EXAM PREP: THERAPEUTIC PROCEDURES

What position can you place a patient with ARDS in to improve oxygenation?

Prone position

What position can you place a patient with CHF in to improve oxygenation?

Fowlers

What position can you place a patient who is obese in to improve oxygenation?

Lateral fowlers

What is an indication for an IS or SMI?

Prevention or treatment of atelectasis for patients who are willing and able to spontaneously take a deep breath.

What are indications for IPPB?

Prevent or correct atelectasis in patients unable or unwilling to take a deep breath

Prevent or decrease pulmonary edema

Decrease the WOB

Distribute aerosols more evenly for better deposition

Improve and promote cough mechanisms

What are contraindications associated with IPPB therapy?

Hypotension, untreated pneumothorax, elevated ICP.

What are hazards associated with IPPB therapy?

Hyperventilation, impending venous return, gastric distention, pneumothorax, air trapping in patients with COPD.

Is the Bird Mark 7 ventilator for IPPB therapy volume or pressure cycled?

Pressure cycled

On a bird mark 7 ventilator for IPPB therapy, how do you decrease the inspiratory time?

Increase the flow

On a bird mark 7 ventilator for IPPB therapy, how do you increase the inspiratory time?

decrease the flow

On a bird mark 7 ventilator for IPPB therapy, how is volume changed?

By adjusting the pressure limit, so an increase in pressure will increase the volume.

Decreasing the flow will increase the volume and vice versa.

On a bird mark 7 ventilator for IPPB therapy, what will prevent normal cycling to exhalation?

Leaks

On a bird mark 7 ventilator for IPPB therapy, the sensitivity should be adjusted to trigger at approx?

-1 to -2 cmH2O

If compliance is decreased, volume will be?

decreased

If compliance is increased, volume will be?

increased

If airway resistance is increased, volume will be?

decreased

If airway resistance is decreased, volume will be?

Increased

Decreased compliance and an increase in resistance means the volume will be?

decreased

Increased compliance and a decrease in resistance means the volume will be?

increased

On a bird mark 7 ventilator for IPPB therapy, what could cause excessive pressure?

An obstruction or excessive flow.

A flat position drains what lobes?

Upper lobes

positioned 15 degrees down drains what lobes?

Middle lobes

Positioned down 30 degrees drains what lobes?

Lower lobes

When should you D/C PEP therapy?

If sinusitis or epistaxis occurs

Patient is instructed to breathe at low lung volumes to loosen secretions from small airways. Patient then increases his/her volume by breathing in the normal VT range. Primarily used in patients with CF and bronchiectasis.

Autogenic drainage

Variable air-pulse generator injects small gas volumes into and out of the vest, creating an oscillatory motion against the patients chest.

HFCWO

HFCWO therapy is conducted at what Hz, for how long, and at what frequency?

5 to 25 Hz (300 to 1500 cycles/min) for 30 minutes, 1 to 6 times/day.

Combination of high frequency pulse delivery (100 to 250 cycles/min) of a sub-tidal volume and dense aerosol. The percussive effect of gas delivery improves ventilation past obstructions in the airway thereby delivering more aerosol to the distal airways.

Intrapulmonary Percussive Ventilation

Delivers deep inspiration by positive pressure, followed by 1 to 2 second breath hold, then negative pressure exsufflation to create a cough. Indicated for patients with neurologic problems or muscle weakness.

Insufflation/Exsufflation devices

On a bubble humidifier when the connecting tubing is occluded and there is no whistling sound, what does this indicate?

There is a leak

Where should the HME be placed?

Between the wye and the patient

What humidifier can delivery 100% body humidity (44 mg/L)?

Wick humidifier

What is an advantage of a heated wire circuit?

Condensation (rain out) is minimized

What are goals of aerosol therapy?

To relieve bronchospasm and mucosal edema

To thin secretions that are thick and tenacious

To humidify the respiratory tract

To administer drugs

What may cause a large volume neb to not be misting enough?

Insufficient flow or water level

Clogged capillary tube

A decrease in temp

With a LVN, what may cause an increase in FiO2?

Any increase in resistance such as water collecting in the tubing, will cause less air to be entrained causing the FiO2 to increase.

What nebulizer is specifically designed to deliver ribavirin (Virazole) for treating RSV?

SPAG / small particle aerosol generator

Has the highest output range of all nebulizers w/o heating. Recommended for patients with thick tenacious secretions.

Ultrasonic nebulizer

This device improves the efficacy of an MDI by allowing larger particles to attach to the walls of the device and decrease oral deposition.

Spacers and Holding Chambers

What is the desired FiO2 range for a patient with COPD?

24% to 28%

What is the therapeutic FiO2 range?

30 to 60%

Nasal cannula:

What FiO2 does it deliver?

0.24 to 0.45

Nasal cannula:

What is the flow range?

1 to 6 L/min

Simple mask:

What FiO2 does it deliver?

0.40 to 0.55

Simple mask:

What is the flow range?

6 to 10 L/min

Partial rebreather mask: has no flap valves

What FiO2 does it deliver?

0.60 to 0.65

Partial rebreather mask: has no flap valves

What is the flow range?

6 to 10 L/min

Non-rebreather mask: Has 3 one way valves

What is the delivered FiO2 range?

0.21 to 1.0

Non-rebreather mask: Has 3 one way valves

Indications

Used to deliver 100% O2

Mixed gas therapy, such as Heliox

What device delivers a precise FiO2 concentration?

Air entrainment mask / Venturi mask

T piece / Briggs adaptor:

What is the delivered FiO2 range

0.21 to 1.0

What should be done if the aerosol on a T piece disappears?

Increase the flow

Add more reservoir tubing

Set up a device to provide more flow [blender, tandem set-up]

A HFNC is a humidification system that can heat and humidify oxygen at flow rates up to?

40 L/min

Oxygen Hood

A clear plastic device that completely encloses the head of the infant for the administration of oxygen and humidity. Flow ranges from 7 to 14 L/min to prevent CO2 build up and maintain FiO2.

Duration of cylinder flow formula

(gauge pressure (psi) x tank factor) / liter flow

What is the tank factor for an E cylinder?

0.28 L/psi (0.3)

What is the tank factor for an H cylinder?

3.14 L/psi (3.0)

Total flow formula

flowmeter setting x Factor

What is the purpose of CPAP?

To improve and support oxygenation at lower FiO2

What form of CPAP is used with neonates?

Nasal CPAP