Lung Expansion 1

Information about Lung Expansion 1

Published on May 2, 2008

Author: Lucianna

Source: authorstream.com

Content

Lung Expansion Therapy Part 1:  Lung Expansion Therapy Part 1 By Jim Clarke What is Lung Expansion Therapy?:  What is Lung Expansion Therapy? A group of medical treatment modalities designed to prevent and/or treat pulmonary atelectasis and associated problems Causes & Types of Atelectasis:  Causes & Types of Atelectasis Resorption atelectasis a blockage occurs in the airway- preventing ventilation downstream - resulting in eventual removal of remaining gas & alveolar collapse Passive atelectasis- Occurs when patients do not take periodic deep breaths (sighs) Compressive atelectasis Occurs when something outside the lung presses on lung tissue causing it to collapse What Patients Are “at-risk” for Atelectasis:  What Patients Are “at-risk” for Atelectasis Post-op thoracic or abdominal surgery patients Any heavily sedated patient Patients who have neuromuscular diseases These diseases may weaken breathing muscles Patients who are unable to ambulate Patients with chest trauma or chest wall injury How do we know if someone has an Atelectasis?:  How do we know if someone has an Atelectasis? “Gold Standard” - evidence of atelectasis on a chest x-ray (CXR) Example of Upper Lobe Atelectasis:  Example of Upper Lobe Atelectasis Methods Used for Lung Expansion Therapy:  Methods Used for Lung Expansion Therapy Incentive Spirometry - IS therapy IPPB - Intermittent Positive Pressure Breathing CPAP - Continuous Positive Airway Pressure Incentive Spirometry:  Incentive Spirometry Used primarily as a preventative or prophylactic treatment Patient are encouraged to take slow - deep inspirations ten times every hour Patients are taught to perform 5-10 second breath holds at maximal inhalation for each of the 10 hourly breaths Advantages of I.S. Therapy:  Advantages of I.S. Therapy Patients can self-administer as often as they like Relatively easy to learn and perform Very rare side effects Inexpensive way of preventing pulmonary complications Reasons Why I.S. May Not Be Appropriate:  Reasons Why I.S. May Not Be Appropriate Patient is not alert or cannot follow instructions Patient cannot hold mouthpiece in their mouth Patient has a large atelectasis that must be treated with more aggressive measures Patient cannot create a large enough breath for I.S. to be of any real value Prior to Teaching I.S. do the following::  Prior to Teaching I.S. do the following: Check the chart for; Order; Admitting Dx; evidence of any recent surgery (when?; type?); evidence of any previous pulmonary problems (COPD; asthma?); Chest X-ray reports At the bedside check for; mental status; ability to comprehend; pain level; evidence of any pulmonary problems (tachypnea &/or S.O.B.?) What to Focus on During I.S. Instruction:  What to Focus on During I.S. Instruction What is I.S. Why is the patient going to learn how to perform it How often should the patient perform it Does the patient have any questions Types of I.S. Devices:  Types of I.S. Devices Volume Oriented devices Actually measure & display the amount of air patient inhaled Flow Oriented devices Only display inspiratory flowrate and may attempt to estimate amount of air inhaled Examples of Two Electronic I.S. Devices:  Examples of Two Electronic I.S. Devices Example of a Flow-Oriented Device :  Example of a Flow-Oriented Device IPPB as Method of Enhancing Lung Expansion:  IPPB as Method of Enhancing Lung Expansion Definition - Lung expansion therapy utilizing positive airway pressure for periods of 15 - 25 minutes to enhance resting lung ventilation by increasing the patients tidal volume (Vt) How Positive Pressure Ventilation Differs from Normal :  How Positive Pressure Ventilation Differs from Normal In normal breathing, inspiratory pressures are negative while expiratory pressure are positive In IPPB, both inspiratory pressures & expiratory pressure are positive How Pressures Change During Inspiration:  How Pressures Change During Inspiration Indications For IPPB:  Indications For IPPB Patient has an atelectasis that is not responding to