Bronchial Hygiene Flashcards Preview

Principles and Practices of Resp II > Bronchial Hygiene > Flashcards

Flashcards in Bronchial Hygiene Deck (66):
1

Patent airway

good breath sounds and strong effective cough

2

Effective cough

Volume and flow- which maintains a patent airway- able to clear secretions

3

COPD constrictive or obstructive?

obstructive

4

Effective cough steps

1. Deep enough breaths (1-2 liters)
2. Adequate lung recoil (emphysema would inhibit)
3. Level of airway resistance (Bronchospasm-asthma pt)
4. Strength of expiratory resp muscles

5

Expiratory respiratory muscles

Rectus abdominal muscles, External Abdominal obliques, Internal abdominal obliquus, Transverses abdominis muscles, Internal intercostals muscles

6

Four phases of cough

1. Irritation 2. Inspiration 3. Compression 4. Expulsion

7

Irritation phase

Medullary response

8

Inspiration phase

1-2 liters

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Compression phase

Glottis Closure, Expiratory muscle contraction-0.2 seconds, Increased pleural and alveolar pressure

10

Expulsion Phase

Glottis opens, Mucus is displaced from airway walls into the air stream, can be swallowed or expectorated

11

What stimulates us to cough?

Inflammation (infection), Mechanical (foreign body/ aspiration), Chemical (pollutant), Thermal (drastic change in temp)

12

Snowball effect

Mucus plugging, atelectasis, impaired oxygenation, increased WOB, Air trapping-overdistention, infection, inflammatory response

13

Cough Impairment

Anesthesia, narcotics. Inadequate pain control, artificial airway- lose compression of cough, Neurologic and or physical dysfunction, inadequate lung recoil, surgery

14

Primary Goal and indication for bronchial Hygiene therapy

1. Help mobilize and remove retained secretions 2. improve gas exchange and reduce work of breathing- collateral ventilation through Pores of Kohn, canals of lambert

15

Indications

1. Pt produce copious amounts of secretion
2. Pt unresponsive to coughing techniques
3. Reduce air trapping
4. Prevent or treat atelectasis
5. pt immobile
6. Optimize delivery of bronchodilator
7. pt in acute resp failure with clinical signs of retained secretions
8. Chronic conditions that need continuous secretion removal

16

Pt unresponsive to coughing techniques=

secretions retained/ stuck

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copious amounts of secretions=

more than 30ml. day/ 100cc

18

Acute respiratory failure, clinical signs of retained secretions=

Adventitious breath sounds, deteriorating arterial blood gases, CXR changes, Physical assessment

19

Chronic conditions that need continuous secretion removal

Cystic fibrosis, Bronchiectasis, Ciliary dyskinectic syndromes, chronic bronchitis

20

Ciliary Dyskinectic

Cilia doesnt work

21

Mucus production and bronchial hygiene

Normal pulmonary tract mucus production is approx 100ml per day and is usually swallowed or reabsorbed in the airway, Bronchial hygiene is appropriate for pt who produce more than 30mL of sputum per day and have trouble clearing it

22

Sputum color

Purulent, clear, mucoid, and hemoptysis

23

Purulent

Infection, containing pus. Yellow, green, rusty, red currant jelly

24

Mucoid

over production of mucus do to exacerbation- asthma

25

Hemoptysis

blood streaked or frank

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frank

all red mucus, get help= BAD!= active hemorrhaging

27

Mucous amount

scant and copious

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scant

few teaspoons (moderate)

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Copious

shot glass to a pint or more

30

Mucous consistency

Thin/ thick, Tenacious, Frothy

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Tenacious

Extremely sticky

32

Frothy

foamy

33

Contraindications, absolute

Unstable head or neck injury (postural drainage), active hemorrhage with hemodynamic instability

34

Relative Contraindications

Unable to tolerate increased WOB, ICP> 20mmHg, Unstable hemodynamics, Active hemoptysis, Untreated pneumothorax, Tympanic membrane rupture, Facial/ oral/skull surgery or trauma, Epistaxis, Esophageal surgery, nausea

35

Epistaxis

Nosebleed

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Hazards and Complications

1. Pulmonary barotrauma 2. Increased ICP 3. Decreased venous return 4. Breakdown of skin 5. Air swallowing 6. Claustrophobia 7. Hypoventilation and hypercapnea

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Hypercapnia

high CO2

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Assessment of outcome

1. change in sputum 2. change in breath sounds 3. change in vitals 4. change in CXR 5. change in ABG's/ labs

