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Questions and Answers
What should be considered before starting lung expansion therapy?
What should be considered before starting lung expansion therapy?
What device can be used as an alternative if a patient cannot tolerate PEP therapy?
What device can be used as an alternative if a patient cannot tolerate PEP therapy?
Which of the following is a sign that a patient may be hyperventilating during therapy?
Which of the following is a sign that a patient may be hyperventilating during therapy?
What complication should be monitored during PEP therapy?
What complication should be monitored during PEP therapy?
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What is a recommended practice after administering PEP therapy?
What is a recommended practice after administering PEP therapy?
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How can patients manage PEP therapy outside of the hospital setting?
How can patients manage PEP therapy outside of the hospital setting?
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What is a common use for PEP therapy in patients?
What is a common use for PEP therapy in patients?
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Which of the following statements about PEP therapy is true?
Which of the following statements about PEP therapy is true?
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What effect does a deep inspiration have on the PAL gradient?
What effect does a deep inspiration have on the PAL gradient?
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Which condition may present with a consistently lower SpO2 and increased respiratory rate?
Which condition may present with a consistently lower SpO2 and increased respiratory rate?
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What is a common sign of severe atelectasis?
What is a common sign of severe atelectasis?
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What does positive pressure lung expansion therapy aim to increase?
What does positive pressure lung expansion therapy aim to increase?
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What is required for IS and other patient-directed lung therapies to be effective?
What is required for IS and other patient-directed lung therapies to be effective?
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Which of the following best describes crackles heard in a patient with atelectasis?
Which of the following best describes crackles heard in a patient with atelectasis?
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Which of the following therapies applies pressure during both inspiration and expiration?
Which of the following therapies applies pressure during both inspiration and expiration?
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What is one of the main issues related to the efficiency of lung expansion therapy?
What is one of the main issues related to the efficiency of lung expansion therapy?
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What is the primary goal of lung expansion therapy?
What is the primary goal of lung expansion therapy?
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Which type of atelectasis occurs when there is compression of lung tissue?
Which type of atelectasis occurs when there is compression of lung tissue?
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Which of the following patients is most likely at risk for developing atelectasis?
Which of the following patients is most likely at risk for developing atelectasis?
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Which of the following is a common clinical sign of atelectasis?
Which of the following is a common clinical sign of atelectasis?
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What does incentive spirometry encourage patients to do?
What does incentive spirometry encourage patients to do?
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How does noninvasive ventilation (NIV) assist patients with lung expansion?
How does noninvasive ventilation (NIV) assist patients with lung expansion?
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What is one of the primary responsibilities of a respiratory therapist regarding lung expansion therapy?
What is one of the primary responsibilities of a respiratory therapist regarding lung expansion therapy?
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Which of the following therapies is NOT typically considered a lung expansion therapy?
Which of the following therapies is NOT typically considered a lung expansion therapy?
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What is the primary goal of deep breathing exercises in patients at risk for atelectasis?
What is the primary goal of deep breathing exercises in patients at risk for atelectasis?
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Which lung sound indicates the presence of consolidation due to atelectasis?
Which lung sound indicates the presence of consolidation due to atelectasis?
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What indicates a significant loss of lung volume on a chest x-ray for a patient with atelectasis?
What indicates a significant loss of lung volume on a chest x-ray for a patient with atelectasis?
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What effect does atelectasis have on the respiratory rate of a patient?
What effect does atelectasis have on the respiratory rate of a patient?
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In what scenario is positive pressure therapy reserved?
In what scenario is positive pressure therapy reserved?
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What might lead to diminished breath sounds in patients with atelectasis?
What might lead to diminished breath sounds in patients with atelectasis?
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What characteristic of the lung sounds changes as atelectasis becomes more pronounced?
What characteristic of the lung sounds changes as atelectasis becomes more pronounced?
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What is the relationship between atelectasis severity and respiratory rate?
What is the relationship between atelectasis severity and respiratory rate?
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What advantage does high-flow nasal cannula (HFNC) provide in terms of oxygen delivery?
What advantage does high-flow nasal cannula (HFNC) provide in terms of oxygen delivery?
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Which of the following is a potential complication of high-flow nasal cannula therapy?
Which of the following is a potential complication of high-flow nasal cannula therapy?
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Which outcome is NOT typically associated with high-flow nasal cannula therapy?
Which outcome is NOT typically associated with high-flow nasal cannula therapy?
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What is a significant physiological benefit of the elevated flow rate in high-flow nasal cannula therapy?
What is a significant physiological benefit of the elevated flow rate in high-flow nasal cannula therapy?
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Which monitoring parameter is essential for assessing the effectiveness of high-flow nasal cannula therapy?
Which monitoring parameter is essential for assessing the effectiveness of high-flow nasal cannula therapy?
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When using high-flow nasal cannula therapy, which symptom indicates a potential issue with the therapy?
When using high-flow nasal cannula therapy, which symptom indicates a potential issue with the therapy?
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Which of the following parameters is NOT typically monitored during high-flow nasal cannula therapy?
Which of the following parameters is NOT typically monitored during high-flow nasal cannula therapy?
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What is a commonly reported outcome of high-flow nasal cannula therapy?
What is a commonly reported outcome of high-flow nasal cannula therapy?
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What is the primary goal of using continuous positive airway pressure (CPAP) in the postoperative period?
What is the primary goal of using continuous positive airway pressure (CPAP) in the postoperative period?
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What are the physiological benefits of early mobility in mechanically ventilated patients as mentioned in the literature?
What are the physiological benefits of early mobility in mechanically ventilated patients as mentioned in the literature?
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Which therapy was compared to high-flow nasal cannula in the study on postextubation outcomes?
Which therapy was compared to high-flow nasal cannula in the study on postextubation outcomes?
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What is a well-documented effect of positive expiratory pressure (PEP) breathing?
What is a well-documented effect of positive expiratory pressure (PEP) breathing?
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In the context of postoperative care, what was highlighted as a common misconception regarding early mobility?
In the context of postoperative care, what was highlighted as a common misconception regarding early mobility?
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Which of the following best describes the focus of the Cochrane Database review regarding early mobility?
Which of the following best describes the focus of the Cochrane Database review regarding early mobility?
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What does the evidence suggest about the use of CPAP for treating postoperative hypoxemia?
What does the evidence suggest about the use of CPAP for treating postoperative hypoxemia?
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During which phase of care is high-flow oxygen therapy most beneficial according to the studies referenced?
During which phase of care is high-flow oxygen therapy most beneficial according to the studies referenced?
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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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Description
This quiz explores lung expansion therapy and its importance in preventing and correcting atelectasis. You will learn about various methods such as incentive spirometry, CPAP, and early mobilization, along with the risks associated with postoperative patients. Understanding patient preferences and the goal of increasing functional residual capacity is also emphasized.
