Week 3 Ch 44 ACT

Question 1

What is ACT

Answer 1

Airway Clearance Therapy.
Involves noninvasive techniques to help mobilize secretions, and improve gas exchange

Question 2

What is the primary method to remove airway secretions invasively ?

Answer 2

Suctioning

Question 3

Normal clearance characteristics:

Answer 3

Cough (one of the most protective reflexes)
Requires:
Patent Airway
Functional mucociliary escalator
Effective cough can move mucus from lower to upper airways
Adequate hydration

Question 4

What are the 4 stages of a cough?

Answer 4

Irritation, inspiration, compression and expulsion

Question 5

What are the characteristics of an abnormal clearance?

Answer 5

Abnormalities in airway patency, mucociliary function, strength of breathing muscles,
thickness of secretions or cough reflex can lead to mucus retention

Question 6

What can mucus plugging lead to?

Answer 6

Atelectasis
Pneumonia
And hypoxemia (Due to shunting)

Question 7

Retained secretions leads to…..

Answer 7

Retained secretions >
infection >
inflammatory response>
release in chemical
mediators(leukotrienes, protease, elastases)>
Damage the epithelium >
increase mucus
production…. Cycle continues

Question 8

What are the diseases associated with abnormal clearance

Answer 8

Asthma/ Lung Cancer
Cystic Fibrosis
Ciliary Dyskinetic Syndrome (CDS)
Bronchiectasis
Neuromuscular Diseases (ALS, Spinal Muscular Dystrophy, MG, GB, and CP)

Question 9

What are indications for ACT?

Answer 9

For acute conditions
Acutely ill patient with copious secretions
PT in acute respiratory failure with clinical signs of retained secretions or ineffective cough (B/S, ABG, CXR, FiO2 requirements)
PT with acute lobar atelectasis
PT w hypoxemia due to lung infiltrates

Question 10

On a CXR with atelectasis what will you see?

Answer 10

More white in the pleural cavity. White means no air, normal lungs are blacked out and filled with air

Question 11

What are the goals of Airway Clearance Therapy?

Answer 11

Mobilize and remove secretions to prevent retention

Question 12

Which patients benefit from chest physical therapy combined with exercise to maintain lung function

Answer 12

Cystic Fibrosis patients

Question 13

What are the physical findings that indicate ACT is needed

Answer 13

Loose, ineffective cough
Labored breathing pattern
Coarse inspiratory & expiratory crackles
Tachypnea/tachycardia
Fever

Question 14

Chest radiograph demonstrating atelectasis and infiltrates require ACT. True or false?

Answer 14

True

Question 15

All of the following are methods of airway clearance except?

A. Exercise
B. Oscillation
C. Chest physical therapy
D. Low frequency compression

Answer 15

D. HIGH frequency compression is part of ACT not low