airway clearance therapy

Question 1

what is required for normal airway clearance

Answer 1

*patent airway (open airway)
*functional mucociliary escaltor ( cilia to move mucus)
*adequate hydration (mucus thin to clear)
*effective cough ( most important protective reflex) -too weak to cough leads to mucus retention &respiratory complications

Question 2

(added on own)
ACT
airway clearance therapy

Answer 2

non invasive techniques:mobilize& remove secretions improves gas exchange and increase ventilation

Options:CPT, PEP,HFCWC, MIE

Question 3

(added on own)
CPT
PEP
HFCWC
MIE

Answer 3

CPT-allow gracity drain mucus
PEP-exhale against fixed resistance to keep airway open and move mucus toward larger airways
HFCWC- “vest” delivers rapid vibrations to chest–>loosen & mobilize mucus
MIE-simulate natural cough, (+)(-) pressure to expel mucus

Question 4

what are the four phases of a cough and what occurs in each phase

Answer 4

*Irritation- stimulus provoke airway to send impulses to stimulate the medullary cough center
*inspiration- cough center generates reflex stimulation of respiratory muscle to initiate deep inspiration
*compression-reflex nerve cause glottis closure & forceful contraction of expiratory muscles
*expulsion-force built up causes a violent, explosive high velocity of airflow from the lungs

Question 5

(added on own)
artifical airway affect coughing phase

Answer 5

ET impaires compression phase, triggers mucus production, cuff of tube blocks mucociliary escalator,
inadequate humidification leads to mucus plugging

Question 6

retention of secretions result in

Answer 6

*full obstruction, mucous plugging leads to atelectasis–> hypoxemia
*partial obstruction restricts airflow, increase WOB, leading to air trapping. lung over distention & V/Q imbalance

Question 7

what diseases impair secretion clearance by affecting the cough reflex

Answer 7

*neuromuscular diseases- cause weak cough (ALS, muscular distrophy, cerebral palsy,MG

Question 8

diseases associated with altered mucocillary function

Answer 8

*cystic fibrosis
*bronchiectasis
*ciliary dyskinetic syndromes
*COPD Pt w/retained secrections

Question 9

diseases associated with abnormal clearance

Answer 9

*internal or external compression of airway lumen
-astma,chronic bronchitis, acute infection
*cystic Fibrosis-increase mucus, impairs movement up respiratory tracts
*bronchietasis- perm. damage & dialtes airways prone to obstruction retained secretions
*neuromuscular diseases- cause weak cough (ALS, muscular distrophy, cerebral palsy)

Question 10

what do you need to know from the medical record for initial assessment

Answer 10

*HX of pulmonary problems causing increased secretions
*admissions for upper abdominal or thoracic surgery
*chest Xray indicating atelectasis
*results of pulmonary function test (PFT)
*arterial blood gas (ABG) values or O2 saturation

Question 11

secretions:normal production

Answer 11

100ml

Question 12

what do you look for when conducting a physical examination for initial assessment

Answer 12

*posture&muscle tone
*effectiveness of cough
*sputum production
*breathing pattern
*general physical fitness
*breathing sounds
*vital signs & heart rhythm

Question 13

secretion: what amount of retained secretions as an indication of ACT

Answer 13

20-30 ml

Question 14

secretions:Amount expected for improvement is when production exceeds

Answer 14

exceeds 30

Question 15

during CPT-PD what do we use to our advantage to help drain secretions from lungs segments

Answer 15

gravity

Question 16

what are the lobe segments and how do you position the patient for postural drainage:

Upper lobes

Answer 16

*posterior seg.-sitting up leans forward 30 degres

*apical seg.- sitting up lean back 30 degree

*anterior seg.- supine pillow under knee

Question 17

what are the lobe segments and how do you position the patient for postural drainage:

right middle Lobe

Answer 17

right lateral seg. &medial seg.-
lying on the left side, right side elevated “14in or 15in” pillow placed under head & leg

Question 18

what are the lobe segments and how do you position the patient for postural drainage:

Left Lingula

Answer 18

superior lingula seg.& inferior liingula seg.- lying on right side w/left side elevated “14 or 15 In”

Question 19

what are the lobe segments and how do you position the patient for postural drainage:

lower lobe

Answer 19

*posterior basal seg.-prone w/pillow under hips head lower then legs “18in or 30 degree”
*anterior basal seg.- lie on Rt side, Lt side elevated, pillow undefr head, head is lower than leds “18 in or 30 degree”
*lateral basal seg.-lie on Lt side w/ Rt side elevated, pillow under head, head is lower than legs “18in 30 degree”
*superior seg. -prone

Question 20

you are doing postural drainage therapy on your patient and they start coughing aggressively. what actions do you take

Answer 20

move into a sitting position until cough subsides.

Question 21

how do you position your hand for manual CPT? and what areas do we avoid percussion

Answer 21

*hand in a cupping position w/relaxed wrist & elbow joint
*3 in from chest strike chest in waving movement
*compressed air b/w hand and chest wall
*percuss back & forth over affected area 3-5 minutes focus on areas of lungs w/ secretions

Question 22

how do you perform vibration

Answer 22

*parallel hand position, hand over hand position on chest
*Pt inhales deeply & exhales through purse lip
*compression & vibration during exhalation only

Question 23

(*added card of my own)
mechanical vibration & percussion

Answer 23

Feq. 20-50 hertz
rythmic mechanics forces to chest- loosen mucus from airway (thick stubborn secretions)
*beneficial for PT cant tolerate manual percussions, easy to use for long therapy sessions, reduce physical strain.

