The respiratory group is located in which areas of the brain?The Pons and Medulla Oblongata
The Dorsal Respiratory groupis located in the posterior medulla. Inspiratory Center Neurons Responsible for the rythem of breathing.
The Ventral Respiratory Groupis located in various areas of the medulla. Controlls inspiration and expiration. In active during normal breathing. Active during exercise/stress. Inspiratory and experiatory neurons.
What are included in the pontine respiratory centers?Apneustic/pneumotaxic (homeostatic mechanism)
Apneusticlower portion of the pons. sends impulses to activate inspiration. Takes over if pneumotaxic is damaged.
Pneumotaxiclocated bilaterally upper 1/3 of pons. Restrains apneustic/cuts off the inspiration. Innervated by the vagus nerve
What are the respiratory monitoring system chemoreceptors?Central chemoreceptors peripheral chemoreceptors
Central chemoreceptorsrespond to an increas in hydrogen ions in CSF. Hydrogen ions porportional to co2.
Peripheral chemoreceptorsspecial 02 sensitive cells that react to a decrease in oxygen levels. Stimulate an increased respiratory rate. Located in cotoid and aortic arch.
Lung expansion therapy is designed to treat and preventatelectasis
What are the two types of atelectasis?passive resorption
Passive atelectasis isthe result of shallow breathing. Caused by persistent use of small tidal volume.
Passive atelectasis can occur with the followingsurgery medications (CNS depressents) Neurolgical disorder neuromuscular weakness bed rest immobility
Resorption atelectasis is the result ofan airway obstruction. Muscus plugs are present in the airway and block ventilation. Capillaries/blood flow absorb gas
What is lobar atelectasisAn entire lobe of atelectasis; a large plug can also be caused by tumors.
what are factors causing atelectasis?obesity neuromuscular disease sedation surgery spinal injury bedridden immobility decreased cough
What are clinical signs of atelectasis?breath sounds: decreased/crackles tachycardia, tachypnea,cyanosis; secondary to hypoxemia. CXR: increased opacity
Normal breathing physicsTranspulmonary Pressure (Ptp)
Transpulmonary Pressure (Ptp)(Palv)-(Ppl) alveolar pressure-pleural pressure creates a gradient
Lung expansion therapyincreases lung volume by increasing the transpulmonary pressure gradient.
The greater the transpulmonary pressure gradientthe more the lung expands.
What are the types of lung expansion therapy?Incentive Spirometry Intermittent Positive Pressure Breathing.
Incentive Spirometry (IS)increases the transpulmonary pressure gradient by lowering pleural pressure. Most effective b/c mimics normal physiology of breathing.
IPPBincreases the transpulmonary pressure gradient by increasing alveolar pressure. (increased risk of damaging lung)
How do you know what to choose?Needed equipment Personnel Risk Cost
Incentive spirometry can be done withmothpiece or a trache.
Incentive spirometrymimics natural sighing by encouraging a slow, deep breathing.
The therapist determinesthe volume and repetitions during IS
Icentive Spirometry ProcedureSlow, deep breath in from resting exhalation, followed by a 3-5 second breath hold. Repeat every hour; 5 to 10 reps
Vital Capaicity65-75 ml/kg (-10 ml/kg) not an effective therapy
THe indications of incentive spirometry.Treat and prevent atelectasis presence of restrictive lung disease
What are the contraindications of IS?patients unable to take a deep breath lack of consciousness/cooperation
What are the hazards/complications of IS?hyperventilation barotrauma discomfort due to pain hypoxia due to interrupted 02 therapy bronchospasm fatigue
What are the three IS devices?indirect volume measuring device volume oriented flow oriented
Indirect volume measuring deviceflow through a fixed orifice over time displaces volume
Volume orientednot used anymore. measures volume via bellows bulky/large
Flow orientedindirectly measures volume
What should you Chart after Incentive Spirometry?Vitals Volume Achieved Repetitions Good breath hold or not If they understood. Assessment of cough Effort/motivation set goal
IPPBinvented by forest bird in 1947. aka hyperinflation therapy used for a broad range of clinical conditions. 1st ventilator
IPPB is used short term or long term?Short term
IPPB csn be administeredseveral times a day or as frequently as once every hour.
