IPPB

Question 1

What does IPPB stand for?

Answer 1

Intermittent positive pressure

Question 2

The application of IPPB IS the inspiratory ______ pressure to a spontaneous breathing patient as an intermittent or ____ term therapeutic modality.

Answer 2

-positive pressure
(Positive pressure is pressure that pushes air into the patient’s lungs during inspiration, helping them take a bigger breath)
-short term.

Question 3

what does SMI stand for?

Answer 3

sustained maximal inspiratory (SMI)

Question 4

SMI is created by running pressurized gas into a _______piece or ______.

Answer 4

mouthpiece or mask.

Question 5

Breath ends when a pre-selected peak pressure is ______ (PIP)

Answer 5

reached.

Exp: the IPPB breath stops when the lungs reached the pressure you set just like you stop blowing up a balloon when it feels tight enough.

Question 6

A person with healthy lungs will require ____ pressure than a patient with decreased lung ______.

Answer 6

-less pressure.
-lung compliance.

Question 7

When given IIPPB it is generally accompanied by ____of sterile ____ or ________ so that air is humidified for the treatment

SVN is placed in line with a pressurized ______.

Answer 7

-SVN
-sterile saline.
-bronchodilator.
-Gas.

This is helpful b/c it’s important because adding a small volume nebulizer provides humidification and medication delivery, preventing airway, dryness, and helping open the airways during IPPB. A small volume nebulizer is placed in line with a pressurized gas so the positive pressure can aerosolize the solution and push the medication deeper into the lung.

Question 8

** passive exhalation after the machine stops positive pressure. The patient simply relaxes and excels passively because the lungs recoil on their own.

Question 9

**The I:E ratio for IPPB is ?

Answer 9

1:3 ratio

Question 10

**The rate also know as frequency is ?

Answer 10

6–8

Question 11

How IPPB works is a driving pressure is set on the machine. When the patient ____ the machine by decreasing pressure in the line (on inhalation), gas starts to move down the tube into the ____ and ____.

Answer 11

triggers
mouth and airways.

Question 12

Exhalation port is shut by _____ valve.

Answer 12

Mushroom valve
(This means that during IPP inspiration, a soft, rubber mushroom shape valve closes the exhalation port, so no air can leak out while the machine pushes positive pressure into the patient’s lungs)

Question 13

Throughout the IPPB treatment, gas is sent down the ___ drive line to the inline SVN.

Answer 13

nebulizer drive.

Question 14

For IPPB When the preset PIP(peak inspiratory pressure) is reached, gas flow shuts off immediately (Inspiratory phase cycles off);-(the machine switches to the exhalation phase) mushroom valve collapses allowing gas to exit ______ port.

Answer 14

exhalation port.

Question 15

**what is the limit respiratory rate for SMI

Answer 15

6-8bpm

Question 16

What are the physiological effects of IPPB(how the pt is feeling during IPPB).

A greater than atmospheric pressure applied to the upper airway will result in an _____ in MAP (mean airway pressure) And intrathoracic pressure -> a decrease in _____ return.

Answer 16

-increase
-venous return.
(Positive pressure from IPPE raise his chest pressure which squeezes the veins and reduces the amount of blood returning to the heart).

Question 17

In normal breathing a negative pressure is created in the thorax which is ? -__ to -___cmH2O
It creates a suction that helps bring blood back to the right side of the heart.

Answer 17

-5 to -10cmH2O

Question 18

In IPPB therapy, ____ thoracic pressure than will hamper(limit) venous return to the right side of the ____,thereby decreasing cardiac _____.

-So PL(trans pulmonary pressure)
will go up. Higher PL.=more lung expansion

-CO will down. (LESS venous return -> less blood pump.)
Higher thoracic pressure LESS blood returning to the heart.

Answer 18

-high thoracic.
(When pressure inside the chest rises above normal because air is being pushed into the lungs with positive pressure.)

