Devices

Question 1

IS (incentive spirometry)

Answer 1

a method of encouraging voluntary “Deep breathing” by providing visual feedback about inspitatory volume. The Px “inhales” until a preset volume is reached, then sustains the inspiratory volume by “holding the breath” for 2-3sec.
It reduces the risk of “atelectasis” and pulmonary consolidation.

Question 2

There is no evidence that IS reduces the incidence of PPC following _____ or ________ surgery (Overland etal, 2001); however, any type of lung expantion intervention is bettter than no prophylaxis (Lawrence et al, 2006).

Answer 2

Cardiac, Upper abdominal

both studies are “a systematic review”!!

Question 3

Name some of the “Oscillating PEP devices”

Answer 3

• Flutter … a small, portable and pipe shaped. (steel ball enclosed)
• Acapella … uses a counterweighed plug and magnet to create airflow oscillations.
• Comet …. consists of a curved hard plastic outer tube. (independent of gravity, so can use in any position)

Question 4

What’s the rationale behind “Oscillating PEP devices”

Answer 4

During expiration through the device (resistance), the movement of the ball creates a positive expiratiory pressure (PEP) (like pursed lip breathing) and an oscillatory vibration of the air within the airways (mucus mobilisation).
[It may precipitate expectoration and should be followed by a pause for BC following a huff (through device) or cough. (Patterson et al, 2005: Acapella as effective as ACBT)]

Question 5

PEP devices rationale (from a lecture slide)

Answer 5

• Obtain temporary increase in FRC
• Allow TV to be above opening volume for otherwise closed airways
• Allow “collateral ventilation” to recruit alveoli
• Gets air behind secretions
• Use FET to mobilise and clear secretions

Question 6

PEP device pressure targets ___ - ___ cmH2O in mid-expiration for sputum clearance.

Answer 6

10 - 20 cmH2O (bubble PEP water level 10cm depth)

Question 7

PEP treatment is usually performed for approximately ___min, ___ a day, in Pxs with stable chest disease and excess bronchial secretions.

Answer 7

15min, twice a day

Question 8

PEP method (from a lecture slide)

Answer 8

1. Sit leaning forowards with elbow support, holding device
2. 5-8 breaths slightly larger than TV
   (with breath hold at the end of inspiration if possible; slightly active expiration against resistance, which aims to increase FRC across the cyle)
3. Huff through device
4. BC to finish the cycle

Question 9

Name 3 “Low flow” oxygen therapy devices.

systems deliver O2 which is diluted with room air

Answer 9

• Nasal Canula (FiO2 … 24 - 36%) [1 - 4L: 1L=24%]
• Simple face mask (FiO2 … 35 - 60%)
• Non re-breathing mask (FiO2 … 60 - 80%)

Question 10

Name 3 “High flow” oxygen therapy devices

systems can deliver a prescribed air/oxygen

Answer 10

• Venturi mask (fixed FiO2 - prescribed O2 concentrations)
• Ambu bag (closed circuit; Reserevoir bag; 100% FIO2)
• High flow nasal prongs (Himidified;

Question 11

“Nasal canula” advantages

Answer 11

• No re-breathing - gd for type1 &2 respiratory failure
• Comfortable & usuaally well tolerated
• Low cost, safe and simple
• good for cofused Px - less easily pulled off
• able to eat and drink, talk

Question 12

Type 1 respiratory failure

Answer 12

PaO2 < 8 kpa with a normal or low PaO2 [Hypocaemic], which is caused by V/Q missmatch.
(common in … lung collapse/consolidation, asthma, pneumonia, pulmonary oedema, pulmonary embolism)

Question 13

Type 2 respiratory failure

Answer 13

PaCO2 > 6.7 kpa accompanied by PaO2 < 8 kpa [Hypercapnic], which indicates inadequate alveolar ventilation
(common in … chronic bronchitis, chest injuries, drug overdose, post operative hypoxemia)

Question 14

“Nasal canula” disadvantages

Answer 14

• Unpredictable FiO2
• Cannot be used for mid/high O2 FiO2 concentrations (>40%)
• Not suitable for Px with nasal obstruction
• Less effective for mouth breathers

Question 15

Difference between “Angiogram” and “Angioplasty”

Answer 15

“Angiogram”: is the image taken when the artery is injected with dye and imaged under x-rays.
“Angiography”: is the procedure used to obtain an angiogram.
They are often used interchangeably in the vernacular.

Question 16

Which oxygen therapy device can be humidified?

Answer 16

nasal prong

high flow; more accurate FiO2 21-60%

Question 17

Simple face mask can be used when you want an accurate O2 concentration. T or F?

Answer 17

False

suitable when accurate O2 concentration are not necessary

Question 18

Which oxygen therapy device gives more fixed FiO2?

Answer 18

Venturi Mask

high flow; cannot be humidified; 24-28-31-35-40-60%