What does IPPB requirespontaneously breathing patient
How can IPPB be givenwith a mouthpiece or a mask (Requires a tight seal)
IPPB is administered with apneumatic machine
Usually IPPB therapy is given accompanyingaerosol 32% less effective than hand held nebulizer. 3cc normal saline if ordered w/out treatment
IPPB Therapy lasts15 minutes
IPPB Requires a what?50 PSI sources
IPPB IndicationsPrevent/Treat atelectasis Inability to clear secretions due to inneffective ventilation and coughing. short-term ventilatory support Deliver aerosol medication.
Condraindications for IPPBuntreated pneumothorax hemodynamic instability increased ICP Recent facial or esophageal surgery tracheosophageal fistula Acive hemoptisis
More contraindications for IPPBActive/untreated TB Evidence of blebs (over distension) Singulations Air swallowing nausea
One important fact…Increased thorax pressure clamps down on the great vessels and drops the blood pressure.
Hazards and complications of IPPBbarotrauma hemodynamic instability increased ICP (clamping of great vessels) Air trapping Nosocomial infection Hemoptysis Hypocarbia Hyperoxia or hypoxemia
more hazards and complications of IPPBGastric distension/aspiration Increased airway resistance increased V/Q mismatch Physchologic dependence bronchospasm
Facts about the Bird Mark 7pneumatically powered requires a closed circuit with exhalation valve and nebulizer
The machine incorporates a venturi or air entrainment jet toenhance flow capabilities and decrease Fi02
What are the IPPB controls?Pressure, Flow, Sensitivity, Air mix control and apnea timer.
Pressuredirectly controls tidal volume. Indirectly affects inspiratory time
Patients lung characteristics also affect tidal volumelung compliance/tidal volume directly proportional. Airway resistance/tidal volume indirectly proportional
Flowdirectly controls speed (i time) indirectly affects tidal volume
Sensitivitycontrols patient effort needed to trigger machine
Air mix controlwhen used increases flow output and decreases Fi02
Apnea Timerbackup rate
Ventilator Class (Bird Mark 7) Pressure controllerPressure does not change as a result of compliance and resistance changes
Volume ControllerVolume does not change as a result of compliance and resistance changes -measures volume directly
Flow controllervolume does not change as a result of compliance and resistance changes -measures volume indirectly by measuring flow
Phase 1change from exhalation to inspiration
Phase 2Inhalation
Phase 3Change from inhalation to exhalation
Phase 4Exhalation
Trigger: Phase 1Variable that triggers (starts) breath delivery. Pressure (patient), manual or time. Other trigger variables flow
Limit:Phase 2Variable not eexceeded above the preset value during inspiration. Inspiration does not end when the variable reaches the preset value. Flow, other limit variables (pressure)
Cycle: Phase 3Variable that cycles (stops) breath delivery. Pressure. Other cycle variables: volume, flow or time.
Phase 4Exhalation is passive
The circuitPressure drive line- powers nebulizer/ exhalation valve
Exhalation valveclose on inspiration/ opens on exhalation Mushroom type valve
The IPPB can have amouthpiece or a mask must have a tight seal
The left side of the IPPB machine isthe ambient side- atmospheric pressure
The right side is thepressure side
The pressure control toggle10-40 cm H20
If pressure increasestidal volume increases
If pressure decreasesTidal Volume decreases
This is a pressure cycle machine and pressureindirectly affects inspiratory time
TLCTrigger, Limit, Cycle
Pressure Cycles the machineoff
Patient lung characteristics affecttidal volume
Overly compliant lungs takelonger to reach pressure (longer i time)
Stiff lungsTake less time to reach pressure, shorter i time
The longer its onthe more volume
lung compliance and tidal volumeare directly proportional
Airway resistanceand tidal volume are indirectly porportional
Flow control5-40 liters per minute
Flow controldirectly controls speed The higher the speed the less time
Flow indirectly affects tidal volumeMore flow less tidal volume less flow more tidal volume
Sensitivity (trigger)Controls patient effort need to trigger machine one
The trigger variableinitiates the machine
Manual triggeris red
Patient triggerbased on their effort
time triggerblack (apnea)
Patient effort for sensitivity5-40 5 easier to trigger 40 more difficult to trigger
Apneamakes machine trigger by itself
The closer the magnetsthe more difficult to trigger machine
The farther away the magnets arethe easier it is to trigger machine
The initial setting on the Bird Mark 7is 15/15/15
The Air max controlin 100% Fi02 out 40-60% FI02
Limit variableFlow Can’t get more or less flow than set
ManomometerGreen +, Pink (-)
How can you measure volumeWrights respirometer Flows over time to give volume measurement Hooks on exhalation valve.
