Egan’s Chapter 39 Practice Questions:

 

Question Answer
Which of the following is not a potential hazard of intermittent positive-pressure breathing? A) Increased cardiac output
Which of the following statements is not true about intermittent positive-pressure breathing (IPPB)? D) IPPB should be the single treatment modality for resorption atelectasis.
All of the following parameters should be evaluated after intermittent positive-pressure breathing therapy except: D) temperature.
All of the following machine performance characteristics should be monitored during intermittent positive-pressure breathing therapy except: C) humidity output.
Which of the following initial flow settings would you select when setting up a continuous positive airway pressure flow-mask system for a patient with atelectasis? A) 2 to 3 times the patient’s minute ventilation
In order to eliminate leaks in an alert patient receiving intermittent positive-pressure breathing therapy, which of the following adjuncts would you first try? D) Nose clips
Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)? A) I and II I. Patients with clinically diagnosed atelectasis who are not responsive to other therapies. II. Patients at high risk for atelectasis who cannot cooperate with other methods.
Which of the following positions is ideal for intermittent positive-pressure breathing therapy? A) Semi-Fowler’s
Which of the following are appropriate initial settings for intermittent positive-pressure breathing given to a new patient? C) Sensitivity 1 to 2 cm H2O below ambient pressure (i.e. -1 to -2 cmHO); pressure 10 to 15 cm H2O; moderate flow
When checking a patient’s intermittent positive-pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case? B) Check the circuit for leaks.
What is the minimum airway pressure at which the esophagus opens, allowing gas to pass directly into the stomach? B) 20 cm H2O
Which of the following will make an intermittent positive-pressure breathing (IPPB) device cycle off prematurely? I. Airflow obstructed II. Kinked tubing III. Occluded mouthpiece IV. Active resistance to inhalation D) I, II, III, and IV I. Airflow obstructed II. Kinked tubing III. Occluded mouthpiece IV. Active resistance to inhalation
Which of the following is an absolute contraindication for using intermittent positive-pressure breathing? C) Tension pneumothorax
During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation? A) System or mask leaks
Which of the following is NOT a potential contraindication for intermittent positive-pressure breathing? D) Neuromuscular disorders
Which of the following are potential desirable outcomes of intermittent positive-pressure breathing (IPPB) therapy? I. Improved oxygenation II. Increased cough and secretion clearance III. Improved breath sounds IV. Reduced dyspnea D) I, II, III, and IV I. Improved oxygenation II. Increased cough and secretion clearance III. Improved breath sounds IV. Reduced dyspnea
The general assessment, common to all patients for whom intermittent positive-pressure breathing (IPPB) is ordered, should include which of the following? D) I, II, and III I. Measurement of vital signs II. Appearance and sensorium III. Chest auscultation
What is the most common complication associated with intermittent positive-pressure breathing (IPPB)? C) Respiratory alkalosis
Which of the following should be charted in the patient’s medical record after completion of an intermittent positive-pressure breathing treatment? D) I, II, and III I. Results of pre- and posttreatment assessment II. Any side effects III. Succint but complete account of the treatment session.
Which of the following are contraindications for continuous positive airway pressure (CPAP) therapy? C) I, II, and III I. Hemodynamic instability II. Hypoventilation III. Facial trauma
Which of the following are appropriate volume goals for intermittent positive-pressure breathing (IPPB) therapy? B) I and II I. 10 to 15 ml/kg ideal body weight II. At least 30% of the inspiratory capacity (IC)
Prior to starting intermittent positive-pressure breathing (IPPB) on a new patient, what should the practitioner explain? A) I, II, III, and IV I. Why the physician ordered the treatment. II. What the IPPB treatment will do. III. How the IPPB treatment will feel. IV. What the expected results are.
Which of the following are potential complications of continuous positive airway pressure (CPAP) therapy? C) I, III, and IV I. Barotrauma III. Gastric distention IV. Hypercapnia
Which of the following is false about gastric distention with intermittent positive-pressure breathing (IPPB)? D) Gastric distention is a relatively harmless effect of IPPB.
Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis? D) I, II, III, and IV I. Recruitment of collapsed alveoli. II. Decreased work of breathing. III. Improved distribution of ventilation. IV. Increased efficiency of secretion removal.
What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPB) treatment of atelectasis? A) Slow, deep breaths held at end-inspiration.
A patient receiving +12 cm H2O flow-mask continuous positive airway pressure, you note that the pressure drops to +6 cm H2O during inspiration, but returns to +12 cm H2O during exhalation. Which of the following would likely correct this problem? C) Increase the system flow.
Which of the following are essential components of a continuous positive airway pressure (CPAP) flow system? D) I, II, III, and IV I. Blended source of pressurized gas II. Breathing circuit with reservoir bag III. Low-pressure or disconnect alarm IV. Expiratory threshold resistor
Intermittent positive-pressure breathing is associated with a passive exhalation. A) True
In administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable? A) 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1:3
The “Administration” of intermittent positive-pressure breathing (IPPB) should include which of the following? C) I, II, and III I. Evaluating alternative approaches to the patient’s problem. II. Setting specific, individual clinical goals or objectives. III. Conducting a baseline assessment of the patient.
In terms of machine performance, what large negative pressure swings early in inspiration indicate? B) Incorrect sensitivity
When adjusting the sensitivity control on an intermittent positive-pressure breathing device, which of the following parameters are you changing? C) Effort required to cycle the device “on” (begin inspiration).

