P7 - Gas Exchange 2 (Basic Adjuncts)

Question 1

What are the primary goals of positioning/mobility in respiratory care?

Answer 1

Increase lung volumes and optimize ventilation/perfusion (V/Q) ratio.

Question 2

What is ACBT and what techniques can be added to enhance its effectiveness?

Answer 2

Active Cycle of Breathing Technique (ACBT) is a breathing exercise that can be enhanced by adding holds and sniffs to deep breaths.

Question 3

What manual techniques can physiotherapists perform for patients with sputum retention?

Answer 3

Percussion, vibrations, and shakes.

Question 4

What is the main function of a flutter device in airway clearance?

Answer 4

It aids sputum clearance by producing oscillations and positive expiratory pressure (PEP).

Question 4

Which respiratory conditions can benefit from the use of a flutter device?

Answer 4

COPD, Asthma, Bronchiectasis, and Cystic Fibrosis (CF).

Question 5

What is the PEP range generated by the flutter device?

Answer 5

10-25 cm H2O.

Question 6

Name two conditions where the flutter device is contraindicated.

Answer 6

Undrained pneumothorax and large bullae.

Question 7

Describe the correct technique for using a flutter device.

Answer 7

Sit comfortably, inhale through the nose beyond normal tidal volume, then exhale through the flutter device with lips tightly sealed around the mouthpiece for 10-15 breaths, followed by FET (Forced Expiratory Technique) and coughing to clear secretions.

Question 8

What are the primary uses of an incentive spirometer?

Answer 8

To prevent atelectasis, encourage lung expansion, and aid in sputum clearance.

Question 9

How does the incentive spirometer increase lung volumes?

Answer 9

By encouraging slow, deep inhalations which increase transpulmonary pressure and inspiratory volumes.

Question 10

What are some common indications for using an incentive spirometer?

Answer 10

Postoperative risk of pulmonary complications, atelectasis, weak respiratory muscles, and conditions predisposing to pulmonary atelectasis.

Question 11

What are some contraindications for using an incentive spirometer?

Answer 11

Patient inability and poor cognition.

Question 12

Explain how Positive Expiratory Pressure (PEP) works.

Answer 12

PEP provides resistance during exhalation, preventing airway collapse and encouraging collateral ventilation.

Question 13

For which patients is PEP therapy particularly useful?

Answer 13

Patients with COPD, Asthma, bronchiectasis, or cystic fibrosis, and those unable to clear secretions effectively.

Question 14

What is the correct technique for using a PEP mask?

Answer 14

nhale to maximal tidal volume, exhale through the mask for 3-5 seconds while maintaining a constant pressure of 20 cm H2O on the manometer.

Question 15

What are the main indications for using a flutter or acapella device?

Answer 15

Excessive/retained secretions, atelectasis, and chronic respiratory conditions like CF, bronchiectasis, and chronic bronchitis.

Question 16

What is the difference between the flutter and acapella devices?

Answer 16

The flutter uses a metal ball to generate oscillations, while the acapella uses a plastic reed to create oscillatory resistance during exhalation.

Question 17

How often should the acapella device be used for optimal sputum clearance?

Answer 17

8-10 breaths, combined with FET/huff, repeated 2-3 times per day.

Question 18

What are the contraindications for using PEP therapy?

Answer 18

Undrained pneumothorax, large bullae, active TB, cardiac instability, and frank haemoptysis.

Question 19

How does oscillatory PEP help with sputum clearance?

Answer 19

The oscillations shake the airway walls, loosening mucus, while the PEP splints open the airways to prevent collapse.

Question 20

What does “collateral ventilation” mean in the context of PEP therapy?

Answer 20

It refers to air moving into poorly ventilated areas of the lungs through smaller airways, improving lung inflation and sputum clearance.

Question 21

What is the role of end-inspiratory holds in using an incentive spirometer?

Answer 21

They maintain airway patency, preventing or reversing atelectasis and aiding sputum clearance.

Question 22

What is the proper technique for using an incentive spirometer?

Answer 22

Sit upright, breathe out normally, seal lips around the mouthpiece, inhale slowly and deeply, hold the breath for 5 seconds, then exhale slowly.

Question 23

What are the steps in respiratory treatment related to positioning and mobility?

Answer 23

Positioning and mobility aim to increase lung volumes and optimize ventilation-perfusion (V/Q) matching.

Question 24

What is the purpose of adding "holds" and "sniffs" to deep breaths in ACBT?