-Right side of the heart.
-cardiac output.

This is because high thoracic pressure squeezes the veins and reduces the amount of blood returning to the heart so the heart has less blood to bump out lowering the cardiac output.

Question 19

during physiology effects of IPPB blood will back up into the head causing _____ to go up.

Answer 19

ICP (intracranial pressure)

Question 20

2. In the physiological effects of IPPB there will be a ______ of WOB.

a. Positive pressure provides ventilatory power reducing the patients respiratory muscle use and energy ______.

Answer 20

-decreased.

-expenditure.
(How much energy the patients body must use to breathe.)

Question 21

3. For IPPB it will help with ______ tidal volume.

a. __-___ fold increases in pts spontaneous VT during treatment.

b. Helps improve distribution of _____ and gas _____.

Answer 21

-increase tidal volume.
- 3-4.
-ventilation and gas exchange.

Question 22

4. **IPPB helps with Mobilization of ________.

a. With SMI (is when the patient takes the deepest breath in they possibly can and holds it for a short moment.) you have to do a ____,___ ___ that will enable a more effective ______.

Answer 22

-secretions.
- slow, deep breath.
-cough.

Question 23

5. Tachycardia.

a. Monitor HR _____,_____ and ____ treatment.

b. Stop treatment if HR increases >____bpm.

Answer 23

-before, during, and after.
->20pbm

This is bc IPPB then increase chest pressure and then a decrease in venous return and then decrease in CO then by the a decreased of CO is the reason why tachycardia occurs. (Compensatory)

Question 24

**The Norma tidal volume of an adult is ?

Answer 24

5mL/kg of ideal body weight.

Question 25

What are the goals for IPPB? 1. It provides Increased ____

Answer 25

VT (tidal volume)

Question 26

What are the goals for IPPB? 2. It improves and promote _____ mechanism.

Answer 26

cough mechanism.

Question 27

What are the goals for IPPB? 3. Improves distribution of ventilation/ reduce ______.

Answer 27

atelectasis.

Question 28

What are the goals for IPPB? 4. Deliver medication: improved _______.

Answer 28

distribution.

Question 29

What are the goals for IPPB? 5. Improves breath sounds especially in _____.

Answer 29

bases.

Question 30

What are the goals for IPPB? 6. Improve _____.

Answer 30

oxygenation.

Question 31

What are the goals for IPPB? 7. It is favorable to pt ______.

Answer 31

response.

Question 32

Indications for IPPB. 1. Atelectasis is not responsive to other therapies like _______,____ ____,_____.

Answer 32

cough, deep breaths and IS

Question 33

Indications for IPPB. 2. A poor cough - inability to clear _______.

Answer 33

airways.

Question 34

Indications for IPPB. 3. Short term non-invasive ventilatory support for __________ patients . a.IPPB has been mostly replaced by _______.

Answer 34

-Hypercapnic (higg CO2 in the blood). -BIPAP

Question 35

Indications for IPPB. 4. Delivery of aerosolized drugs when SVN has failed on pts who cannot take a deep _______.

Answer 35

breath.

Question 36

Indications for IPPB. 5. prevent or decrease pulmonary edema. a.Decrease venous return thereby decreasing pressure in the right ______. b.Positive pressure may push fluid back into pulmonary ______. c.Increase VT improving oxygenation resulting in better___ activity. d. replaced by CPAP

Answer 36

-right heart. -pulmonary capillaries. -CO activity.

Question 37

Absolute contraindications. (A hard NO) We will NOT do IPPB tx if a pt has a ________?

Answer 37

untreated pneumothorax. Any untreated pneumothorax can become tension pneumothorax as positive pressure pushes more air into the chest from the airway.

Question 38

Relative Contraindications (Use with casution) 1. ____ practitioner

Answer 38

Unskilled

Question 39

Relative Contraindications (Use with casution) 2. ICP (intracranial pressure) over _____mmHg

Answer 39

15mmhg. -10mmhg is normal.