Which of the following situations is a contraindication for incentive spirometry? I. A patient whose vital capacity is less than 10 ml/kg. II. A patient who cannot cooperate or follow instructions. III. An unconscious patient.D) I, II, and III
Which of the following conditions is most likely to predispose a patient to atelectasis?C) Surgery to the liver.
Ideally, when should high-risk surgical patients be oriented to incentive spirometry?B) Preoperatively, before undergoing the surgical procedure.
A patient complains of numbness around his lips during IS. What should the therapist recommend?B) Tell the patient to slow his/her breathing rate
Physical signs of atelectasis that involves a significant portion of the lungs include: I. decreased or bronchial/tubular breath sounds. II. tachypnea. III. normal breath sounds. IV. tachycardia when hypoxemia is present.D) I, II and IV only I. decreased or bronchial/tubular breath sounds. II. tachypnea. IV. tachycardia when hypoxemia is present.
In teaching a patient to perform the sustained maximal inspiration maneuver during incentive spirometry, what would you say?A) “Exhale normally, then inhale as deeply as you can, then hold your breath for 5 to 10 seconds.”
A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?B) Hyperventilation
Which of the following is FALSE about flow-oriented incentive spirometry devices?C) They have proved less effective than volumetric systems.
Which of the outcomes would indicate improvement in a patient previously diagnosed with atelectasis who has been receiving incentive spirometry? I. Improved PaO2 II. Decreased respiratory rate III. Improved chest radiograph IV. (FVC) V. TachycardiaA) I, II, and III I. Improved PaO2 II. Decreased respiratory rate III. Improved chest radiograph
Persistent breathing at small tidal volumes can result in which of the following?C) Passive atelectasis
Correct instruction in the technique of incentive spirometry should include which of the following?B) Diaphragmatic breathing at slow to moderate flows.
Lung expansion therapy works because of an increase in what pressure gradient?A) Transpulmonary
Which of the following are potential indications for incentive spirometry? I. A restrictive disorder such as quadriplegia II. Abdominal surgery in a COPD patient III. Presence of pulmonary atelectasisD) I, II, and III I. A restrictive disorder such as quadriplegia II. Abdominal surgery in a COPD patient III. Presence of pulmonary atelectasis
The therapist should instruct the patient to perform IS:B) hourly.
Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following? I. (IS) II. Positive end-expiration pressure therapy III.(IPPB) IV.(EPAP)B) II, III, and IV II. Positive end-expiration pressure therapy III. Intermittent positive-pressure breathing (IPPB) IV. Expiratory positive airway pressure (EPAP)
In observing a postoperative woman conduct incentive spirometry, you note repetitive performance of the sustained maximal inspiration maneuver at a rate of about 10 to 12/min. Which of the following would you recommend to her?C) Take a 30-second rest period between breaths.
Which of the following patient categories are at high risk for developing atelectasis? I. Those who are heavily sedated. II. Those with upper abdominal or thoracic pain following surgery III. Those with neuromuscular disorders.D) I, II, and III I. Those who are heavily sedated. II. Those with upper abdominal or thoracic pain following surgery III. Those with neuromuscular disorders.
Which of the following is not a potential hazard or complication of incentive spirometry?B) Decreased cardiac output
How do all modes of lung expansion therapy aid lung expansion?A) By increasing the transpulmonary pressure gradient.
What should the monitoring of patients using incentive spirometry include? I. Number of breaths per session. II. Volume and flow goals achieved. III. Maintenance of breath-hold. IV. Patient effort and motivation.C) I, II, III, and IV I. Number of breaths per session. II. Volume and flow goals achieved. III. Maintenance of breath-hold. IV. Patient effort and motivation.
Which of the following modes of lung expansion therapy is physiologically most normal?B) Incentive spirometry
Acute respiratory alaklosis is a very common problem and occurs when the patient performs IS too rapidly.A) True
An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend?A) Incentive spirometry
Successful application of incentive spirometry depends on:C) the effectiveness of patient teaching.
How can the transpulmonary pressure gradient be increased? I. Increasing alveolar pressure. II. Decreasing pleural pressure. III. Decreasing transthoracic pressure.A) I and II I. Increasing alveolar pressure. II. Decreasing pleural pressure.
Incentive spirometry devices can generally be categorized as which of the following? I. Pressure-oriented II. Flow-oriented III. Volume-orientedD) II and III II. Flow-oriented III. Volume-oriented
Which of the following is not at high risk for developing postoperative atelectasis?D) Those with a non-smoking history.