Answer 24

Holds and sniffs can enhance the effectiveness of deep breathing by promoting greater lung expansion and aiding sputum clearance.

Question 25

What are the main indications for using an Acapella device?

Answer 25

Excessive secretions, atelectasis, chronic respiratory conditions (CF, bronchiectasis, chronic bronchitis), and difficulty clearing secretions independently.

Question 26

How does the Acapella device work during exhalation?

Answer 26

A plastic reed inside oscillates, creating pressure changes that combine oscillatory resistance with positive expiratory pressure (PEP).

Question 27

What is the difference in use between the flutter and Acapella devices?

Answer 27

The flutter must be held in a specific angle to change oscillation frequency, whereas the Acapella can be used in any position, including lying down.

Question 28

What is the role of a manometer in PEP therapy, particularly when using devices like Aerobika?

Answer 28

A manometer measures the expiratory pressure, ensuring it stays within the therapeutic range of 10-25 cm H2O.

Question 29

How many breaths are typically performed when using the Aerobika device for airway clearance?

Answer 29

Between 5-10 breaths, combined with FET or huffing, repeated cycles for 10-15 minutes, 2-4 times per day.

Question 30

What feature of the Aerobika device allows it to be used with nebulisers?

Answer 30

The Aerobika device can attach to a nebulizer to deliver medication while performing airway clearance therapy.

Question 31

What are the common conditions treated using an Aerobika device?

Answer 31

COPD, asthma, bronchiectasis, cystic fibrosis, and any condition where mucus clearance is impaired.

Question 32

What is the purpose of the equal pressure point (EPP) in PEP therapy?

Answer 32

The EPP ensures that airway pressures are equalized at a point that prevents collapse, promoting sputum clearance without airway compression.

Question 33

Why is PEP therapy recommended for patients with chronic bronchitis?

Answer 33

PEP therapy helps to clear mucus, prevent airway collapse, and improve lung ventilation in patients with excessive mucus production and obstructive conditions like chronic bronchitis.

Question 34

What are some hazards or complications of using an incentive spirometer incorrectly?

Answer 34

Hyperventilation, discomfort from pain, hypoxia due to interruption of oxygen therapy, and bronchospasm.

Question 35

What is the role of collateral ventilation in PEP therapy?

Answer 35

Collateral ventilation allows poorly ventilated lung areas to receive airflow through smaller airways, enhancing lung expansion and sputum clearance.

Question 36

What is a common postoperative use for the incentive spirometer?

Answer 36

The incentive spirometer is used to prevent pulmonary complications, such as atelectasis, after upper abdominal or thoracic surgeries.

Question 37

What types of patients may not be suitable candidates for using an incentive spirometer?

Answer 37

Patients with poor cognition or inability to follow instructions are contraindicated for incentive spirometer use.

Question 38

What is Forced Expiratory Technique (FET) and when is it used?

Answer 38

FET is a controlled breathing maneuver used after performing airway clearance exercises (e.g., after using flutter, acapella, or aerobika devices) to clear mucus by huffing or coughing.

Question 39

In PEP therapy, why is it important to maintain a pressure of 20 cm H2O on the manometer?

Answer 39

Maintaining this pressure ensures optimal PEP, which helps keep the airways open, preventing collapse and aiding sputum clearance.

Question 40

What are some key precautions when using PEP or oscillatory devices?

Answer 40

Avoid use in patients with undrained pneumothorax, large bullae, active TB, cardiac instability, or frank haemoptysis.

Question 41

How should a patient be positioned when using a flutter, acapella, or aerobika device for best results?

Answer 41

The patient should ideally be seated, with a forward lean if needed, but these devices can also be used in lying or side-lying positions.

Question 42

Why is dynamic compression of the airways a concern during forced expiration, and how do PEP devices address this?

Answer 42

Dynamic compression can collapse small airways, making it harder to clear mucus. PEP devices create back pressure that prevents airway collapse during expiration.

Question 43

What are the recommended breath cycles when using flutter, Acapella, or Aerobika devices for airway clearance?

Answer 43

Typically, 10-15 breaths are performed, followed by FET or a huff, then coughing to clear secretions.

Question 44

What is the primary goal of breathing exercises in respiratory care?

Answer 44

To increase lung volumes and improve oxygenation by optimizing ventilation-perfusion (V/Q) matching.

Question 45

What are the key benefits of using manual techniques like percussion, vibrations, and shaking in patients with sputum retention?

