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Midterm 2021 > Bronchial Hygeine And IS > Flashcards

Bronchial Hygeine And IS Flashcards

(56 cards)

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1
Q

Normal clearance of secretions for effective cough

A
  1. Irritation
    * stimulates sensors
    * chemical, thermal, inflammatory
  2. Inspiration
  3. Compression
  4. Expulsion
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2
Q

Retention of secretions

A 
Artificial airways 
Inadequate humidification 
High FiO2’s 
Paralytic, anesthetics 
Mucus plugging, can cause atelectasis and infection
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3
Q

Examples of impairments in compression phase of cough

A

Artificial airway

Abdominal surgery

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4
Q

Goals for bronchial hygiene

A

To mobilize secretions and remove retained secretions
— immobile patients
— chronic lung disease

To improve gas exchange
—treats atelectasis caused from retained secretions

To reduce work of breathing

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5
Q

Bronchial hygiene indications

A

Cystic fibrosis
Ciliary dyskinesia syndrome
Bronchiectasis
Chronic bronchitis

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6
Q

Bronchial hygiene therapy bedside signs and symptoms of the need for bronchial hygiene

A

Ineffective cough

Decreased breath sounds, crackles, and/or rhonchi

Fever

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7
Q

Methods of bronchial hygiene therapy

A 
Postural drainage 
Chest percussion 
Coughing and deep breathing 
Positive airway pressures 
Breathing exercises (diaphragmatic breathing, segmental breathing, pursed lips breathing)
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8
Q

What is the primary purpose of turning a patient

A

Improves oxygenation

Place the bad lung up which improves V/Q relationship

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9
Q

Turning indications

A

Poor oxygenation associated with position (unilateral lung disease [bad lung up])

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10
Q

Turning absolute contraindications

A

Worsening of SpO2

Unstable spinal cord injury

Traction of arm abductors

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11
Q

Postural drainage uses gravity and mechanical energy to

A

Mobilize secretions

Improve V/Q balance

Normalize FRC

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12
Q

Postural drainage is best for

A

Excessive secretions >25 ml/day

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13
Q

Modify the trendelenberg with the condition

A

Decreased SpO2

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14
Q

What should be assessed to establish the need for postural drainage therapy

A

Decreased breath sounds and/or crackles and/or rhonchi suggesting secretions in the airway

Abnormal chest X ray consistent with atelectasis, mucus plugging, or infiltrates

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15
Q

Postural drainage indications

A

Evidence of difficulty clearing secretions
Presence of atelectasis
Diagnosis of diseases such as CF, bronchiectasis, cavitation lung disease

Presence of foreign body in airway
External manipulation of the thorax to assist the movement of secretions by vibrations

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16
Q

All positions are contraindicated for

A

ICP
Empyema
Large pleural effusions

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17
Q

Trendelenburg position is contraindicated for

A

Empyema

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18
Q

Hazards of postural drainage

A 
Hypoxemia 
Increased ICP
Acute hypotension
Pulmonary hemorrhage 
Pain or injury to muscles, ribs, or spine 
Vomiting and aspiration 
Bronchospasm 
Dysrhythmias 
Headache, dizziness
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19
Q

Lung segment

Apical (anterior upper ) segments of both upper lobes

A

Semi-Fowler’s position with the head of the bed raised 45 degrees

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20
Q

Lung segment

Anterior segments of both upper lobes

A

Patient supine with the bed flat

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21
Q

Posterior (posterior apical) segments of both upper lobes

A

Patients sitting up and leaning forward

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22
Q

Right middle lobe (medial and lateral segments)

A

Patient 1/4 turn from supine with right side up and foot of the bed elevated 12”

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23
Q

Lingular segment of left upper lobe (superior and inferior segments)

