A female patient's chest radiograph shows bilateral lower lobe ...

[renzo156]

A female patient's chest radiograph shows bilateral lower lobe atelectasis. She is alert and ori-ented.
 
  Arterial blood gas analysis reveals mild hypoxemia and respiratory alkalemia; her vital signs are within normal limits. Which of the following is most appropriate at this time?
  a. Chest physiotherapy every 4 hours
  b. Continuous positive airway pressure +5 cm H2O
  c. Intrapulmonary percussive ventilation every 2 hours
  d. Intermittent positive-pressure breathing 35 cm H2O Q4

Question 2

An assessment of a patient with newly diagnosed chronic bronchitis reveals an alert, cooperative, and oriented patient. Low-pitched wheezes are heard bilaterally on auscultation.
 
  The patient has a productive cough, producing copious amounts of sputum; no fever; a pulse of 85 beats/min; respirations of 18 breaths/min; and blood pressure of 145/90. The most appropriate lung expansion therapy for this patient is which of the following?
  a. Incentive spirometry
  b. Intermittent positive-pressure breathing
  c. Positive expiratory pressure
  d. Flutter valve

[kjo;oj]

Answer to Question 1

ANS: B
This patient requires lung expansion therapy to reverse the atelectasis. Chest physiotherapy and intrapulmonary percussive ventilation are both bronchial hygiene therapy. Intermittent posi-tive-pressure breathing is lung expansion therapy, but it is not appropriate for this patient because she is alert and oriented. Continuous positive airway pressure will help to reverse her mild hy-poxemia and atelectasis.

Answer to Question 2

ANS: C
Because he is alert, cooperative, and oriented, intermittent positive-pressure breathing is not ap-propriate for him. Incentive spirometry might be an alternative; however, it will not help this pa-tient to mobilize the copious amounts of sputum being produced. Positive expiratory pressure not only acts as an enhancement to the movement of mucus, but it also reverses atelectasis and opti-mizes delivery of bronchodilators to patients with chronic bronchitis. The flutter valve will serve only as bronchial hygiene therapy.