Unit 1 - Bronchial Hygiene Therapy

Question 1

Airway clearance therapy uses what?

Answer 1

Noninvasive techniques to improve gas exchange

Question 2

Normal clearance requires three things:

Answer 2

Patent airway, Functional mucocilary escalator, effective cough

Question 3

What can an effective cough do?

Answer 3

Move mucus from lower airways to upper airways (to be coughed out)

Question 4

Abnormal clearance is any abnormality that alters: 5 factors:

Answer 4

Airway patency, Mucocilary function, Breathing muscle strength, secretion thickness, cough reflex

Question 5

Normal clearance 4 steps to cough:

Answer 5

Irritation, Inspiration, Compression, Expulsion

Question 6

Retention of secretions may result in two things:

Answer 6

Full obstruction or mucus plugging, partial obstruction that restricts airflow.

Question 7

Full obstruction results in what?

Answer 7

Atelectasis - causes hypoxemia due to shunting.

Question 8

Partial obstruction can do what?

Answer 8

Increase WOB, Air-trapping, lung over-distention, and V/Q imbalances.

Question 9

Diseases associated with abnormal clearance:

Answer 9

CF, Bronchiectasis, Neuromuscular diseases

Question 10

Intubated patients may have these factors associated with impaired mucocilary clearance:

Answer 10

Endo or trach tube, Tracheobronchal suction, Drugs, high FiO2 values, Opiates, underlying pulmonary diseases.

Question 11

Indications for airway clearance therapy for ACUTE conditions?

Answer 11

copious secretions, inability to mobilize secretions, ineffective cough.

Question 12

Indications for airway clearance for CHRONIC conditions?

Answer 12

CF, Bronchiectasis, ciliary dyskinetic syndromes, COPD patients with retained secretions.

Question 13

Who could benefit from airway clearance therapy?

Answer 13

Acutely ill patients, CF

Question 14

Physical findings that determine the need for airway clearance?

Answer 14

Loose, ineffective cough, Labored breathing pattern, Coarse inspir. & expir. crackles, Tachypnea/Tachycardia, Fever

Question 15

Five ways or approaches to doing airway clearance?

Answer 15

CPT, Cough, Positive Airway pressure, High frequency compression, physical activity or mobilization.

Question 16

What is Chest Physical Therapy (CPT)?

Answer 16

Use of positioning & gravity; cupped hand striking; mechanical vibrations.

Question 17

What are some limitations to CPT?

Answer 17

May not tolerate Trendelenburg position (if dyspnea), dependent on appropriate positioning, requires help of caregiver.

Question 18

How long does caregiver perform CPT?

Answer 18

3 - 5 minutes on each affected area/lobe.

Question 19

Factors to assess Airway clearance methods? Did it work?

Answer 19

Change in: sputum production, breath sounds, dyspnea level, vital signs, chest radiograph, ABG results, ventilator variables.

Question 20

What items need to be documented & followed up in airway clearance methods?

Answer 20

Positions used, time in positions, patient tolerance, indicators of effectiveness, any bad effects observed.

Question 21

What is a directed cough?

Answer 21

Deliberate cough that is taught, supervised, and monitored. Mimic the spontaneous cough.

Question 22

Who can’t use directed cough?

Answer 22

Obtunded, paralyzed, or uncooperative patients.

Question 23

What is Forced Expiratory Technique (FET)?

Answer 23

Modification of directed cough - “HUFF cough”; one or two forced expirations of middle to low lung volumes without closure of glottis.

Question 24

What is FET goal?

Answer 24

To clear secretions with less change in pleural pressure and less bronchial collapse.

Question 25

FET is most helpful to what patients?

Answer 25

COPD, CF, bronchiectasis

Question 26

What is Manual Assisted Cough?

Answer 26

External application of pressure to the thoracic cage or epigastric region with forced exhalation.

Question 27

Who benefits from Manual Assisted Cough?

Answer 27

Patients with neuromuscular conditions that cannot generate forceful expulsion.

Question 28

What are the steps to Active Cycle of Breathing Technique?

Answer 28

Relaxation & Breathing control, 3-4 thoracic expansion exercises, repeat twice, then at least 1 huff cough (FET), and repeat relaxation/breathing control.

Question 29

Positive Airway Pressure is used to treat?

Answer 29

Atelectasis and mobilize secretions.

Question 30

The three types of Airway pressure devices:

Answer 30

Continuous PAP (CPAP), expiratory PAP (EPAP), and positive pressure (PEP)

Question 31

Physical activity therapy should result in 4 things:

Answer 31

Increased tidal ventilation, increased heart rate, increased cardiac output, and improved physical conditioning.

Question 32

The PEP device uses what flow?

Answer 32

fixed or variable orifice expiratory flow restrictor to generate expiratory pressures of 10 to 20 cmH2O as patient actively exhales through device.

Question 33

What is high frequency Compression or Osscillation?

Answer 33

Vest: inflates/deflates, creating pressure pulses against the thorax that cause chest wall oscillations and move secretions forward.

Question 34

Intrapulmonary percussive ventilation does what?

Answer 34

Rapid series of pressurized gas minibursts to the airway at rates of 100 to 225 cycles per minute.

Question 35

What is bronchial hygiene therapy?

Answer 35

Non-invasive techniques to improve gas exchange and promote, mobilize, and remove secretions.

Question 36

Characteristics of CF?

Answer 36

Increased sputum viscosity, increased mucus volume & impaired clearance.

Question 37

Who typically gets CF?

Answer 37

Children and young adults

Question 38

Characteristics of Bronchiectasis?

Answer 38

Mucostasis, retained secretions, loss of mucuciliary escalator and repeated pneumonia.

Question 39

Who typically gets Bronchiectasis?

Answer 39

Adults with history of lung infection

Question 40

Three ways to rotate the body along the longitudinal axis?

Answer 40

Self-turning, caregiver turning, rotational beds

Question 41

Roto rest bed is done for two reasons if patient is?

Answer 41

Sedated, paralyzed

Question 42

Contraindications of Rotobed?

Answer 42

Morbidly obese, rib fractures, cervical spine injuries

Question 43

Dolphin Mattress does what?

Answer 43

Keeps mucus and secretions moving in the lungs.

Question 44

What position should the "good" lung be in?

Answer 44

Down always. "Good down, bad up"

Question 45

Contraindications of Chest PT?

Answer 45

Intercranial pressure, spinal cord injury, Feeding tubes, Burns/wounds, Combative, osteoporosis, rib fractures.

Question 46

What is Autogenic Drainage?

Answer 46

Modified coughing technique: breathing pattern that varies lung volume and expiratory flow in three different phases.

Question 47

Mechanical insufflation exsufflation (MIE) technique does what?

Answer 47

Blow first, then suck last. Pressure in then pull back out. | * Good for cardiac patients.

Question 48

Where is the flutter Valve used?

Answer 48

At-home patients

Question 49

Acapella is used for how long?

Answer 49

10 - 20 minutes