A patient who is receiving intermittent positive-pressure breathing therapy for atelectasis now exhibits improved breath sounds and an increased ability to clear secretions
Chest radiography reveals improvement, but not total resolution, of atelectasis. The intermittent positive-pressure breathing therapy is discontinued. What is the most appropriate action at this time?
a. Flutter valve
b. Incentive spirometry
c. Continuous positive airway pressure
d. Intrapulmonary percussive ventilation (IPV)
ANS: B
The patient's increased ability to clear secretions, improved breath sounds, and improved chest radiograph demonstrate an improvement in his atelectasis and overall condition. At this time, "stepping-down" therapy would be appropriate. The most appropriate physiologic therapy that targets atelectasis is incentive spirometry. Flutter valve and intrapulmonary percussive ventilation are therapies for mobilizing retained secretions, and continuous positive airway pressure should be used when atelectasis fails to respond to incentive spirometry and intermittent posi-tive-pressure breathing.
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