Answer 45

These techniques help loosen and mobilize mucus, making it easier for the patient to clear their airways

Question 46

What is the primary function of Positive Expiratory Pressure (PEP) devices?

Answer 46

PEP devices help splint open the airways, preventing collapse and aiding in sputum clearance by producing positive expiratory pressure.

Question 47

What is the importance of maintaining a PEP of 10-25 cm H2O during therapy?

Answer 47

It prevents airway collapse while allowing the Equal Pressure Point (EPP) to help with sputum clearance and collateral ventilation.

Question 48

How does PEP therapy prevent dynamic airway compression?

Answer 48

By providing positive pressure during exhalation, PEP keeps the airways open, preventing their collapse and aiding mucus movement upwards.

Question 49

What is the correct inhalation technique when using an incentive spirometer?

Answer 49

Breathe in slowly and deeply through the mouthpiece, ensuring the piston rises steadily, followed by an end-inspiratory hold for at least 5 seconds.

Question 51

Why should a patient take brief 3-second rests between breaths while using an incentive spirometer?

Answer 51

To avoid hyperventilation and allow for better control over lung expansion without causing fatigue or discomfort.

Question 52

What is the significance of the "outer yellow indicator" in an incentive spirometer?

Answer 52

It marks the patient's best effort, which serves as a goal to achieve or surpass during subsequent breathing exercises.

Question 53

Why is PEP therapy particularly useful for patients with chronic respiratory conditions like cystic fibrosis or bronchiectasis?

Answer 53

PEP therapy helps to maintain open airways and promotes effective mucus clearance, which is crucial in managing chronic conditions with frequent mucus buildup.

Question 54

What are the contraindications for the use of a flutter device?

Answer 54

Undrained pneumothorax, large bullae, active tuberculosis (TB), cardiac instability, and frank haemoptysis.

Question 55

What technique should be used to clear secretions after using a flutter or acapella device?

Answer 55

The Forced Expiratory Technique (FET) or a huff, followed by a cough, to effectively clear loosened secretions.

Question 56

Why is the flutter device effective in airway clearance?

Answer 56

It combines oscillatory resistance with PEP, which loosens mucus and prevents airway collapse, making it easier for the patient to clear their airways

Question 57

What is a key difference in technique between using a flutter and an Acapella device?

Answer 57

The flutter device needs to be held at specific angles to adjust oscillations, while the Acapella device can be used in any position, including lying down.

Question 58

How does the plastic reed inside an Acapella device function during exhalation?

Answer 58

It oscillates to create pressure changes that combine with PEP, helping to mobilize secretions for easier clearance.

Question 59

What is the purpose of attaching a manometer to a PEP device like the Aerobika?

Answer 59

To measure and ensure the patient is maintaining the correct expiratory pressure during therapy.

Question 60

Why is it important to inhale to maximal tidal volume before exhaling through a PEP device?

Answer 60

Inhaling maximally ensures that the lungs are fully inflated, which optimizes the effectiveness of the PEP in clearing secretions.

Question 61

What are the main indications for using PEP devices in respiratory therapy?

Answer 61

Excessive or retained secretions, atelectasis, and chronic respiratory conditions like cystic fibrosis, bronchiectasis, and chronic bronchitis.

Question 62

What are the key hazards or complications associated with improper use of an incentive spirometer?

Answer 62

Hyperventilation, discomfort due to pain, hypoxia from interrupted oxygen therapy, bronchospasm, and fatigue.

Question 63

How does PEP therapy encourage collateral ventilation in the lungs?

Answer 63

By keeping the airways open, PEP allows air to move into poorly ventilated areas of the lungs, promoting better overall ventilation.

Question 64

What is the Equal Pressure Point (EPP) in PEP therapy, and why is it important?

Answer 64

EPP is the point where intrapleural and alveolar pressures equalize, preventing airway collapse and promoting effective sputum clearance.

Question 65

What technique is used to prevent airway collapse during PEP therapy?

Answer 65

Resisted expiration through the PEP device helps prevent airway collapse by maintaining positive pressure throughout exhalation.

Question 66

What are some common hazards or complications of using PEP devices if not used correctly?

Answer 66

Discomfort, hyperventilation, exacerbation of bronchospasm, and airway instability if pressures are not monitored correctly.

Question 67

What should patients do between breath cycles when using a flutter, Acapella, or Aerobika device?

Answer 67

Take brief rests and perform forced expiratory techniques (FET) or huffing to help clear secretions effectively.