CPT I - EXAM 2 Flashcards
(198 cards)
1
Q
What are the 3 primary functions of the ventilatory pump?
A
- Ventilation
- Airway clearance
- Gas exchange
2
Q
SpO2 going down = decreased
A
respiration
3
Q
Patient has trouble breathing which affects metabolic demand and increases…
A
MET level during activity
4
Q
Metabolic demand = VO2 =
A
CO x (a-vO2)
5
Q
TV
A
Tidal volume
Volume of air inspired or expired per breath
6
Q
Normal TV?
A
600-500 mL
7
Q
IRV
A
Inspiratory Reserve Volume
Volume of air from end of tidal inspiration to max inspiration
8
Q
ERV
A
Expiratory Reserve Volume
Volume of air from end of tidal expiration to max expiration
9
Q
TLC
A
Total Lung Capacity
Volume of air in the lungs at the end of max inspiration
10
Q
Normal TLC?
A
6000-4200 mL
11
Q
RV
A
Residual Volume
Volume of air in the lungs after max expiration
12
Q
Normal RV?
A
1200-1000 mL (20-25% TLC)
13
Q
VC
A
Vital Capacity
Volume of air from max inspiration to max expiration
14
Q
IC
A
Inspiratory Capacity
Volume of air from tidal expiration to max inhalation
15
Q
FRC
A
Functional Residual Capacity
Volume of air in the lungs after a tidal expiration
16
Q
Normal FRC?
A
2400-1800 mL (40-50% TLC)
17
Q
FVC
A
Forced Vital Capacity
18
Q
FEV1
A
Forced Expiratory Volume in 1 second
19
Q
Normal FEV1?
A
75-80% FVC
20
Q
FEV1/FVC ratio
A
75-80%
21
Q
FEF 25-75%
A
Forced Midexpiratory Flow
22
Q
PEF
A
Peak Expiratory Flow
23
Q
Normal PEF?
A
9-10 L/sec
24
Q
Innervation of upper trap and SCM?
A
Spinal Accessory (CN XI)
25
Innervation of scalenes?
C4-C8
26
Innervation of abdominals?
T5-L1
27
What 3 dimensions are tested regarding respiratory muscle function?
Strength
Endurance
Tension-time index
28
How is respiratory muscle strength tested?
Maximal inspiratory pressure (-)
| Maximal expiratory pressure (+)
29
How is respiratory muscle endurance tested?
Maximal voluntary ventilation (RR x TV)
| Breathing endurance time
30
What does the tension-time index represent?
Work imposed on inspiratory muscles at any point in time
Function of how strong muscle is contracting and time it is contracting.
31
Body will manipulate breathing patterns to avoid... at expense of...
To avoid excessive workload (fatigue) at expense of gas exchange (efficiency).
32
What are the 3 things that influence ventilation?
Compliance
Elasticity
Airway resistance
33
In a healthy individual, WOB at rest is what percent VO2max?
< 5%
34
In a healthy individual at max exercise, MV/MVV =
80%
35
Effective and efficient inhalation requires...
1. Low resistance to airflow
2. Sufficient compliance in the lungs
3. Sufficient compliance in the chest wall
4. Adequate diaphragmatic excursion
5. Adequate inspiratory neuromuscular function, strength, and endurance
6. Ability to decrease physiologic dead space
7. Pain free
8. Adequate exhalation
36
Effective and efficient exhalation requires...
1. Low resistance to airflow
2. Elastic recoil of the lungs and chest wall
3. Free of obstruction
4. Adequate expiratory muscle function
5. Pain free (for coughing, pulmonary hygiene)
6. Adequate inhalation
37
Effective and efficient gas exchange requires...
Diffusion:
1. Surface area
2. Permeability
3. Partial pressures
4. Time
38
What is respiratory failure?
Ventilatory pump can't meet demands at any time
39
What is Type I respiratory failure?
Primarily Hypoxic
Inadequate oxygen carrying capacity of blood.
< 80 PaO2 is abnormal
< 60 PaO2 is failure
40
What is Type II respiratory failure?
Primarily Hypercapnic
Low oxygen, high CO2
> 50 PaCO2 is failure
(normal is 35-45)
41
What is acute respiratory failure?
Sudden onset; may or may not be reversible; probably unstable
42
What is chronic respiratory failure?
