Chapter 5: Airway Clearance Flashcards
(19 cards)
What is the primary purpose of airway clearance therapy?
Enhance gas exchange by assisting in the mobilization and removal of secretions
Airway clearance therapy is crucial for certain patient populations and conditions despite its cost and potential ineffectiveness.
What factors are important for normal airway clearance?
- Patent airways
- Functional mucociliary escalator
- Adequate hydration
- Effective cough
An effective cough is considered the most important protective reflex.
What are the four phases of the cough reflex?
- Irritation
- Inspiration
- Compression
- Expulsion
Each phase plays a critical role in the cough mechanism.
What can cause abnormal airway clearance?
Any abnormality from airway clearance mechanisms
Examples include critical care interventions like endotracheal tubes.
What are the consequences of retained secretions in the airways?
- Full obstruction (mucus plugging, atelectasis, hypoxemia, shunting)
- Partial obstruction (infections, increased WOB, air trapping, V/Q imbalance)
Infections can provoke an inflammatory response, leading to increased mucus production.
What are the effects of artificial airways on airway clearance?
- Block mucociliary escalator
- Erode tracheal mucosa
- Prevent closure of the glottis
Suctioning and inadequate humidification can also lead to thickened secretions.
What is the primary goal of airway clearance therapy (ACT)?
Assist patients in mobilizing and removing retained secretions to improve gas exchange
It also promotes alveolar expansion and reduces the work of breathing.
In which acute conditions is ACT indicated?
- Copious secretions
- Retained secretions or ineffective cough
- Acute lobar atelectasis
- V/Q abnormalities
These conditions may require immediate attention to prevent complications.
What are the contraindications for airway clearance therapy?
- Routine care of COPD
- Pneumonia without significant sputum production
- Routine postoperative care
- Uncomplicated asthma
ACT should be tailored to individual patient needs and conditions.
What is chest physical therapy (CPT) considered?
The standard of care for CF patients
CPT includes postural drainage and percussion or vibration to aid mucus transport and expectoration.
What does the CPT procedure involve?
- Explain the procedure
- Inspect and obtain vitals
- Monitor subjective responses and vital signs
- Use head-down positioning
- Maintain positions for a minimum of three minutes
- Encourage proper coughing techniques
The procedure must be adjusted based on patient comfort and condition.
What is mechanical insufflation-exsufflation (MIE)?
A technique used to prevent respiratory complications by generating sufficient flow rates to aid in secretion clearance
Particularly beneficial for patients unable to create a peak cough flow of > 180 L/min.
What are the components of a directed cough technique?
- Instruction on proper positioning
- Instruction on breathing control
- Exercises to strengthen expiratory muscles
The effectiveness can be evaluated by observing sputum production and changes in vital signs.
What is autogenic drainage?
A technique using diaphragmatic breathing to mobilize secretions by varying lung volumes and expiratory airflow in three distinct phases
Coughing should be suppressed until all three phases are complete.
What is the purpose of PEP therapy?
Involves active expiration against a fixed orifice to prevent airway collapse during expiration
Respiratory drug therapy can be added to enhance effectiveness.
What is high frequency oscillation (HFO) in airway clearance?
A therapy that uses oscillatory pressure to mobilize secretions while delivering aerosolized medications
Devices like the Volara System integrate multiple therapies for comprehensive treatment.
What role does early mobilization play in patient care?
Reduces complications and provides overall health benefits
It is particularly important for chronic disease and hospitalized patients.
What factors should be considered when selecting an airway clearance method?
- Patient motivation
- Correct application
- Age
- Disease
- Barriers to learning
- Cost
- Goals of therapy
Tailoring therapy to individual patients is essential for effectiveness.
What are the indicators that airway clearance therapy is meeting its objectives?
- Change in sputum production
- Change in breath sounds
- Change in dyspnea level
- Change in vital signs
- Change in chest radiograph or ABG results
- Change in ventilator variables
Regular evaluation of ACT orders is necessary for optimal patient outcomes.
