Kettering - Therapeutic Procedures Questions
With Complete Solutions
ideal breathing pattern for improving ventilation correct answer: the same regardless of what type of therapy is given (SMI, IPPB, aerosol therapy, etc) slow, deep inspiration (from resting exhalation) inspiratory pause/hold (1-3 seconds) exhalation is slow, passive and relaxed patient may relax in between maneuvers with normal tidal volume breathing
patient positioning correct answer: a modification of the patients position may enhance oxygenation examples: prone position for ARDS fowlers position for CHF lateral fowlers position patients who are obese good lung down for unilateral lung disease inspiratory muscle training (IMT) correct answer: ventilatory muscle training benefits patients by increasing their muscle strength and endurance, decreasing dyspnea, the need for medication and hospital visits training is based on the concept of progressive resistance, this means that over time, greater resistance is imposed on the inspiratory muscles, this should increase muscle strength and endurance, which should improve the patients exercise tolerance
before training begins, the patients maximal inspiratory pressure
(MIP) is measured and compared to established normal values, this provides a baseline to use for monitoring progress and a guideline for initial therapy settings
inspiratory muscle training (IMT) procedure correct answer: patient sits in a comfortable position, relaxing the abdominal muscles the flow resistor is initially set at the lowest resistance setting patient is instructed to breathe slowly through the device if the patients inspiratory pressure is less than 30% of their measured MIP, increase the resistance level until a 30% effort is achieved consistently patient is instructed to use the device twice per day for 10-15 minutes, building up to full 30 minute sessions incentive spirometry (IS) or sustained maximal inspiration (SMI) indication correct answer: coached recruitment maneuver, incentive spirometry utilizes visual motivation and feedback to encourage patients to take a deep breath prevention or treatment of atelectasis for patients who are willing and able to spontaneously take a deep breath
IS/SMI procedure correct answer: should be performed hourly while the patient is awake for about 10 breaths date, time, and volume achieved (inspiratory capacity) should be
charted (not duration of the treatment) surgical patients should receive instruction prior to surgery so that they better understand the procedure and the therapist can establish a post-op volume goal increase or decrease volume goals based upon patients performance, goals should be set within the patients ability post op goal should be one-half of the pre op inspiratory capacity auscultate breath sounds before and after treatment to evaluate the effectiveness of the therapy
so if a patients pre op inspiratory capacity is 2600 mL, start with
a post op goal about half of pre op (1300 mL) correct answer: if
patient is only achieving 400 ml with initial post op therapy, you
may need to lower the goal and re evaluate daily IS/SMI troubleshooting correct answer: often patients must be reminded to inhale and not exhale into device if patient is unable to achieve targeted volume, check connections and patient mouth seal before reducing volume target
intermittent positive pressure breathing (IPPB) therapy indications (desirable physiological effects of IPPB) correct answer: prevent or correct atelectasis in patients unable or unwilling to take a deep breath prevent or decrease pulmonary edema decrease the WOB (decrease accessory muscle use in patients with COPD) distribute aerosols more evenly in the airways for better deposition of medications improve and promote the cough mechanism
IPPB contraindications correct answer: unskilled practitioners and users hypotension untreated pneumothorax elevated intracranial pressure
With Complete Solutions
ideal breathing pattern for improving ventilation correct answer: the same regardless of what type of therapy is given (SMI, IPPB, aerosol therapy, etc) slow, deep inspiration (from resting exhalation) inspiratory pause/hold (1-3 seconds) exhalation is slow, passive and relaxed patient may relax in between maneuvers with normal tidal volume breathing
patient positioning correct answer: a modification of the patients position may enhance oxygenation examples: prone position for ARDS fowlers position for CHF lateral fowlers position patients who are obese good lung down for unilateral lung disease inspiratory muscle training (IMT) correct answer: ventilatory muscle training benefits patients by increasing their muscle strength and endurance, decreasing dyspnea, the need for medication and hospital visits training is based on the concept of progressive resistance, this means that over time, greater resistance is imposed on the inspiratory muscles, this should increase muscle strength and endurance, which should improve the patients exercise tolerance
before training begins, the patients maximal inspiratory pressure
(MIP) is measured and compared to established normal values, this provides a baseline to use for monitoring progress and a guideline for initial therapy settings
inspiratory muscle training (IMT) procedure correct answer: patient sits in a comfortable position, relaxing the abdominal muscles the flow resistor is initially set at the lowest resistance setting patient is instructed to breathe slowly through the device if the patients inspiratory pressure is less than 30% of their measured MIP, increase the resistance level until a 30% effort is achieved consistently patient is instructed to use the device twice per day for 10-15 minutes, building up to full 30 minute sessions incentive spirometry (IS) or sustained maximal inspiration (SMI) indication correct answer: coached recruitment maneuver, incentive spirometry utilizes visual motivation and feedback to encourage patients to take a deep breath prevention or treatment of atelectasis for patients who are willing and able to spontaneously take a deep breath
IS/SMI procedure correct answer: should be performed hourly while the patient is awake for about 10 breaths date, time, and volume achieved (inspiratory capacity) should be
charted (not duration of the treatment) surgical patients should receive instruction prior to surgery so that they better understand the procedure and the therapist can establish a post-op volume goal increase or decrease volume goals based upon patients performance, goals should be set within the patients ability post op goal should be one-half of the pre op inspiratory capacity auscultate breath sounds before and after treatment to evaluate the effectiveness of the therapy
so if a patients pre op inspiratory capacity is 2600 mL, start with
a post op goal about half of pre op (1300 mL) correct answer: if
patient is only achieving 400 ml with initial post op therapy, you
may need to lower the goal and re evaluate daily IS/SMI troubleshooting correct answer: often patients must be reminded to inhale and not exhale into device if patient is unable to achieve targeted volume, check connections and patient mouth seal before reducing volume target
intermittent positive pressure breathing (IPPB) therapy indications (desirable physiological effects of IPPB) correct answer: prevent or correct atelectasis in patients unable or unwilling to take a deep breath prevent or decrease pulmonary edema decrease the WOB (decrease accessory muscle use in patients with COPD) distribute aerosols more evenly in the airways for better deposition of medications improve and promote the cough mechanism
IPPB contraindications correct answer: unskilled practitioners and users hypotension untreated pneumothorax elevated intracranial pressure
