CPT

Question 1

_____ involves the use of noninvasive techniques designed to help mobilize and remove secretions and improve gas exchange. Previously, airway clearance methods often were grouped under a broad category of techniques called ________

Answer 1

Airway clearance therapy, chest physical therapy (CPT).

Question 2

Normal airway clearance requires a________

Answer 2

patent airway, a functional mucociliary escalator, and effective cough.

Question 3

there are four distinct phases to a normal cough:

Answer 3

irritation, inspiration, compression, and

expulsion

Question 4

Infection is a good example of cough stimulation caused by an ______ Foreign bodies can provoke a cough through _______. _______ can occur when irritating gases are inhaled (e.g., cigarette smoke). Finally, cold air may cause _____ of sensory nerves and produce a cough.

Answer 4

inflammatory process, mechanical stimulation, Chemical stimulation, thermal stimulation

Question 5

During the third, or compression, phase, reflex nerve impulses cause _______ of the expiratory muscles. This compression phase is normally about _______and results in a rapid increase in pleural and alveolar pressures, often greater than_____ mm Hg

Answer 5

glottic closure and a forceful contraction, 0.2 seconds, 100

Question 6

Full obstruction, or mucous plugging, can result in_______. By restricting airflow, partial obstruction can ________

Answer 6

atelectasis and impaired oxygenation secondary to shunting, increase the work of breathing and lead to air trapping, overdistention, and ventilation/perfusion (V/Q) imbalances

Question 7

The presence of the tube in the trachea increases _____, whereas the cuff of the tube mechanically blocks the _______. In addition, movement of the tube tip and cuff can _________. Lastly, endotracheal tubes impair the compression phase of the cough reflex by preventing _______

Answer 7

mucus secretion, mucociliary escalator, cause erosion of the tracheal mucosa and impair mucociliary clearance further, closure of the glottis

Question 8

Inadequate humidification can cause ______ of secretions, mucous plugging, and airway obstruction. High fractional inspired oxygen (FiO2) concentrations can impair _______, either directly or by causing ______.

Answer 8

thickening or inspissation, mucociliary clearance, acute tracheobronchitis

Question 9

In CF, the_____ of the mucus is altered because of abnormal ______ transport. This alteration increases the ______ and impairs its movement up the respiratory tract.

Answer 9

solute concentration, sodium and chloride, viscosity of mucus

Question 10

The most common conditions affecting the cough reflex are _____, including muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, myasthenia gravis, poliomyelitis, and cerebral palsy

Answer 10

musculoskeletal and neurologic disorders

Question 11

The primary goal of airway clearance therapy is to help _________, with the ultimate aim to ________

Answer 11

mobilize and remove retained secretions, Improve gas exchange, promote alveolar expansion, and reduce the work of breathing

Question 12

In treating acute respiratory conditions, _______ before airway clearance therapy may improve the overall effectiveness of the treatment both by opening the airways and by increasing the mucociliary activity.

Answer 12

inhaled bronchodilator therapy

Question 13

For acute pulmonary infections, _______ after airway clearance therapy can lead to improved deposition of the antibiotic

Answer 13

inhaled antibiotics

Question 14

Generally, sputum production must exceed _______for airway clearance therapy to improve secretion removal significantly

Answer 14

25 to 30 ml/day

Question 15

The best-documented preventive uses of airway clearance

therapy includes _____

Answer 15

(1) body positioning and patient mobilization to prevent retained secretions in acutely ill patients
(2) CPT combined with physical activity to maintain lung function in patients with CF

Question 16

Five general approaches to airway clearance therapy, which

can be used alone or in combination, include

Answer 16

(1) CPT;
(2) coughing and related expulsion techniques (including manual insufflation-exsufflation [MIE]);
(3) positive airway pressure (PAP) adjuncts (positive expiratory pressure [PEP], continuous PAP [CPAP], expiratory PAP [EPAP]);
(4) high-frequency compression/oscillation methods; and
(5) mobilization and physical activity

Question 17

Postural drainage involves the use of _______to help mobilize secretions. The various body positions assumed are intended to drain secretions from each of the patient’s lung segments into the ______, where they can be removed by cough or suctioning

Answer 17

gravity and mechanical energy, central airways

Question 18

This drainage is accomplished by simply placing the segmental bronchus to be drained in a more ____ position, permitting gravity to assist in the process. Positions generally are held for_____ minutes (longer in special situations) and modified as the patient’s condition and tolerance warrant

Answer 18

vertical, 3 to 15

Question 19

______is most effective in conditions characterized by excessive sputum production (>25 to 30 ml/day). For maximum effect, head-down positions should exceed _______.

