TMC: THERAPEUTIC PROCEDURES – Flashcards
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what's your ideal BREATHING PATTERN?
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- slow, deep inspiration - inspiratory hold (1 - 3 seconds) - exhalation is slow, passive and relaxed - PT may relax in between maneuvers with normal VT
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how do you position an ARDS patient?
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prone
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how do you position a CHF patient?
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fowlers
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how do you position a OBESE patient?
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lateral fowlers
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how do you position the lung if you have a UNILATERAL disease?
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good lung down
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what do you measure before an inspiratory muscle training (IMT)?
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maximal inspiratory pressure (MIP)
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where do you SET the flow resistor on a IMT?
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the lowest resistance setting
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what percentage must you achieve when using a IMT?
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30%
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how many times do you use a IMT?
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2x per day (10 - 15 minutes)
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when is an INCENTIVE SPIROMETRY indicated for?
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prevention/treatment of atelectasis for patients who are willing and able to take a DEEP breath
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how should an (IS) be performed?
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hourly, while patient is awake for about 10 breaths
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what do you chart after an (IS)?
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date, time, and volume (INSPIRATORY CAPACITY)
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how much should POST OP goal be on (IS)?
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1/2 of PRE OP inspiratory capacity
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if PT can't achieve goal what's the FIRST thing you do?
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check connections and PT mouth seal
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when do you use an IPPB?
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prevention/correction of ATELECTASIS for PT who can't or wont take a deep breath
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what helps distribute aerosols much DEEPER in the airways?
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IPPB
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what are some CONTRAINDICATIONS for IPPB?
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- hypotension - untreated pneumothorax - high ICP
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what are some HAZARDS of IPPB?
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- hyperventilation - impending venous return - gastric distension - pneumothorax - too much O2 / air trapping with COPD PT
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name a PNEUMATICALLY POWERED / PRESSURE cycled ventilator
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bird mark 7
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what does an INCREASE FLOW give you?
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low I-TIME
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how do you CHANGE VOLUME on a BIRD MARK 7?
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adjusting pressure limit
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what can PREMATURELY end inspiration on a BIRD MARK 7?
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- obstruction - coughing
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whats the recommended SENSITIVITY on a bird mark 7?
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-1 to -2 cm H2O
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"loss of pressure" in IPPB
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- leak - insufficient flow
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"excessive pressure" in IPPB
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- obstruction - too much flow
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"fails to cycle into inspiration" in IPPB
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- adjust sensitivity - tight seal around the mouthpiece
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"fails to cycle off" - caused by a leak via IPPB
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- mouthpiece / mask seal - cuff leaking - fenestrated trach tube open - loose equipment connection
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"pressure doesnt rise" needle reads low or negative in IPPB
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insufficient flow "PRESSURE MANOMETER WIDE"
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advantages of CPAP?
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- improves oxygenation - supports oxygenation at LOWER FIO2
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MASK cpap
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- fits over mouth and nose or BOTH - used for SHORT TERM ventilation, helps improve oxygenation in patients with CO POISONING - HARD to maintain seal and POORLY tolerated
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NASAL cpap
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- used for NEONATES who are NOSE breathers - can lose cpap if baby is CRYING - if losing cpap, ADJUST NASAL PRONGS
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when is BRONCHIAL HYGIENE therapy needed?
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for: - cystic fibrosis patients - bronchiectasis patients
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what are some HAZARDS/CONTRAINDICATIONS of bronchial hygiene therapy?
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UNSTABLE: cardiovascular, pulmonary, POST OP and untreated tuberculosis
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prone
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face down
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supine
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lying on spine
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what position is best for hypoxic, obese, post op, or patients with PULMONARY EDEMA?
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fowlers, semi fowlers, or reverse trendelenburg
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trendelenburg
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for PTs with low blood sugar
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lateral fowlers
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obese PTs with AIR HUNGER
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lateral flat
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BEST position to prevent aspiration
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good lung down
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affected lung up
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what do you do when PT aspirates while in a body position?
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suction and place in opposite position for postural drainage
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indications for CHEST PERCUSSION
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- combination with postural drainage - secretions hard to dislodge
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PURPOSE of "vibration" procedure
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to move secretions to larger airways
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when is "huff coughing" used?
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for PTs who have COPD or HEAD TRAUMA to prevent HIGH ICP
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how do you "enhance" a better cough?
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splinting
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good basic cough
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deep breath, followed by a forceful exhalation
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how long do you use PEP therapy?
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- 15 to 20 minute intervals - 3 to 4 times a day
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when do you "discontinue" PEP therapy?
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if sinusitis, epistaxis, or middle ear infection occurs
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how long is EXHALATION in PEP therapy?
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2 - 3 times longer than inspiration
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when is "autogenic drainage" used?
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for patients with cystic fibrosis and bronchiectasis
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what volume does autogenic drainage target?
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ERV
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how long is a HFCW device used for?
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5 - 25 Hz (300 - 1500 cycles/min) for 30 minutes 1 - 6 times a day
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what do therapeutic device do you use for PTs who are unconscious or can't follow orders?
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intrapulmonary percussive ventilation (IPV)
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starting pressure for IPV?
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30 psi
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what type of aerosol does an IPV give off?
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dense
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when do yo use an INSUFFLATION/EXSUFFLATION device?
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for PTs with neurologic problems or muscle weakness
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when to "discontinue" bronchial hygiene
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- clear breath sounds/xray - ambulating - strong cough - afebrile for 24 hours - hazards occur (SOB, dizziness, cyanosis)
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what is humidity?
