Hyperinflation therapy used with patients who are suffer from atlectasis

1. Hyperinflation
Therapy

2. IPPB
 Classification
 Flow
 Air-Mix
 Expiratory Time
 Pressure
 Sensitivity

3. IPPB - Troubleshooting
 Loss of pressure
 Excessive pressure
 Failure to trigger inspiration
 Failure to cycle off
 Pressure does not rise normally

4. A patient is receiving chest percussion, lung
expansion therapy, and directed cough to
treat obstructive atelectasis. Which of the
following diagnostic procedures should be
recommended to evaluate the patient's
response to respiratory care?
A. chest radiograph
B. computed tomography (CT scanning)
C. peak expiratory flow measurement
D. body plethysmography

5. A physician has ordered lung expansion
therapy for a patient with atelectasis. The
patient had a recent right lower lobectomy.
Upon examination, the patient is alert, oriented,
and has a nonproductive cough. Which of the
following should the respiratory therapist
recommend?
A. chest physiotherapy and postural drainage
B. IPPB
C. incentive spirometry
D. vibratory PEP

6. While administering an IPPB treatment at 20
cmH2O to a patient with pulmonary
emphysema, the respiratory therapist notes
the patient has suddenly become very short
of breath and cyanotic. The therapist's most
appropriate action would be to
A. suction the patient.
B. discontinue the treatment.
C. decrease the peak pressure to 10 cmH2O.
D. stop the treatment for 10 to 20 minutes.

7. The respiratory therapist is administering an
IPPB treatment by mask to a patient who is
unconscious. The machine cycles to
expiration before the patient receives an
adequate volume. Which of the following
adjustments should the respiratory therapist
make?
A. Increase the cycling pressure.
B. Increase the flow.
C. Decrease the sensitivity.
D. Decrease expiratory time.

8. Which of the following patient categories are
at high risk for developing atelectasis?
I. Those who are heavily sedated
II. Those with abdominal or thoracic pain
III. Those with neuromuscular disorders
A. I and II
B. II and III
C. I and III
D. I, II, and III

9. How do all modes of lung expansion
therapy aid lung expansion?
A.Increasing the transpulmonary
pressure gradient
B. Decreasing the transthoracic
pressure gradient
C.Increasing the pressure in the pleural
space
D.Decreasing the pressure in the alveoli

10. How can the transpulmonary
pressure gradient be increased?
I. Increasing alveolar pressure
II. Decreasing pleural pressure
III.Decreasing transthoracic pressure
A.I and II
B.II and III
C. I and III
D. I, II, and III

11. Which of the following is not a
potential hazard or
complication of IS?
A. Pulmonary barotrauma
B. Decreased cardiac output
C. Respiratory alkalosis
D. Fatigue

12. A postop patient using IS
complains of dizziness and
numbness around the mouth after
therapy sessions. What is the most
likely cause of these symptoms?
A. Gastric insufflation
B. Hyperventilation
C. Pulmonary barotrauma
D. Respiratory acidosis

13. Which of the following outcomes would indicate
improvement in a patient previously diagnosed
with atelectasis who has been receiving IS?
I. Improved PaO2
II. Decreased respiratory rate
III. Improved chest x-ray
IV. Decreased forced vital capacity (FVC)
V. Tachycardia
A. I, II, and III
B. I, III, and IV
C. I, II, III, IV, and V
D. III, IV, and V

14. Ideally, when should high-risk surgical patients be
oriented to IS?
A.Postoperatively, after full recovery from the
anesthesia
B.Preoperatively, before undergoing the surgical
procedure
C.Postoperatively, while they are still in the recovery
room
D.Postoperatively, but no sooner than 24 hours after
surgery

15. In performing the SMI maneuver during incentive
spirometry, the patient should be instructed to
sustain the breath for at least how long?
A. 10 to 15 seconds
B. 5 to 10 seconds
C. 3 to 5 seconds
D. 1 to 2 seconds

16. Which of the following is an absolute
contraindication for using IPPB?
A. Hemodynamic instability
B. Active untreated tuberculosis
C. Tension pneumothorax
D. Recent esophageal surgery

17. What is the minimum airway pressure at which
the esophagus opens, allowing gas to pass
directly into the stomach?
A. 25 to 30 cm H2O
B. 20 to 25 cm H2O
C. 15 to 20 cm H2O
D. 10 to 15 cm H2O

18. Which of the following are potential desirable
outcomes of IPPB therapy?
I. Improved oxygenation
II. Increased cough and secretion clearance
III. Improved breath sounds
IV.Reduced dyspnea
A. II and IV
B. I, II, and III
C. III and IV
D. I, II, III, and IV

19. When checking a patient's IPPB breathing circuit
before use, you notice that the device will not cycle
off, even when you occlude the mouthpiece. What
would be the most appropriate action in this case?
A. Secure a new IPPB ventilator.
B. Check the circuit for leaks.
C. Decrease the flow setting.
D. Increase the pressure setting

20. Which of the following are appropriate initial settings
for IPPB given to a new patient?
A.Sensitivity –2 cm H2O; pressure 25 cm H2O; high
flow
B.Sensitivity –3 cm H2O; pressure 5 cm H2O;
moderate flow
C.Sensitivity –1 cm H2O; pressure 15 cm H2O;
moderate flow
D.Sensitivity –8 cm H2O; pressure 15 cm H2O;
moderate flow

21. The End

22.  During IPPB therapy, a patient complains of
dizziness and tingling sensations in her
fingers. Which of the following should the
respiratory therapist record in the patient's
chart?
I. medication administered during the treatment
II. the patient's vital signs before and after the
treatment
III. the patient's symptoms
IV. the family's reaction to the patient's complaint
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only

23. Persistent breathing at small
tidal volumes (VTs) can result in
which of the following?
A. Reabsorption atelectasis
B. Spontaneous pneumothorax
C. Passive atelectasis
D. Respiratory alkalosis

24. Which of the following patient groups should be
considered for lung expansion therapy using
IPPB?
I. Patients with clinically diagnosed atelectasis
who are not responsive to other therapies
II. Patients at high risk for atelectasis who cannot
cooperate with other methods
III. All obese patients who have undergone
abdominal surgery
A. I and II
B. II and III
C. I and III
D. I, II, and III

25. Which of the following is not a potential hazard of
IPPB?
A. Increased cardiac output
B. Respiratory alkalosis
C. Pulmonary barotrauma
D. Gastric distension

26. During administration of a CPAP flow mask to a
patient with atelectasis, you find it difficult to
maintain the prescribed airway pressure. Which
of the following are most likely the problems?
I. System or mask leaks
II. Outflow obstruction
III. Inadequate system flow
A. I and III
B. I and II
C. II and III
D. I

27. Which of the following initial flow settings would
you select when setting up a CPAP flow-mask
system for a patient with atelectasis?
A. 2 times the patient's minute ventilation
B. At least 6 to 10 liters per minute
C. 4 times the patient's minute ventilation
D. 10 times the patient's VT

28. Which of the following mechanisms probably
contribute to the beneficial effects of CPAP in
treating atelectasis?
I. Recruitment of collapsed alveoli
II. Decreased work of breathing
III. Improved distribution of ventilation
IV. Increased efficiency of secretion removal
A. I, II, and IV
B. II and III
C. I and IV
D. I, II, III, and IV

29. An alert and cooperative 28-year-old woman
with no prior history of lung disease
underwent cesarean section 16 hours ago.
Her x-ray currently is clear. Which of the
following approaches to preventing
atelectasis would you recommend for this
patient?
A. IS
B. PEEP therapy
C. Deep breathing exercises
D. IPPB therapy