Answer 19

Postural drainage, 25 degrees below horizontal

Question 20

In patients in critical care, including patients on mechanical ventilation, postural drainage should be performed every _____ as indicated. In spontaneously breathing patients, frequency should be determined by _______

Answer 20

4 to 6 hours, assessing patient response to therapy

Question 21

To avoid gastroesophageal reflux and the possibility of aspiration, treatment times should be scheduled before or at least _______

Answer 21

1 and half hour to 2 hours after meals or tube feedings

Question 22

Because postural drainage positioning predisposes patients to _______, pulse oximetry should be considered if hypoxemia is suspected

Answer 22

arterial desaturation

Question 23

Generally, to obtain the proper head-down position, the clinician must
lower the head of the bed by at least _______ to achieve the desired 25-degree angle.

Answer 23

16 to 18 inches

Question 24

A _____ allows precise positioning at head-down angles up to 45 degrees.

Answer 24

tilt table

Question 25

Absolute Contraindication of Postural drainage

Answer 25

Head and Neck injury until stabilized

Active hemorrhage with hemodynamic instability

Question 26

What is the total treatment time of postural drainage

Answer 26

30-40 mins.

Question 27

Typically, the clinician may initially note _______ before therapy that changes to ______ after treatment. This change is due to the loosening of secretions and their movement into the larger airways, an intended purpose of the therapy

Answer 27

diminished breath sounds and crackles, coarse crackles

Question 28

the postural drainage order should be reevaluated at least every ______ for patients in critical care and at least every ____ for other
hospitalized patients. Patients receiving home care should be reevaluated at least every ______ or whenever their status changes

Answer 28

48 hours, 3 days, 3 months

Question 29

_______ involve application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices.

Answer 29

Percussion and vibration

Question 30

In theory, _____ should help loosen secretions from the
tracheobronchial tree, making them easier to remove by coughing or suctioning. ______should aid the movement of secretions toward the central airways during exhalation.

Answer 30

percussion, Vibration

Question 31

The clinician performs manual percussion with his or her hands in a ________

Answer 31

cupped position, with fingers and thumb, closed

Question 32

The clinician rhythmically strikes the chest wall in a _______, using both hands alternately in sequence with the elbows partially flexed and wrists loose

Answer 32

waving motion

Question 33

Ideally, the clinician should percuss back and forth in a ______ pattern over the localized area for ______

Answer 33

circular, 3 to 5 minutes.

Question 34

These devices have both frequency and percussion force control. Most units provide frequencies up to ______

Answer 34

20 to 30 cycles per second, or 20 to 30 Hz

Question 35

______is a deliberate maneuver that is taught, supervised, and monitored. It aims to mimic the features of an _______ in patients who are too weak to produce a forceful expiratory maneuver.

Answer 35

Directed cough, effective spontaneous cough

Question 36

______ can thwart efforts to implement an effective directed cough regimen

Answer 36

systemic dehydration; thick, tenacious secretions;
artificial airways; or the use of a central nervous system
depressants

Question 37

For patients with pain or patients subject to bronchiolar collapse, it is probably best that they be shown how to “stage” their expiratory
effort into ______

Answer 37

two or three short bursts

Question 38

______ is an external application of pressure to the thoracic cage or epigastric region, coordinated with forced exhalation. In this technique, the patient takes as deep inspiration as possible, assisted as needed by the application of positive pressure via a self-inflating bag or intermittent positive pressure breathing device.

Answer 38

Manually assisted cough

Question 39

At the end of the patient’s inspiration, the clinician begins
exerting pressure on the ______

Answer 39

lateral costal margins or epigastrium

Question 40

Manually assisted cough with pressure to the lateral costal
margins is contraindicated in patients with _______. Manually assisted cough using epigastric pressure is contraindicated in ________

Answer 40

osteoporosis or flail chest, unconscious patients with unprotected airways, in pregnant women, and in patients
with acute abdominal pathology, abdominal aortic aneurysm, or hiatal hernia

Question 41

____ is a modification of the normal directed cough. ____, consists of one or two forced expirations of middle to low lung volume without _____, followed by a period of _____

Answer 41

FET, FET, or huff cough, closure of the glottis, diaphragmatic breathing and relaxation.

Question 42

The goal of this method is to help clear secretions with less change in _____ and less likelihood of _______

Answer 42

pleural pressure, bronchiolar collapse.

Question 43

To help keep the glottis open during FET, the patient is taught to _______ during expiration. The period of diaphragmatic breathing and relaxation following the forced expiration is essential in _________.

Answer 43

phonate or “huff”, restoring lung volume and minimizing fatigue

Question 44

ACBT consists of repeated cycles of ________

Answer 44

breathing control, thoracic expansion, and FET

Question 45

Breathing control involves gentle _______ with relaxation of the upper chest and shoulders. This phase is intended to help prevent _______

Answer 45

diaphragmatic breathing at normal tidal volumes for 5 to 10 seconds, bronchospasm

Question 46

The thoracic expansion exercises involve ______, approaching vital capacity, with ______, which may be accompanied by percussion, vibration, or compression. The thoracic expansion phase is designed to help ________.

