Secretion Clearance

Question 1

Why is secretion clearance so important? (educate)

Answer 1

aid in respiratory status

• increase ventilation
• decrease work of breathing and thus O2 consumption

Question 2

Indications for secretion clearance

Answer 2

hyper secretory lung disease
inability to clear secretions
risk of secretion retention
disease that impairs cough

Question 3

precautions/contraindications for airway clearance techniques

Answer 3

coughing up blood (hemoptysis) 
pneumothorax 
raised ICP 
headache 
sinusitis 
GERD 
Nausea and or vomiting 
pregnancy 
hypertension 
rib fracture/osteoporosis 
chest wall pain/discomfort 
chest wall surgery 
coagulation disorders

Question 4

what are some adjunct treatments to enhance airway clearance ?

Answer 4

inhalation therapy
physical activity 
noninvasive ventilation 
analgesia 
Humidification

Question 5

What should be apart of every secretion clearance technique

Answer 5

the basic cough

Question 6

Describe Huffing (forced expiratory technique FET

Answer 6

Huff (2 reps ) then deep breath (3 reps)
huff is 2 secs more than inspiration
arms bent and placed at side
mouth in O
tighten chest wall and abdomen
huff is forced not violent
FET changes the equal pressure point in the airway thereby stabilizing the airway and improving clearance

Question 7

what is assisted cough especially good for?

Answer 7

quads
duchenne muscular dystrophy
ALS
neuromuscular disease

Question 8

Active Cycle of Breathing Basics

Answer 8

Normal Breath
Thoracic Expansion
Huff (FET)
should be done in sitting or in postural drainage positions

Question 9

how long should you be in a postural drainage position for?

Answer 9

3- 10 mins per broncho

pulmonary segment

Question 10

how many postural drainage positions for RUL

Answer 10

3 (apical, posterior, anterior)

Question 11

how many postural drainage positions for RML

Answer 11

1 ( lateral/medial)

Question 12

how many postural drainage positions for RLL

Answer 12

superior, medial basal, anterior basal, lateral basal

posterior basal

Question 13

how many postural drainage positions for LUL

Answer 13

4 (apical, posterior, anterior, lingula

Question 14

how many postural drainage positions for LLL

Answer 14

anterior , lateral , posterior

Question 15

what lobes drainage position is head of bed or sitting at 90 degrees supine

Answer 15

Right & left upper lobe apical segment

Question 16

what lobes drainage position is just supine

Answer 16

RUL - anterior

Question 17

what lobes drainage position is prone

Answer 17

RLL superior

LLL superior

Question 18

prone with quarter turn with right lung up

Answer 18

RUL- posterior

Question 19

30-45 degrees downward tilt side lying with right side up ?

if left side was up?

Answer 19

RML - medial & lateral segments
RLL- lateral

RLL- medial &
LUL lingula
LLL- lateral

Question 20

30-45 degrees downward tilt and prone

Answer 20

RLL - posterior

LLL - posterior

Question 21

30-45 degrees downward tilt supine

Answer 21

RLL & LLL-anterior segment

Question 22

head of bed at 45 degrees and supine

Answer 22

LUL anterior

Question 23

sitting/leaning over bed/chair

Answer 23

LUL - posterior

Question 24

percussion technique

Answer 24

cupped hands
30-60 secs at a time
slow breaths

Question 25

vibrations technique

Answer 25

during exhalation in direction of ribs and soft tissue usually done with 3 deeper breaths than normal post percussions followed by coughing

Question 26

rib springing technique

Answer 26

chest compression followed by overpressure and quick release at end expiration only a few reps

Question 27

precautions/contraindications

Answer 27

``` fractured ribs prone to hemorrhage osteoporosis metastatic bone cancer burns/recent skin graft subcutaneous emphysema of neck/thorax pneumothorax chest wall surgery ```

Question 28

Positive Expiratory Pressure (PEP) Mask

Answer 28

one way breathing valve patient presses face against mask and slowly inhales through inspires 5-20 times with active exhalations ratio of 1:3 or 1:4 usually followed by FET go until patient has expelled all secretions usually about 15-20 mins Good for children with CF

Question 29

What is collateral channel;s

Answer 29

the ventilation of alveolar structures through passages or channels that bypass the normal airways

Question 30

oscillating pep

Answer 30

handheld device which one breath into the device and it oscillates/vibrates the small/large airways no difference between PEO for evidence based practice