Question 40

Relative Contraindications (Use with casution) 3. Hemodynamic _______

Answer 40

Hemodynamic instability (The heart and vessels cannnot keep blood pressure and circulation steady.)

Question 41

Relative Contraindications (Use with casution) 4. Active _____/______ hemorrhage. A. Application of positive pressure can make bleeding WORSE.

Answer 41

Hemoptysis(cough up blood) and pulmonary hemorrhage (bleeding of the lung)

Question 42

Relative Contraindications (Use with casution) 5.Conditions that predispose(cause) pt to Hemoptysis (if something predisposes a patient to hemostasis and means the condition increases the likelihood that the patient will bleed in through their airways and cup of blood.) -Active untreated ____. -Lung ____. -Cystic _____. -Recent surgery to _____.

Answer 42

-TB -lung CA (cancer) -CF -lung

Question 43

T-E fistula which is abnormal connection(a hole or a passage) between the trachea and the esophagus.

Question 44

T-E fistula: Air will leave the airway and go into the ____ to into the ______.

Answer 44

-chest -esophagus This is relative contradiction for IPP because positive pressure can force air or gastric context through pistol increasing the risk of aspiration and gastric distention

Question 45

Relative Contraindications (Use with casution) 7. Recent esophageal surgery. B. IPPB pt can swallow a lot of ___ which hampers the healing of esophagus and can lead to ______.

Answer 45

-air -bleeding

Question 46

Relative Contraindications (Use with casution) 8. Recent _____,____ or _____ surgery.

Answer 46

facial, oral, or skull surgery.

Question 47

Relative Contraindications (Use with casution) 9. Singulation (hiccups) can trigger the IPPB machine.

Question 48

Relative Contraindications (Use with casution) 10. Nausea. A. Due to air swallowing, IPPB can rapidly inflate the ____ and causing vomiting. B.Pressure over ___mmhg are associated with gastric detention (Gastric detention is Eric gets pushed into his stomach, causing it to stretch and enlarge)

Answer 48

-belly. 20mmhg.

Question 49

Relative Contraindications (Use with casution) 11. Radiographic evidence of ____.

Answer 49

bleb ( tiny bubble on the outside of the lung)

Question 50

Relative Contraindications (Use with casution) 12. Wheezing: gives IPPB with _________.

Answer 50

bronchodilator

Question 51

Hazards of IPPB 1. There is a decreased of ___ due to impeded venous return.

Answer 51

CO

Question 52

Hazards of IPPB 2. Increased ______ in persons who are sensitive to cooling airways.

Answer 52

increased RAW (the airways are tighter, narrower, or obstructed so its harder for air to flow in and out of the lungs.)

Question 53

Hazards of IPPB 3. Barotrauma (injury to the lungs or airways caused by too much pressure)/Pneumothorax: in persons who are getting excessive _____ and ____ or who air trap, especially ______ patients. A. IPPB forces more air than pt can _____. B. Blebs (weak spots) can _____.

Answer 53

-volume and pressure -COPD -exhale -burst.

Question 54

Hazards of IPPB 5.________ infections: sends bacteria deep into the lungs

Answer 54

Nosocomial

Question 55

Hazards of IPPB 1. Hemoptysis A. STOP tx _________. B. Blood vessels break causing air to get into blood stream (air embolism).

Answer 55

immediately

Question 56

Hazards of IPPB 7.Hyperventilation due to increased VT. A.Fingers tingling and _______. B. Blood PH becomes _____ -can trigger ______ _________.

Answer 56

-tingling and lightheadedness -alkalotic- can trigger cardiac arrhythmias (it lowers blood potassium, and increases the accessibility of the heart electrical system.)