Answer 46

deep inhalation, relaxed exhalation, loosen secretions, improve the distribution of ventilation, and provide the volume needed for FET

Question 47

ACBT seems to minimize or prevent the _______ so common during postural drainage, at least in patients with CF

Answer 47

O2 desaturation

Question 48

ACBT is not useful with _______

Answer 48

young children (<2 years old) or critically ill patients.

Question 49

________ is another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained patients.

Answer 49

Autogenic drainage (AD)

Question 50

During AD, the patient uses _____ to mobilize secretions by varying lung volumes and expiratory airflow in ____ distinct phases

Answer 50

diaphragmatic breathing, three

Question 51

Patients are taught to control their expiratory flows to prevent airway collapse while trying to achieve a ______ rather than a wheeze

Answer 51

mucous “rattle”

Question 52

In the early 1950s, “artificial cough machines,” or MIE

devices were used to help patients with ______

Answer 52

polio clear secretions

Question 53

The use of MIE devices (also called _______) has experienced a resurgence more recently, especially in patients with certain neuromuscular disorder

Answer 53

cough-assist device or “coughlator”

Question 54

The MIE device delivers a positive pressure breath of ______ via a face mask or tracheal airway. The airway pressure is abruptly reversed
to _________. Peak expiratory “cough” flows obtained with this device are in the normal range (mean _____), far better than can be achieved with manually assisted coughing

Answer 54

30 to 50 cm H2O over a 1- to 3-second period, −30 to −50 cm H2O and maintained for 2 to 3 seconds, 7.5 L/sec

Question 55

A typical treatment session consists of about ______of MIE followed by a period of ______ (to avoid hyperventilation). This process is repeated five or more times until secretions are cleared and the vital capacity and SpO2 return to baseline

Answer 55

five cycles, normal spontaneous or assisted breathing

Question 56

MIE is contraindicated in patients with a ________

Answer 56

history of bullous emphysema, known susceptibility to pneumothorax or pneumomediastinum, or recent barotraumas

Question 57

PEP therapy involves ______ against a variable
flow resistance. In theory, PEP helps move secretions into
the larger airways by ______. A subsequent______ maneuver allows the patient to generate the flows needed to expel mucus from blocked airways.

Answer 57

active expiration,(1) filling underaerated or nonaerated
segments via collateral ventilation and (2) preventing
airway collapse during expiration, huff or FET

Question 58

In addition, PEP therapy cannot be used in ______

Answer 58

young children (<3 years old)

Question 59

_____ refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract. At high frequencies (12 to
25 Hz), these oscillations act as a ________,” enhancing cough clearance of secretions.

Answer 59

oscillation, physical “mucolytic

Question 60

There are two general approaches to oscillation: _______

Answer 60

external (chest wall) application and airway application

Question 61

High-frequency chest wall oscillation is accomplished by

using a two-part system:

Answer 61

(1) a variable air-pulse generator
(2) a nonstretch inflatable vest that covers the patient’s
entire torso (Vest Airway Clearance System)

Question 62

Typically, RTs perform ______ HFCWC therapy
sessions at oscillatory frequencies between_______. Depending on need and response, _______therapy sessions may occur per day

Answer 62

30-minute, 5 Hertz (Hz)and 25 Hz, one to six

Question 63

__________ (inspiratory vs. expiratory) determine the effectiveness of HFCWC therapy

Answer 63

Compression frequency and flow bias

Question 64

_____ is an airway clearance technique that uses a pneumatic
device to deliver a series of pressurized gas minibursts at
rates of __________ to the respiratory tract, usually via a ______

Answer 64

IPV, 100 to 225 cycles per minute (1.6 to 3.75 Hz), mouthpiece

Question 65

The duration of each percussive cycle is manually controlled by the patient or clinician using a _____ button.

Answer 65

thumb

Question 66

The manufacturer recommends a total treatment time of about _____

Answer 66

20 minutes

Question 67

_____ changes are now standard preventive interventions for atelectasis and pneumonia in postoperative patients

Answer 67

Early mobilization and frequent position

Question 68

_______ devices produce PEP with oscillations
in the airway during expiration. These devices are believed
to work based on the principle of ____________,
which suggests that airflow can occur between adjacent
lung segments through the canals of Lambert and through
the pores of Kohn.

Answer 68

Airway oscillating, collateral ventilation

Question 69

The valve consists of a pipe-shaped device with a heavy steel ball sitting in an angled ___

Answer 69

Flutter valve, “bowl”

Question 70

The pipe bowl is covered by a ________. When the patient exhales actively into the pipe, the ball creates a positive expiratory
pressure of between ____________. At the same time, the pipe angle causes the ball to flutter back and forth at about ____.

Answer 70

perforated cap, 10 cm H2O and 25 cm H2O, 15 Hz