 

Questions:

 

1. What is lung expansion therapy used for?

2. What is gas absorption atelectasis?

3. What is compression atelectasis?

4. What factors can cause atelectasis?

5. What does atelectasis cause?

6. What are clinical signs of atelectasis?

7. How does lung expansion therapy work?

8. How can you increase the transpulmonary pressure gradient?

9. What therapy decreases pleural pressure?

10. What therapy increases alveolar pressure?

11. What is another name for incentive spirometry?

12. How does incentive spirometry work?



13. What are indications for IS?

14. What are contraindications to IS therapy?

15. What are hazards and complications of IS therapy?

16. How do you teach IS therapy?

17. When is it best to teach IS therapy?

18. What must be done before and after each IS treatment?

19. What are outcomes of IS therapy?

20. What instructions are given for IS therapy?

21. What has to be documented?

22. What is intermittent positive pressure breathing?

23. How does IPPB work?

24. What are indications for IPPB therapy?

25. What are contraindications for IPPB?

26. hazards and complications of IPPB?

27. What is the baseline assessment of IPPB?

28. What are the outcomes of IPPB?

29. What is the administration of IPPB?

30. what has to be documented with IPPB?

31. What is the triple s rule for IPPB?

32. What is PEP, EPAP, and CPAP stand for?

33. what is CPAP therapy?

34. What is indications for CPAP?

35. What are contraindications for CPAP?

36. What are hazards and complications for CPAP?

37. What is the most common problem with PAP therapies?

38. What should be monitored during CPAP?

39. How do you choose an approach?

40. What type of patients are at risk for postoperative atelectasis?

41. What is the cause of postoperative atelectasis?

42. What therapy is physiologically most common?

43. What is monitored during IS?

44. What are symptoms of Hyperventilation during IS?

45. What are two devices used during IS?

46. How does volumetric IS work?

47. How does flow oriented IS work?

48. What do both devices do?

49. What patients benefit from IPPB?

50. What should be included in the preliminary planning?

51. What is the purpose of a cough?

 

Answers:

 

1. Tt is utilized to prevent or correct respiratory complications in postoperative period

2. Gas absorption occurs when mucus plugs block ventilation to selected regions of lung or if there is a significant shift in V/Q, gas distal to obstruction is absorbed by passing blood

3. It is caused by persistent breathing with small tidal volumes and/or certain types of restrictive chest wall disorders

4. Obesity, neuromuscular disorders, heavy sedation, surgery near diaphragm, bed rest, poor cough, history of lung disease, restrictive chest wall abnormalities

5. Decreased FRC, V/Q mismatch, arterial hypoxemia, decreased surfactant production, and an ineffective cough which leads to retained secretions and possible pneumonia

6. History of recent major surgery, tachypnea, fine late inspiratory crackles, bronchial or diminished breath sounds, tachycardia, and an increased density and signs of volume loss on chest radiograph

7. It works by increasing the transpulmonary pressure gradient (which is the difference between alveolar and pleural pressure) the greater the transpulmonary pressure gradient the more alveolar expansion will occur

8. It can be increased by decreasing the surrounding pleural pressure or increasing the alveolar pressure



9. Incentive spirometry

10. IPPB and positive pressure therapies

11. Sustained maximal inspiration (SMI)

12. IS mimics natural sighing by encouraging patients to take slow deep breaths, they provide visual cues to patient when desired inspiratory volume of flow is reached

13. Presence of pulmonary atelectasis, presence of conditions that could cause atelectasis like upper abdominal surgery, thoracic surgery, surgery in patients with COPD, presence of restrictive lung defect associated with quadriplegia or dysfunctional diaphragm

14. Unconscious patients or those unable to cooperate, inability to comprehend instructions, patients unable to generate adequate inspiration less than 10 ml/kg

15. Hyperventilation, discomfort, fatigue or overexertion, pulmonary barotraumas, hypoxemia (if O2 therapy was interrupted)