VolumeThe amount of space occupied by a three-dimensional object or region of space, expressed in cubic units.
CapacityThe ability to receive, hold, or absorb: The maximum amount that can be contained.
TIDAL VOLUME (Vt)Most common volume that RCPs deal with on a daily basis is _____. Amount of volume you have going in and out with every breathe.
FRC (Functional Residual Capacity)Most common capacity that we deal with is ____ A tool used to help a patient oxygenate.
TLCtotal lung capacity – 6000mL
IRVIspiratory reserve volume – 3100mL
ERVExpiratory reserve volume – 1200mL
RVResidual Volume – 1200mL. unable to be measured directly. It can never be exhaled in order to help with the next inhalation.
Normal Tidal volumeabout 500mL
ICInspiratory capacity – about 3600mL
FRCFunctinal residual capacity – 2400mL
VCVital capacity – 4800mL
how do you measure RV?Helium Dilution Method Nitrogen Washout Method Body Plethysmographic Method (Body Box)
The higher FRC isthe more likely you are to retain CO2
restrictive diseasecause low lung volumes and low cause low capacities. Ex. kyphoscoliosis.
outcomes for IPPB therapysecretions, improved BS, increase O2, decrease CO2, better ABG, cough
Explanation of IPPB to patientwhy it’s ordered, how it will feel, what is expected
What type of patients do you recommend EzPAP topatients with decrease FRC
contraindications for IPPBfacial surgery, hypotension, TE fistula
If Needle lags and drags on inspiratoryincrease the flow, let machine do work
This control indirectly controls volume patient receivespressure
Physiological effects of IPPBdecrease WOB, increase volume tidal, IE ratio, normal ABG
FiO2 will be 40% or greater in air mix mode due toincrease in lung compliance, pressure, or flow
Pressure setting for sensitivity-.5 to -2 cmH20
EzPAP outcomedecrease atelectasis
Increase pressure, decrease venous returndeadspace
Venturi set at 40% when it ispulled out
Flow rate should be10-15
If patient is not getting enough volume tidalcheck pressure, flow rate and check for leaks
devices to prevent leaksnose clips, flange mouth clips, form fitting mask
Purpose of EzPAPincrease FRC, treat atelectasis
What to monitor for EzPAPBS, vitals, resp pattern, exp pressure
What happens when you increase pressure to normal compliance lungincrease volume


What to write on order of IPPBduration, treatment, frequency, medication,
What to monitorappearance, BS, vitals
explain to ptwhy the doctor ordered it, and how it’s going to feel and how to use it
Definition of IPPBdelivery of slow deep inspiratory by device, short intermittent non -invasive therapy
Indications for IPPBpt can’t take a deep breath, to improve lung expansion, non-responsive to other treatments
BenefitsPt that can’t take a deep breath, prevent or treat atelectasis
Goalsdeeper breath, promote cough, improve distribution of ventilation
Hazardshypoventilation (to much O2), hyperventilation, gastric distinction, decrease venous return except with pt with pulmonary edema
How to minimize hazardslower pressures, lower flows
Contraindicationsfacial surgery, bleb, TE fistula, hemoptysis
Assist modept starts breath
control modetimer
IPPBdecrease WOB, increase ventilation, decrease CO2 which increases pH, decrease venous return
Pt with greatest risk to pneumothoraxpt with emphysema ( you want to use lowest pressure possible)
Absolute contraindicationuntreated pneumothorax
After performing a multi-breath Nitrogen washout on a patient you observe the following tracing. What is the result of the tracing?Leak
When should you suspect poor effort by the patient when comparing the SVC and FVC?When the FVC is larger than the SVC
In the normal patient, how should the FVC and SVC compareThey should be the same
When performing measurements with the body-box and Helium dilution tests you notice that the results are higher on the results from the body-box. What would account for this difference?Body-box measures the traped gases. Helium dilution does not.
