Lung Expansion & Therapies (Class 14) - 2024 PDF

Lung Expansion HESS Chapter 16  Incentive Spirometry - Review 1. Tell me 5 things about IS. 2. What is the IBW of a man 5’10” weighing 190 lbs.? 3. What would his IC be? 4. Can anyone name a contraindication? 5. Can anyone name a hazard?  Incentive Spirometry Most Comm...

Lung Expansion HESS Chapter 16  Incentive Spirometry - Review 1. Tell me 5 things about IS. 2. What is the IBW of a man 5’10” weighing 190 lbs.? 3. What would his IC be? 4. Can anyone name a contraindication? 5. Can anyone name a hazard?  Incentive Spirometry Most Common Hyperinflation Therapy Performed using devices that give the pt. a visual clue by showing the pt. numbers signifying the volume achieved. Pt. can see that volume/flow is reached. Indications Upper abdominal surgery Chest surgery COPD pt. undergoing or having undergone surgery Bedridden pts. Contraindications Pt. cannot be instructed/supervised on proper use of the device. Unconscious pt. or unable to speak.  Applying Age ◼ 45 ml. per kg (IBW) = IC for the incentive, figured at age 20. ◼ For every 10 years over 20 subtract (-) 100 ml. from the IC ◼ Exa: If the patient is 70 yrs. old, subtract 500 ml. from the IC, then figure 30%.  Applying Age ◼ Exa: You need to administer IS to a 50Y female, who is 5’5” tall. What is her IC and what volume would be her targeted goal? 5 x 5= 25 25 + 105 = 130 130 / 2.2 = 59.09 – Just use 59 59 x 45 = 2,655 ml = IC She is 30Y over the age of 20, which = 300 ml. 2655 – 300 = 2355 2355 x 30% = 706.5 I would set her IS at 700 ml. – This is close enough.  Physiological Basis of IS ◼ The basic maneuver of IS is a sustained maximal inspiration (SMI). ◼ A SMI is a slow, deep inhalation from the FRC up to (ideally) the total lung capacity, followed by a 5 to 10 second breath hold. ◼ A SMI is thus functionally equivalent to performing an inspiratory capacity (IC) maneuver, followed by a breath hold. Lung Volumes & Capacities  Physiological Basis of IS ◼ During the inspiratory phase of spontaneous breathing, the drop in PL pressure caused by expansion of the thorax is transmitted to the alveoli. ◼ This assists in maintaining open alveoli and recruiting collapsed alveoli, thereby correcting atelectasis.  ® acapella For Vibratory PEP Therapy  Vibratory PEP Therapy It is Positive Expiratory Pressure therapy -With- A vibratory assist to further loosen and move secretions  Vibratory PEP Therapy Positive pressure created by expiratory resistance splints open the airways …through Collateral Ventilation… Inspired air fills collapsed alveoli through the Canals of Lambert and the Pores of Kohn Secretions are moved to the larger airways  Vibratory PEP Therapy ◼ Vibration during the therapy ◼ Provides a percussive effect that disengages mucus from the airway walls ◼ Pulsates the mucus forward towards the larger airways ◼ Reduces the visco-elasticity of mucus  Inside the acapella 3. The movement of the doughnut 1. Patient’s inhaled breath flows through the and rocker creates the vibratory flow tube effect 2. One-way valve allows patient to inhale and exhale without removing acapella from their mouth and directs their exhalation through the vibratory mechanism  Acapella Frequency and resistance dial is pre-set at DHD in the lowest frequency and resistance setting Increase Decrease frequency frequency and and resistance resistance Attach Mouthpiece or Mask Here Change Resistance & Frequency Here  5. Patient may inhale and exhale 1. acapella works in any position through acapella without removing it from their mouth 2. Meets a wide range of patient needs 3. Change the frequency 6. acapella may be used with a and resistance at the dial mouthpiece or a mask 4. 22mm connections allow a pressure indicator to be attached,  Acapella with Nebulizer Exhale Inhale Perform both therapies in the time it takes to do one. Valving in acapella eliminates the need for a valved T piece. acapella DH – For patients capable of maintaining an expiratory flow rate >15 lpm for 3-4 seconds The majority of your patients will use this device  Cleaning acapella 1. Once a day, remove the Mouthpiece (mask) from the acapella and soak the entire unit in warm, soapy water. 2. Rinse the equipment well, flushing water thoroughly through both ends of the acapella. 3. Soak the entire unit in a vinegar solution containing 2 parts white distilled vinegar with 3 parts distilled water for 20 minutes. 4. Rinse thoroughly, shake dry and place on a paper towel to dry. Allow to dry overnight. It is very important that the equipment is completely dry to help prevent the growth of bacteria. Intentionally Left Blank Intentionally Left Blank Flutter Device During exhalation through the device, the patient's respiratory system undergoes internal vibrations which are triggered by repeated variations of the exhaled airflow and by oscillations of the endobronchial pressure. The Flutter Device It generates an automatically controlled oscillating positive pressure. The patient is thus protected against a collapse of the airways, as well as against any prolonged hyperpressure which could occur should the instructions for use not be followed and exhalations be repeatedly forced.  The Flutter Device It enables a modulation of the pressure and airflow oscillation frequency. By tuning this frequency to his/her own lung resonance frequency (usually between 6 and 26 Hz) the patient induces maximal vibrations of the bronchial walls which promote clearance of the small airways where CF infections and airway damage occur. AerobiKA Intentionally Left Blank EzPAP Positive Airway Pressure System  EzPAP – What You'll Learn What is Positive Airway Pressure Therapy? Who are the patients that benefit from EzPAP? How does EzPAP work? How do you use EzPAP? What is in an EzPAP Kit?  Positive Airway Pressure Therapy ◼ A therapy where a positive pressure is maintained in a patient’s airways throughout the breathing cycle. ◼ The therapeutic pressure range is usually between 5 and 30 cm of water (cm H20). ◼ The positive airway pressure splints open the airways to help stabilize them and re-inflate collapsed alveoli.  EzPAP Provides PAP Therapy ◼ When exhaling, the patient breathes against the resistance caused by the airflow creating a positive expiratory pressure ◼ The breath hold is positive pressure ◼ The patient receives a positive pressure inspiratory assist when inhaling  EzPAP not CPAP ◼ Airway pressure with CPAP, is basically constant throughout breathing ◼ Airway pressure with EzPAP increases during exhalation and decreases during inhalation ◼ A positive, variable airway pressure is maintained throughout breathing 16 Pressure [cmH2O] 14 12 Airway 10 8 EzPAP 6 CPAP 4 2 Expiration 0 Inspiration Expiration Expiration Inspiration Expiration  How Does it Work? The expiratory resistance provides PEP therapy to further splint open the airways and re-inflate the alveoli through Collateral Ventilation The inspiratory pressure assist helps to hold the airways open The elevated positive pressure is maintained throughout the breathing cycle  Who Benefits? 1. Post-Surgical patients who develop atelectasis 2. Patients unable to perform deep breathing exercise due to pain or non- cooperation 3. Patients needing lung expansion therapy that cannot follow instructions 4. Patients requiring lung expansion, but with inadequate inspiratory capacity (