Chronic state of altered gas exchange; CO2 levels gradually elevate and bodies become accustomed to it as long as O2 levels are ok.
43
What are the 2 main categories of pulmonary dysfunction?
Restrictive Lung Dysfunction (RLD)
| Obstructive Lung Dysfunction (OLD)
44
What is the primary problem with RLD?
Compliance (lung inflation) - problem getting the air IN
45
How does fibrosis cause RLD?
Fibrotic tissue replaces normal tissue in the lungs or chest wall (inspiratory muscles). Fibrotic tissue is not extensible so lung volume is decreased.
46
What happens to lung volumes in RLD?
TV is preserved at the expense of ERV and IRV. This causes decreased volumes and capacities yet ratios stay normal.
47
Implications of less reserve in RLD?
Less ability to decrease physiologic dead space and perform more than rest activity.
48
Characteristics of RLD
1. Decreased lung volumes/capacities
2. Tachypnea
3. Dyspnea, initially with exercise
4. Decreased breath sounds (crackles)
5. Increased WOB
6. Non-productive cough
7. Hypoxemia (V/Q mismatching)
8. Emaciation
9. Cor Pulmonale
49
Why does tachypnea occur in RLD?
Elevated RR to maintain ventilation
50
Why kind of breath sounds do you hear in RLD?
Decreased breath sounds
Crackles upon inhalation (opening airways)
51
VI =
VI = MV/MVV
52
What are the 2 reasons for increased WOB in RLD?
1. Respiratory muscle required to contract harder
| 2. Overall MV greater (breathing faster - wasted ventilation; air going more to anatomical dead space)
53
Why is there a non-productive cough in RLD?
Can't get the air in
54
Why is there emaciation in pulmonary disease?
Takes work to eat
Increased metabolism due to WOB
Inactivity (muscle wasting)
55
What is the connection between secretions and RLD?
Pathology generally not due to secretions, but possible to develop secretions secondary to pathology.
56
What is cor pulmonale?
Right-sided heart failure secondary to chronic pulmonary disease.
Hypoxemia occurs due to V/Q mismatch, ventilation decreases, vasocontriction increases to compensate, this increases after load which causes pulmonary HTN which increases workload on the right side of the heart and creates ventricular hypertrophy.
57
Hyaline membrane disease
RLD / Infant Respiratory Distress Syndrome
Premature infants - presence of immature surfactant; surfactant begins production at 26-28 weeks but not mature until 36 weeks
58
Bronchopulmonary Dysplasia
RLD
Chronic inflammation and fibrosis in premature babies that needed long-term breathing support and/or oxygen.
59
Idiopathic Pulmonary Fibrosis
RLD
Formation of excessive fibrous tissue, as in a reparative or reactive process.
60
What environmental factors can cause RLD?
Asbestos, silicone, coal mines, etc.
61
Pneumonia
RLD
Inflammatory process of the lungs that usually comes on mid to late in life. Unknown origin but suspected viral, genetic, or immunological causes. Inflammation leads to tissue destruction and scarring/fibrosis. High mortality rate within 3-5 years of dx.
62
Adult Respiratory Distress Syndrome
RLD
Caused by acute lung injury causing hypoxemia and changes in permeability of alveolar tissue. Common source of injury is barotrauma or volume trauma from mechanical ventilation. Severe form of pulmonary edema.
63
Bronchogenic Carcinoma
RLD
Invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.
64
Pleural Effusion
RLD
Fluid within the pleural space
65
Pulmonary edema.
RLD
Fluid buildup within the parenchyma
66
Pulmonary Emboli
RLD
Blockage of arterial pulmonary vasculature from embolic event. Usually occurs as result of DVT dislodging and migrating into pulmonary vasculature.
67
How does SCI or neural dysfunction cause RLD?
Restriction caused by a weakened and ineffective ventilatory pump from respiratory muscle dysfunction of neurologic origin.
Postural changes and alterations in muscle tone can affect breathing.
68
Musculoskeletal causes of RLD?
Abdominals (no diaphragmatic excursion), severe scoliosis, rib fracture, trauma.
69
What connective tissue disorders cause RLD? Why?
RA, lupus, etc. - affect the pleura and compliance of the chest wall.
70
Why do obesity and pregnancy cause RLD?
Diaphragm can't expand properly.