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A

Patient 1/4 turn from supine with left side up and foot of the bed elevated 12 “

24
Q

Superior segments of both lower lobes

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A

Patient prone with bed flat and pillow under abdomen

25
Anterior segments of bot lower lobes
Patient supine with foot of bed elevated 20”
26
Posterior segments of both lower lobes
Patient prone with foot of bed elevated 20”
27
Right lateral segment of right lower lobe
Patient directly on left side with right side up and the foot of the bed elevated 20”
28
Left lateral segment of right lower lobe
Patient directly on right side with left side up and the foot of the bed elevated 20”
29
What rule do you follow when you see an adverse patient response during postural drainage therapy
Follow the triple s rule Stop the therapy Stay with the patient Stabilize the patient
30
Assessment of outcome in bronchial hygiene therapy Change in ventilator variables
Airway resistance Peak pressures
31
Monitoring patient during bronchial hygiene therapy
Sputum production and cough effectiveness — color, consistency, amount SpO2 Modify therapy if needed
32
Percussion and vibration help to
Shake the secretions toward the central airways during exhalation
33
What are the four components of an effective cough
Irritation Inspiration Compression Expulsion
34
What is a directed cough
A deliberate maneuver to mimic spontaneous cough
35
Directed cough indications
The need to aid the removal of retained secretions from central airways The presence of atelectasis Prophylaxis against post-operative complications Routine part of bronchial hygiene for CF, bronchiectasis, chronic bronchitis, necrotizing pulmonary infection, spinal cord injury Integral part of bronchial hygiene therapy’s —postural drainage, PEP therapy, incentive spirometry, aerosol therapy To obtain sputum specimens for diagnostic analysis
36
For directed cough technique, patient needs to have
Hydration Pain control Be able to sit at bedside with feet on floor or sit them up and bend their knees
37
Hazards and complications of directed cough
Incisional pain, evisceration Coordinate with pain medications
38
Assessment of need for directed cough
Spontaneous cough that fails to clear secretions Ineffective spontaneous cough Post operative patients Long term care patients with tendency to retain airway secretions Presence of ETT or trach tube
39
Positive airway pressure (PAP) | Indications
To reduce air trapping in asthma and COPD To aid in mobilization of retained secretions To prevent or revers atelectasis To optimize delivery of bronchodilators in patients receiving bronchial hygiene therapy
40
Hazards and complications of PAP
Fatigue, shorten treatment time and continue with SVN Barotrauma Increased ICP Cardiovascular compromise Skin break down and discomfort from mask Air swallowing, vomiting, aspiration Claustrophobia Increased WOB that may lead to hypoventilation and hypercapnia
41
Bronchial hygiene therapy PAP What is PEP for
Great for CF patients or to treat air trapping Can be used with SVN for patient who need medication and have documented atelectasis
42
Flutter valve
Good for CF patients, especially if they cannot tolerate chest physical therapy
43
Chest wall compression
Increases patient compliance to bronchial hygiene therapy, especially in the home
44
Resorption atelectasis
When lesions or mucus plugs are present in the airways and block ventilation to the affected region (nitrogen is absorbed and not replaced)
45
Passive atelectasis
Caused from patients breathing shallow | Anesthesia, sedatives, bed rest, painful deep breathing
46
Who is lung expansion therapy good for
Upper abdominal or thoracic surgery patients Best time to orient patient is prior to surgery
47
Clinical signs of atelectasis
Increased RR Breath sounds have fine, late inspiratory crackles.
48
The trans pulmonary pressure gradient can be increased by
Decreasing surrounding pleural pressures
49
What is IS designed to mimic
Natural sighing, by encouraging patients to take slow, deep breaths through their mouths
50
What is an SMI
A slow, deep inhalation after normal expiration (in other words they begin the breath at FRC) They should have a 5-10 second breath hold
51
Indications for lung expansion therapy
Treating existing atelectasis Presence of conditions predisposing to atelectasis, upper abdominal surgery, thoracic surgery, COPD surgery patients Presence of a restrictive lung defect with quadriplegic and/or dysfunctional diaphragm
52
IS contraindications
Unconscious or obtruded patients Patients unable to cooperate Vital capacity <10 ml/kg Inspiratory capacity < 1/3 predicted normal
53
Hazards of IS
Hyperventilation and respiratory alkalosis
54
Incentive spirometry outcome assessment
Absence or improvement in the signs of atelectasis Decreased RR Normal HR Temperature should normalize Breath sounds should clear and/or improve Normal chest X-ray Increased SpO2, PaO2, and or PAO2 Increased VC and peak expiratory flow rate
55
Flow oriented IS equipment calculation of approximate volume inspired
of spheres raised x total #seconds
56
IS instructions
Exhale normally Take deep slow breath through mouthpiece, keeping flow indicator in proper position Hold breath 5 - 10 seconds once lungs are full Wait 30 seconds to 1 minute between attempts Repeat procedure 5-10 times every hour

Midterm 2021 (5 decks)

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