Lung Expansion Therapy and FRC Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common problem associated with performing incentive spirometry too rapidly?

Nausea

Dizziness

Acute respiratory alkalosis (correct)

Hypoxemia

What symptom is most frequently reported in patients experiencing respiratory alkalosis?

Headache

Chest pain

Numbness around the mouth (correct)

Fever

What is a common reason for discomfort with deep inspiratory efforts in postoperative patients?

Inadequate pain control (correct)

Inflammation of the lungs

Dehydration

Unfamiliarity with the device

Which type of incentive spirometry device measures and visually indicates the volume achieved during a sustained maximal inspiration?

Volume-oriented devices Signup and view all the answers

What is the equation that relates flow to volume in the context of flow-oriented devices?

Volume = flow x time Signup and view all the answers

What phase follows planning in the successful application of incentive spirometry?

Implementation Signup and view all the answers

What is recommended for setting the initial goal for incentive spirometry?

Setting a realistic, attainable goal with moderate effort Signup and view all the answers

What is a key component of teaching a patient to use incentive spirometry effectively?

Demonstration of correct technique Signup and view all the answers

What condition is most likely indicated by fine, late-inspiratory crackles heard over the affected lung region?

Atelectasis Signup and view all the answers

Which factor increases the risk of postoperative atelectasis following upper abdominal surgery?

Incision location relative to the diaphragm Signup and view all the answers

What sign is most indicative of significant atelectasis on a chest film?

Increased opacity in the atelectatic region Signup and view all the answers

What problem is likely to occur due to an ineffective cough in postoperative patients?

Retained secretions Signup and view all the answers

Which of the following is NOT a common physical sign of atelectasis?

Excessive wheezing Signup and view all the answers

How does a spontaneous deep inspiration affect pleural pressure?

It decreases the pleural pressure gradient Signup and view all the answers

Which of the following conditions does NOT typically lead to fever unless pneumonia is also present?

Atelectasis Signup and view all the answers

What is one indirect sign of significant atelectasis seen on imaging?

Elevation of the diaphragm Signup and view all the answers

What is the primary reason resorption atelectasis occurs?

Mucus plugs blocking ventilation Signup and view all the answers

Which type of atelectasis is commonly associated with general anesthesia and sedatives?

Passive atelectasis Signup and view all the answers

What is considered a severe form of atelectasis that occurs in about 5% of lung resection patients?

Lobar atelectasis Signup and view all the answers

How can pulmonary complications such as atelectasis be minimized in high-risk patients?

Implementing proper respiratory therapy Signup and view all the answers

What can lead to a decrease in Functional Residual Capacity (FRC) in patients?

Alveolar collapse in the basal lung areas Signup and view all the answers

Which factor contributes to passive atelectasis in bedridden patients?

Insufficient tidal volumes Signup and view all the answers

What characterizes resorption atelectasis compared to other forms of atelectasis?

It occurs due to absorption of gas distal to airways blockage Signup and view all the answers

What is the purpose of Sustained Maximal Inspiration (SMI) in lung expansion therapy?

To encourage slow, deep breaths that mimic natural sighing Signup and view all the answers

What factor is NOT commonly associated with pulmonary complications post-surgery?

Frequent deep breathing exercises Signup and view all the answers

How often should incentive spirometry (IS) be performed?

5 to 10 times an hour, 20 times every two hours Signup and view all the answers

What physiological benefit does IS provide during the inspiratory phase of spontaneous breathing?

Maintains open alveoli and recruits collapsed alveoli Signup and view all the answers

What is a primary indication for the use of incentive spirometry?

To treat existing atelectasis Signup and view all the answers

Which factor is NOT used to set the inspired volume goal for incentive spirometry?

Weight Signup and view all the answers

What does a sustained, maximal inspiration (SMI) typically include?

A slow, deep inhalation followed by a 5 to 10 second breath hold Signup and view all the answers

Which of the following is considered a complication or hazard of incentive spirometry?

Hypoventilation Signup and view all the answers

When might incentive spirometry be used as a preventive measure?

When a patient is bedridden or postoperative Signup and view all the answers

What is the minimum inspiratory capacity (IC) to avoid inappropriate therapy?

< 15 ml / kg Signup and view all the answers

Which step is NOT included in the mnemonic O-G-P-A-E-R & WASH?

Order Patient's Medication Signup and view all the answers

How do you calculate inspiratory capacity for a male patient who is 71 inches tall?

106 + (6 x 11) / 2.2 Signup and view all the answers

When preparing the patient, which aspect is considered essential?

Pain management Signup and view all the answers

In which situation should you NOT proceed with the therapy?