71
Tension pneumothorax
RLD
Pneumothorax is abnormal collection or air or gas in pleural space. If amount of air increases markedly when a one-way valve is formed by an area of damaged tissue, this leads to tension pneumothorax, a medical emergency that can cause steadily worsening oxygen shortage and low blood pressure.
72
How do chemotherapy and radiation therapy cause RLD?
Thoracic stiffness
73
When a person develops SOB, what do they typically do?
Become inactive (think they are just deconditioned). This allows pulmonary disease to progress to serious levels.
74
What is the primary problem with OLD?
Problem getting the air out
75
What number leading cause of death is COPD? Why?
5th worldwide, projected 3rd by 2020.
3rd in US currently
Under diagnosed and managed.
76
OLD Characteristics
```
Problem with exhalation
Increased RV (flattened diaphragm)
Increased dead space
Decreased flow rates
Decreased FEV1/FVC ratio
Increased mucous (not always)
Chronic productive cough
Hypoxia and hypercapnea
Barrel chested
Wheezing, dyspnea, increased WOB
Accessory muscle use
Pursed lip breathing
Tripod position
Postural changes
Nutritional imbalance
```
77
Increased residual volume means air is...
trapped in the lungs
78
Why is there increased dead space in OLD?
Physiologic dead space becomes fixed
79
Why is there a decrease in FEV1/FVC in OLD but not RLD?
In RLD, FEV1 decreases, but so does FVC. In OLD, only FEV1 decreases.
80
What does barrel chested mean?
Hyper-inflated; increased AP diameter; ribs more horizontal
81
Why does a patient with OLD use pursed lip breathing?
Helps control and prolong exhalation; keeps airways open longer by increasing their pressure and therefore helps get more air out).
82
Why does a patient with OLD use the tripod posture?
Seated, leaning forward with hands on knees - fixes upper extremities to reverse action the accessory breathing muscles.
Secondarily, it compresses abdominal contents and pushes diaphragm up into more dome shape.
83
Chronic accessory muscle use leads to...
Orthopedic problems - FHP, scapular pain, etc.
84
COPD =
Emphysema + chronic bronchitis
85
What is chronic bronchitis?
Cough productive of sputum for 2-3 months for 2 consecutive years. Generally associated with smoking and not reversible.
86
What 2 cells line airways?
Goblet cells - produce sputum
Ciliated cells - eat sputum
87
What is the pathogenesis of chronic bronchitis?
Pathogen inhaled constantly over time
Hypersecretion of mucous
Hypertrophy of goblet cells encroach airway
Hyperplasia of goblet cells
Ciliated cells can't handle increased sputum
Excessive mucous causes cough
Bacterial infection --> exacerbation --> inflammation --> lung deterioration
Interference with gas exchange
CO2 retention / hypoxemia
Cor pulmonale
88
Constant mucous =
Chronic infection (bacteria thrive in mucous)
89
Characteristics of emphysema?
Similar etiology to bronchitis (smoking)
Nothing to do with secretions
Caused by smoking or alpha-1 antitrypsin deficiency (genetic defect)
Inflammatory reaction
Enlarged airways: bullae (hyperinflated air sacs)
Pneumothorax
90
People with emphysema produce secretions because...
They often have bronchitis as well
91
Emphysema destroys alveolar sacs and causes loss of
Elastic recoil
92
Characteristics of asthma
Reactive airways
Reversible obstruction
Stimulants: allergens, infection, exercise, stress (cold dry air)
Asthma attacks: SOB, wheezing, airway obstruction
93
What are the 3 causes of airway inflammation?
Mucous production
Airway muscle tightening
Swollen bronchial membranes
94
What is wheezing?
High-pitched sounds associated with air moving through a narrowed passageway.
95
Median survival age of CF?
36.8 years
96
What race are patients with CF?
94% are caucasion
97
Characteristics of Cystic Fibrosis?
Genetic recessive exocrine disorder
Defective CFTR channel (Cystic Fibrosis Transmembrane Regulator) - affects hydration content of mucous: left with thick mucous that blocks airways & infection
DX by genetic testing or sweat test (elevated Cl-)
Progressive; cause of death is respiratory disorder.
98
What is atelectasis?
Airway collapse
99
What is bronchiectasis?
Abnormal dilated airways (breakdown and loss of elastic recoil)
100
What is hemoptysis?
Coughing up blood (bleeding in airways)
101
What are symptoms of CF exacerbation?
