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Definition
| "irritation, inspiration, compression, expulsion" |
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Term
| What are examples of impairments affecting the irritation phase of the cough reflex |
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Definition
| "Anesthesia, CNS depression, Narcotic-analgesics" |
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|
Term
| What are examples of impairments affecting the Inspiration phase of the cough reflex |
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Definition
| "pain, neuromuscular dysfunction, pulmonary restriction, abdominal restriction" |
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Term
| What are examples of impairments affecting the compression phase of the cough reflex |
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Definition
| "laryngeal nerve damage, artificial airway, abdominal muscle weakness, abdominal surgery " |
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Term
| What are examples of impairments affecting the expulsion phase of the cough reflex |
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Definition
| "airway compression, airway obstruction, abdominal muscle weakness, inadequate lung recoil (emphysema)" |
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Term
| "In the initial irritation phase of a cough, an abnormal stimulus provokes what" |
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Definition
| sensory fibers in the airways to send impulses to the brain's medullary cough center |
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Term
| What are the different stimuli that provokes sensory fibers in the airway that send impulses to brain during the irritation phase of a cough |
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Definition
| "inflammatory, mechanical, chemical, or thermal" |
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Term
| What is a good example of a cough stimulation due to an inflammatory process |
|
Definition
|
|
Term
| What can provoke a cough through mechanical stimulation |
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Definition
|
|
Term
| What is an example of chemical irritant that would stimulate a cough |
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Definition
|
|
Term
| what is an example of thermal stimulation of a cough |
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Definition
|
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Term
| What happens after the initial irritation phase of a cough with regard to stimuli - second phase/inspiration phase |
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Definition
| "Once the afferent impulses are received, the cough center generates a reflex stimulation of the respiratory muscles to initiate a deep inspiration (in adults, averages 1 - 2L)" |
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Term
| What happens in the third phase/compression phase of cough reflex with regard to stimuli |
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Definition
| reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles. .2 seconds and results in a rapid rise in pleural and alveolar pressure |
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Term
| What initiates the expulsion phase (fourth phase) |
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Definition
| "with the glottis open, a large pressure gradient between the intrathoracic airways and the atmospheric pressure is exposed. contraction of expiratory muscles along with this, causes a pressure gradient causing a violent expulsive flow of air from the lungs. high velocity gas flow, dynamic airway compression together create huge shear force displacing mucus from airway walls into air stream forcing it to be expelled from lower to upper airways and expectorated" |
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Term
| "What can mucus plugging, which is full airway obstruction, result in" |
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Definition
| "atelectasis, and impaired oxygenation due to shunting" |
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Term
| What can rentention of secretions lead to |
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Definition
| "in the presence of pathogenic orgamisms, can lead to infection which in turn can provoke an inflammatory response and the release of chemical mediators." |
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Term
| What are chemical mediators released in the inflammatory process and what is the danger of them with regard to abnormal clearance/retention of secretions |
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Definition
| "leukotrienes, proteases and elastases and they can damage the airway epithelium and increase mucus production resultin gin a vicious cycle of worsening airway clearance" |
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Term
| What is a compounding factor associated with retained secretions |
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Definition
| failure of the cough reflex. interference with any of the four phases of cough reflex can result in ineffective airway clearance |
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Term
| Identify different conditions that can impair airway clearance |
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Definition
| "Internal obstruction or external compression of the airway lumen - such as: foreign bodies, tumors, congenital or acqured thoracid anomalies (kyphoscoliosis). " |
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Term
| "With regard to airway clearance, internal obstruction can occur with what?" |
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Definition
| "mucus hypersecretion, inflammatory changes, or bronchospasm, further narrowing the lumen. Ex include asthma, chronic bronchitis adn acute infections" |
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Term
| What is a disorder that alters normal mucociliary clearance and can also cause secretion retention. |
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Definition
| CF - the solute concentration of mucus is altered because of abnormal sodium and chloride transport. This increases mucus viscosity and impairs its movement up the respiratory tract. |
