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98 Cards in this Set
- Front
- Back
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What is Intrapulmonary Percussive Ventilation? (IPV)
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The combination of high frequency phased pulse gas delivery and the administration of a dense aerosol
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What is the high frequency breath delivery for IPV?
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100-250 breaths / min
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What is the low tidal volume for breath delivery with the IPV?
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<100 mL / breath
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What is the breath triggering with the IPV?
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where the pt manually triggers a breath
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What kind of aerosol delivery does the IPV provide?
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Continuous DENSE aerosol delivery
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IPV compared with SVN or IPPB has double the volume, why?
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b/c of the addition of saline
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What are the conceptual perspective of the IPV theray?
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1- IPPB at a higher frequency has lower tidal volumes
2- High frequency causes "gas trapping" and a pressure splint 3-Not all the tidal breath is exhaled 4- The "pressure splint" hyperinflates the lungs |
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What are the clinical GOALS for IPV?
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1- Reduce air trapping in Asthma / COPD pts
2- Aids in mobilization of screation (IPV is similar to CPT only internal) 3- Prevent or reverse atelectasis ( removal of secreations reduces mucus plugging / air trapping) 4- Optimize delivery of bronchodilators |
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What are the hazards of IPV therapy?
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1- Hypocapnea (hyperventilation)
2- Hypoventilation (hypoxic drive) 3- Baro-Effects (pressure effects) 4- Decreased cardiac output 5- Increased ICP 6- Pneumothroax |
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IPV works on ________ and ________
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Pressure and frequency
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What is the function of the percussionator on the IPV?
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Pneumatically power, time cycled pressure controller
Pneumatic heart of the ventilator |
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Why does the percussionator give a pulsed delivery of about 10 psi?
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pulsed b/c it's to high for direct application to the lungs.
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What is the volume delivery on the IPV
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1- Controlled by pressure 25-40 psi
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How is the frequency controlled on the IPV ventilator?
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Controlled / adjusted via the Percussion control
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What is the phasitron?
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the interface between the percussionator and the patient circuit
Pneumatic clutch |
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What is the function of the phasitron?
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the venture reduces / dampens the pressure from the percussionator so its full pressure isn't applied to the lungs.
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What is the operation of the phasitron during INSPIRATION?
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gas pressure distorts a diaphragm sliding a venturi forward CLOSING the exhalation port.
Ambient air is drawn through the venturi at a (1:5) ratio so aerosol can be given |
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What happens to the phasitron during EXHALATION?
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a spring slide the venturi back, opening the exhalation port and the pt can exhale
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How do you correctly assmble the IPV circuit?
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Its color coded so match them up
Yellow Red Green White |
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What is the IPV-1C ventilator?
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1- "Standard" acute care ventilator
2- Used in the hospitals |
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What is the "SPANKER" ventilator?
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1- Requires an E cylinder / portable compressor
2- External regulator 3- Designed for home use |
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What is the TPX?
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1- Its a transport ventilator
2- Requires an E cylinder / external regulator 3- manually triggered breath 4-manually triggered expiratory hold |
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How do you troubleshoot the IPV ventilator?
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1- check circuit
2- check phasitron 3- check directional flow of 1 way valves 4- PATIENTS INSTRUCTION |
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How do you assess the outcomes of IPV therapy?
What do you look for? |
1- change in sputum production
2- change in breath sounds 3- improved pt subjective response 4- change in Vital signs dec. HR,RR 5- improved CXR 6- Improved ABGs |
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If you increase the frequency in the IPV what happens to pressure?
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Pressure will decrease
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What happens to frequency if you increase the pressure with IPV therapy?
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Frequency will decrease
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Postural drainage by itself is effective in ?????
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Mobilization and secretion removal
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There are _______ postural drainage positions, which drain _________ bronchopulmonary segments
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12 positions
18 segments |
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Define postural drainage?
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a technique where the patient is positioned in specific ways that allow gravity to facilitate the removal of pulmonary secretions
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What is chest percussion?
Manual CPT |
Clapping the hands over the appropriate pulmonary segment during postural drainage
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What is the idea behind the manual CPT?
Clapping |
The clapping traps an air pocket between the hand and the chest wall
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What effect does clapping have on the patient?
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1- the clapping causes a vibration to occur in the lung parenchyma
2- physically shakes the musous loose so the patient can cough it out |
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How can percussion be accomplished mechanically?
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1- pneumatic devices
2- electric devices 3-palm cups / "FLippers" for peds |
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What is the goal of doing vibration on a pt?
shaking your fingers |
to help force mucous to the larger airways so pt can cough it out
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How do you perform vibration?
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its an isometric maneuver that is performed ONLY during exhalation
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What is the common sequencing of techniques for CPT?
