lung expansion therapy #1

ideal body weight calculation for men

50 + (2.3 x inches over 5ft)

ideal body weight calculation for women

45 + (2.3 x inches over 5ft)

kg to lbs

x 2.2 = lbs

inspiratory capacity (IP)

maximum amount of air that can be inhaled from the resting end-expiratory level

IS

incentive spirometry/ sustained maximum inhalation (SMI); device to measure the maximum inspiratory volume provided by a spontaneously breathing patient

indications for IS

presence of atelectasis (upper abdominal/thoracic surgery, surgery in COPD pt.), presence of restrictive lung defect associated with quadriplegia or dysfunctional diaphragm

contraindications of IS

patients who cannot be instructed or supervised to ensure appropriate device use

patients who cannot understand or demonstrate proper use of device

patients unable to take a deep breath (IC < 1/3 of predicted normal)

hazards of IS

hyperventilation

barotrauma

discomfort secondary to inadequate pain control

hypoxia

fatigue

types of IS

flow-oriented

volume oriented

flow-oriented

measures flow rate of inspired gas and converts it to a volume for display

volume-oriented

inspire until a pre-determined volume of gas is inhaled (what we have)

frequency of IS

10 breaths every hour, 30-60sec rest in between breaths

breathing exercises

Diaphragmatic breathing and pursed-lip breathing.

diaphragmatic breathing

1. pt. in supine position (laying down), instruct them to take a slow, deep breath through the nose and exhale through pursed lips

2. place one hand on pt. upper chest and one hand on the epigastric area and apply moderately firm pressure during inspiration

3. the patient should move your hand by elevating the abdomen. the upper chest and shoulders should expand but not move up

4. replace your hands with a light book and instruct the pt. to practice moving the book up on inspiration

pursed lip breathing

1. Instruct pt. to take a deep breath through the nose

2. exhale through pursed lips with a slow, steady exhalation (decrease air trapping)

*allows the pt. with obstructive disease to maintain pressure in the airways throughout exhalation to "stent" the airway open

mucous clearance techniques

flutter, EZ-PAP & acapella

flutter

combines EPAP with high-frequency oscillations at the airway opening

1. pt. takes a deep breath in through the nose and exhales actively but not forcefully through a pipe shaped device with a heavy steel ball sitting in an angled bowl

2. on exhalation the ball oscillates at about 15Hz and provides 10-15cwp

** gravity dependent: the angle of the device to the mouth is adjusted ip and down to identify the point at which the greatest oscillation is felt

frequency of flutter sessions

5-10 active exhalations followed by coughing 1 set

acapella

utilizes a counterweighted plug and magnet to achieve valve closure

10 breaths, 1 set

1. pt takes a deep breath in through the nose (hold if possible) and exhales actively but not forcefully through the mouthpiece

green- adults, flows> 15LPM

blue- kids and elderly, flows

EZ PAP indications

treatment and prediction of atelectasis, pt. must be capable of following directions

how frequently do you do the EZ PAP?

10 breaths, 3 sets

minimum flow

5LPM *never exceed 15

desired expiratory airway pressure

10-20 cm H2O

which of these can also be delivered with an SVN

EZ PAP, acapella

contraindications to the EZ PAP

inability to tolerate increased WOB

ICP>20mm Hg

recent facial or head trauma

esophageal surgery

untreated pneumo

tympanic membrane damage

hemodynamic instability

epistaxis

nausea

active hemoptysis

IPV

intrapulmonary percussive ventilation

what three therapies are in IPV

aerosol, IPPB, airway percussion (positive pressure breathing)

indications of IPV

treatment of atelectasis, consolidation, ARDS, and inhalation burns, and CF

contraindications of IPV

none