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CardioPulm > Airway Clearance > Flashcards

Airway Clearance Flashcards

1
Q

CF is an autosomal recessive disease associated with a defect in the ____ gene.

A

CFTR gene

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2
Q

Mucus plugging begins at the ___ airways and slowly progresses to the ____ airways over time.

A

distal -> proximal

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3
Q

Mucus plugging creates areas of _____.

A

bronchiectasis

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4
Q

What are PT interventions for CF?

A
  1. airway clearance
  2. aerobic/anaerobic training
  3. postural re-ed
  4. strength training
  5. balance and urinary incontinence screening
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5
Q

Describe manual airway clearance or “chest PT”:

A
  1. percussion: loosen secretions lining bronchial walls to enhance mvmnt to prox airways
  2. chest vibration with exhale/huff
    * performed in postural drainage position
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6
Q

How long are positions held for manual technique?

A

2-5 mins

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7
Q

Explain what happens after percussion:

A

3-10 deep breaths (with 2-3 second hold) and vibration to chest wall during exhale (or huffing)
Then cough or huff to clear secretions

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8
Q

Percussion, vibration, postural drainage possible side effects?

A 
inc intracranial pressure
short term dec PaC02, FEV1
dec CO
Hemoptysis
bronchoconstriction
GERD
dyspnea
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9
Q

What is hemoptysis?

A

bleeding into the airways

*streaks in mucus is no worry, but frank red blood > tsp can be emergency

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10
Q

Cupping during percussion should sound:

A

hollow!

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11
Q

What must be monitored and when for chest pt?

A

all vitals, auscultate, and breathing pattern before and after treatment at a minimum

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12
Q

What is the purpose of active cycle of breathing with forced expiratory technique?

A

mobilize and clear secretions

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13
Q

Describe the process of active cycle of breathing with forced expiratory technique:

A
  1. breathing control: diaphragmatic breathing 30-60 sec
  2. thoracic expansion with tactile/verbal cues 15-30 sec
  3. repeat step 1 and 2 followed by forced expiratory technique to clear secretions
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14
Q

Describe forced expiratory technique (FET):

A

2-3 huffs followed by 15 seconds of breathing control and a repeat of the huff as needed
(can be used alone or with active cycle of breathing)

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15
Q

What makes huffing effective?

A

somewhat stabilizes collapsible airways to remain open while secretions are mobilized

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16
Q

What is the negative affect of FET?

A

can sometimes cause bronchospasm

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17
Q

Describe autogenic drainage:

A

breath at different lung volumes to loosen, collect, and evacuate secretions

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18
Q

Describe the loosening phase of autogenic drainage:

A

diaphragmatic breathing at tidal volumes for 30 sec followed by low lung volumes with 2-3 second hold at the top of inspiration to mobilize secretions from distal airways

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19
Q

Describe the collection phase of autogenic drainage:

A

secretions mobilized to mid-sized airways with deeper breathing

20
Q

Describe the evacuation phase of autogenic drainage:

A

deeper breathing into normal and higher lung volumes to collect secretions into central proximal airways; when cough can no longer be avoided the patient huffs (FET)

21
Q

“The Vest” is also known as:

A

high frequency chest wall oscillation (HFCWO)

22
Q

How does HFCWO work?

A
  1. air pumps change pressure against chest wall
  2. inc. overall airflow which leads to shear forces that thin the mucus
  3. loosens secretions from bronchiole walls
  4. pushes secretions toward larger airways
23
Q

What is the typical frequency and time for HFCWO treatment?

A

12-16 Htz; 20-30 min

24
Q

How often should patients be active during the HFCWO treatment?

A

stop and deflate vest every 3-5 mins to cough or perform huff/FET
**NOT a passive treatment

25
Q

How is PEP performed?

A
  1. patient performs diaphragmatic breaths with larger than normal volume followed by 2-3 second hold against 10-20 cm H20 pressure (via mask or mouthpiece) then exhales through the device
  2. after 10-20 breath cycles, FET/huff and repeat the process 3-5 times
26
Q

How does PEP work?

A
  1. pressure stabilizes small airways preventing collapsed

2. reduces air trapping & improves ventilation by collateral ventilation

27
Q

Describe patient position for PEP:

A

sit upright with elbows supported on table

28
Q

PEP is highly effective in post-op patients with _____.

A

post-op patients with atelectasis

29
Q

PEP is highly effective in ____ diseases that chronically trap air.

A 
obstructive diseases
(COPD, CF, etc)
30
Q

What are the two main oscillatory PEP devices?

A

acapella and flutter

31
Q

How does oscillation added to PEP influence the treatment?

A

sharing forces thin secretions by dec. the viscosity

32
Q

Describe the acapella instructions:

A
  1. inhale 3/4 max breath
  2. hold inhalation 2-3 sec
  3. exhale through device
  4. repeat 5-10 breaths
  5. full inhale
  6. hold 2-3 sec
  7. huff/FET
  8. cough and clear secretions
  9. repeat the whole cycle 2-3 times
33
Q

Flutter valve is characterized by ____ to create PEP and oscillation.
Flutter valve is very ____ dependent.

A

metal ball

position and technique dependent

34
Q

Acapella is characterized by ____ to create PEP and oscillation.

A

magnets

**NOT position dependent

35
Q

What makes aerobic exercise effective for CF population?

A

increased minute ventilation… inc. turbulent airflow and brings secretions more proximally

36
Q

What is minute ventilation?

A

MV = RR x Tidal Volume

37
Q

Aerobic exercise in CF patients helps hydrate secretions via ______?

A

bronchial stretch reflex that changes influx of Na+ into the cell (thins mucus and delivers secretions to proximal airways for expectoration)

38
Q

What is the purpose of incentive spirometry?

A

inc thoracic expansion as an inspiratory technique (VENT PUMP ISSUES)
*mobilize secretions via increased inspiration

39
Q

What position should the pt be in to clear the apical segments of the upper lobes?

A

pt leans back 30 degrees

40
Q

What position should the pt be in to clear the posterior segments of the Upper lobes?

A

Pt leans forward 30 degrees

41
Q

What position should the pt be in to clear the anterior segments of the Upper lobes?

A

pt flatlying

42
Q

What position should the pt be in to clear the Lingula?

A

pt with head down 15 degrees, upper body rotated 1/4 turn backward

43
Q

What position should the pt be in to clear the middle lobe?

A

pt with head down 15 degrees, upper body rotated 1/4 turn backward

44
Q

What position should the pt be in to clear the anterior basal segments of the lower lobes?

A

pt with head down 30 degrees, sidelying position

45
Q

What position should the pt be in to clear the posterior basal segments of the lower lobes?

A

pt with head down 30 degrees, prone

46
Q

What position should the pt be in to clear the lateral basal segments of the lower lobes?

A

pt with head down 30 degrees, rotated one-quarter turn forward

47
Q

What position should the pt be in to clear the superior segments of the lower lobes?

A

pt prone with bed flat

CardioPulm (13 decks)

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