Lung Expansion Therapy Overview

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Questions and Answers

What should be considered before starting lung expansion therapy?

  • The patient's preference for therapy type
  • The presence of untreated pneumothorax (correct)
  • The availability of equipment
  • The patient's activity level

What device can be used as an alternative if a patient cannot tolerate PEP therapy?

  • Incentive spirometer
  • CPAP (correct)
  • Nebulizer
  • Supplemental oxygen

Which of the following is a sign that a patient may be hyperventilating during therapy?

  • Clear communication
  • Increased energy levels
  • Improved breath sounds
  • Dizziness (correct)

What complication should be monitored during PEP therapy?

<p>Tingling in the extremities (D)</p> Signup and view all the answers

What is a recommended practice after administering PEP therapy?

<p>Taking a tidal or slightly larger breath (C)</p> Signup and view all the answers

How can patients manage PEP therapy outside of the hospital setting?

<p>Integrating it into a daily regimen (A)</p> Signup and view all the answers

What is a common use for PEP therapy in patients?

<p>To aid lung recruitment in certain diseases (C)</p> Signup and view all the answers

Which of the following statements about PEP therapy is true?

<p>Cleaning of the device can be done in a dishwasher. (B)</p> Signup and view all the answers

What effect does a deep inspiration have on the PAL gradient?

<p>It decreases the pressure within the pleural space. (A)</p> Signup and view all the answers

Which condition may present with a consistently lower SpO2 and increased respiratory rate?

<p>Severe atelectasis (B)</p> Signup and view all the answers

What is a common sign of severe atelectasis?

<p>Absent breath sounds (C)</p> Signup and view all the answers

What does positive pressure lung expansion therapy aim to increase?

<p>The Palv inside the lungs (A)</p> Signup and view all the answers

What is required for IS and other patient-directed lung therapies to be effective?

<p>An alert and cooperative patient (B)</p> Signup and view all the answers

Which of the following best describes crackles heard in a patient with atelectasis?

<p>Late-inspiratory crackles over affected regions (D)</p> Signup and view all the answers

Which of the following therapies applies pressure during both inspiration and expiration?

<p>CPAP (C)</p> Signup and view all the answers

What is one of the main issues related to the efficiency of lung expansion therapy?

<p>Staff time and equipment (D)</p> Signup and view all the answers

What is the primary goal of lung expansion therapy?

<p>To optimize airway clearance and maximize alveolar recruitment (C)</p> Signup and view all the answers

Which type of atelectasis occurs when there is compression of lung tissue?

<p>Compression atelectasis (C)</p> Signup and view all the answers

Which of the following patients is most likely at risk for developing atelectasis?

<p>A post-operative patient recovering from abdominal surgery (C)</p> Signup and view all the answers

Which of the following is a common clinical sign of atelectasis?

<p>Absence of lung sounds (B)</p> Signup and view all the answers

What does incentive spirometry encourage patients to do?

<p>Deeply inhale to expand lungs and increase tidal volume (B)</p> Signup and view all the answers

How does noninvasive ventilation (NIV) assist patients with lung expansion?

<p>By delivering positive pressure to keep airways open (D)</p> Signup and view all the answers

What is one of the primary responsibilities of a respiratory therapist regarding lung expansion therapy?

<p>Monitoring patient compliance with therapy (C)</p> Signup and view all the answers

Which of the following therapies is NOT typically considered a lung expansion therapy?

<p>Administering bronchodilators (B)</p> Signup and view all the answers

What is the primary goal of deep breathing exercises in patients at risk for atelectasis?

<p>To prevent collapse of the alveoli (A)</p> Signup and view all the answers

Which lung sound indicates the presence of consolidation due to atelectasis?

<p>Egophony (D)</p> Signup and view all the answers

What indicates a significant loss of lung volume on a chest x-ray for a patient with atelectasis?

<p>Displacement of interlobar fissures (A)</p> Signup and view all the answers

What effect does atelectasis have on the respiratory rate of a patient?