List 4 measurements commonly made with the body-boxFRC TLC TGV RV RV/TLC% Raw
Once the FRC has been determined how are the RV and TLC calculated?FRC – ERV = RV RV + VC = TLC
When should the patient be ‘switched in’ to start the nitrogen washout test?at FRC
Why does the nitrogen washout test not require a CO2 absorber?open circuit, no rebreathing
How long should it take the normal patient to washout during the nitrogen washout test?3 minutes
Briefly describe how to perform the nitrogen washout procedure.1. Have the patient breath 100% O2 and measure the %N2 exhaled. 2. Switch-in occurs at FRC 3. Test ends when %N2 is < 1% or 7 minutes
What 3 measurements are determined during the nitrogen washout procedure?1. FRC 2. RV 3. TLC
What would explain why a Helium dilution test never equilibrates and the [He] falls to zero?leak
Briefly describe how to perfom the Helium dilution test on a typical patient1. Switch-in occurs at FRC. 2. O2 must be added because of consumption 3. Test ends when [He] change < 0.2% in 30 second interval or after 7 minutes 4. Rebreathing requires CO2 and H2O absorbers (closed circuit)
What three (3) volumes/capacities can be measured/calculated with the Helium dilution test?FRC RV TLC
______________ is the only capacity/flowrate used to identify restrictionVital Capacity
What are the 3 volumes measured during the SVC test? and what are there typical values?1. Vt 0.5 L 2. IRV 3.1 L 3. ERV 1.2 L
Given: ERV = 1400 mlTLC = 6200 mlVt = 600 mlIC = 3700 mlCalculate; IRV & VCIRV = 3700 – 600 = 3100 VC = TLC – RV = 6200 – 1100 = 5100
Given: ERV = 1400 mlTLC = 6200 mlVt = 600 mlIC = 3700 mlCalculate; FRC & RVFRC = 6200 – 3700 = 2500 RV= 2500 – 1400 = 1100
Briefly describe the principle of the multi-breath, open circuit, nitrogen washout testwashes out the nitrogen in the lungs by having the patient breath 100% oxygen for several minutes
_________ Volume of air remaining in the lungs at tidal volume end-expirtaory levelFRC
_________ Maximum amount of air the can be exhaled after maximun inhaltionVC
_________ Volume of air in the lungs after maximum inhalationTLC
_________ Maximum amount of air that can be inhaled from tidal volume end-expiratory levelIC
_________ Volume of air remaining in the lungs after maximum exhalationRV
___________ Maximum amount of air that can be exhaled below the tidal volume end expiratory level.ERV
The results of a Helium dilution test show an equilibrium time of 7 minutes with an increase in FRC value, this is most likely due to;the patient has obstructive lung disease
You notice that you have entered information on a female instead of a male. What results of % predicted would change which you switch the computer over to a male?FVC
Which of the following is best for meauring Raw?plethysmography
Which of the following parameters are NOT used to calculate the predicted normals for an individual?weight
A FVC that is reduced and a SVC that is normal would indicateobstructive disorder
A patient with a FEV-1/FVC of greater than 35% would be consistent with;obstructive disorder
Which of the following would be consistent with a pure restrictive lung disorder?decreased VC, increased FEV-1
Which of the following is measured by the Plethysmograph?TGV
In a healthy subjects who have no lung disease, a graph of N2 washout curve appear ______ when displayed on a semilogrhythmic graphstraight line
The FEF(25%-75%) is depends on which of the following?FVC
Which of the following are characteristics of obstructive lung disease when measured values are compared to predicted normals?The FRC is increased The RV is increased The RV/TLC is increased
A patient has the following results from a pulmonary function test:SVC—4.35FRC—3.40ERV—1.20IRV—2.65Vt —0.50The residual volume would be:Choose the answer2.2 L 0.25 L 2.90 3.15
A patient has the following results from a pulmonary function test:SVC—4.35FRC—3.40ERV—1.20IRV—2.65Vt —0.50The total lung capacity would be:Choose the answer7.75 L 6.05 L 6.55 L 7.25 L
A patient has the following lung volumes:——-Measured——-%PredictedSVC——2.95————-71%FRC——1.85————-67%RV——-1.03————-75%TLC——3.98————-67%The intrepretation would most likely state:(Choose the answer)normal lung volumes hyperinflation restrictive pattern or process mixed obstructive and restrictive pattern or process
Which of the following correctly describes the measurement of FRC by the nitrogen washout method?The test is continued until alveolar N2 is 1%. Some N2 is released from the blood/tissue
Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?C) High expiratory pleural pressures compress the small airways.
Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?B) I and II I. If the glottis collapses during exsufflation. II. Presence of fixed airway obstruction.
Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?B) Restore lung volume and minimize fatigue.
All of the following are goals of bronchial hygiene therapy except:A) reverse the underlying disease process.
Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?B) Move the patient to the sitting position until the cough subsides.
All of the following conditions impair secretion clearance by affecting the cough reflex except:C) chronic bronchitis.