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1- Postural drainage
2- Percussion 3- Vibration |
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What are the segments and lobes of the Right Upper Lung?
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RUL:
Apical Anterior / Posterior |
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What are the segments / lobes of the right middle lobe?
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RML:
Lateral Medial |
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What are the segments / lobes of the Right lower lobe?
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RLL:
Superior basal Lateral basal Anterior basal Posterior basal Medial basal |
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What is the upper division of the Left upper lobe?
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LUL:
Apical Posterior Anterior "upper division of LUL" |
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What is the middle division of the left upper lobe?
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Superior lingula
Inferior lingula |
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What are the segments / lobes of the left lower lobe?
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Superior basal
Lateral basal Anterior basal Posterior basal |
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What are the clinical indication for CPT with pts that have ACUTE pulmonary conditions?
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1- Hypersecretion
2- Retained secretions 3- Lobar / segmental atelecasis |
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What are the clinical indications for CPT for pts that have CHRONIC pulmonary conditions?
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1- Copious secretion ie:
Cystic Fibrosis 2- COPD Emphysema Bronchiectasis Bronchitis |
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What kinds of conditions would CPT be warranted?
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1- Acute pulmonary conditions
2- Chronic pulmonary conditions 3- Prophylactic use |
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Why would you use CPT for prophylactic use?
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1- For the prevention of post-op complications
2- Neuromuscular disorders Ones that effect the diaphragm |
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What post -op complications can CPT help prevent?
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1-Pneumonia
2-Atelectasis |
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What kind of Neuromuscular disorders benefit from the prophylactic use of CPT?
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1- muscular dystrophy
2- Myasthenia gravis |
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What are the complication / hazards associated with CPT?
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1-Hemorrhage
2-Rib Fx 3- Increased intracranial pressure 4-Hypoxemia 5- Imparied Cardiac output 6-Increased airway resistance |
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How is a hemorrhage caused with CPT?
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In patients that have pulmonary abscess (empyema) or bronchopulmonary fistula
"NEED TO DRAIN THE EMPYEMA FIRST" (PUS) |
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How is rib Fx a complication of CPT?
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msiapplied pressure via mechanical or manual techniques
Be careful of young / elderly patients |
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why is increased intracranial pressure a complication for CPT?
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Has to do with patient positionig not the percussion.
Don't modify position id the patient has a: CLOSED HEAD INJURY / POST CRANIOTOMY |
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Why is hypoxemia a hazard with CPT?
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Worsening of V/Q mismatch
NEVER PUT THE DISEASED SIDE DOWN! you move blood away from the good area |
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How can impaired cardiac output be a hazard for CPT?
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patient may have an underlining cardiovascular disease.
Its position related |
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How can CPT increase airway resistance?
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Loose secretions may obstruct other areas.
If your pt is experiencing bronchospasms use a bronchodilator prior to CPT |
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what is the AARC CPGs indications for Postural Drainage Therapy PDT?
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1- Turning
2- Postural Drainage 3- External manipulation of the Thorax |
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Why is Turning an indication for the AARC to do CPT?
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1- inability of the pt to change body positions
2-poor oxygenation b/c of position 3-presence of atelectasis 4-presence of artificial airway |
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Why is Postural drainage an indication for the AARC to do CPT?
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1-evidence/suggestion of difficulty w/secretion clearance
2-difficulty clearing secretions w/expectorated sputum production greater than 25 ml/day 3-mucous plugging 4-foreign body in artificial airway |
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Why is External Manipulation of the thorax an indication by the AARC for CPT?
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To assist movement of secretions b/c of sputum volume / consistency
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What are the AARC CPGs for complications with CPT?
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1-hypoxemia
2-increased cranial pressure 3-acute hypotension during procedure 4-Pulmonary Hemorrhage 5-Pain/injury to muscles of rib/spine 6-Vomiting / aspiration 7-bronchospasm 8-Dysrhythmias |
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How would a doctor order CPT?
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1-location of treatment
Lobes / segments 2-Duration of TX (20min) 3-Frequency of TX (Q4hr, QID,TID) |
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How would you find the location of TX for CPT?
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1- HX, what is the problem?
2-Is CPT warreanted? 3-Look up lab work: CXR, ABG 4-Physical assessment: Auscultation-correlates w/CXR Percussion-areas of dullness |
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What are the AARC outcomes / goals
for PDT Postural drainage therapy? |
1- change in sputum production
2-Change in BS of the segments being drained 3- Pt subjective response to therapy 4-Change in vital signs 5-Change in CXR 6-change in ABG / O2 saturation 7-Change in Ventilator varibles |
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How do you chart CPT?
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1- lobe / segment drained
2-time of postural drainage 3-percussion technique manual / mechanical 4-Effectiveness of therapy Pt cough: productive / non, color, quantity of sputum 5-Pt subjective response, HR, SpO2 6-Pre/Post assessment: HR,BS, RR |
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What is breathing retraining?