<p>Increases respiratory rate (B)</p> Signup and view all the answers

In what scenario is positive pressure therapy reserved?

<p>For high-risk patients unable to perform incentive spirometry (C)</p> Signup and view all the answers

What might lead to diminished breath sounds in patients with atelectasis?

<p>Excessive secretions in the airways (D)</p> Signup and view all the answers

What characteristic of the lung sounds changes as atelectasis becomes more pronounced?

<p>Lower frequency transmission (B)</p> Signup and view all the answers

What is the relationship between atelectasis severity and respiratory rate?

<p>Directly proportional (B)</p> Signup and view all the answers

What advantage does high-flow nasal cannula (HFNC) provide in terms of oxygen delivery?

<p>It provides a more stable FiO2. (D)</p> Signup and view all the answers

Which of the following is a potential complication of high-flow nasal cannula therapy?

<p>Increased risk of nosocomial infection. (D)</p> Signup and view all the answers

Which outcome is NOT typically associated with high-flow nasal cannula therapy?

<p>Worsened chest x-ray findings. (C)</p> Signup and view all the answers

What is a significant physiological benefit of the elevated flow rate in high-flow nasal cannula therapy?

<p>It helps to wash out excess CO2. (B)</p> Signup and view all the answers

Which monitoring parameter is essential for assessing the effectiveness of high-flow nasal cannula therapy?

<p>Flow rate of the device. (A)</p> Signup and view all the answers

When using high-flow nasal cannula therapy, which symptom indicates a potential issue with the therapy?

<p>Dryness of the mouth and upper airway. (A)</p> Signup and view all the answers

Which of the following parameters is NOT typically monitored during high-flow nasal cannula therapy?

<p>Patient calorie intake. (D)</p> Signup and view all the answers

What is a commonly reported outcome of high-flow nasal cannula therapy?

<p>Improved ventilation. (D)</p> Signup and view all the answers

What is the primary goal of using continuous positive airway pressure (CPAP) in the postoperative period?

<p>Preventing postoperative morbidity and mortality (D)</p> Signup and view all the answers

What are the physiological benefits of early mobility in mechanically ventilated patients as mentioned in the literature?

<p>Decreased risk of blood clots and improved lung function (B)</p> Signup and view all the answers

Which therapy was compared to high-flow nasal cannula in the study on postextubation outcomes?

<p>Conventional oxygen therapy (A)</p> Signup and view all the answers

What is a well-documented effect of positive expiratory pressure (PEP) breathing?

<p>Enhanced mucus clearance and improved ventilation (B)</p> Signup and view all the answers

In the context of postoperative care, what was highlighted as a common misconception regarding early mobility?

<p>It has no impact on patient outcomes (B)</p> Signup and view all the answers

Which of the following best describes the focus of the Cochrane Database review regarding early mobility?

<p>The benefits of early mobility in hospitalized adults (C)</p> Signup and view all the answers

What does the evidence suggest about the use of CPAP for treating postoperative hypoxemia?

<p>It significantly reduces the risk of reintubation (C)</p> Signup and view all the answers

During which phase of care is high-flow oxygen therapy most beneficial according to the studies referenced?

<p>Postoperative phase (B)</p> Signup and view all the answers

Flashcards

Atelectasis

A condition where part or all of a lung collapses, preventing the alveoli from filling with air.

Compression Atelectasis

Atelectasis caused by pressure on the lungs, often from a tumor or fluid build-up.

Gas Absorption Atelectasis

Atelectasis caused by the absorption of air from tiny air sacs (alveoli) in the lungs.

Incentive Spirometry

A technique using a device that encourages patients to take deep breaths and cough to prevent or treat atelectasis.

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Noninvasive Ventilation (NIV)

A type of non-invasive ventilation that helps patients breathe by delivering pressurized air through a mask.