```
Increased cough/sputum
Increased dyspnea
Fever
Weight loss
Fatigue
Decreased PFTs
Increased WBC count (infection)
Decreased exercise tolerance
```
102
Secondary complications of CF?
```
Pancreatic insufficiency
Infertility (males)
Depression (QOL)
Osteoporosis
CF-related diabetes
CF-related arthropathies and postural dysfunction
Nutritional compromise
```
103
Pulmonary effects of aging
Decreased strength of respiratory muscles (RLD)
Decreased chest wall compliance (RLD)
Increased alveolar compliance (OLD)
Decreased pulmonary vasculature
104
OLD/RLD: when is FEV1 reduced?
Both
105
OLD/RLD: when does FEV1/FVC go down?
OLD
106
FEF25-75 is a sign of
small airway disease
107
OLD/RLD: when does RV/TLC increase?
OLD (trouble getting air out, volume stays in body).
108
What does FEV1/FVC have to be in order to indicate COPD? What is then used to determine stage of COPD?
FEV1/FVC has to be < 70
FEV1 used to determine stage
109
Concerns with ventilatory pump dysfunction
```
Ventilation
Respiration
Protection
Impact on exercise and functional capacity
Impact on QOL
```
110
Concerns with suspected ventilatory pump dysfunction
```
Ability to maintain oxygenation
How much energy to breath
Handle metabolic cost of exercise in addition to metabolic cost of breathing
What is their ventilatory reserve
Can they keep airways clear
```
111
Phase I of pulmonary rehab?
Acute stage: focus on airway clearance and pulmonary hygiene
112
What phase are pulmonary patients usually in?
Usually in both with rehab focusing on one. Ex: acute patient (phase I): getting out of bed might be their aerobic exercise (phase II)
112
Phase II of pulmonary rehab?
Aerobic training, strengthening
113
If patient had pulmonary rehab, they should not...
have orthopedic rehab on the same day.
114
Who are candidates for pulmonary rehab?
Anyone with pulmonary issues or potential to develop pulmonary issues
115
What is required for pulmonary rehab reimbursement?
Pulmonary diagnosis and documented functional limitations secondary to pulmonary issues
116
What are the most common symptoms of pulmonary disease? Others?
Dyspnea
Fatigue
Others: cough, sputum, breathing pattern
116
Definition of dyspnea
Perception of SOB (subjective experience)
117
Acute dyspnea
Sudden onset of SOB, change in condition without explanation
118
Chronic dyspnea
Predictable SOB at rest or with activity; can be explained and controlled
119
Causes of dyspnea
1. Increased ventilatory demand
2. Dynamic airway compression (exhalation triggers receptors that cause perception)
3. Hyperinflation (trigger receptors in lungs)
4. Respiratory muscle dysfunction (weaker, work perceived as more intense)
120
Baseline Dyspnea Index (BDI)
Measures dyspnea at particular point in time (baseline)
120
Transitional Dyspnea Index (TDI)
Assesses changes in dyspnea (ex: at end of intervention)
121
Both BDI and TDI look at:
1. Functional impairment
2. Magnitude of effort
3. Magnitude of task
122
What is the MMRC Dyspnea Scale?
Measures how dyspnea affects function
123
What tests are used for exercise capacity?
Graded exercise tests
Six-minute walk test
Modified shuttle test
Step tests
124
Which exercise capacity test is used as criteria for lung transplant?
6MWT
126
What questionnaires are used for QOL?
Chronic Respiratory Disease Q
St. George's Respiratory Q
Cystic Fibrosis Q
126
What is the BODE index?
```
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
```
127
Exercise limitations in COPD
Ventilatory factors max out before cardiovascular system
May not maintain 98% SpO2 or blow off extra CO2
Deconditioning and pulmonary HTN: cardiovascular problems
Skeletal muscle dysfunction
Depression, motivation, comorbidities, orthopedic problems, diabetes
128
Skeletal Dysfunction in COPD
```
Direct inflammatory-mediator effects
Malnutrition
Blood-gas abnormalities (retain CO2)
Impaired O2 delivery from right heart failure
Electrolyte imbalance
Medications
Comorbidities
```
129
Retaining CO2 makes blood more...
acidic which slows reactions down
130
What are the 4 electrolytes?
K, Cl, Na, Ca
132
Chronic steroids --> muscle...
wasting
132
Why are patients with COPD losing aerobic capacity?