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Breathing exercises to increase lung expansion
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What are the goals of breathing retraining?
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1- increase lung expansion
2-improve / reverse atelectasis 3-promote / improve the cough |
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What are the breathing retraining exercises types?
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1-Controlled cough
2-pursed lip breathing 3-Abdominal breathing 4-Sniffing 5-Panting 6-Unilateral chest expansion |
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What is the "Controlled cough" technique?
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3 strong deep breaths and cough
Used with post-op pt Most effective with splinting |
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What is the "pursed lip breathing" technique?
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Technique creates a back pressure w/in the lungs
1-Inhale through nose 2-than exhale through pursed lips |
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What is the Abdominal breathing technique?
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Increases the depth of inspiration
Involves the abdominal muscels |
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What is the "Sniffing" technique?
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Increases inspiratory depth
Increases intrathoracic pressure |
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What is the "Panting" technique?
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Used to stimulate a coughof support
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What is the "Unilateral chest expansion" technique?
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Designed to improve one lobe, Lung, or segment at a time
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What is the purpose of good body mechanics?
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Injury Prevention
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What are the general rules employed in good body mechanics?
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1-Use good body alignment: bend your knees
2-Position your feet to provide a good base of support 3-Move close to your pt |
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How would you position your pt to be "PRONE"?
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lay your pt on their STOMACH with the bed flat
Pillow under ankles Pillow under head if desired |
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How would you position your pt to be "SUPINE"?
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Lying your patient on their BACK, bed flat
Pillow under head |
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What is the "SIMS" position?
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Pt lying on their side, w/upper leg moved forward to prevent rolling into prone position
Pillow under head, under upper arm, under upper knee-ankle for support |
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What is the Semi-Flowlers poistion?
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Sitting upright w/head of the bed between 20-35 degrees
Pillow under head |
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That is the "Trendelenberg's" position?
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Pt on their BACK with foot of the bed elevated 18 inches tilting entire plane of the bed
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What is the "Reverse Trendelenberg's" position?
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Pt on their BACK with the head of the bed at 18inches with the entire plane descending down
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What is PEP Therapy?
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application of positive pressure during exhalation
Pt exhales to ambient pressure |
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What is a typical therapy session?
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10-20 breaths followed by coughing
Can be self-administered |
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What is the flutter valve therapy?
AKA: Acupella |
Pt exhales against the resistance of a ball the oscillates up / down
Therapy pattern similar to PEP |
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What is the HFCWO?
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High frequency chest wall oscillation therapy
Pneumatic Vest that gets the vibrations into the lungs |
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What is the Emerson Coughassist MI-E?
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Maximal inspiration / expiration
Applies +pressure than -pressure to the airways Pushes air in than sucks it out! |
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How would you drain the Anterior Apical segments of the R / L upper lobes?
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Position pt sitting / leaning back at a 45 degrees
Percuss just below the clavicle |
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How would you drain the Posterior Apical segments of the R /L upper lobes?
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Position pt sitting / leaning FORWARD about 45 degrees
Percuss just above scapula w/fingers extending up onto the shoulders |
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How would you drain the Anterior segments of the R/L upper Lobes
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Position the pt supine (back) with the bed flat
Percuss just above the nipple |
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How would you Drain the posterior segment of the LUL
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Position pt 1/4 turn from prone resting on the R side w/head of bed elevated 18inches
Percuss over the L scapula |
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How would you drain the Posterior segment of the RUL?
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Position pt 1/4 turn prone resting on L side with bed flat
percuss just above R scapula |
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How would you drain the Lingulas?
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Position pt 1/4 from supine resting R side w/foot of bed elevated 18in
Percuss just above the L nipple and under the armpit |
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How would you drain the RML?
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Position pt 1/4 from turn from supine w/foot of bed elevated 12in
Percuss just above the R nipple and under the armpit |
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How would you drain the Anterior basal segments of the R /L lung?
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position pt supine (back) w/foot of bed elevated 18-20 inches
Percuss over lower lobes |
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How would you drain the Posterior basal segments of the R / L lungs
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position pt prone (stomach) w/foot of the bed elevated 18-20 inches
Percuss over the lower ribs |
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How would you drain the L lateral segment of the Lower Lobes
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Position pt on the R side w/foot of the bed elevated 18-20 inches
Percuss over the lower ribs |
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How would you drain the R lateral segment of the lower lobes?
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Position the pt on the L side w/foot of the bed elevated 18-20 inches
Percuss over the lower ribs |
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How would drain the superior segments of the R / L lower lobes?
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Position pt prone (stomach) w/bed flat
Percuss just below the lower margin of the scapula |