*cystic fibrosis,bronchiectasis

Question 24

contraindications for CPT

Answer 24

*head or neck injury
*active hemmorage/hemodynamic instability
*ICP>20
*spinal injury
*rib fractures
*active hemoptysis or turberculosis
*empyem (pus in lungs)
*large plueral effusion or pnemothorax
*pulmonary embolism

Question 25

complications and hazards for CPT

Answer 25

*hypoxemia *increased ICP *acute hypotension during procedure *pulmonary hemorrage *pain/injury to muscles,ribs,or spine *vomiting & aspirations *bronchospasm *arrythmias

Question 26

how do you teach your patient to perform a directed cough? what patients is directed coughing beneficial for

Answer 26

steps: sit pt upright w/one shoulder rotated inward and head and spine flexed foward, slow deep inspiration through nose using diaphram, after inhale insrruct pt to "bear down" and perform a forceful cough maintaining glottic closure before cough. *do not use on obtunded, paralyzed, uncooperative pt *pt that cant cough effectively on their own, *modifiy for surgical Pt,COPD Pt, neuromuscular disease

Question 27

how does the huff cough work for patients with COPD a. compression of middle to low lung volumes w/out closure of glottis b. how do we modify the technique

Answer 27

huff coughing-PT exhales in short burst making huff sound-staccato like burst of air against an open glottis a. clear secretions with less pressure, move effectively w/out causing airway collapse b.post operative:splinting-pillow or blanket used to support incision area during expiratory phase of cough COPD -moderate inspiration rather than full, exhale through purse lips while bending forward, repeat 3-4 times

Question 28

how do you perform the manual assisted cough

Answer 28

quad cough-apply external pressure on chest or abdomen during exhalation (neuromuscular conditions) *Pt takes deep inspiration as possible (assisted if needed with self inflating bag or intermittent p.p breathing device) *end of Pt inspiration, RT begins exerting pressure on the lateral costal margins or epigastrium

Question 29

how does a mechanical insufflation-exsufflation work?

Answer 29

(manage secretions in pt w/ neuromuscular disorder:ALS, Spinal cord injury) *positive pressure breath followed by a rapid switch to negative pressure *stimulates a cough forces air into lungs than pulls it out, help expel mucus from airway.

Question 30

when are oronasal mask effecftive

Answer 30

no fixed airway obstruction or glottic collapse during exsufflation (forceful exspiration)

Question 31

when doing PEP therapy a. inhale or exhale b. variable or fixed resistance

Answer 31

exhale fixed resistance cystic fibrosis, COPD

Question 32

what duration of time and pressure is recommended for Mechanical insufflation-exscufflation

Answer 32

postive pressure (30-50)cmH2O for 1-3 seconds negative pressure (-30- -50)cmH20 for 2-3 seconds sessions of 5 cycles

Question 33

what three modalities does Metaneb deliver

Answer 33

*aerosolized medification via small volume nebulizer *lung expansion therapy *airway clearance

Question 34

(*card inserted on own) HFCWC- "vest"

Answer 34

5-25 hertz: vest airway clearance system-mobilize secretions in PT w/ respiratory conditons like cystic firbrosis *2 types:variable, non stretch inflatable vest that wraps around torso *generator inflates&deflates vest -pressure against thorax/chest oscillations secretions out. *self administered

Question 35

what outcomes do you assess that indicates therapy should continue

Answer 35

*change in sputum production *viscosity *change in breath sounds *change in dyspnea level *change in chest radiograph/ABG results *change in ventilator variables (peak pressure)

Question 36

there will be scenarios with therapies being given or picking appropriate therapies for your patient

Question 37

specific documentations used for ACT

Answer 37

*position used *time in position *PT tolerance *indicatior of effectiveness *any lung expected effects observed

Question 38

CPT chest pressure therapy

Answer 38

CPT-positions-allow gravity to drain mucus. percussion&vibration-loosen secretions-->expel them.

Question 39

bronchiectasis

Answer 39

abnornal condition of the bronchial tree charcterized by irreversible dialation&destruction of bronchial walls

Question 40

ciliary dyskinetic volume

Question 41

forced expiratory technique

Answer 41

modification of normal/cough sequence designed to facilitate clearance of bronchial secretions while minimizing the likelihood of bronchiolar collapse

Question 42

Hertz

Answer 42

unit measuring frequency. happens once a second

Question 43

HFCWC-high frequency chest wall compression

Answer 43

a mechanical technique for augmenting secretion clearance; small gas volumes are alternately injected into and withdrawn from a vest by an air-pulse generator at a fast rate, creating an oscillatory motion against the patient’s thorax.

Question 44

huff coughing

Answer 44

a type of forced expiration with an open glottis to replace coughing when pain limits normal coughing

Question 45

inspissation

Answer 45

process of becoming thickened (mucus)

Question 46

IPV intrapulmonary percussive ventilation

Answer 46

 airway clearance technique that uses a pneumatic device to deliver a series of pressurized small-volume breaths at high rates (1.6 to 3.75 Hz) to the respiratory tract, usually via a mouthpiece; usually combined with aerosolized bronchodilator therapy

Question 47

MIE mechanical insufflation exsufflation

Answer 47

simulates an effective cough by using positive airway pressure on inspiration than switching to negative pressure during exhalation

Question 48

mucous plugging

Answer 48

partial or complete obstruction of the airway by thick mucus

Question 49

oscillation

Answer 49

back and forth motion, vibration or the effects of mechanical of electrical vibration

Question 50

PEP positive expiratory pressure

Answer 50

mobilize secretions, expiratory pressure 10-20 exhale against fixed pressure to keep airways open & move mucus toward larger airways, increasesd lung volume,and recruits collapsed alveoli.

Question 51

splinting

Answer 51

immobilizing, restraining or supporting a body part ( squeezing a pillow against abdomen or incision area)