39

Coughing techniques

Directed cough, Manually assisted cough, splinting, forced expiratory technique (FET) or "huff coughing", Active cycle breathing (ACB), Autogenic drainage (AD), Cough assist (Insuflattor/ Exuflattor)

40

Manually Assisted cough (quad cough)

1. Manual thrust similar to heimlich maneuver, performed during expiration splinting

41

ACB

Active cycle breathing 1. Relaxation and breathing control 2. Thoracic expansion exercises 3. Huff cough

42

AD

Autogenic drainage 1. Varying lung volumes with controlled expiratory flows 2. Cough is suppressed until you complete a cycle 3. Moving secretions from the small, med, large airways 4. Mucus rattle

43

Cough Asisst (insuflattor/ exuflattor)

1. Delivers a positive pressure for 2-3 seconds followed by an abrupt change into expiration created with a neg pressure (mimics a cough)

44

PEP Therapy

Active expiration agains variable flow resistance, preventing airway collapse during exhalation

45

Patient instruction during PEP Therapy

1. Have pt sit up 2. Instruct them to take a slightly larger than norm breath 3. Exhale actively but not forceful (through mouthpiece or mask) 4. Have the pt perform 10-20 breaths per cycle 5. have pt cough 6. Evaluate for independent use (if apparatus allows)

46

Therapeutic pressures on PEP therapy

10-20 cm H2O, pressure is measured with manometer

47

How many breath cycles on PEP therapy

repeat: 4-8 cycles

48

PEP I/E ratio

1:3 or 1:4

49

Total treatment time on PEP therapy

no more than 20 minutes

50

PD (postural drainage)

Invovled the use of gravity to help move resp tract secretions from distal lung lobes or segments into the larger central airway where they can be removed via coughing or suctioning

51

Head down positions should exceed

25 degrees below horizontal (hess- 12 inches for lingula/ RML and 18 inches for lower lobes)

52

Perform PD

every 4 to 6 hours or as ordered, must have adequate hydration for secretion mobility

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How many PD positions? (times)

approx 11 positions are possible each position is held for 5 to 10 minutes, total treatment time is typically 20-30 minutes up to one hour

54

PD scheduled when

before meal or more than 1 hour after mules or tube feeding. coordinate with pain medications. can be done with percussion therapy

55

Special Beds for rotating/ turning a pt

Rotorest, Rotoprone. Triadyne. May also provide percussion. Prone position

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Rotorest/ triadyne

bed that holds body and rotates

57

Concerns of PD

may need to modify positions, Medically intensive pt

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Contraindications of PD

Absolute- unstable spinal cord injuries, Traction of arm abductors, Emphysema, Bronchopleural fistula, Pulmonary embolism, Large pleural effusion

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Hazards specific to PD

hypoxemia (positional), acute hyptension, pulmonary hemorrhage, pain or injury to muscles/ribs/ spine, Vomiting and aspiration, bronchospasm, arrhythmias

60

Percussion and vibration involves

the application of mechanical energy to chest wall by the use of either hands or various electrical or pneumatic devices- Percussion should loosen secretion- vibration should aid in the movement of secretions toward the central airways

61

Hand clapping

Cupped position-fingers and thumb closed which creates a cushion of air when striking pt, rhythmically strike the chest wall with loose wrists, alternating hands , percuss in circular pattern over a localized area for 3-5 minutes, avoid bony prominences

62

Vibration

1. Performed during exhalation, vibrating the chest wall with hands 2. Mechanical and pneumatic machines provide frequencies of up to 20-30 Hz

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Oscillatory PEP and high frequency chest wall compression/ oscillation

vest, flutter, acapella, IPV (intrapulmonary percussive ventilation), Metaneb

64

IPV

Intrapulmonary percussive ventilation- a pneumatic device that delivers a series of pressurized gas mini-bursts at a rate of 100 to 225 cycles per min usually with a mouthpiece, contains nebulizer, maintains constant PAP, the percussion is controlled by the pt or person giving the treatment

65

A pneumatic device that delivers a series of pressurized gas mini-bursts at a rate of

100-225 cycles per minutes usually with a mouthpiece

66

Selecting bronchial hygiene

1. Pts motivation/ compliance/ goals 2. physician/ caregiver goals 3. Effectiveness of technique 4. pts learning ability 5. Skill of therapist/ availability, work required 6. disease process 7. Equipment 8. cost