Are you looking for a study guide on Lung Expansion Therapy? If so, then you have definitely come to the right place. The practice questions found here cover everything you need to know for Egan’s Chapter 42 in order to ace your exams in Respiratory Therapy school.
I’m ready to get started. Are you ready to get started? Then let’s go ahead and dive right in!
Oh, and before I forget. If your Respiratory Therapy school is like mine, then you probably use the Egan’s Workbook as well. Don’t get me wrong, it’s a solid workbook that can be helpful at times. But my biggest issue is the fact that it takes way too long to look up all the answers! Instead of being a helpful tool, it actually caused me more stress because of how much time it required.
So to help with that, we looked up all the answers for you so that you don’t have to waste any more of your valuable time. If you do need access to all the Egan’s Workbook Answers, you can check out our Workbook Helper. 🙂
Lung Expansion Therapy 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 | 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. |
| 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) |
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.
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
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
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
36. Barotrauma, hypoventilation, gastric distention, vomiting, and aspiration
37. System
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
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.
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.
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
| Question | Answer |
|---|---|
| The respiratory group is located in which areas of the brain? | The Pons and Medulla Oblongata |
| The Dorsal Respiratory group | is located in the posterior medulla. Inspiratory Center Neurons Responsible for the rythem of breathing. |
| The Ventral Respiratory Group | is located in various areas of the medulla. Controlls inspiration and expiration. In active during normal breathing. Active during exercise/stress. Inspiratory and experiatory neurons. |
| What are included in the pontine respiratory centers? | Apneustic/pneumotaxic (homeostatic mechanism) |
| Apneustic | lower portion of the pons. sends impulses to activate inspiration. Takes over if pneumotaxic is damaged. |
| Pneumotaxic | located 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 chemoreceptors | respond to an increas in hydrogen ions in CSF. Hydrogen ions porportional to co2. |
| Peripheral chemoreceptors | special 02 sensitive cells that react to a decrease in oxygen levels. Stimulate an increased respiratory rate. Located in cotoid and aortic arch. |
| Lung expansion therapy is designed to treat and prevent | atelectasis |
| What are the two types of atelectasis? | passive resorption |
| Passive atelectasis is | the result of shallow breathing. Caused by persistent use of small tidal volume. |
| Passive atelectasis can occur with the following | surgery medications (CNS depressents) Neurolgical disorder neuromuscular weakness bed rest immobility |
| Resorption atelectasis is the result of | an airway obstruction. Muscus plugs are present in the airway and block ventilation. Capillaries/blood flow absorb gas |
| What is lobar atelectasis | An 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 physics | Transpulmonary Pressure (Ptp) |
| Transpulmonary Pressure (Ptp) | (Palv)-(Ppl) alveolar pressure-pleural pressure creates a gradient |
| Lung expansion therapy | increases lung volume by increasing the transpulmonary pressure gradient. |
| The greater the transpulmonary pressure gradient | the 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. |
| IPPB | increases 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 with | mothpiece or a trache. |
| Incentive spirometry | mimics natural sighing by encouraging a slow, deep breathing. |
| The therapist determines | the volume and repetitions during IS |
| Icentive Spirometry Procedure | Slow, deep breath in from resting exhalation, followed by a 3-5 second breath hold. Repeat every hour; 5 to 10 reps |
| Vital Capaicity | 65-75 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 device | flow through a fixed orifice over time displaces volume |
| Volume oriented | not used anymore. measures volume via bellows bulky/large |
| Flow oriented | indirectly 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 |
| IPPB | invented 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 administered | several times a day or as frequently as once every hour. |
| What does IPPB require | spontaneously breathing patient |