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Term
| Chronic airway inflammation and infection can lead to bronchiectasis which is a common finding in which two things |
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Definition
| [image]CF and ciliary dyskinetic sydromes |
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Term
| "In bronchiectasis, what happens to the airway" |
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Definition
| "airway is permanently damaged, dilated and prone to [image] Airway is permanently damaged, dilated, and prone to constant obstruction by retained secretions |
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Term
| what are other conditions that can lead to bronchiectasis |
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Definition
| "chronic obstructive lung diseases, foreign body aspiration and obliterative bronchiolitis" |
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Term
| any condition that affects the four components of an effective cough will also alter what |
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Definition
|
|
Term
| "With normal mucociliary function but an ineffective cough, what happens" |
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Definition
| "musculoskeletal and neurological disorders, including muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, myasthenia gravis, poliomyelitis and cerebral palsy" |
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Term
| What is the primary goal of bronchial hygiene therapy |
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Definition
| "help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange and reduce the work of breathing" |
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Term
| What are the indications for bronchial hygiene therapy treating acute conditions |
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Definition
| "copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, V/Q abnormalities caused by unilateral lung disease" |
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|
Term
| what are disorders associated with retention of secretions |
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Definition
| "acute diseases - immobile patients, postoperative patients, exacerbations of COPD; chronic disease: cystic fibrosis and neuromuscular disorders" |
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Term
| "Identify the condition where ""proning"" is most commonly applied" |
|
Definition
| patients with ALI (acute lung injury) - it has been shown to improve oxygenation in patients with ALI without negative effects on hemodynamics |
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|
Term
| What is the primary purpose of proning |
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Definition
| "to promote lung expansion, improve oxygenation and prevent retention of secretions. Also, reduction in venostasis and prevention of skin ulcers" |
|
|
Term
| What factors contribute to improved oxygenation when proning patients with ALI (acute lung injury) |
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Definition
| "the transpulmonary pressure generated in the prone position probably exceeds the airway opening pressure in dorsal lung regions (where atelectasis, shunt, and V/Q heterogeneity are most severe). the prone position probably shifts blood flow away from shunt regions, thus increasing areas with normal V/Q balance. " |
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|
Term
| Why does the prone position redistribute blood flow |
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Definition
| most likely caused by gravity-induced recruitment of previously atelectatic but healthy areas. |
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|
Term
| The prone position may decrease the likelihood of further lung injury associated with positive pressure ventilation of patients with what? |
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Definition
|
|
Term
| How much sputum production indcates improvement in airway clearance |
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Definition
| sputum production must exceed 25 - 30 ml per day for bronchial hygiene therapy to significantly improve secretion removal |
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|
Term
| What are the best-documented preventive uses of bronchial hygiene therapy |
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Definition
| body positioning and patient mobilization to prevent retained secretions in teh acutely ill; PDPV combined with exercise to maintain lung function in CF. |
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Term
| "When assessing for the need for bronchial hygiene therapy, what two areas should be reviewed" |
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Definition
| medical record; patient observation/interview |
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|
Term
| "Initial assessment of need for bronchial hygiene therapy, what should be reviewed in the pt medical record" |
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Definition
| "hx of pulmonary problems causing increased secretions; upper abdominal or thoracic surgery (consider: age, hix of COPD, obesity, nature of prcedure, type of anesthesia, duration of procedure); presence of artificial tracheal airway; chest radiograph indicating atelectasis or infiltrates; results of pulmonary function testing; abg values or 22 sats" |
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|
Term
| "Initial assessment of need for bronchial hygiene therapy, what should be reviewed in the pt interview and observation of patient assessment" |
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Definition
| "posture, muscle tone; effectiveness of cough; sputum production; breathing pattern; general physical fitness; breath sounds; vital signs, heart rate and rhythm" |
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Term
| What are the indications for directed coughing |
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Definition
