Lab 7-Hyperinflation and Lifting moving 2020 (1) (1)
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RESP 3710 – Lab Exercise 7
Hyperinflation Techniques/ Lifting and Moving Patients
Introduction:
Hyperinflation techniques are used to increase lung volumes as patients
suffer from disorders with decreased lung compliance.
These therapies can be used to
correct and treat atelectasis.
All aspects of hyperinflation therapy should be understood,
including indications, contraindications, hazards/complications, assessment of need, and
assessment of outcome.
Goal: Upon completion of this lab, the student will be able safely administer hyperinflation
therapy techniques.
Objectives: The student will
1.
Select, identify components, assemble the following delivery systems
a.
Incentive spirometer
b.
CPAP systems
2.
Determine the effects of patient and equipment variables on delivery of therapy.
3.
Instruct, assess, monitor and evaluate therapy using a simulated patient.
4.
Terminate therapy in response to adverse reactions
5.
Accurately document therapy
6.
Interact with a simulated patient in a professional manner
Equipment Required:
For IS:
Incentive Spirometer
Stethoscope
Mouthpiece or 6 inch large bore tubing
CPAP:
BiPAP machine
BiPAP circuit
Mask
Pig Lung
Bed
Wheelchair
1
Safely lifting and moving
A.
Define and illustrate the following terms related to patient positions in a hospital bed:
Supine
Prone
Trendelenburg
Fowlers
Semi Fowlers
B.
Find and activate the bed controls that permit
1.
raising and lowering of side rails
2.
locking and unlocking of the bed wheels
C.
Pulling the patient to the head of the bed (HOB)
1.
Raise the bed to a comfortable working height.
2.
Lower the HOB so that the mattress is flat.
3.
The patient's head should be positioned at the top of the mattress.
If the patient is
not correctly placed in bed, s(he) will be malpositioned when the HOB is raised or
lowered.
2
4.
Align the patient's body (or ask the patient to do so) so that the spine is straight and
s(he) is in the supine position.
5.
If the patient is cooperative, ask him/her to bend knees and place heels on the
mattress to assist himself with the move.
6.
Ask the patient to push his body along the mattress to the HOB on your command
(count to three….)
7.
You & a partner will the use a draw sheet to re-position the patient.
a.
Roll the draw sheet so that it forms a "stretcher" beneath the patient.
b.
On your command, you and your partner lift the patient's body from the
mattress surface and move him/her toward the head of the bed.
c.
Realign the draw sheet to prevent any pressure points beneath the patient's
body.
8.
Raise side rails and place call light or other communication device within patient's
reach.
D.
Sitting the patient up in bed
1.
Position the patient in the supine position with his/her head at the top of the
mattress as described in exercise A.
2.
Using the bed control, raise the head of the bed to a 30 degree elevation or to a
comfortable height.
Assure patient tolerance of this position.
3.
Raise side rails and place call light or other communication device within patient's
reach.
E.
Positioning the patient on his/her side (rescue position)
1.
Position the bed at a comfortable working height.
2.
Lower the bed rails while assuring patient safety.
3.
Move the patient to the head of the bed as described in exercise A.
4.
Move the patient's body to one edge of the bed by placing your hands under his/her
shoulders and waist and pulling his/her torso toward you.
Then, move to the
patient's legs, place your arms beneath his/her hips and legs and perform the same
maneuver, bringing the patient's lower body toward you.
5.
Place support pillows or foam wedges within easy reach.
6.
Roll the patient's body away from you as a unit.
7.
Position pillows or supports beneath the patient's head and between his/her knees
to prevent pressure points.
8.
Raise bed rails.
F.
Positioning the patient in Trendelenburg
Trendelenburg position may be applied during postural drainage sessions and/or during
cardiopulmonary arrest to improve circulation to the brain.
Hospital beds may utilize several different methods to position the head of the bed
lower than the rest of the patient's body.
In Trendelenburg position, the mattress
remains flat (unbroken) and the patient's feet and legs are elevated so that blood will
flow from the legs and trunk to the brain.
1.
Find the Trendelenburg lock on the hospital bed
2.
Follow the instructions near the lock to position the bed in Trendelenburg.
G.
Moving the patient to the dangle position
1.
Raise the bed to a comfortable working height
2.
Pull the patient to the head of the bed and then move the patient to the edge of the
bed as described in side lying instructions.
3.
Sit him/her up in bed a described in previous exercises.
3
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4.
Lower the bed rails nearest the patient
5.
Grasp the patients shoulder (the farthest shoulder from you)
6.
Ask the patient to swing his/her legs over the side of the bed while you assist
him/her in assuming a sitting position.
H.
Moving the patient from bed to wheelchair (or chair)
1.
Lower bed so that patient's feet will reach the floor, and place pt in the dangle
position.
2.
Allow a few moments for patient to acclimate to change in position (hypotension
may occur when pts move from supine to standing or sitting positions).
