Ch.44 Egans Flashcards

1
Q

What is abnormal clearance?

A

Any abnormalities that alter:
• airway patency
• mucociliary function
• strength of breathing muscles
• thickness of secretions
• cough reflex
Can impair airway clearance leading to retention of secretions

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2
Q

Retention of secretions results in:

A

• full obstruction or mucous plugging (atelectasis)
• partial obstruction

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3
Q

What are causes of impaired mucociliary clearance in intubated pt’s?

A
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4
Q

What is the primary goal of ACT?

A

To assist the pt to mobilize and remove retained secretions.

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5
Q

Removal of these retained secretions may:

A

Improve gas exchange, promote alveolar expansion, and reduce WOB

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6
Q

What are the indications for ACT?

A
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7
Q

What are the 5 general approaches to ACT?

A

Can be used alone or in combination
1. CPT
2. Coughing and related expulsion techniques
3. PAP
4. High frequency oscillation devices
5. Mobilization and physical activity

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8
Q

What is the initial assessment of need for ACT?

A
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9
Q

What are some ACT techniques and devices?

A

• CPT includes percussion and PD
• Active cycle of breathing
• Autogenic drainage
• MIE
• PEP or OPEP
• High frequency positive airway pressure devices
• HFCWC
• Mobilization & physical activity

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10
Q

What are some contraindications to the use of CPT?

A

• Empyema
• PE
• ICP > 20mmHg
• Bronchospasm
• Osteoporosis

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11
Q

What is the Triple “S” rule?

A
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12
Q

What are 5 complications with PD?

A

• Hypoxemia
• Increased ICP
• Pulmonary hemorrhage
• Bronchospasm
• Arrhythmias

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13
Q

What is HFCWC?

A

An external (chest wall) application vest airway clearance system.

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14
Q

How does HFCWC work?

A

Generator inflates and deflates the vest creating pressure pulse against the thorax that cause chest wall oscillations and move secretions forward.

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15
Q

What are the 2 parts to HFCWC?

A
  1. variable air pulse generator
  2. a non stretch inflatable vest that wraps around the pts entire torso
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16
Q

What are some key factors in selecting an airway clearance strategy?

A
17
Q

What are assessment outcomes after ACT?

A
18
Q

For volume controlled what do you set?

A

Vt, FiO2, PEEP, Flow

19
Q

What is controlled in volume controlled?

A

Volume

20
Q

Pressure ______ during volume controlled?

A

Varies

21
Q

T or F Volume and flow are constant during volume control?

A

True

22
Q

T or F Pressure changes during volume controlled?

A

True

23
Q

What can you run the risk of during volume controlled?

A

Barotrauma

24
Q

What happens during pressure controlled?

A

Pressure is constant and volume and flow will change

25
Q

What is the inspiratory pressure in pressure controlled?

A

Vt

26
Q

What do you set for pressure controlled?

A

RR, FiO2, PEEP, Ti

27
Q

What is the flow range for pressure controlled? What do we usually start with?

A

40-80; 60

28
Q

What are some common methods for delivering inspiration?

A
29
Q

What are ventilator control functions during inspiration?

A

Box 3.3