Question 57

Hazards of IPPB 7. **Respiratory depression in chronic hypercapniec patient. A. Air/mix mode had FIO2 of ____-___% B. May wipe out hypoxic drive of CO2 retainer. (Some COPD patients especially chronic CO2 retainers no longer rely on CO2 levels to tell them to breathe their normal respiratory drive is damaged so instead, they breathe based on low oxygen levels. This is called the hypoxic drive, low O2 stimulates them to breathe.) C. Give IPPB with compressed ____.

Answer 57

-40-60%. -Air.

Question 58

Hazards of IPPB 8. Gastric insufflation/distention due to air swallowing. A. Belching =burping B. Pain/discomfort C. Vomiting D. Restricts movement of _____.

Answer 58

diaphragm.

Question 59

Hazards of IPPB 9. Psychological _______.

Answer 59

dependence (This means that the patient becomes mentally dependent on the IPPB machine and feels like they cannot breathe without it even though they actually can)

Question 60

Hazards of IPPB 10. Secretions impaction (inadequate humidity) This means the IPPB gas is too dry, which thickens the secretions and increases the risk of mucus impaction).

Question 61

Assessment of patient on IPPB.. PRE. 1. Assess need for therapy. A. Outcomes should be measurable. B. Consider alternatives such as ___,____, or EZ-PAP( A device that uses the patients own breathing.(and flow from oxygen or air) to create positive pressure and help treat Atelectasis)

Answer 61

-IS, SMI OR EZ-PAP

Question 62

Assessment of patient on IPPB.. PRE. 2. READ CHART Look for contraindications in history or ____.

Answer 62

x-ray

Question 63

Assessment of patient on IPPB.. PRE. 3. Assess baseline vital signs. A. HR can increase from baseline due to pressure alone. ->Meaning if heart rate increases and returns to normal within a few _______,it is pressure not medication increasing the heart slow down and wait longer between each breath. B. RR: should decrease after treatment. ->If bronchospasm or barotrauma, RR may _____. C. Sensorium -If pt has chronic Hypercapnia, additional FIO2 will cause them to get ___ and _____.

Answer 63

-minutes. -increase. -sleepy and confused.

Question 64

4. Address breath sounds and breathing pattern. -decreased WOB. -Measure returned VT.

Question 65

Assessment of patient on IPPB. After 5 min. -Repeat ___sings -check ____. -check returned____.

Answer 65

-vital sings -check sensorium -returned VT. (is the amount of air that the patient actually excels back out of the IPPB machine after receiving a breath)

Question 66

Assessment of patient on IPPB. POST TREATMENT. **Have pt _____. -Repeat breath sounds, VS (vital signs) and breathing pattern to assess effectiveness of therapy.

Answer 66

cough.

Question 67

Administration of IPP. 1. Patient positioning is ?

Answer 67

semi-fowlers position

Question 68

Administration of IPP. 2. Tight seal around _____.

Answer 68

Mouthpiece.

Question 69

Administration of IPP. 3. **Set sensitivity so that patient can tigger a breath with minimal effort. _-_ cmH2O

Answer 69

-1 - -2cmH2O

Question 70

Administration of IPP. 4. Give adequate VT by setting PIP (peak inspiratory pressure) A. VT is dependent on __ selected by RCP and actual lung compliance or RAW of the patient. B. Increase ___ = Increase ____. (Increase pressure cycled IPPB increasing the PIP increases VT because the breath is delivered until the higher pressure is reached.) C.Strive for VT of __-__ ml/kg IBW or at least 30% of pts predicted IC. D.** Pressures as high as __-___ cmH2O may be needed when lung compliance is reduced.

Answer 70

-PIP. - PIP=VT 12-15 ml/kg IBW 30-35

Question 71

Administration of IPP. 5. Give adequate flow. A. To decrease I-time, _____ flow. (Increasing flow delivers air faster, so the inspiratory phase and sooner which decreases I- time) B. To Increase I-time, _______ flow. C.** Keep I-time between __-_.__ seconds (really fast flow relates cause Increased RAW) D.Expiratory time at least _to _ times longer that inspiratory time. E. I:ratio is?