Peripheral muscle fibers shift from aerobic to anaerobic; patients constantly exercising in anaerobic condition which builds up CO2
134
If exercise can't change right-sided heart failure, fixed FEV1, etc., why have patient with COPD exercise?
Prevents progression and working on skeletal muscle for training effects that will improve aerobic capacity so SOB is less frequent, anaerobic threshold is pushed back, and QOL is improved.
135
Patients can be a little SOB during exercise, but if they stay SOB afterward, that means...
they worked too hard
136
Frequency and duration of aerobic exercise for pulmonary rehab?
Freq: 3-5x/week; lower if severe disease
Duration: 20-30 min; intermittent is best
137
Target of aerobic exercise intensity?
SpO2 > 90%
| Target: 60% max work rate
139
How do you prevent exercise-induced asthma?
Pre-medicate
Avoid stimulants
Prolonged warmup
140
Patients with asthma are usually on two types of...
bronchodilators
Long-acting: maintain level of drug
Short-acting: rescue inhaler
141
What is burkholderia cepacia?
Bacteria in some CF patients - very hard to treat and needs to be isolated; associated with rapid decline in pulmonary function in patients with CF and poor outcomes for lung transplant.
142
Definition of ventilatory movement strategies
Coordination of inhalation and exhalation with movement and exercise based on the fact that inhalation is an extension moment and exhalation is a flexion moment of the trunk.
144
What are segmental breathing exercises?
Defined as utilization of manual or verbal biofeedback to enhance ventilation to particular area of the lung.
Indicated in individuals with dynamic asymmetrical breathing patterns.
144
Purpose of ventilatory movement strategies?
Enhance ventilation
146
What is primary determinant of airway clearance?
Ventilation
147
What questionnaires are used for QOL?
Chronic Respiratory Disease Q
St. George's Respiratory Q
Cystic Fibrosis Q
148
What questionnaires are used for QOL?
Chronic Respiratory Disease Q
St. George's Respiratory Q
Cystic Fibrosis Q
149
What is the BODE index?
```
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
```
150
What is the BODE index?
```
B = body mass index (BMI)
O = degree of airflow obstruction (FEV1)
D = level of dyspnea (MMRC)
E = exercise capacity (6MWT)
```
151
Exercise limitations in COPD
Ventilatory factors max out before cardiovascular system
May not maintain 98% SpO2 or blow off extra CO2
Deconditioning and pulmonary HTN: cardiovascular problems
Skeletal muscle dysfunction
Depression, motivation, comorbidities, orthopedic problems, diabetes
152
Skeletal Dysfunction in COPD
```
Direct inflammatory-mediator effects
Malnutrition
Blood-gas abnormalities (retain CO2)
Impaired O2 delivery from right heart failure
Electrolyte imbalance
Medications
Comorbidities
```
153
Retaining CO2 makes blood more...
acidic which slows reactions down
154
What are the 4 electrolytes?
K, Cl, Na, Ca
155
Chronic steroids --> muscle...
wasting
156
Why are patients with COPD losing aerobic capacity?
Peripheral muscle fibers shift from aerobic to anaerobic; patients constantly exercising in anaerobic condition which builds up CO2
157
If exercise can't change right-sided heart failure, fixed FEV1, etc., why have patient with COPD exercise?
Prevents progression and working on skeletal muscle for training effects that will improve aerobic capacity so SOB is less frequent, anaerobic threshold is pushed back, and QOL is improved.
158
Patients can be a little SOB during exercise, but if they stay SOB afterward, that means...
they worked too hard
159
Frequency and duration of aerobic exercise for pulmonary rehab?
Freq: 3-5x/week; lower if severe disease
Duration: 20-30 min; intermittent is best
160
Target of aerobic exercise intensity?
SpO2 > 90%
| Target: 60% max work rate
161
How do you prevent exercise-induced asthma?
Pre-medicate
Avoid stimulants
Prolonged warmup
162
Patients with asthma are usually on two types of...
bronchodilators
Long-acting: maintain level of drug
Short-acting: rescue inhaler
163
What is burkholderia cepacia?
Bacteria in some CF patients - very hard to treat and needs to be isolated; associated with rapid decline in pulmonary function in patients with CF and poor outcomes for lung transplant.
