Author Question: A surgeon writes an order for lung expansion therapy for a 28-year-old 110-lb woman who has ... (Read 172 times)

ashley · **on:** Jul 16, 2018

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

Question 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

joewallace · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: D
For the patient having no difficulty with secretions, if the VC exceeds 15 ml/kg of lean body weight, or the IC is greater than 33 of predicted, incentive spirometry is given.

Answer to Question 2

ANS: A
If either the VC or IC is less than these threshold levels, IPPB is initiated, with the pressure gradually manipulated from the initial setting to deliver at least 15 ml/kg.