| How can IPPB be given | with a mouthpiece or a mask (Requires a tight seal) |
| IPPB is administered with a | pneumatic machine |
| Usually IPPB therapy is given accompanying | aerosol 32% less effective than hand held nebulizer. 3cc normal saline if ordered w/out treatment |
| IPPB Therapy lasts | 15 minutes |
| IPPB Requires a what? | 50 PSI sources |
| IPPB Indications | Prevent/Treat atelectasis Inability to clear secretions due to inneffective ventilation and coughing. short-term ventilatory support Deliver aerosol medication. |
| Condraindications for IPPB | untreated pneumothorax hemodynamic instability increased ICP Recent facial or esophageal surgery tracheosophageal fistula Acive hemoptisis |
| More contraindications for IPPB | Active/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 IPPB | barotrauma hemodynamic instability increased ICP (clamping of great vessels) Air trapping Nosocomial infection Hemoptysis Hypocarbia Hyperoxia or hypoxemia |
| more hazards and complications of IPPB | Gastric distension/aspiration Increased airway resistance increased V/Q mismatch Physchologic dependence bronchospasm |
| Facts about the Bird Mark 7 | pneumatically powered requires a closed circuit with exhalation valve and nebulizer |
| The machine incorporates a venturi or air entrainment jet to | enhance flow capabilities and decrease Fi02 |
| What are the IPPB controls? | Pressure, Flow, Sensitivity, Air mix control and apnea timer. |
| Pressure | directly controls tidal volume. Indirectly affects inspiratory time |
| Patients lung characteristics also affect tidal volume | lung compliance/tidal volume directly proportional. Airway resistance/tidal volume indirectly proportional |
| Flow | directly controls speed (i time) indirectly affects tidal volume |
| Sensitivity | controls patient effort needed to trigger machine |
| Air mix control | when used increases flow output and decreases Fi02 |
| Apnea Timer | backup rate |
| Ventilator Class (Bird Mark 7) Pressure controller | Pressure does not change as a result of compliance and resistance changes |
| Volume Controller | Volume does not change as a result of compliance and resistance changes -measures volume directly |
| Flow controller | volume does not change as a result of compliance and resistance changes -measures volume indirectly by measuring flow |
| Phase 1 | change from exhalation to inspiration |
| Phase 2 | Inhalation |
| Phase 3 | Change from inhalation to exhalation |
| Phase 4 | Exhalation |
| Trigger: Phase 1 | Variable that triggers (starts) breath delivery. Pressure (patient), manual or time. Other trigger variables flow |
| Limit:Phase 2 | Variable not eexceeded above the preset value during inspiration. Inspiration does not end when the variable reaches the preset value. Flow, other limit variables (pressure) |
| Cycle: Phase 3 | Variable that cycles (stops) breath delivery. Pressure. Other cycle variables: volume, flow or time. |
| Phase 4 | Exhalation is passive |
| The circuit | Pressure drive line- powers nebulizer/ exhalation valve |
| Exhalation valve | close on inspiration/ opens on exhalation Mushroom type valve |
| The IPPB can have a | mouthpiece or a mask must have a tight seal |
| The left side of the IPPB machine is | the ambient side- atmospheric pressure |
| The right side is the | pressure side |
| The pressure control toggle | 10-40 cm H20 |
| If pressure increases | tidal volume increases |
| If pressure decreases | Tidal Volume decreases |
| This is a pressure cycle machine and pressure | indirectly affects inspiratory time |
| TLC | Trigger, Limit, Cycle |
| Pressure Cycles the machine | off |
| Patient lung characteristics affect | tidal volume |
| Overly compliant lungs take | longer to reach pressure (longer i time) |
| Stiff lungs | Take less time to reach pressure, shorter i time |
| The longer its on | the more volume |
| lung compliance and tidal volume | are directly proportional |
| Airway resistance | and tidal volume are indirectly porportional |
| Flow control | 5-40 liters per minute |
| Flow control | directly controls speed The higher the speed the less time |
| Flow indirectly affects tidal volume | More flow less tidal volume less flow more tidal volume |
| Sensitivity (trigger) | Controls patient effort need to trigger machine one |
| The trigger variable | initiates the machine |
| Manual trigger | is red |
| Patient trigger | based on their effort |
| time trigger | black (apnea) |
| Patient effort for sensitivity | 5-40 5 easier to trigger 40 more difficult to trigger |
| Apnea | makes machine trigger by itself |
| The closer the magnets | the more difficult to trigger machine |
| The farther away the magnets are | the easier it is to trigger machine |
| The initial setting on the Bird Mark 7 | is 15/15/15 |