Patient’s IC is < 15 ml / kg Signup and view all the answers

What is the first step in instructing the patient on inspiratory capacity?

Gather the equipment Signup and view all the answers

What is used to determine an individual's ideal body weight (IBW) for females taller than 5 feet?

45.5 kg + 2.3 kg for each inch over 5 feet Signup and view all the answers

What should be assessed after preparing the patient and equipment for therapy?

Patient's pain level and alertness Signup and view all the answers

Study Notes

### Lung Expansion Therapy

Lung expansion therapy aims to minimize or prevent respiratory problems in post-operative patients.
Resorption atelectasis occurs when mucus plugs block airways, leading to alveolar collapse due to gas absorption.
Passive atelectasis results from shallow breathing due to pain, sedation, or weakened diaphragm muscles.
Lobar atelectasis, a severe form of atelectasis, involves a large mucus plug or multiple factors and affects approximately 5% of lung resection patients.

Functional Residual Capacity (FRC)

A decrease in FRC is associated with alveolar collapse, often in the lower lung region.
This ventilation/perfusion (V/Q) mismatch leads to arterial hypoxemia.
The closer the surgical incision is to the diaphragm, the higher the risk of post-operative atelectasis.

Importance of Coughing

Post-operative patients often have difficulty coughing effectively due to shallow breathing.
Coughing can be painful, necessitating incision splinting during the process.
Ineffective coughing hinders secretion clearance and elevates the chance of retained secretions.

Pre-Surgery Evaluation

Upper abdominal or thoracic surgery can indicate potential atelectasis.
Patients with chronic lung disease or smoking history are prone to respiratory complications after major surgery or prolonged bed rest.
Obstructive Sleep Apnea (OSA) can also contribute to complications.

Physical Signs of Atelectasis

Significant atelectasis leads to increased respiratory rate.
Fine inspiratory crackles might be heard over the affected lung area, signifying reopening of distal airways during deep breathing.
Bronchial breath sounds can be present as the lung consolidates with atelectasis.
Diminished breath sounds are common when secretions block airways.
Atelectasis alone does not cause fever unless pneumonia is present.

X-Ray Chest Film

Chest X-ray helps confirm atelectasis presence.
The atelectatic lung region shows increased opacity.
Significant atelectasis demonstrates lung volume loss.
Indirect signs include diaphragm elevation, tracheal/heart/mediastinum shift, pulmonary opacification, rib space narrowing, and lung hyperinflation.

Incentive Spirometry (IS)

IS is a primary treatment for atelectasis and can be used preventively where the risk is high.
IS devices monitor lung function by correlating performance with vital capacity (VC) measurement.
IS is a simple and safe modality, with few contraindications.

Hazards/Complications of IS

Acute respiratory alkalosis (hyperventilation) can occur due to rapid IS performance and results in dizziness and numbness.
Discomfort during deep inspiration, often due to insufficient pain control, can be managed with patient-controlled analgesia (PCA) pump.

IS Equipment

IS devices are either volume- or flow-oriented.
Volume-oriented devices measure and display the inhaled volume.
Flow-oriented devices track inspiratory flow, which can be correlated with volume by analyzing inspiration duration.
No definitive evidence supports one type being more beneficial than the other.

IS Administration

IS implementation includes three phases: planning, implementation, and follow-up.
Planning involves patient assessment and selecting specific therapeutic goals.
Implementation requires effective patient education, setting achievable goals, and observing correct technique.
Follow-up focuses on assessing patient performance and ensuring goal attainment.

Instructing IS Step by Step

The process involves gathering, preparing equipment, assessing the patient, evaluating therapy, recording and reporting, adhering to hand hygiene protocols.
Patient assessment involves evaluating their orientation, ability to follow instructions, and self-support.
Therapy evaluation includes assessing patient performance, effort based on predicted values, pain level, oxygen saturation, heart rate, respiratory rate, and breath sounds.

Figure Inspiratory Capacity (IC)

IC is the maximal volume inhaled after maximal exhalation.
Inappropriate therapy is indicated by an IC less than 15ml/kg.
Formulas help calculate IC based on height and sex, and require conversion to kilograms.
A 30% IC is often used as the initial goal for IS.

Therapy Mnemonic

O – G – P – A – E – R & WASH
O = Orders
G = Gather Equipment
P = Prepare Equipment and Patient
A = Assess Patient
E = Evaluate Therapy
R = Record and Report
Wash Hands before and after all patient contact.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers key concepts related to lung expansion therapy, its importance in preventing respiratory issues in post-operative patients, and the factors contributing to various forms of atelectasis. It also addresses the significance of effective coughing in enhancing lung function after surgery.