Kettering TMC Review - Therapeutic
Procedures
Incentive spirometry should be performed ____________ while patient is awake for
about 10 breaths.
Hourly
Surgical patients should receive instruction on incentive spirometry prior to surgery so
that they better understand the procedure and the RT can establish a post-op volume
goal. The goal should be ____________ of the pre-operative inspiratory capacity.
One-half
We should auscultate breath sounds before and after the use of incentive spirometry to
evaluate the ___________ of therapy.
Effectiveness
Intermittent positive pressure breathing (IPPB) therapy: Indications (5)
1. Prevent or correct atelectasis in patients unable or unwilling to take a deep breath
2. Prevent or decrease pulmonary edema
3. Decrease WOB (COPD patients)
4. Distribute aerosols evenly with better disposition
5. Improve/promote cough mechanism
Contraindications of IPPB therapy (4)
1. Unskilled practitioners
2. Hypotension
3. Untreated pneumothorax
4. Elevated ICP
5 hazards of IPPB therapy:
1. Hyperventilation
2. Gastric distension
3. Impeding venous return
4. Pneumothorax
5. Excessive oxygenation/increased air trapping in COPD patients
What two symptoms usually present in hyperventilation?
1. Dizziness
2. Tingling of the fingers (due to decreased CO2)
Impeding venous return can result in these two things:
1. Decreased cardiac output
2. Increased ICP
,The Bird Mark 7 IPPB is pneumatically powered and ___________ cycled.
Pressure
Connect to a 50 psi wall outlet
Bird Mark 7 IPPB: Volume is changed by adjusting the ____________ limit.
Pressure
Bird Mark 7 IPPB: ___________ in the circuit will prevent normal cycling to exhalation.
Leaks
Bird Mark 7 IPPB: Obstruction/coughing will prematurely end ____________.
Inspiration
Bird Mark 7 IPPB: Increasing the ________ decreases the I-time and vice versa.
Flow
Bird Mark 7 IPPB: Adjust the sensitivity to allow the ventilator to trigger at
approximately negative _____ to ______ cmH20.
1.0 to 2.0 cmH20
Bird Mark 7 IPPB: Self-cycling will occur if the ventilator sensitivity/trigger is set too
___________.
Sensitive
Bird Mark 7 IPPB: Increasing the flow will increase __________ and decrease
__________.
Turbulence, volume
Volume decreases due to decreased I-time
Bird Mark 7 IPPB: Troubleshooting
a. Loss of pressure?
b. Excessive pressure?
c. Fail to cycle into inspiration?
d. Fail to cycle off?
e. Pressure does not rise normally?
a. Loss of pressure?
1. Leak
2. Insufficient flow
b. Excessive pressure?
1. Obstruction
2. Excessive flow
c. Fail to cycle into inspiration?
1. Improper sensitivity/trigger setting
2. Improper seal around mouthpiece
d. Fail to cycle off?
1. Leak in mouthpeice/mask seal
2. Cuff is leaking
, 3. Fenestrated trach tube is open
4. Loose equipment connection
e. Pressure does not rise normally?
1. Insufficient flow
Types of Bronchial Hygiene Therapy
1. Postural Drainage
2. Chest Percussion
3. Vibration
4. Cough Techniques
5. Alternative Airway Clearance (PEP therapy vibratory PEP, autogenic drainage,
external percussive devices, intrapulmonary percussive ventilation,
insufflation/exsufflation devices)
The purpose of bronchial hygiene therapy is to remove bronchopulmonary secretions,
thus improving ______________.
Ventilation
Ideal breathing pattern for improving ventilation (4) :
1. Slow, deep inspiration (from resting exhalation)
2. Inspiratory pause/hold for 1-3 seconds
3. Exhalation is slow, passive, and relaxed
4. Patient may relax in between maneuvers with normal tidal volume breathing
Modifying patient position according to oxygenation needs/pathology:
ARDS:
CHF:
Obese patients:
Unilateral lung disease:
ARDS: Prone
CHF: Fowler's
Obese patients: Lateral fowler's
Unilateral lung disease: Good lung down
What is inspiratory muscle training?
Ventilatory muscle training benefits patient's by increasing their muscle strength and
endurance, decreasing dyspnea, the need for medication and hospital visits.
Inspiratory muscle training is based on the concept of ______________
_____________. This means that over time, greater resistance is imposed on the
inspiratory muscles. This should increase muscle strength and endurance, which should
improve the patient's ______________ ____________.