A typical mechanical insufflation-exsufflation treatment session should continue until what point?C) I, II, and III I. Secretions are cleared. II. The vital capacity (VC) returns to baseline. III. The SpO2 returns to baseline.
What are the best documented preventive uses of bronchial hygiene therapy?B) I and II I. Prevent retained secretions in the acutely ill. II. Maintain lung function in cystic fibrosis.
Primary objectives for turning include all of the following except to:A) prevent postural hypotension.
Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy?C) Patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD).
A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?B) Patient supine with a pillow under knees, bed flat
During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?D) Stop therapy, sit the patient up, give O2, and contact the physician.
A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?B) I, II, and III I. Enhancing expiratory flow by bending forward at the waist. II. Using short, expiratory bursts or the “huffing” method. III. Using only moderate (as opposed to full) inspiration.
Which of the following is NOT a hazard or complication of postural drainage therapy?D) Pulmonary barotraumas
Which if the following is the only absolute contraindication to turning?D) When the patient has unstable spinal cord injuries.
A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?A) Patient prone with a pillow under abdomen, bed flat
In which of the following patients would you consider modifying any head-down positions used for postural drainage?A) I, II, III, and IV I. A patient with unstable blood pressure. II. A patient with a cerebrovascular disorder. III. A patient with systemic hypertension. IV. A patient with orthopne
Which of the following is false about the FET?D) It occurs from mid to high lung volume without glottis closure.
When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except:C) number of prior surgical procedures.
Which of the following measures would you use to ask patients for the presence of copious mucus production?B) 1 ounce
Which of the following occur(s) during the compression phase of a cough?D) I I. Expiratory muscle contraction
A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?A) I, II, and IV I. Coordinating coughing with pain medication II. Using the forced expiration technique (FET) IV. “Splinting” the operative site
Primary objectives for postural drainage include all of the following except:A) prevent pneumonia.
All of the following laboratory data are essential in assessing a patient’s need for bronchial hygiene therapy except:C) hematology results.
Percussion should NOT be performed over which of the following areas?D) I, II, and III I. Surgery sites II. Bony prominences III. Fractured ribs
Conditions that can lead to bronchiectasis include all of the following except:B) muscular dystrophy.
A patient about to receive postural drainage and percussion is attached to an (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?B) Inspect and adjust the equipment to ensure function during therapy.
Properly performed chest vibration is applied at what point?D) Throughout expiration
In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?A) 30 ml/day
Which of the following conditions are associated with chronic production of large volumes of sputum?A)I, III, and IV I. Bronchiectasis III. Cystic fibrosis IV. Chronic bronchitis
Which of the following are mandatory components of the preassessment for postural drainage?C) I and III I. Vital signs III. Auscultation
Which of the following should be charted after completing a postural drainage treatment?C) I, II, III, and IV I. Amount and consistency of sputum produced II. Patient tolerance of procedure III. Position(s) used (including time) IV. Any untoward effects observed
Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the teaching the patient this maneuver?B) Having the patient phonate or “huff” during expiration.
Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?C) I, II, III, and IV I. Posture and muscle tone II. Breathing pattern and ability to cough III. Sputum production IV. Cardiovascular stability
While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%). Which would you recommend to manage this problem?A) Increase the patient’s FIO2 during therapy.
Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?D) I, II, III, and IV I. Foreign bodies II. Tumors III. Inflammation IV. Bronchospasm
Which of the following is/are necessary for normal airway clearance?B) I, II, III I. Patent airway II. Functional mucociliary escalator III. Effective cough
The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?B) Postural drainage therapy
For which of the following patients directed coughing might be contraindicated?C) I and IV I. Patient with poor coronary artery perfusion IV. Patient with an acute unstable spinal injury
All of the following are contraindications for directed coughing except the presence of:D) necrotizing pulmonary infection.
Which of the following is/are TRUE of postural drainage?B) I, II, and III I. It is most effective in disorders causing excessive sputum. II. It is most effective in head-down positions greater than 25 degrees. III. It requires adequate systemic hydration to be effective.
Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?C) I, II, and III I. Strengthening of the expiratory muscles II. Instruction in breathing control III. Instruction in proper positioning
All of the following are considered bronchial hygiene therapies except:B) incentive spirometry.
Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except:B) acute asthma.
All of the following can impair mucociliary clearance in intubated patients except:A) use of respiratory stimulants.