| The Air max control | in 100% Fi02 out 40-60% FI02 |
| Limit variable | Flow Can’t get more or less flow than set |
| Manomometer | Green +, Pink (-) |
| How can you measure volume | Wrights respirometer Flows over time to give volume measurement Hooks on exhalation valve. |
| Question | Answer |
|---|---|
| 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. Tachycardia | A) 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 atelectasis | D) 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-oriented | D) 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. |
| Question | Answer |
|---|---|
| Volume | The amount of space occupied by a three-dimensional object or region of space, expressed in cubic units. |
| Capacity | The 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. |
| TLC | total lung capacity – 6000mL |
| oxygenatin | O2 |
| Ventilation | CO2 |
| IRV | Ispiratory reserve volume – 3100mL |
| ERV | Expiratory reserve volume – 1200mL |
| RV | Residual Volume – 1200mL. unable to be measured directly. It can never be exhaled in order to help with the next inhalation. |
| Normal Tidal volume | about 500mL |
| IC | Inspiratory capacity – about 3600mL |
| FRC | Functinal residual capacity – 2400mL |
| VC | Vital capacity – 4800mL |
| how do you measure RV? | Helium Dilution Method Nitrogen Washout Method Body Plethysmographic Method (Body Box) |
| The higher FRC is | the more likely you are to retain CO2 |
| restrictive disease | cause low lung volumes and low cause low capacities. Ex. kyphoscoliosis. |
| Question | Answer |
|---|---|
| outcomes for IPPB therapy | secretions, improved BS, increase O2, decrease CO2, better ABG, cough |
| Explanation of IPPB to patient | why it’s ordered, how it will feel, what is expected |
| What type of patients do you recommend EzPAP to | patients with decrease FRC |
| contraindications for IPPB | facial surgery, hypotension, TE fistula |
| If Needle lags and drags on inspiratory | increase the flow, let machine do work |
| This control indirectly controls volume patient receives | pressure |
| Physiological effects of IPPB | decrease WOB, increase volume tidal, IE ratio, normal ABG |
| FiO2 will be 40% or greater in air mix mode due to | increase in lung compliance, pressure, or flow |
| Pressure setting for sensitivity | -.5 to -2 cmH20 |
| EzPAP outcome | decrease atelectasis |
| Increase pressure, decrease venous return | deadspace |
| Venturi set at 40% when it is | pulled out |
| Flow rate should be | 10-15 |
| If patient is not getting enough volume tidal | check pressure, flow rate and check for leaks |
| devices to prevent leaks | nose clips, flange mouth clips, form fitting mask |
| Purpose of EzPAP | increase FRC, treat atelectasis |
| What to monitor for EzPAP | BS, vitals, resp pattern, exp pressure |
| What happens when you increase pressure to normal compliance lung | increase volume |
| Question | Answer |
|---|---|
| What to write on order of IPPB | duration, treatment, frequency, medication, |
| What to monitor | appearance, BS, vitals |
| explain to pt | why the doctor ordered it, and how it’s going to feel and how to use it |
| Definition of IPPB | delivery of slow deep inspiratory by device, short intermittent non -invasive therapy |
| Indications for IPPB | pt can’t take a deep breath, to improve lung expansion, non-responsive to other treatments |
| Benefits | Pt that can’t take a deep breath, prevent or treat atelectasis |
| Goals | deeper breath, promote cough, improve distribution of ventilation |
| Hazards | hypoventilation (to much O2), hyperventilation, gastric distinction, decrease venous return except with pt with pulmonary edema |
| How to minimize hazards | lower pressures, lower flows |
| Contraindications | facial surgery, bleb, TE fistula, hemoptysis |
| Assist mode | pt starts breath |
| control mode | timer |
| IPPB | decrease WOB, increase ventilation, decrease CO2 which increases pH, decrease venous return |
| Pt with greatest risk to pneumothorax | pt with emphysema ( you want to use lowest pressure possible) |
| Absolute contraindication | untreated pneumothorax |
| Question | Answer |
|---|---|
| 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 compare | They 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-box | FRC 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 patient | 1. 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 restriction | Vital 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 & VC | IRV = 3700 – 600 = 3100 VC = TLC – RV = 6200 – 1100 = 5100 |
| Given: ERV = 1400 mlTLC = 6200 mlVt = 600 mlIC = 3700 mlCalculate; FRC & RV | FRC = 6200 – 3700 = 2500 RV= 2500 – 1400 = 1100 |