I.S. therapy Patient cannot perform I.S. therapy This may also be a problem with IPPB!! Poor cough effort & secretion clearance due to inability to take a deep breath Short term ventilatory support when patient is hypercapnic Enhancement of aerosol medication delivery in patient unable to take a deep breath Contraindications to IPPB:  Contraindications to IPPB Untreated pneumothorax High intracranial pressure (>15 mm Hg) Active hemoptysis Radiographic evidence of a bleb Nausea Tracheo-esophagel fistula Recent esophageal surgery Hazards & Complications of IPPB:  Hazards & Complications of IPPB Barotrauma (pneumothorax) Hyperventilation (dizziness) Gastric distension (secondary to air swallowing) Decrease in venous return (possible drop in B.P.) Increased airway resistance May actually cause bronchospasm in some patients! Monitoring the IPPB Treatment:  Monitoring the IPPB Treatment What is the pulse & respiratory rate prior to treatment? What are the patients breath sounds; their color; respiratory effort; mental state - prior to the Tx? What is the patients SpO2 or peakflow before the treatment (if giving bronchodilators) Equipment Needed for IPPB:  Equipment Needed for IPPB IPPB Ventilator - Bennett “PR series” ventilator OR Bird “Mark series” ventilator IPPB tubing circuit “Universal” disposable circuits now used Additional equipment “possibly” needed; Mouthseal & noseclips for patients who cannot use mouthpiece Mask (if mouthseal is not available) Connector for using circuit with trach patient Key Elements of IPPB Instruction:  Key Elements of IPPB Instruction What is IPPB Why is the patient going to be receiving IPPB treatments How long is each treatment & how often will they receive it What should they do during the treatment Any questions What should the patient do during IPPB?:  What should the patient do during IPPB? Patient starts their breath; the machine cycles on Patient relaxes and lets the machine fill their lungs Patient should NOT be actively breathing after the machine cycles (turns on) Patient will exhale normally in a relaxed way through the mouth when machine ends inspiration (pre-set pressure is reached) What should the therapist emphasize during the treatment?:  What should the therapist emphasize during the treatment? Make sure patients keep lips sealed tight around the mouthpiece Coach patient to not actively breath “Relax and let the machine fill your lungs!” Make sure patient does not breath too rapidly during treatment This will cause dizziness secondary to hyperventilation Key Aspects & Terms Associated with IPPB ventilators:  Key Aspects & Terms Associated with IPPB ventilators Patient initiates the breath and machine is able to detect the patient’s effort and then starts delivering gas into the mouthpiece The ability of machine to detect the patients need for a breath is called “sensitivity” Sensitivity should be set so that machine will begin breath at a pressure that is 1 or 2 cmH2O pressure below zero (or -1 to -2 cmH2O pressure) These machines are “pressure cycled”:  These machines are “pressure cycled” This means that inspiration ends when a preset pressure is reached in the circuit Preset pressure is set by the therapist Typical pressure ranges (15 - 25 cmH2O) Pressures higher than 25 associated with “air swallowing” particularly with mouthseal or mask treatments Pressures less than 15 may be insufficient to increase the tidal volume (Vt) Characteristics of Pressure Cycling:  Characteristics of Pressure Cycling Any leak in the “circuit” or in the patient will cause the machine to not end inspiration (cycle off) Patient can easily end the breath by blowing back into the mouthpiece putting their tongue over the mouthpiece Pressure cycled machine can NOT guaranteed to deliver any specific volume to the patient Characteristics of Pressure Cycling:  Characteristics of Pressure Cycling Volume delivered is based upon; the patients ability to relax and let the machine deliver the breath the pressure level set by the therapist the higher the pressure level set - the greater the volume delivered to the patient (ideally) End of Week 2 - Thursday:  End of Week 2 - Thursday

