A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has undergone lower abdominal surgery.
In evaluating this patient at the bedside, you obtain a VC of 800 ml and an IC of 44 predicted. Although a chest radiograph indicates basal atelectasis, she has no problem with retained secre-tions. What lung expansion treatment would you recommend?
a. Intermittent positive-pressure breathing at 6 to 8 breaths/min at 10 to 15 ml/kg
b. Continuous positive airway pressure ther-apy at 10 cm H2O for 24 hr
c. Positive end expiratory pressure therapy with bronchodilator and bronchial hygiene
d. Incentive spirometry 10 times an hour at an initial volume of 500 to 600 ml
Q. 2 A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has de-veloped atelectasis after thoracic surgery.
On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend?
a. Intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg
b. Continuous positive airway pressure ther-apy at 12 cm H2O for 24 hr
c. Positive end expiratory pressure therapy with bronchodilator and bronchial hygiene
d. Incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml
Q. 3 Which of the following are the hazards and complications of incentive spirometry? 1. Hyperventilation 2. Fatigue 3. Discomfort secondary to inadequate pain control 4. Barotrauma
a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4
Q. 4 Which of the following has a direct relationship with the degree to which atelectasis can present itself with a postoperative patient?
a. Spontaneous respiratory rate
b. Bradycardia
c. Hypocapnia
d. Hypothermia
Q. 5 A 59-year-old COPD patient comes to the hospital with upper abdominal surgery. The physician diagnoses the patient with pulmonary atelectasis. The patient has a vital capacity of 25 ml/kg.
Which of the following lung expansion therapy will you recommend to assist this patient's ate-lectasis?
a. Incentive spirometry
b. IPPB
c. CPAP
d. EPAP
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