Answer 71

I-time =Inspiratory time. -Increase flow. -decrease flow. -1-1.5 seconds -3to4 - 1:3to 1:4

Question 72

Administration of IPP. 6. Give appropriate RR. A. _-_bpm B. Patient may breathe _____, but they can do so off the IPB.

Answer 72

-6-8bpm. -Faster

Question 73

Administration of IPP. Treatment typically lasts for ___-___minutes.

Answer 73

15-20 min

Question 74

Administration of IPP. 7. Breathing Instructions. A. Instruct the patient to ____, which will cycle the ventilator on. B. It is important for pt to relax on inspiratory to allow the ventilator to fill the ____. C. At the end of inspiration, instruct the pt to pause briefly before ______. D. ** Exhalation is ____, requiring little effort. E. After exhalation, have pt count to ____ before starting next breath. This will help to decrease ____.

Answer 74

-inhale. -lungs. -exhaling. -passive. -3. -RR.

Question 75

** Sensitivity of __-__cmH2O (Sensitivity is the setting that detects the patient’s inspiratory effort and triggers, the IPPB machine to deliver a breath)

Answer 75

-1– -2cmH2O

Question 76

IPPB -Monitoring and troubleshooting. -Large negative pressure swings early in inspiration indicates incorrect ___ or trigger setting.

Answer 76

sensitivity

Question 76

**Initial pressure between __-__cm H20

Answer 76

10-15 cmH20

Question 77

IPPB -Monitoring and troubleshooting. -Too high flow will cause the device to cycle off ______.

Answer 77

prematurely. (if flow is set too high pressure, built too fast in the IPPB machine ends the breath earlier than it should)

Question 77

IPPB -Monitoring and troubleshooting. -If system pressure drops after inspiration begins or fails to rise steadily, _______ the flow until system pressure rises steadily.

Answer 77

increase.

Question 78

IPPB -Monitoring and troubleshooting. Tubing, occluded, mouthpiece, and active resistance to inhalation may also cause device to cycle off prematurely.

Question 79

IPPB -Monitoring and troubleshooting. ** leaks device will not reach preset pressure and will not cycle off (Ends the breath) when it reaches the preset pressure. A. Machine leaks vs. pt interface leaks B. Leaks through nose are corrected with ___ _____

Answer 79

Nose clips. (The IPPB leaks when air escapes from the system or the patient’s interface. If air leaks, the machine cannot reach the preset pressure so it will not cycle off. Machine leaks come from equipment. Patient leaks come from poor ceiling at the mouth or nose.)

Question 80

IPPB- charting. How treatment was given -MP -nose clips -mask -tracheotomy 1. Pressure in cmH2O 2.Air/mix or 100% O2 3. Pt position. 4. Length of tx. 5. Pt position. 6. PEEP used in cmH2O 7.Medication/dosage 8.Adverse effects 9.Vital signs, breath sounds.

Question 81

Bennett PR2 1. Classification -pressure-limited, time or patience-cycled ventilator. 2. Penumatically powered- requires ____ psi.

Answer 81

50 psi.

Question 82

An IPPB machine cycles on with the patient ever but does not shut off the most likely cause of the problem is?

Answer 82

leaks.

Question 83

A patient is having difficulty initiating each breath with an IPPB machine the RCP should adjust the ?

Answer 83

Sensitivity

Question 84

Which control is used to increase the volume delivered by the IPPB machine?

Answer 84

Turn peak, inspiratory pressure

Question 85

When adjusting the flow rate on an IPPB machine, the RCP would be altering the?

Answer 85

I:E ratio (the relationship between inspiratory time and expiratory time during breathing.) -the 1:3 tells you how much time is spent inhaling versus exhaling with the normal ratio being 1:3 1=inhale for 1 seconds. 3=exhale for 4 seconds.