3.
Move wheelchair or chair close to the bed.
4.
Support patient by placing your hands under his/her arms
5.
Ask patient to place weight on feet and stand.
6.
Assist patient to move his/her feet so that (s)he is standing directly in front of the
chair, back of legs toughing the chair.
7.
Assure stability of chair and
8.
Assist patient to seated position.
9.
Stabilize the chair and the patient, if necessary
I.
Moving the patient from stretcher to bed (may take from 2-4 caregivers)
1.
Remove extra furniture so that the stretcher can be lined up immediately next to
bed, heads of bed and stretcher together, side by side.
Lock the wheels of both the
hospital bed and the stretcher.
2.
Caregivers line up on sides of bed and stretcher.
3.
Raise bed and stretcher to comfortable working height (usually high off the floor).
Lower side rails.
Position patient supine.
4.
If patient is able to assist, ask him/her to "scoot" to the edge of the bed closest to
the stretcher.
5.
Caregivers on one side places hands beneath patient's neck and small of back;
caregiver on opposite side supports head, legs, or suitable areas of patient's body
that require support (ex: limb in cast)
6.
On the count of 3, caregivers slide patient from bed onto stretcher
7.
Alternately, a draw sheet may be used.
The draw sheet is placed beneath patient's
torso (shoulders to hips) to act as both a support and a sling in moving.
8.
Reposition the patient comfortably on the stretcher; provide pillow and cover as
needed.
9.
Raise safety rails on the stretcher.
10.Unlock the stretcher wheels and "steer" the stretcher from the head of the bed.
Use
care to avoid pinching IV tubing, O2 tubing, patient's fingers, etc in the side rails.
I.
Incentive Spirometry
1.
Identify and draw the following components of the Incentive Spirometer:
a.
Flow cue device
b.
Volume measuring cue
c.
Patient tubing attachment
d.
Volume markings
4
2.
Procedure
a.
Wash your hands
b.
Attach the wide bore tubing to the bottom port of the incentive spirometer.
1.
If you were performing therapy on a patient you would need to have
confirmed the physician order and reviewed the chart (patient condition,
x-ray and RT notes)
c.
Perform the following on your partner
1.
ID the patient (lab partner)
2.
Introduce yourself
3.
Explain the procedure
4.
Reassure the patient
5.
Evaluate RR________ HR______ BS__________
d.
Instruct your lab partner to sit up. You may need to assist with splinting.
e.
Explain the procedure and have y
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1.
Exhale normally
2.
Take a slow maximal (deep) breath in (keeping the flow cue in the
optimal range)
3.
Hold your inspiration for a few seconds
4.
Exhale normally
5.
Repeat this 10 times striving for a deeper inspiration each time
f.
Record the following: Inspiratory Capacity ___________
g.
At the end of the procedure you should ask the patient to cough.
h.
Reevaluate your lab partners HR___ RR___ and BS_______
i.
Wash your hands and return the equipment to storage.
3.
Chart your results here as if it were in a patient’s medical record
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5
Questions for thought:
1.
What are the indications for IS therapy?
2.
When performing an IS, what are you measuring (volume or capacity)?
III.
Continuous Positive Airway Pressure (CPAP)
A.
Components of the BiPAP Unit
BiPAP
Focus
– identify the following components
1.
Power switch
2.
Power cord
3.
User Interface
4.
Patient circuit
B.
User Interface
– identify and note the following components of the user interface
Panel Controls
1.
Standby/Power
2.
Alarm
3.
Alarm Reset
4.
Alarm Silence
5.
Measured Parameters
6.
Battery (on/charging)
7.
Up/Down Keys
8.
Enter
9.
Cancel
10.
Change Screen
6
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B.
Changing Settings
1.
Secure the mask tightly to the mannequin or test lung.
2.
Turn on the CPAP machine.
3.
Use the Arrow keys to highlight the CPAP mode, and press ENTER.
4.
Diagram the screen and note the settings in this mode.
5.
Set the following settings (to change settings, use the arrow keys to highlight the
desired setting, press ENTER, adjust that setting with the arrow keys, then press
ENTER when appropriate parameter is reached):
a.
CPAP:
4 cmH2O
b.
Ramp Time:
0 minutes
c.
Ramp Start:
5 cmH2O
6.
Attach circuit to pig lung and record your findings.
7.
Increase the CPAP to 10 cmH2O.
8.
Increase CPAP to 15 cmH2O.
9.
Increase CPAP to 20 cmH2O.
10.
Decrease CPAP to 5 cmH2O.
Questions for thought.
3.
Describe your findings when adjusting the CPAP level.
7
4.
What are the indications for CPAP?
5.
What are the hazards/complications of CPAP?
Please turn all equipment off, place all supplies in the appropriate baskets and return
to storage area.
This lab report will be due next Wednesday.
Thank you.
8