Myasthenia gravis is causing a patient to have respiratory muscle ...

[bucstennis@aim.com]

Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital capac-ity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications?
 
  a. Incentive spirometry
  b. Deep-breathing exercises
  c. Positive expiratory pressure
  d. Intermittent positive-pressure breathing

Question 2

To determine outcome for a patient undergoing intermittent positive-pressure breathing (IPPB) therapy, the respiratory therapist should assess which of the following?
 
  1. Peak expiratory flow
  2. Breath sounds
  3. Sputum color
  4. Maximum inspiratory pressure
  a. 1 and 2 c. 1, 2, and 3
  b. 3 and 4 d. 2, 3, and 4

[coyin]

Answer to Question 1

ANS: D
The patient's vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient's respiratory weakness plus the fact that there is no mention of excessive sputum make positive expiratory pressure therapy inappropriate. In-termittent positive-pressure breathing is appropriate because of the patient's low vital capacity and inability to cough effectively.

Answer to Question 2

ANS: A
Assessment of outcomes for intermittent positive-pressure breathing include tidal volume meas-urement, FEV1, peak expiratory flows, cough assessment, chest radiograph review, and subjec-tive patient response. The color of the patient's sputum is not a determining factor in the outcome of intermittent positive-pressure breathing; it is an outcome assessment for the use of antibiotics. Maximum inspiratory pressure is not used in the determination of the effectiveness of intermit-tent positive-pressure breathing.

[bucstennis@aim.com]

TYSM

[shailee]

Excellent