A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you recommend for this patient?D) Head down, patient half-rotated to left, right lung up
Absolute contraindications for postural drainage include which of the following?A) I and II I. Head and neck injury (until stabilized) II. Active hemorrhage with hemodynamic instability
A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient’s clearance problem?A) I and IV I. Combining manual chest compression with suctioning. IV. Using mechanical insufflation-exsufflation.
During autogenic drainage, when should patients be encouraged to cough?D) After phase 3 only
Partial airway obstruction can result in all of the following except:C) increased expiratory flows
Which of the following are potential indications for positive airway pressure therapies?D) I, II, III, and IV I. Reduce air-trapping in asthma or chronic obstructive pulmonary disease. II. Help mobilize retained secretions. III. Prevent or reverse atelectasis . IV. Optimize bronchodilator delivery.
Contraindications for positive airway pressure therapies include all of the following except:D) air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease.
All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:B) improvement in ABG values
Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?C) I, II, III, IV, and V I. Increased work of breathing II. Claustrophobia III. Increased ICP IV. Vomiting and aspiration V. Skin breakdown and discomfort
A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. Which of the following should be monitored?B) I, II, III, and IV only I. Sputum production II. Breath sounds III. Pulse rate IV. Breathing pattern
Which of the following best describes positive expiratory pressure (PEP) therapy?A) Expiration against a variable flow resistance.
In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?B) I and II I. Filling underaerated segments through collateral ventilation. II. Preventing airway collapse during expiration.
Proper instructions for positive expiratory pressure include all of the following except.B) Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O.
A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy?A) II and III II. Attach a metered-dose inhaler to the system’s one-way valve inlet. III. Place a small-volume nebulizer in-line with the PEP apparatus.
What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?C) Oscillation
Which of the following parts are required to conduct high-frequency external chest wall compression?C) I and III I. Variable air-pulse generator III. Nonstretch inflatable thoracic vest
All of the following are typical of high-frequency external chest wall compression therapy except:D) long inspiratory oscillations.
Which of the following determines effectiveness of high-frequency external chest wall compression therapy?C) I and III I. Compression frequency III. Flow bias
The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following?A) Intrapulmonary percussive ventilation
Which of the following is true about exercise and airway clearance?C) I, II, III, and IV I. Exercise can enhance mucus clearance. II. Exercise can improve pulmonary function. III. Exercise can improve V/Q matching. IV. Exercise can cause desaturation in some patients.
Patients can control a flutter valve’s pressure by changing what?C) Their expiratory flow
Advantages of the flutter valve over other bronchial hygiene methods include all of the following except:B) greater effectiveness.
Which of the following is not an advantage of the Acapella over the flutter?C) It is more portable.
Which of the following should be considered when selecting a bronchial hygiene strategy?D) I, II, III, and IV I. Patient’s goals, motivation, and preferences. II. Effectiveness and limitations of technique or method. III. Patient’s age, ability to learn, and tendency to fatigue. IV. Need for assistants, equipment, and cost.
Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?A) Postural drainage, percussion, and vibration
Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality (bulbar palsy) and intact upper airway?D) I and III I. Postural drainage, percussion, and vibration III. Mechanical insufflation-exsufflation
In assessing an adult outpatient for bronchial hygiene therapy, has (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?B) positive expiratory pressure therapy
A patient who has been ordered to have expiratory flow rates measured probably has _______asthma
What is the pressure do we use with the IPPB?10-20 cmH2O
What is the maneuver that requires a deep inspiration, closing the gottis, having the diaphragm and other muscles of respiration contracting and high interpulmonic pressure being achievedvalsalva
Lung expansion therapies which cause increased positive transpulmonary pressure are best for lung expansion: true or falsefalse
what is the best therapy for lung expansionnegative transpulmonary pressure- incentive spirometry
name the 4 IPPB interfacesmask, flange, trach adapter, mouth piece
IPPB stands forintermittent positive pressure breathing
To increase Vt on an IPPB you would increase/decrease _________increase, pressure
If the patient cant trigger an IPPB breath and the manometer needle is not moving off of the zero mark, you would suspect?the patient is breathing through their nose
What do we call the commonly used device, for lung expansion, which requires negative tranpulmonary pressureincentive spirometry
What is improving Ventilation refers to?It is helping pts. To improve their breathing in general.
What is Optimal Breathing Pattern & they are used on what kind of patients?They used on consious pts. It is to inspires slowly &deeply. Pause @ the top of inspiration for 1-3secs. Exhales slowly & passively 4.Totally relaxes b/w breaths. This pattern is suitable for all breathing situations-IPPB, SMI,Mech. Ventilation etc.
