Respiratory Therapy & Intervention Techniques Flashcards
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Read the first 7 Respiratory Therapy & Intervention Techniques flashcards as text
When titrating PEEP in a patient with ARDS using the ARDSNet lower-PEEP/FiO₂ table, what is the primary therapeutic goal of applying PEEP?
Answer: Maintain alveolar recruitment and improve oxygenation while limiting FiO₂
PEEP prevents cyclic alveolar collapse (atelectrauma), recruits flooded alveoli, improves V/Q matching, and allows reduction of potentially toxic FiO₂ levels.
A hospitalized patient refuses to use the incentive spirometer despite education. Which motivational approach is MOST consistent with patient-centered respiratory education?
Answer: Explore the patient's concerns, clarify misconceptions, and mutually set achievable goals
Patient-centered education involves assessing barriers, addressing misunderstandings, and collaboratively setting goals to improve adherence.
In prone positioning for severe ARDS, which physiological mechanism primarily accounts for improved oxygenation?
Answer: Redistribution of perfusion to better-ventilated dorsal lung regions that are now dependent
In the prone position, previously ventral (now dorsal) lung regions are better perfused, and their improved aeration reduces V/Q mismatch and intrapulmonary shunt.
A patient on long-term home oxygen therapy at 2 L/min nasal cannula requires a higher FiO₂ during exertion. Which device modification is MOST appropriate without changing the liter flow?
Answer: Switch to a reservoir (pendant) nasal cannula
A reservoir cannula stores oxygen during exhalation and delivers a higher FiO₂ on each inhalation at the same liter flow, conserving oxygen and improving portability.
Which finding during a spontaneous breathing trial (SBT) indicates the patient is NOT ready for extubation?
Answer: Rapid shallow breathing index (RSBI) of 120 breaths/min/L
An RSBI (f/VT) above 105 breaths/min/L predicts extubation failure; this patient's RSBI of 120 indicates rapid shallow breathing with inadequate tidal volume.
Which bronchial hygiene technique is specifically contraindicated in patients with active hemoptysis?
Answer: Postural drainage with percussion in a head-down position
Head-down postural drainage and percussion can dislodge clots and worsen or redistribute hemorrhage in patients with active hemoptysis.
A patient with obstructive sleep apnea (OSA) has difficulty tolerating CPAP at 10 cmH₂O due to pressure on exhalation. Which therapy modification is the BEST first step?
Answer: Change to an auto-titrating CPAP (APAP) device
APAP automatically adjusts pressure to the minimum needed breath-by-breath; this often improves comfort compared to a fixed high pressure while maintaining therapeutic efficacy.