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water in vaporous form
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what's proper humidification?
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44 mg/L at 37 C or 47 mmHg
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what type of flow is a "bubble humidifier"
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low flow
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what's the PRESSURE POP-OFF VALVE set at?
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- 2 psig - 40 mm Hg
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how do you check "proper function" of a bubble humidifier?
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occluding or pinching the connecting tube and listening for whistling sounds
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no sound while occluding/pinching tube?
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leak is present!
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what HUMIDIFICATION system can heat/humidify O2 at 40 L/min?
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membrane cartridge system (VAPOTHERM)
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what do you use with a membrane cartridge system?
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high flow nasal cannula
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how does a "membrane cartridge system" operate?
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keep consistent temperature/high humidity without condensation in the tubing
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where do you place a HME?
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between the WYE and the PATIENT
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what do you do if HME "increases" delivered pressure?
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replace HME!
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what do you do if HME increase/thicken secretions?
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change to a heated humidifier
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"when" do you use a HME?
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- patient transport - short term ventilation
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what "humidifier" can deliver 100% humidity (44 mg/L)?
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WICK HUMIDIFIER
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what humidifier has a "low risk" of contamination?
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a wick humidifier
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what can you use a wick humidifier with?
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- ventilators - CPAP - patients w/ artificial airways
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goals of aerosol therapy?
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- relive bronchospasm/mucosal edema - thin thick secretions - administer drugs - humidify respiratory tract
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what devices have a HIGH RISK of "cross contamination"?
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LVN and heated aerosol devices
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used for ACUTE ASTHMA
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short acting beta agonist (albuterol/levabuterol)
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used for THICK SECRETIONS
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mucolytic agents (acetylcysteine/pulmozyme)
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meds administered through a SVN
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antibiotics (tobramycin)
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whats DPI used for?
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asthma and COPD
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meds that can be delivered using a DPI
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long acting beta agonists (salmeterol/formoterol)
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when do you use a "ultrasonic nebulizer"?
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FOR THICK SECRETIONS
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whats NORMAL aerosol temperature?
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98.6F or 37C
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what do you do if patient complains of "tingling of fingers"?
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tell them to breath slow with an inspiratory hold
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COPD FIO2
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24-28%
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therapeutic FIO2
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30-60%
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emergency FIO2
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100%
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nasal cannula FLOW
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1-6 L/min
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nasal cannula FIO2
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24-45%
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how do you estimate FIO2?
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4% for every 1 L/min
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when will you recommend a nasal cannula?
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for COPD patients with "stable" respiratory rates and volumes
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simple mask FIO2
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40-55%
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simple mask flow
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6-10 L/min
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why is 6 L/min the lowest setting for a simple mask?
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to flush out exhaled CO2
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partial re-breather mask FIO2
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60-65%
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how many valves does a non rebreather mask have?
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3
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what do you if NON RB bag collapses?
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increase flow
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what do you do if NON RB valve is stuck?
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replace mask
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why is an AIR ENTRAINMENT MASK/VENTURI MASK used for COPD patients?
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it can deliver PRECISE FIO2 (COPD PT)
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what else do you use an AIR ENTRAINMENT MASK/VENTURI MASK for?
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patients with irregular VT, rates, and breathing pattern
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T-PIECE/BRIGGS ADAPTER FIO2
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20-100%
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what to do when aerosol DISAPEARS during inspiration
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- increase flow - add more tubing - set up TANDEM SET UP/blender or change flowmeter
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aerosol masks, trach collars, and face tents have what FIO2?
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21-100%
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how do you STOP room air from entering aerosol masks exhalation ports?
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by making sure the device flow is greater than inspiratory flow (>40 L/min)
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flow range of an oxygen hood?
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7-14 L/min to prevent CO2 build up and to maintain FIO2
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wheres the BEST place to analyze O2 on an oxygen hood?
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near the infants face
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how do you provide a more accurate control of the FIO2?
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use a blender
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if blender is too loud near oxygen hood use a?
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humidifier instead of nebulizer
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what do you use an isolette (incubator) for?
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for stable newborns
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when do you use an isolette (incubator)?
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for temperature control, will maintain a neurothermal enviroment
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when do you use a radient warmer(open incubator)?
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for unstable newborns who need constant care
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how do you PREVENT debris from entering the tank regulator?
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by opening the cylinder valve slowly to discharge, then close
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how do you VERIFY the accuracy of a flowmeter?
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- with a ROTAMETER or CALIBRATION flowmeter - differential pressure transducer (pneumotach)
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what do you do if a MASSIVE leak occurs after removing the flowmeter?
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- reinsert it into the wall - contact personnel and give O2 - turn off zone valve
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duration of cylinder flow
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psi x tank factor / liter flow
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24 (air-oxygen entertainment ratio)
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25:1
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28 (air-oxygen entertainment ratio)
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10:1
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35 (air-oxygen entertainment ratio)
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4.6:1
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40 (air-oxygen entertainment ratio)
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3:1
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60 (air-oxygen entertainment ratio)
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1:1
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how do you achieve a PRECISE FIO2 with a blender?
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use a non-rebreather
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why do you use a blender?
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control of air/O2 to get a "specific" FIO2
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what does the LOW PRESSURE alarm indicate on a blender?
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low inlet pressure (<40 PSI)
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where can you use a air compressor?
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to power a nebulizer for a COPD patient at home
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when do you use a sputum induction?
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patients with suspected pneumonia who don't have a productive cough
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what do you use a sputum induction with?
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an ultrasonic or high output pneumatic nebulizer
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when do you do a sputum induction?
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early in the morning