16. Demonstrate then observe the patient tell the patient to sustain inspiratory effort for 5 to 10 seconds

17. preoperative patients prior to surgery

18. Auscultating breath sounds

19. Absence or improvement of atelectasis signs, 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 flow, restoration of preoperative FRC or VC, improved inspiratory muscle performance and cough, attainment of preoperative flow and volume levels, and increased FVC

20. Exhale normally, slow deep inspirations, inspiratory pause/breath hold, exhalation is slow and passive, rest between breaths, each treatment should have 10 efforts, most IS orders are ordered q1hr while awake

21. Date and time given, type of treatment, goals reached and number of times, breath sounds before and after, cough and nature of secretions, adverse reactions

22. It uses positive airway pressure, it is noninvasive ventilation, does not provide full ventilation but provides machine assisted deep breaths and stimulates coughing, treatments last 15-20 minutes exhalation is passive

23. Positive pressure is applied to airway transmitted to alveoli and pleural space during inspiratory phase, alveolar pressures rise pleural pressures increase (less negative), gas flows in lungs because of pressure differences, exhalation is passive

24. Patient with atelectasis isn’t responsive to other therapies, patient at high risk for atelectasis who can’t perform IS

25. Tension pneumothorax, ICP>15mmHg, hemodynamic instability, active hemoptysis, tracheoesophageal fistula, recent esophageal surgery, active untreated tuberculosis, radiographic evidence of blebs, recent facial oral or skull surgery, singultus (hiccups), air swallowing, and nausea

26. Increased airway resistance, pulmonary barotrauma, nosocomial infection, respiratory alkalosis, hyperoxia with O2 as gas source, impaired venous return, gastric distension, air trapping auto-PEEP overdistention, psychological dependence

27. Medical history, vital signs, sensorium and appearance, and breathing pattern and chest auscultation

28. Improved VC, increased FEV peak flow, enhanced cough and secretion clearance, improved chest radiograph, improved breath sounds, improved oxygenation, favorable patient subjective response

29. RT has to explain why the treatment is ordered what the treatment does how it feels and expected results, patient needs to be sitting up or semi fowler, may need nose clip, have to adjust pressure and flow treatment lasts 15-20 minutes

30. Preassessment, postassessment, adverse affects, medication used, settings used, volume achieved, length of treatment

31. If patient has severe adverse reaction stop treatment, stay with patient, and stabilize patient

32. Positive expiratory pressure, expiratory positive airway pressure, and continuous positive airway pressure

33. Patients breathe through pressurized circuit against a threshold resistor at pressures between 5 and 20 CPAP maintains positive pressure during inspiration and expiration where as IPPB only maintains pressure on inspiration

34. Recruit collapsed alveoli, decrease patient work of breathing, improve distribution of ventilation, enhance secretion removal, treatment of cardiogenic pulmonary edema reduces venous return to right heart and consequently reduces filling volume of left heart

35. Hemodynamic instability and patients with hypo ventilation

36. Barotrauma, hypoventilation, gastric distention, vomiting, and aspiration

37. System leaks

38. Monitor for hypoventilation and elevated PCO2 inspiratory flow must be adequate

39. Choose the one that is safest, simplest, and most effective, evaluate level of cooperation, amount of pulmonary secretions, and spontaneous vital capacity

40. Patients with a history of lung disease that causes increased mucus production, chronic bronchitis and cigarette smoking with complications during surgery also patients with a history of inadequate nutritional intake

41. Ineffective cough in postoperative patients because it increases chances of retained secretions

42. Incentive spirometry

43. Patient performance, frequency of sessions, number of breaths per session, inspiratory volume or flow goals and 3-5 second breath hold, effort and motivation, compliance with technique, device within reach and encouragement for patient to do it idependently, new and increasing inspiratory volumes each day, and vital signs

44. Lightheadedness and dizziness are possible.

45. Volumetric IS and Flow-oriented IS

46. Volumetric IS devices measure and visually indicate the volume achieved during SMI they employ a bellow that rises according to the inhaled volume when patient reaches target inspiratory volume a controlled leak in the device allows patient to sustain inspiratory effort for short period like 5 – 10 seconds

47. Flow oriented devices measure and visually indicate degree of inspiratory flow this flow can be equated with volume by assessing duration of inspiration or time

48. They attempt to encourage the same goal for patient a sustained max inspiratory effort to prevent or correct atelectasis one is not better than the other

49. Short term use for patients who are at high risk for atelectasis and are unable to participate in more patient directed techniques such as IS or deep breathing

50. The desired therapeutic outcomes are established the outcomes are based on diagnostic information that supports the need for IPPB therapy outcomes should be explicit, measurable and consistent with indications

51. Secretion clearance or airway clearance