Related presentations


Other presentations created by Lucianna

Nutritional Care of Burns
04. 01. 2008
0 views

Nutritional Care of Burns

spine2 no background
08. 05. 2008
0 views

spine2 no background

banking
14. 04. 2008
0 views

banking

emerging security threats
29. 09. 2007
0 views

emerging security threats

Thunderstorms
03. 10. 2007
0 views

Thunderstorms

i2 traffic shaping
03. 10. 2007
0 views

i2 traffic shaping

bind
07. 10. 2007
0 views

bind

prefix delegation requirement1
09. 10. 2007
0 views

prefix delegation requirement1

dipo
12. 10. 2007
0 views

dipo

Living Things
12. 10. 2007
0 views

Living Things

wnv062904
21. 10. 2007
0 views

wnv062904

latinoamerica
22. 10. 2007
0 views

latinoamerica

Rachinsky
11. 10. 2007
0 views

Rachinsky

Slide presentazione
24. 10. 2007
0 views

Slide presentazione

feynman
16. 10. 2007
0 views

feynman

gt bot
13. 10. 2007
0 views

gt bot

fr summit marginson 230306
30. 10. 2007
0 views

fr summit marginson 230306

Accelerators CZ
15. 11. 2007
0 views

Accelerators CZ

Les Animaux du Zoo
11. 10. 2007
0 views

Les Animaux du Zoo

Rapport Nationale MAROC
23. 10. 2007
0 views

Rapport Nationale MAROC

Grammar essentials
16. 11. 2007
0 views

Grammar essentials

sponge
20. 11. 2007
0 views

sponge

Crans Montana 03 nieuw
15. 10. 2007
0 views

Crans Montana 03 nieuw

Workshop
02. 11. 2007
0 views

Workshop

NSF 12 6 2001
31. 12. 2007
0 views

NSF 12 6 2001

Class8
07. 01. 2008
0 views

Class8

toc wkshp nov03
18. 10. 2007
0 views

toc wkshp nov03

VCT Morocco
24. 10. 2007
0 views

VCT Morocco

NACADA Combined Workshop 11 04
29. 09. 2007
0 views

NACADA Combined Workshop 11 04

sky
13. 11. 2007
0 views

sky

file Kigali Strengthening Local
07. 01. 2008
0 views

file Kigali Strengthening Local

10638221831Maroc MinInt French
23. 10. 2007
0 views

10638221831Maroc MinInt French

ub geographicimagery051 001
27. 09. 2007
0 views

ub geographicimagery051 001

Presentación RR EXPORTA def
23. 10. 2007
0 views

Presentación RR EXPORTA def

prosper
28. 12. 2007
0 views

prosper

HPCN summary 7 5 2007
17. 10. 2007
0 views

HPCN summary 7 5 2007

ammosov
12. 10. 2007
0 views

ammosov

A NEW ENGLISH COURSE Book 3
20. 02. 2008
0 views

A NEW ENGLISH COURSE Book 3

Food Bank of New Jersey
29. 02. 2008
0 views

Food Bank of New Jersey

lewis
19. 10. 2007
0 views

lewis

XC Safety and mentor
03. 04. 2008
0 views

XC Safety and mentor

NA3
07. 04. 2008
0 views

NA3

Civitas Plus2006
18. 03. 2008
0 views

Civitas Plus2006

Ch14 7e
10. 04. 2008
0 views

Ch14 7e

Team2
11. 04. 2008
0 views

Team2

fmla
04. 10. 2007
0 views

fmla

retailcompetition
17. 04. 2008
0 views

retailcompetition

Using ILS
22. 04. 2008
0 views

Using ILS

shaw
16. 03. 2008
0 views

shaw

CSI Presentation 2007
19. 02. 2008
0 views

CSI Presentation 2007

NIST TDT2004
07. 05. 2008
0 views

NIST TDT2004

chapter3v2
15. 10. 2007
0 views

chapter3v2

MEDOPSBOOKFEB01
02. 05. 2008
0 views

MEDOPSBOOKFEB01

BostwPres
02. 05. 2008
0 views

BostwPres

555 Spanish
02. 05. 2008
0 views

555 Spanish

hexapod Shirke
02. 05. 2008
0 views

hexapod Shirke

Aaron
02. 05. 2008
0 views

Aaron

CMI slides Feb05
01. 11. 2007
0 views

CMI slides Feb05

SAP1012
10. 03. 2008
0 views

SAP1012

lesson 4
15. 10. 2007
0 views

lesson 4

2006 APHA
05. 10. 2007
0 views

2006 APHA

probir
30. 03. 2008
0 views

probir

Rauf Presentation NEW
18. 10. 2007
0 views

Rauf Presentation NEW

IAJAPAN
09. 10. 2007
0 views

IAJAPAN

Mr Daisuke Matsunaga
09. 10. 2007
0 views

Mr Daisuke Matsunaga

3 KukaGLBThealthissues
29. 10. 2007
0 views

3 KukaGLBThealthissues

Bernard ANSELMETTI
24. 10. 2007
0 views

Bernard ANSELMETTI

NBII Newark 10 02
21. 10. 2007
0 views

NBII Newark 10 02

MarketingWorkshop 4 22 05rev1
24. 10. 2007
0 views

MarketingWorkshop 4 22 05rev1

FEESTDAGEN
06. 11. 2007
0 views

FEESTDAGEN

trainplanesandautomo biles
13. 03. 2008
0 views

trainplanesandautomo biles

NWA June00
05. 10. 2007
0 views

NWA June00

Panama 2004 Reporte
25. 10. 2007
0 views

Panama 2004 Reporte

SAKURA Yamamoto
25. 03. 2008
0 views

SAKURA Yamamoto

tiner presentation
04. 01. 2008
0 views

tiner presentation

aseancjp
09. 10. 2007
0 views

aseancjp

schools talk
29. 10. 2007
0 views

schools talk

BethkeA
02. 10. 2007
0 views

BethkeA

DeVidtsPresentation
11. 10. 2007
0 views

DeVidtsPresentation

Zhu Zhiyong
16. 10. 2007
0 views

Zhu Zhiyong

pres1 1
22. 10. 2007
0 views

pres1 1

AESC 2005 VERMONT Result
02. 11. 2007
0 views

AESC 2005 VERMONT Result