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Continuous Positive Airway Pressure (CPAP)

A type of non-invasive ventilation where pressurized air is delivered continuously through a mask to keep airways open.

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Intermittent Positive Airway Pressure (IPPB)

A type of non-invasive ventilation where pressurized air is delivered in short bursts to help the patient breathe.

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Positive Expiratory Pressure (PEP)

A type of therapy that involves using a device to deliver positive pressure during exhalation, helping clear mucus from the lungs.

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Bronchial breath sounds

A lung sound that is normally heard over the trachea and large airways. It can be present with atelectasis as the lung becomes more consolidated.

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Diminished breath sounds

A lung sound heard when listening over the lungs. It occurs when the airways are blocked and prevent breath sounds from being transmitted.

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Egophony

A lung sound that changes the letter "E" to "Aaay." It can be present with atelectasis due to consolidation of lung tissue.

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Chest x-ray

A type of chest x-ray that can be used to confirm the presence of atelectasis.

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Incentive Spirometry (IS)

A technique that helps to increase lung volume and prevent atelectasis. It involves taking deep breaths and holding them for a few seconds.

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Positive pressure therapy

A technique that involves using a machine to deliver positive pressure to the lungs. This can help to prevent atelectasis.

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Hypoxemia

A condition that can occur when atelectasis causes a decrease in oxygen levels in the blood.

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Positive Airway Pressure (PAP)

A type of lung expansion therapy that applies pressure to the lungs during inspiration, expiration, or both. It increases pressure in the lungs (Palv) to help keep the alveoli open.

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Alveolar-to-Pleural Pressure Gradient (PAL Gradient)

A measure of the difference in pressure between the alveoli and the pleura. It helps assess lung expansion and function.

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Breath Sounds

Sounds heard during breathing, often indicating an abnormality in the lungs. They can range from faint crackles to wheezing or bronchial sounds.

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Oxygen Saturation (SpO2)

The amount of oxygen in the blood, typically measured as a percentage.

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Crackles

Short, crackling sounds heard during breathing, often indicating fluid in the lungs or collapsed alveoli.

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Increased Respiratory Rate

Rapid breathing, sometimes a sign of respiratory distress or difficulty breathing.

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High Flow Nasal Cannula (HFNC)

A method of delivering oxygen therapy through the nose with high flow rates.

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Stable FiO2 with HFNC

The fraction of inspired oxygen (FiO2) is more stable with HFNC because of the higher inspiratory flow rates.

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CO2 Washout with HFNC

High flow rates in HFNC help to wash out carbon dioxide (CO2) from the lungs.

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Nosocomial Infection with HFNC

A risk of HFNC therapy where bacteria can grow in the device.

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Improved Chest X-Ray with HFNC

A potential outcome of HFNC therapy where the patient's chest x-ray shows improvement in lung condition.

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Headache with HFNC

A risk of HFNC therapy where the patient experiences a headache.

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Dry Mouth/Upper Airway with HFNC

A risk of HFNC therapy where the patient's mouth and upper airway dry out.

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Secretion Impaction with HFNC

A risk of HFNC therapy where mucus can build up in the airways due to inadequate humidification.

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What is atelectasis?

A condition where the lung collapses, preventing the air sacs from filling with air.

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What is PEP therapy?

Therapy that uses positive pressure during exhalation to help clear mucus from the lungs.

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When is PEP therapy used?

Patients may require PEP if they have difficulty clearing mucus from their lungs, which often happens after lung surgery or in conditions like COPD.

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What are the contraindications for PEP therapy?

Examples of reasons to avoid PEP therapy include an untreated pneumothorax and a baseline assessment that reveals other issues.

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What are the potential hazards and complications of PEP therapy?

Potential complications of PEP therapy include dizziness, tingling in the extremities, and lightheadedness caused by hyperventilation.

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What's the follow-up after PEP therapy?

When PEP therapy is discontinued, the patient should continue a daily regimen of pulmonary hygiene and dyspnea management.

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When is PEP therapy used as an alternative treatment?