IPPB used on what patients?It is used for unconsious patients.
What are the 6 reasons(Indications) to use IPPB?1. Decrease WOB. 2.Correct/Prevent ATELECTASIS 3. Mobilize secretions & Improve cough effectiveness. 4.Provide Bronchodilation 5.Deliver Medications 6. Treat/Prevent Pulmonary Edema
What are the 3 reasons NOT to use(Contra Indications) of IPPB?1. Untreated Pneumothorax 2. Active TB 3. Current Pulmonary hemorrhage
What are the hazards of IPPB?1. Pneumothorax 2. Gastric Distensions 3. Increased Air trapping(COPD & Severe asthma pts.) 4.Excessive elimination of CO2 which causes dizziness. 5.Decrease Venous return & decreased Cardiac output.
What is the other name of Incentive Spirometry (IS)?Sustained Maximal Inspiration (SMI)
What is the procedure for incentive Spirometry?1. The IS is to motivate a pt. to effectively perform the procedure Maneuver. It is done hourly 8-10breaths each time. Pt. is instructed to inhale not exhale. Document date, time & volume not duration of treatment.
What are the 3 reasons(indications) to Use Incentive Spirometry?1. Prevent ATELECTASIS (only in consious pts.) 2. help post-operative pts. Achieve their pre-operative values. 3. Helpful in preventing post-operative pulmonary complications.
When should a pt. do Incentive Spirometry?to obtain a baseline-value Before surgery. Baseline value is used as a goal after surgery. Initial post operation goal should be around 1/2 of Pre-operative Baseline Value. If pt. not close to goal -lower to something achievable. Once achieved raise goal.
What are the 2 types of Spirometers?1. Flow-oriented 2. volume-Oriented
What is one disadvantage of an electrical SMI device?It requires new batteries if not functioning properly.
Define IPPBshort term breathing treatment in which pressure above Atmospheric pressure are delivered to pt lung via a pressured cycled ventilator
Goals of IPPBdeeper breath, promote cough, improve distribution of ventilation, better ABGs
indications of IPPBhypoventilation, atelectasis not responsive to other tx, reduced cough effort, increased airway resistance, increased WOB, accumulation of secretions, the inablility to inspire adequately
General pt who can benefit from IPPB therapypt that can not take a deep breath
hazards of IPPBhypoventilation (to much O2), hyperventilation, pneumothorax, gastric distinction, decreased venous return exept with pt with pulmonary edema
medication side effectsdizziness, tingling, numbness
contraindications for IPPBfacial surgery, hypotension, TE fistula, bleb, hemoptysis
Physiological effectsdecrease WOB, increase tidal volume (ventilation), decrease CO2, increase O2 normal pH
What should be included in an IPPB orderduration, treatment, frequency, and medication
what should be monitored during IPPB treatmentappearance (color), BS, vitals
Bird Mark 7Pressure cycled, with assist and assist/control modes, requires 50 psi gas source
Pressure chambercontain the pt pressure until the beginning of inspiration and houses the pressure control
ambient chamberexposed to room air and is the side that houses the sensitivity control
alternative therapy to IPPBEzPAP, IS, or pursed lip breathing
Information to chart after delivery of IPPBdrug used, pre and post vitals, adverse reactions or responses
assist modemachine breath is delivered only when on inspiratory effort by the pt is sensed by the ventilator (PT IS TRIGGERING BREATH)
assist/control modea machine breath is delivered when an inspiratory effecy by the patient is sensed by the ventilator (assist) or at set time intervals if the rate occurrence of insp effort fails below a set rate (control)
control modemachine breaths are delivered at preset intervals (MACHINE BREATH)
Factors that determine the length of inspiration in a pressure cycled ventilatorpressure setting, flowrate, pt ventilator pattern, pt lung compliance and airway resistance
How flow adjustment affects insp and exp timeWhen increase flow it decreases insp time When decrease flow it increases insp time
What is the ideal I:E ratio when delivering IPPByou want more expiratory time
Purpose of EzPAPprevention and treatment of atelectasis and for lung expansion therapy, recommended for pt with a decreased FRC
Contraindications for EzPApnone
adverse reactions for EzPAPincreased WOB that may lead to hypoventilation, increased cranial pressure, cardiovascular compromise, decreased venous return, air swallowing, and pulmonary barotrauma
Therapeutic outcomes of EzPAPdecrease atelectasis