164
Definition of ventilatory movement strategies
Coordination of inhalation and exhalation with movement and exercise based on the fact that inhalation is an extension moment and exhalation is a flexion moment of the trunk.
165
Purpose of ventilatory movement strategies?
Enhance ventilation
166
What are segmental breathing exercises?
Defined as utilization of manual or verbal biofeedback to enhance ventilation to particular area of the lung.
Indicated in individuals with dynamic asymmetrical breathing patterns.
167
What is primary determinant of airway clearance?
Ventilation
168
Pneumothorax
Air in pleural space
169
Hemothorax
Blood/bleeding in pleural space
170
What is the 6MWT?
6-minute walk test
Submax exercise used to indirectly measure an individual's functional exercise capacity
171
Step tests are commonly used as...
a measure of fitness; easy to do with limited equipment/space needed; constant load test (to metronome) so can repeat to note improvement
Requires coordination!
172
Astrand-Rhyming protocol
3-minute step test
3-minute YMCA step test
Examples of...
methods to objectively measure activity tolerance in certain individuals; considered submax tests
173
During an exercise test, what SpO2 level indicates that you should stop?
< 90%
174
Problems with excessive secretions
Interference with ventilation
Interference with gas exchange
Increases WOB
Increases risk for infection
175
How do excessive secretions interfere with gas exchange?
Limit alveolar ventilation
Directly interferes with transport of O2 and CO2
Decreases surface area available for gas exchange
176
How do excessive secretions increase the risk for infection?
Can't get bacteria out and it flourishes in the moisture.
177
Goblet cells are most numerous in...
the larger and medium size airways
178
Function of mucus?
Protective mechanism against pathogens
179
Function of cilia?
Line the airways from trachea to terminal bronchioles - propel mucus to upper airways
180
Need to have what percent of VC for adequate cough?
60%
181
Need to have what percent of FEV1 for adequate cough?
60%
182
Cough is a.... moment
flexion
183
Value of the cough is only effective down to...
the sixth and seventh bronchial generation
Secretions below the seventh generation are harder to cough out; need secretions to get to the upper airways; collapse of upper airways will prevent secretions from being coughed out.
Healthy people could get lower airway secretions out with a lot of energy, but unhealthy patients cannot
184
What are the stages of a cough?
1. Effective inhalation
2. Closure of the glottis
3. Buildup of pressure
4. Forceful exhalation
185
Splinted cough
Used for post-op patients
Hold pillow or towel over wound, then take deep breath and cough
186
What is the most important factor of mucus movement?
Ventilation - without airflow there can be no effective movement
187
Why should a patient breathe slowly when using a nebulizer?
More deposition of particles throughout the lungs - fast breathing only allows medicine to reach upper airways
188
3 avenues of collateral ventilation?
Pores of Kohn - interalveolar
Canals of Lambert - bronchoalveolar
Canals of Martin - interbronchiolar
189
Equal Pressure Point
EPP - site at which pressure within the airway is equal to the pleural pressure and hence the pressure difference across the wall is zero
190
With tidal volumes, the EPP is in...
| As lung volumes decrease, the EPP is moved...
Tidal: proximal (large) airways
Decrease: peripheral (small) airways
191
Determinants of mucociliary clearance
```
Quantity of mucus
Viscosity of mucus
Airway aperture
Cilia beat frequency
External influences
VENTILATION
```
192
How does smoking suppress ciliary function?
Numbs and paralyzes the cilia
193
What is the danger of surgery regarding mucociliary clearance?
Anesthesia suppresses cilia function when mechanical ventilators increase mucus production
194
Indications for pulmonary hygiene
Aid in mobilizing secretions to maximize ventilation and maintain clear airways
Individual with difficulty mobilizing secretions secondary to an elimination problem, ventilation problem, and/or mucus problem
Individuals at risk for secretion build up
195
Goal of airway clearance
```
Decrease airway obstruction
Enhance muco-ciliary clearance
Improve ventilation
Optimize gas exchange
Decrease risk for infection
Expedite recovery
Optimize cough
```
196
Crackles are a good thing if...
it shows you are stimulating airways to open, but ultimately you want to get rid of them
197
Initially you might want more sputum volume to know you're getting it out, but...
over long-term, you want volume to decrease to indicate less production
198
What are the primary methods to maintain pulmonary hygiene?
Exercise
Functional mobility
(stimulates deep breathing)