Progressive resistance, exercise tolerance
Procedures
Incentive spirometry should be performed ____________ while patient is awake for
about 10 breaths.
Hourly
Surgical patients should receive instruction on incentive spirometry prior to surgery so
that they better understand the procedure and the RT can establish a post-op volume
goal. The goal should be ____________ of the pre-operative inspiratory capacity.
One-half
We should auscultate breath sounds before and after the use of incentive spirometry to
evaluate the ___________ of therapy.
Effectiveness
Intermittent positive pressure breathing (IPPB) therapy: Indications (5)
1. Prevent or correct atelectasis in patients unable or unwilling to take a deep breath
2. Prevent or decrease pulmonary edema
3. Decrease WOB (COPD patients)
4. Distribute aerosols evenly with better disposition
5. Improve/promote cough mechanism
Contraindications of IPPB therapy (4)
1. Unskilled practitioners
2. Hypotension
3. Untreated pneumothorax
4. Elevated ICP
5 hazards of IPPB therapy:
1. Hyperventilation
2. Gastric distension
3. Impeding venous return
4. Pneumothorax
5. Excessive oxygenation/increased air trapping in COPD patients
What two symptoms usually present in hyperventilation?
1. Dizziness
2. Tingling of the fingers (due to decreased CO2)
Impeding venous return can result in these two things:
1. Decreased cardiac output
2. Increased ICP
,The Bird Mark 7 IPPB is pneumatically powered and ___________ cycled.
Pressure
Connect to a 50 psi wall outlet
Bird Mark 7 IPPB: Volume is changed by adjusting the ____________ limit.
Pressure
Bird Mark 7 IPPB: ___________ in the circuit will prevent normal cycling to exhalation.
Leaks
Bird Mark 7 IPPB: Obstruction/coughing will prematurely end ____________.
Inspiration
Bird Mark 7 IPPB: Increasing the ________ decreases the I-time and vice versa.
Flow
Bird Mark 7 IPPB: Adjust the sensitivity to allow the ventilator to trigger at
approximately negative _____ to ______ cmH20.
1.0 to 2.0 cmH20
Bird Mark 7 IPPB: Self-cycling will occur if the ventilator sensitivity/trigger is set too
___________.
Sensitive
Bird Mark 7 IPPB: Increasing the flow will increase __________ and decrease
__________.
Turbulence, volume
Volume decreases due to decreased I-time
Bird Mark 7 IPPB: Troubleshooting
a. Loss of pressure?
b. Excessive pressure?
c. Fail to cycle into inspiration?
d. Fail to cycle off?
e. Pressure does not rise normally?
a. Loss of pressure?
1. Leak
2. Insufficient flow
b. Excessive pressure?
1. Obstruction
2. Excessive flow
c. Fail to cycle into inspiration?
1. Improper sensitivity/trigger setting
2. Improper seal around mouthpiece
d. Fail to cycle off?
1. Leak in mouthpeice/mask seal
2. Cuff is leaking
, 3. Fenestrated trach tube is open
4. Loose equipment connection
e. Pressure does not rise normally?
1. Insufficient flow
Types of Bronchial Hygiene Therapy
1. Postural Drainage
2. Chest Percussion
3. Vibration
4. Cough Techniques
5. Alternative Airway Clearance (PEP therapy vibratory PEP, autogenic drainage,
external percussive devices, intrapulmonary percussive ventilation,
insufflation/exsufflation devices)
The purpose of bronchial hygiene therapy is to remove bronchopulmonary secretions,
thus improving ______________.
Ventilation
Ideal breathing pattern for improving ventilation (4) :
1. Slow, deep inspiration (from resting exhalation)
2. Inspiratory pause/hold for 1-3 seconds
3. Exhalation is slow, passive, and relaxed
4. Patient may relax in between maneuvers with normal tidal volume breathing
Modifying patient position according to oxygenation needs/pathology:
ARDS:
CHF:
Obese patients:
Unilateral lung disease:
ARDS: Prone
CHF: Fowler's
Obese patients: Lateral fowler's
Unilateral lung disease: Good lung down
What is inspiratory muscle training?
Ventilatory muscle training benefits patient's by increasing their muscle strength and
endurance, decreasing dyspnea, the need for medication and hospital visits.
Inspiratory muscle training is based on the concept of ______________
_____________. This means that over time, greater resistance is imposed on the
inspiratory muscles. This should increase muscle strength and endurance, which should
improve the patient's ______________ ____________.
Progressive resistance, exercise tolerance
