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Egan's Ch 43

front 1 Understand the causes of atelectasis.	back 1 Gas absorption atelectasis- occurs either when there is a complete interruption of ventilation to a section of the lung or when there is a significant shift in V/Q; gas distal to obstruction is absorbed by passing blood Lobar atelectasis- can occur when ventilation is compromised in a larger airway or bronchus Compression atelectasis-occurs when the transthoracic pressure exceeds the trans alveolar pressure
front 2 Identify which patients are at the greatest risk for developing atelectasis and needing lung expansion therapy.	back 2 obesity neuromuscular disorders heavy sedation surgery near diaphragm bed ridden/ bed rest poor cough history of lung disease restrictive chest-wall abnormalities
front 3 Define the clinical findings seen in atelectasis.	back 3 History of recent major surgery Tachypnea Fine, late-inspiratory crackles Bronchial or diminished breath sounds Tachycardia Increased density and signs of volume loss on chest radiograph History of chronic lung disease or cigarette smoking or both
front 4 Describe how lung expansion therapy is able to reverse atelectasis.	back 4 Lung expansion therapy corrects atelectasis by increasing the P_AL gradient by either: 1) decreasing the surrounding P_pl or 2) increasing the P_alv This can be accomplished by deep spontaneous breaths or by the application of positive pressure P_AL= P_alv(alveolar pressure) - P_pl (pleural pressure)

front 5 Baseline Assessment	back 5 before beginning therapy, a baseline assessment should be conducted this information helps to individualize the treatment & allows objective evaluation of the patient's subsequent response to therapy measuring vital signs assessing the patient's appearance & sensorium assessing the breathing pattern through chest auscultation patient's level of motivation & their ability to follow instructions
front 6 Early Mobilization of the Patient	back 6 Intensive Care Unit Patients evidence supports that it is better for the overall recovery of patients to get them out of the bed and provide early ambulation. Complications of prolonged bed rest include: cardiovascular, pulmonary, gastrointestinal, and skin integrity issues Pulmonary complications of immobility: development of atelectasis, pneumonia, and pulmonary emboli (PE) Mobilization includes: not only walking, but also sitting, standing, and getting out of the bed into a chair
front 7 List the indications, hazards and complications associated with the various modes of lung expansion therapy.	back 7 Incentive Spirometry- indications- presence of pulmonary atelectasis; presence of conditions predisposing to atelectasis: upper abdominal surgery, thoracic surgery, surgery in patients with COPD; presence of a restrictive lung defect associated with quadriplegia or dysfunctional diaphragm
front 8 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Incentive Spirometry Contraindications	back 8 Contraindications patient cannot be instructed or supervised to ensure appropriate use of device, patient cooperation is absent or patient is unable to understand or demonstrate proper use of device, patient is unable to deep breathe effectively (VC< 10 mL/kg or IC< 1/3 of predicted)

front 9 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Incentive Spirometry Hazards and Complications	back 9 Hazards & Complications hyperventilation & respiratory alkalosis, discomfort secondary to inadequate pain control, pulmonary barotrauma, exacerbation of bronchospasm, fatigue
front 10 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Intermittent Positive Pressure Breathing (IPPB) Indications	back 10 Indications no data to support the use of IPPB as a method of preventing or expanding atelectasis patient with atelectasis not responsive to other modalities such as IS patient at high risk for atelectasis who cannot perform IS
front 11 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Intermittent Positive Pressure Breathing (IPPB) Contraindications	back 11 Contraindications tension pneumothorax ICP > 15 mm Hg hemodynamic instability active hemoptysis tracheoesophageal fistula recent esophageal surgery radiographic evidence of blebs recent facial, oral, or skull surgery singulars (hiccups) nausea
front 12 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Intermittent Positive Pressure Breathing (IPPB) Hazards and Complications	back 12 Hazards and Complications hyperventilation and respiratory alkalosis discomfort secondary to inadequate pain control pulmonary barotrauma exacerbation of bronchospasm fatigue

front 13 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Continuous Positive Airway Pressure (CPAP) Indications	back 13 Indications evidence supports the use of CPAP therapy in the treating postoperative atelectasis, with all mechanical techniques, the duration of beneficial effects appears limited
front 14 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Continuous Positive Airway Pressure (CPAP) Contraindications	back 14 Contraindications tension pneumothorax / untreated pneumothorax ICP > 15 mm Hg hemodynamic instability active hemoptysis tracheoesophageal fistula recent esophageal surgery radiographic evidence of blebs recent facial, oral, or skull surgery singulars (hiccups) nausea hypoventilation
front 15 List the indications, hazards and complications associated with the various modes of lung expansion therapy. Continuous Positive Airway Pressure (CPAP) Hazards and Complications	back 15 Hazards and Complications barotrauma, pneumothorax nosocomial infection hypercarbia hemoptysis pressure ulcers from mask gastric distension impaction of secretions (associated with inadequately humidified gas mixture) impedance of venous return hypoventilation increased V_D vomiting and aspiration
front 16 Describe the primary responsibilities of the respiratory therapist in planning, implementing, and evaluating lung expansion therapy.	back 16 RTs are responsible for implementing, monitoring and documenting results of lung expansion therapy. in-depth knowledge of both methods available the specific condition and needs of the patient being considered for therapy

front 17 atelectasis	back 17 collapse of the distal lung parenchyma
front 18 compression atelectasis	back 18 collapse of a part of the lung as a result of an external force compressing the lung.
front 19 continuous positive airway pressure (CPAP)	back 19 a method of ventilatory support whereby the patient breathes spontaneously without mechanical assistance against threshold resistance, with pressure above atmospheric maintained at the airway throughout breathing.
front 20 deep breathing/directed cough	back 20 movements used to improve pulmonary gas exchange or to maintain respiratory function, especially after prolonged inactivity or general anesthesia

front 21 egophony	back 21 physical examination finding of increased resonance of voice sounds when auscultating the chest (e.g., due to lung consolidation).
front 22 gas absorption atelectasis	back 22 collapse of airways due to hyperoxygenation and nitrogen washout.
front 23 incentive spirometry (IS)	back 23 purpose of IS is to coach the patient to take a sustained maximal inspiratory (SMI) effort resulting in a decrease in P_AL & maintaining the potency of airways at risk of closure the process of encouraging a bedridden patient to take deep breaths to avoid atelectasis; most often done with the use of an incentive spirometer that provides feedback to the patient when a predetermined lung volume is reached during inspiration
front 24 intermittent positive airway pressure breathing (IPPB)	back 24 the application of positive- pressure breaths to a patient for a relatively short period (10 to 20 minutes).

front 25 lobar atelectasis	back 25 a collapsing of the airways and or alveoli limited to one lung segment.
front 26 noninvasive ventilation (NIV)	back 26 mechanical ventilation performed without intubation or tracheostomy, usually using a mask.
front 27 high-flow nasal cannula (HFNC)	back 27 a variation of the standard nasal cannula that can deliver both FiO2 and relative humidity greater than 90% by using heated, humidified O2 with flows up to 50 L/min. These systems have been shown to successfully treat moderate hypoxemia through a combination of a high FiO2, distending PAP, and meeting or exceeding the patient’s minute ventilation.
front 28 positive expiratory pressure (PEP)	back 28 an airway clearance technique in which the patient exhales against a fixed-orifice flow resistor to help move secretions into the larger airways for expectoration via coughing or swallowing.