Airway Clearance Flashcards
(29 cards)
What does CF look like on a chest xray?
Lungs are have scattered white areas within, indicative of scaring.
How does one get CF and what is the life expectancy?
Autosomal recessive genetic disorder from both parents
38 yo
What is the pathophysiology of CF?
Impaired chloride, sodium and water secretion in cells
-includes GI tract, pancreas, sweat glands and lungs
Excretion of greater amounts of salt
Considering the pathophys of CF, why is mucus thick and difficult to remove from the lung?
Decreased water content makes mucus thick and sticky.
-collects in small airways
What direction does mucus plugging happen with CF and what chronic disease does this cause?
Distal to proximal airways.
-causes bronchiectasis
What are the PT implications of CF?
Airway clearance Aerobic training Postural Re-education (do before dysfunction) Anerobic training Strength training Balance
How does aerobic training mobilize secretions?
Adding moisture
- also increases tidal volume first, then RR increases
- moves secretions proximally
How many generations down can a cough mobilize secretions?
Only 5-8.
Name the 9 types of airway clearance techniques.
- Percussion
- Vibration
- Postural drainage
- HFCWO vest
- Positive expiratory pressure (PEP)
- Oscillatory PEP: Flutter and acapella
- Active cycle of breathing
- Autogenic drainage
- Forced expiratory technique: huff
What types of patients should not be tipped during manual clearance techniques and why?
Infants (aspiration) and patients with GERD (reflux).
Postural drainage uses gravity to move secretions from lobes to the bronchus. How fast is a normal sputum elevator?
2-3 hours, 3-5mL per minute.
What is the procedure for percussion?
2-5 minutes per lobe in postural drainage position, followed by FET with vibration.
- 2-3 second breath hold
- 3-10 exhalations
- cough at end
- auscultate before and after
List a few side effects of percussions. Any contraindications?
Decreased CO Decreased PaO2 (short term) Bronchoconstriction
CONTRA
- Unstable angina or arrhythmias
- Any fracture or bone disease
There are 3 phases to active cycle of breathing technique to mobilize secretions. Name them and their parameters.
BREATHING CONTROL
- diaphragmatic, 30-60s
- hands on belly and upper chest
- tell patient to breath into hands
- tidal volume breathing
- goal to decrease work of breathing
THORACIC EXPANSION
- tactile and verbal cues
- lateral costal expansion 15-30s
FORCED EXPIRATORY TECHNIQUE
-clear secretions
What is the purpose of lateral costal expansion?
Helps open alveoli that may be blocked by distal air secretions.
-works by collateral passage between lungs.
How do you instruct a patient to do lateral costal expansion?
Provide force with your hands on their lateral ribs. Tell them to breathe into your hands. Provide resistance at first and gradually reduce. Not res. for exp.
- emphasize TLC insp.
- breath hold 2-3s
The forced expiratory technique (FET) consists of 2-3 huffs from mid to low lung volume. What is the best way to teach it and what is the main thing to avoid?
Demonstration works best (like fogging a mirror).
-avoid contracting throat muscles or using vocal cords.
Helps stabilize airways from collapse to mobilize secretions.
How much FEV1 do people with CF lose per year? How can mobilizing secretions helps?
2-4%.
Reduce that to 1/4% per year.
How long do you continue diaphragmatic breathing during autogenic drainage?
30 seconds.
-cough suppressed throughout cycle.
What are the 3 phases of autogenic drainage?
- Loosening
- Collecting
- Evacuation
Can autogenic drainage sometimes cause bronchospasms? Is it otherwise useful?
Yes.
Yes, can yield tremendous results if therapist and patient have skill to complete it.
With a HFCWO vest, how often should a FEP technique be used?
Every 5 minutes. Need to clear secretions after they are loosened.
With are HFCWO vest parameters?
20-30 minutes
12-16 hz
How does positive expiratory pressure (PEP) work, and what are its parameters?
Pt breathes against 10-20cm H2O. Pressure stabilizes smaller airways preventing collapse, reducing air trapping.
Pt usually sits upright with elbows on desk or table.
Diaphragmatic breathing, 2-3s hold, PEP, huff. 3-5x.
