Suppurative lung disorders

Question 1

What is suppurative inflammation?

Answer 1

Infam process producing purulent exudate + liquification necrosis & death of associated lung tissue

Question 2

What is CSLD? Chronic suppurative lung disease

Answer 2

Wet productive cough > 8wks
Persistent & recurrent infections
Poor clearance

Question 2

S&S of CSLD?

Answer 2

Exertional dyspnoea, coughing wheezing, tightness in chest, growth failure, Hyperinflation -barrel chest, clubbing, ausc. amphoric, Chest xray - opacities, hyperinflation

Question 3

Pathophys of CSLD

Answer 3

Patho not removed
-> further infection & secretion production
-> tissue destruction.
->Further impairment of MCC + Smooth mm to distorted floppy airways.
= decreased secretion clearance

Question 4

Impairments of CSLD

Answer 4

Excessive secretion movement & clearance issues

Question 5

Types of CSLD

Answer 5

Cystic fibrosis, bronchiectasis, lung abscesses

Question 6

Define bronchiectasis general path

Answer 6

abnormally dilated, distorted thick-walled medium-sized bronchi that are chronically inflamed and infected by bacteria.

Question 7

Which pop group is most affected by bronchiectasis?

Answer 7

Indigeous Aus kids. 147/10,000

Question 8

Aetiology of CF: genetic & acquired

Answer 8

Genetic: CF & Kartagener.
Acquired: TB, pneumonia, inhaled foreign bodies, tumours

Question 9

Airway clearance techniques for CSLD

Answer 9

1. ACBT (+ postural drainage) & oscillating peps (therapep, acapella, flutter) (plus postural drainage & FET)
2. Postural drainage
3. FET should be taught

Question 10

Airway techniques & education

Answer 10

Made aware of airway clearance techniques available.
Encouraged to be independent with chosen clearance technique.
Pt preference & treatment must be taken into account.

Question 11

Physio for CF

Answer 11

Prophylactic removal of secretions.
Preventative strategies
Assist with removal of infected secretions
Maintain & improve lung function

Question 12

Evidence for secretion clearance in CF

Answer 12

Treatment based on patient preference.
Aerobic activity should be considered an adjunctive to therapy for additional health benefits.

Question 13

What PT interventions can we use?

Answer 13

PEP, flutter or acapella, postural drainage, percussion or vibrations, nebulised saline or hypertonic saline, ultrasonic nebulisation, exercise

Question 14

Mechanism of a lung abscess

Answer 14

Aspiration > small cavities > encapsulated >erodes tissue >bronchopulmonary fistula > drainage of secretions

Question 15

S&S of lung abscess

Answer 15

Febrile, leukocytosis, putrid sputum, amphoric breath sounds, empyema (pus in pleural space), fatigue.

Question 16

Precautions for lung abscess

Answer 16

Take care not to perforate encapsulated LA.
If draining secretions, care not to spread thru lungs.
Encourage compliance with medication

Question 18

Interventions for difficulty clearing

Answer 18

Huff & Cough
Increase lung volumes (DBE)

Question 19

Interventions for excessive secretions

Answer 19

PD, Percussion, vibrations, shaking, ACBT, FET, PEP, flutter, Acapella, Exercise, Hypertonic & nebulised saline

Question 20

Describe FET (combined techniques)

Answer 20

1-2 huffs + breathing control

Question 21

What is breathing control

Answer 21

‘Relaxed tidal breathing using the lower chest and encouraging relaxation of the upper chest and shoulders

Question 22

Define ACBT

Answer 22

FET + TEE =
TEE (DBE) + BC + Huff + BC - repeat

Question 23

ACBT used in which pop groups?

Answer 23

COPD, non-CF bronchiectasis, excessive secretions, CF.

Question 23

What is PEP / TheraPEP?

Answer 23

Applies resistance via mouthpiece or mask & results in back pressure through airways. May increase expiratory flow in the peripheral airways > annular flow

Question 24

Mechanism of action for PEP

Answer 24

Aeration of alveoli through collateral channels

Question 25

Theory of PEP

Answer 25

reduces dynamic closure during expiration - splinting airways open

Question 26

Effects of oscillation devices

Answer 26

Optimise airflow (13Hz) Maximise exp. flow Decrease viscosity of mucus Augmentation of cilial beat (12Hz) Stimulate spontaneous coughs

Question 27

Aspects of postural drainage

Answer 27

Gravity driven drainage Bronchus perpendicular to floor

Question 28

What is the PD position for the RM lobe?

Answer 28

LSL 15 degree head down tilt, 1/4 off supine

Question 29

Precautions for head down tilt

Answer 29

Unstable haemodynamics: HTN (BP>150/100) arrythmias. Stomach issues: oesophageal surgery, GORD, just eaten, hiatus hernia. Pneumonectoomy (dont lie on operated side). Common sense: orthopnea, head injury, patient distress, pulmonary oedema, severe obesity, head/neck surgery, facial trauma, cerebral aneurysm.

Question 30

Percussion

Answer 30

Rhythmic tapping of hands 1-2 per second

Question 31

Proposed physiological effects

Answer 31

increased exp. flow. Oscillation of expiratory flow (augment cilial beat, decreased viscosity of mucus. Mechanical loosening secretions Stimulate spontaneous coughing

Question 32

Precautions C/I for manual techniques

Answer 32

Bones, bleed & bronchospasm. Specifically: Ribs - #, flail, rib cancer, Frank haemoptysis OP Burns, surgical incision or IC drain Severe bronchospasm Severe pleuritric pain Very low platelets

Question 33

What is autogenic drainage

Answer 33

Unstick secretions - large exhale then small breath in, abdominal breath. Hear secretions start to crackle. Resist any desire to cough. Repeat for at least 3 breaths. Then change to medium breaths x 3. Evacuate secretions - when the crackles are louder still, take long, slow, full breaths into your absolute maximum inspiration, continuing to take small breaths out x 3