| "need to aid in the removal of retained secretions from central airways; presence of atelectasis; prophylaxis against postoperative pulmonary complications; routine part of bronchial hygiene in pts with CF, bronchiectasis, chronic bronchitis, necrotizing pulmonary infection or spinal cord injury; As an integral part of other bronchial hygiene therapies, such as postural drainage therapy, PEP therapy, and incentive spirometry; to obtain sputum specimens for diagnostic analysis" |
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|
Term
| What parts of the body should not be percussed |
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Definition
| "avoid tender areas or sites of trauma or surgery, and never percuss directly over bony prominences such as te clavicles or vertebrae" |
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Term
| What are some examples of factors that could limit the effectiveness of directed cough techniques |
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Definition
| "obtunded, paralyzed, or uncooperative patient. Advanced COPD; severe restrictive disorders (including neurologic, muscular, or skeletal abnormalities) may not be able to generate an effective spontaneous cough. pain or fear of pain caused by coughing may limit the success of directed cough. systemic dehydration, thick, tenacious secretions, artificial airways, or the use of central nervous system (CNS) depressants can thwart efforts" |
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|
Term
| What is autogenic drainage (AD) |
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Definition
| Modification of directed coughing - uses diaphragmatic breathing to mobilize secretions by varying lung volumes and expiratory airflow in three distinct phases. |
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Term
| What are the three phases of AD (autogenic drainage) |
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Definition
| "phase one involves a full inspiratory capacity maneuver, follwed by breathing at low lung volumes. designed to ""unstick"" peripheral mucus. Phase two involves breathing at low to middle lung volumes in order to collect mucus in the middle airways. Phase three is the evacuation phase, in which mucus is readied for expulsion from the large airways" |
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Term
| What are the indications for PAP therapy |
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Definition
| to reduce air trapping in asthma and COPD; to aid in mobilization of retained secretions (in CF and chronic bronchitis); to prevent or reverse atelectasis; to optimizer delivery of bronchodilators in pt receiving bronchial hygiene therapy |
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|
Term
| What are the hazards associated with PAP therapy |
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Definition
| "pulmonary barotrauma; increased ICP; cardiovascular compromise (myocardial ischemia, decreased venous return); skin breakdown and discomfort from mask; air swallowing, vomiting, and aspiration; claustrophobia; increaseed work of breathing that may lead to hyupoventilation and hypercapnea" |
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|
Term
| how does PEP move secretions into the larger airways |
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Definition
| helps move secretions into larger airways by 1) filling underaerated or nonaerated segments via collateral ventilation and 2) preventing airway collapse during expiration |
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|
Term
|
Definition
| active expiration against a variable flow resistence; positive expiratory pressure |
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Term
| "After PEP therapy, what allows the pt to generate the flows needed to expedl mucus from blocked airways" |
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Definition
| a subsequent huff or FET maneuver |
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Term
|
Definition
| "intrapulmonary percussive ventilation - an airway clearance technique that uses a pneumatic device to deliver a series of pressurized gas minibursts at rates of 100 to 225 cycles per minute (1.6 to 3.75 Hz) to the respiratory tract, usually via a mouthpiece" |
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|
Term
| Explain flutter valve as PEP therapy |
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Definition
| "it combines the techniques of EPAP with high-frequency oscillations (HFO's) at the airway opening. The valve consists of a pipe-shaped device with a heavy steel ball sitting in an angled ""bowl"". The pipe bowl is in an angled ""bowl"" The pipe bowl is covered by a perforated cap. PT exhales into actively into the pipe, the ball creates a positive expiratory pressure of betwen 10 and 25 cmH2O. The pipe angle causes the ball to flutter back and forth at about 15 Hz. When valve is properly used, oscillations created are transmitted down into the airways. Pt can control the pressure by changing expiratory flow, changing angel alters oscillations" |
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Term
| What are advantages of flutter valve |
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Definition
| "can decrease mucus viscoelasticity within the airways allowing it to be cleared more easily by cough. it is readily accepted by patients, inexpensive, and fully portable and does not require caregiver assistance" |
|
|
Term
|
Definition
| "used to help mobilize secretions and treat atelectasis. as adjuncts for airway clearance, these methods are never used alone but always comgined with directed cough or other airway clearance techniques" |
|
|
Term
| What are the three PAP adjuncts that are commonly used |
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Definition
| continuous PAP (CPAP); expiratory PAP (EPAP); and positive expiratory pressure (PEP) |
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|
Term
| Describe action taken for a patient experiencing arrhythmias during postural drainage |
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Definition
| "stop therapy, return patient to previous resting position, and administer or increase oxygen delivery while contacting physician" |
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