| Briefly describe the principle of the multi-breath, open circuit, nitrogen washout test | washes 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 level | FRC |
| _________ Maximum amount of air the can be exhaled after maximun inhaltion | VC |
| _________ Volume of air in the lungs after maximum inhalation | TLC |
| _________ Maximum amount of air that can be inhaled from tidal volume end-expiratory level | IC |
| _________ Volume of air remaining in the lungs after maximum exhalation | RV |
| ___________ 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 indicate | obstructive 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 graph | straight 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 |
| Question | Answer |
|---|---|
| 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 |
| Question | Answer |
|---|---|
| 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 |
| Question | Answer |
|---|---|
| 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 achieved | valsalva |
| Lung expansion therapies which cause increased positive transpulmonary pressure are best for lung expansion: true or false | false |
| what is the best therapy for lung expansion | negative transpulmonary pressure- incentive spirometry |
| name the 4 IPPB interfaces | mask, flange, trach adapter, mouth piece |
| IPPB stands for | intermittent 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 pressure | incentive spirometry |
| Question | Answer |
|---|---|
| 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. |
| Question | Answer |
|---|---|
| Define IPPB | short term breathing treatment in which pressure above Atmospheric pressure are delivered to pt lung via a pressured cycled ventilator |
| Goals of IPPB | deeper breath, promote cough, improve distribution of ventilation, better ABGs |
| indications of IPPB | hypoventilation, 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 therapy | pt that can not take a deep breath |
| hazards of IPPB | hypoventilation (to much O2), hyperventilation, pneumothorax, gastric distinction, decreased venous return exept with pt with pulmonary edema |
| medication side effects | dizziness, tingling, numbness |
| contraindications for IPPB | facial surgery, hypotension, TE fistula, bleb, hemoptysis |
| Physiological effects | decrease WOB, increase tidal volume (ventilation), decrease CO2, increase O2 normal pH |
| What should be included in an IPPB order | duration, treatment, frequency, and medication |
| what should be monitored during IPPB treatment | appearance (color), BS, vitals |
| Bird Mark 7 | Pressure cycled, with assist and assist/control modes, requires 50 psi gas source |
| Pressure chamber | contain the pt pressure until the beginning of inspiration and houses the pressure control |
| ambient chamber | exposed to room air and is the side that houses the sensitivity control |
| alternative therapy to IPPB | EzPAP, IS, or pursed lip breathing |
| Information to chart after delivery of IPPB | drug used, pre and post vitals, adverse reactions or responses |
| assist mode | machine breath is delivered only when on inspiratory effort by the pt is sensed by the ventilator (PT IS TRIGGERING BREATH) |
| assist/control mode | a 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 mode | machine breaths are delivered at preset intervals (MACHINE BREATH) |
| Factors that determine the length of inspiration in a pressure cycled ventilator | pressure setting, flowrate, pt ventilator pattern, pt lung compliance and airway resistance |
| How flow adjustment affects insp and exp time | When increase flow it decreases insp time When decrease flow it increases insp time |
| What is the ideal I:E ratio when delivering IPPB | you want more expiratory time |
| Purpose of EzPAP | prevention and treatment of atelectasis and for lung expansion therapy, recommended for pt with a decreased FRC |
| Contraindications for EzPAp | none |
| adverse reactions for EzPAP | increased WOB that may lead to hypoventilation, increased cranial pressure, cardiovascular compromise, decreased venous return, air swallowing, and pulmonary barotrauma |
| Therapeutic outcomes of EzPAP | decrease atelectasis |
Final Thoughts
And that wraps up our study guide on Lung Expansion Therapy. I hope that these practice questions were helpful for you. I’m confident that if you go through them a few times, you can easily learn everything you need to know about Egan’s Chapter 42. But as I always say, it never hurts to go back and read the entire chapter and that’s something I always recommend. Thanks again for reading and as always, breathe easy my friend.
And don’t forget, if you need help with your Egan’s Workbook, we looked up the answers for you so that you don’t have to. Check out our Workbook Helper to learn more.