PEP therapy is a common alternative for patients who cannot tolerate CPAP or HFNC.

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What are the long-term benefits of PEP therapy?

PEP therapy might be continued at home as part of a daily regimen for pulmonary hygiene and dyspnea management if the patient has non-cystic fibrosis bronchiectasis or severe COPD.

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Study Notes

Lung Expansion Therapy

  • Lung expansion therapy aims to prevent or correct atelectasis (alveolar collapse)
  • Common complications in postoperative patients include atelectasis, pneumonia, and acute respiratory failure
  • Lung expansion therapy encompasses various procedures: early mobilization, deep breathing/directed cough, incentive spirometry (IS), continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), intermittent positive airway pressure breathing (IPPB), and high-flow nasal cannula (HFNC).
  • All techniques aim to improve pulmonary function by maximizing alveolar recruitment and optimizing airway clearance
  • Patient preference is important in selecting the appropriate method, as there's no universally superior approach.
  • The goal of all therapies is increased functional residual capacity (FRC), simulating a deep breath or sigh.
  • Risk factors for atelectasis include obesity, neuromuscular disorders, heavy sedation, upper abdominal/thoracic surgery, and inadequate nutritional intake.
  • Clinical signs of atelectasis can be subtle, but may include an increased respiratory rate, fine, late-inspiratory crackles, and bronchial-type breath sounds.
  • Chest X-rays are often used to confirm atelectasis, showing increased opacity in the affected area.

Causes of Atelectasis

  • Gas absorption atelectasis: Occurs with ventilation interruption or significant ventilation/perfusion (V/Q) mismatch. Gas distal to an obstruction is absorbed, leading to alveolar collapse. Lobar atelectasis can develop if ventilation is compromised in a larger airway.
  • Compression atelectasis: Occurs when transthoracic pressure (difference between body surface and alveoli) exceeds transalveolar pressure. This is common after general anesthesia, bed rest, surgery (especially upper abdominal/thoracic), and in morbidly obese patients.

Factors associated with Atelectasis

  • Obesity
  • Neuromuscular disorders
  • Heavy sedation
  • Upper abdominal or thoracic surgery
  • Diaphragmatic position/function
  • Reduced ability to take deep breaths
  • Morbid obesity
  • Impaired surfactant function
  • Ineffective coughing mechanisms

Rule of Thumb - Atelectasis

  • The closer the surgical incision is to the diaphragm, the higher the risk of postoperative atelectasis.
  • Patients with low albumin levels (<3.2 mg/dL) are at increased risk for postoperative pulmonary complications, likely due to weaker inspiratory muscles.

Lung Expansion Therapies

  • Incentive Spirometry (IS): Encourages sustained maximal inspiratory effort, decreasing pleural pressure and maintaining airway patency. Visual cues guide the patient.
  • Continuous Positive Airway Pressure (CPAP): Maintains a positive pressure in the airways throughout the breathing cycle. Aims to inflate collapsed alveoli.
  • Intermittent Positive Airway Pressure (IPPB): A form of NIV, delivers positive pressure during inspiration, usually for short periods (15 minutes).
  • Noninvasive Ventilation (NIV): A breathing support method that avoids an artificial airway, reducing risk of infection and sedation.

Baseline Assessment

  • Vital signs measurement
  • Assessing patient's appearance and sensorium
  • Auscultation of breath sounds
  • Determining patient's motivation and ability to follow instructions

Early Mobilization

  • Early mobilization (getting out of bed, sitting, standing) is beneficial for postoperative patients to prevent complications
  • Respiratory therapy techniques should be considered alongside early mobilization for high-risk patients

Implications for Risk Category Patients

  • The most appropriate therapy may vary significantly depending on the specific risk profile of the patient, and should be decided based on preliminary planning.
  • Risk factors to consider for selecting appropriate therapy include: patient's existing health conditions; and history of smoking, obesity, or upper abdominal surgery.

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