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RCV 1 - physio > airway clearance adjuncts > Flashcards

airway clearance adjuncts Flashcards

1
Q

what is ACBT?

A

-active cycling breathing technique
-use to mobilise and clear excess secretions

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2
Q

what are the 3 main phases of ACBT?

A

-breathing control
-deep breathing exercises
-huffing or forced expiratory technique

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3
Q

why do we need to use airway clearance techniques?

A

-for infection & inflammation
-airway obstruction
-ineffective cough reflex
-parenchyma damage
-airways have become blocked up with thick mucous

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4
Q

what is the purpose of airway clearance?

A

-to loosen thick sticky mucous, so it can be cleared easily from the lungs

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5
Q

what does normal airway clearance need?

A

-open airway
-effective cough
-functional mucocilary escalator

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6
Q

explain the ACBT technique

A

-Breathing control - normal breathing for 20/30 seconds (in through nose and out through mouth)
-Then 3-4 deep breaths (fill the bottom of the lungs as best as they can) can ask them to put hands at bottom of lungs
-Breathing control (normal breathing)
-3-4 deep breaths
-Breathing control
-Huffing - put a tissue in front of them - get them to blow on the tissue
-Then cough if needed

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7
Q

for clearing secretions, should ACBT be used on it own?

A

it is recommended to use another manual clearance technique as well as ACBT

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8
Q

how can we make ACBT more effective?

A
  • Get the patients sitting up or standing - it will be more effective EXCEPT for spinal cord patients (gravity will help push diaphragm up a little)
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9
Q

what is autogenic drainage?

A

-utilises different speeds of breathing to move mucous
-each phase is 2-3 mins to complete and total treatment is 20-45 mins (v time consuming)

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10
Q

what kind of pts can AD be used for?

A

Cf or non CF bronchiectasis patients

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11
Q

describe the 3 phases of AD

A

-phase 1 - moving mucous from small airways (unsticking)
-phase 2- moving mucous from small airways to medium sized airways (collecting)
phase 3- moving mucous from medium sized airways to the large airways for expectoration (evacuation)

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12
Q

what is positive expiratory pressure?

A

-a person breathes through a mask or a handheld mouthpiece. PEP devices allow air to flow freely as you breathe in, but not when you breathe out. You must breathe out harder against the resistance.
-reduces airway collapse caused by bronchiectasis

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13
Q

what are indications for positive expiratory pressure?

A

-CF
-bronchiectasis
-large volume of secretions
-mucousal swelling
-

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14
Q

what are examples of contraindications for positive expiratory pressure?

A

-inner ear pathology
-nose blood history (epistaxis)
-oesophageal surgery
-nausea
-recent trauma to skull, face or mouth
-active haemoptysis (blood in sputum)
-high ICP (as holding breath can raise pressure further)

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15
Q

what does PEP technique involve?

A

-mask is used
-1 way valve to which expiratory resistors are attached
-flow dependent to mobilise secretions
-patient exhales against fixed expiratory resistance generating pressures during expiration that usually ranges from 10-20cm H20

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16
Q

what are the risks of introducing PEP to patients with a bacterial infection eg CF pts?

A

-people forget to tell them how to clean the device
-when pts come back, it is so full of bacteria
-need to think if the pt is going to be compliant with cleaning the device

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17
Q

describe inspiratory muscle training

A

-form of resistance / weight training
-diaphragm and intercostal muscle training
-evidence suggests reduced dyspnoea on exertion and increases exercise tolerance

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18
Q

what is important to consider about inspiratory muscle training?

A

NEED to consider the FIIT principles
reps, sets etc

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19
Q

what kind of pts can IMT be used?

A

-cystic fibrosis
-COPD
-heart failure
-asthma
-stroke etc

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20
Q

what is non invasive ventilation (NIV)

A

delivery of oxygen (ventilation support) via a face mask

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21
Q

what kind of patients can we use NIV for?

A

-used with COPD
-sleep apnoea - obstructive
-type 1 resp failure (hypoxia)
-nocturnal support for advanced CF
-neuromuscular conditions eg MND

22
Q

what does CPAP stand for?

A

-continuous positive airway pressure

23
Q

describe CPAP

A

-provides continuous pressure throughout entire resp cycle
-face mask is worn
-increases functional residual capacity
-prevents airway closure

24
Q

what does BIpap stand for?

A

-bilevel positive airway pressure

25
Q

what is IPAP and EPAP?

A

IPAP - inspiratory positive air pressure
-EPAP - expiratory positive airway pressure

26
Q

what are the aims of BiPAP?

A

-slow daytime hypercapnia
-improve hypoxemia
-stabilise hypercapnia
-decreases work of breathing

27
Q

what are indications for BiPAP?

A

-sputum retention
-atelectasis
-blood gas abnormality
-resp muscle weakness
-inability to engage with ACBT

28
Q

what are the contraindications for BiPAP?

A

-CVS instability
-upper airway obstruction
-head injury / increased ICP
-severe haemoptysis
-upper GI surgery
-facial trauma or surgery
-undrained pneumothorax
-kung transplant / surgery

29
Q

what does IPPB stand for?

A

-intermittent positive pressure breathing

30
Q

what is manually assisted cough?

A

-when the PT uses manual technique to mimic the action of the diaphragm
-compression of the diaphragm

31
Q

what does the manual assisted cough technique involve?

A

-pt is sitting/ half lying w/ head elevated
-position heel of your hands off the patient ribs, above belly button
-patient breathes max involuntary inhalation and hold breath in
-on cough, pt initiates a cough as the physio applies one forceful push in and up through the abdomen

32
Q

what are examples of contraindications for manual assisted cough?

A

-undrained pneumothorax
-vomiting
-facial fractures
-osteoporosis - could fracture a rib
-CVS instability
-raised ICP
-recent upper GI surgery

33
Q

what is self manual assisted cough?

A

-ask them to sit and lean forward
-pt does inward and upward movement
-however, pt might not have strength to do this

34
Q

what is an example of a patient population that could use a cough assist device?

A

neuro patients eg MND, spinal cord injury, stroke

35
Q

what are indications for the use of cough assist device?

A

-peak cough flow of less than 180L/min are unlikely to clear secretions
-audible secretions at the mouth
-crackles heard on auscultation
-non productive cough
-poor inspiratory efforts

36
Q

what is a normal peak cough flow?

A

should be 500-800L/min

37
Q

how does a cough assist device work?

A

-applies a positive pressure to fill the lungs, quickly switching to a negative pressure to produce a high expiratory flow rate and stimulate a cough

38
Q

how is a cough assist device applied?

A

-mask
-mouth piece
-endotracheal tube

39
Q

what is MI:E?

A

A mechanical insufflator-exsufflator (MI-E) device
-used to assist coughing in patients

40
Q

what are indications for use of MI:E?

A

-redcued peak cough flow
-neuromuscular disease eg ALS, muscular dystrophy, MS, myasthenia gravis

41
Q

what is breathstaking?

A

-the process of stacking breaths to recruit lung fields and improve oxygenation via taking a deep inhalation facilitating peak expiratory flow and peak cough flow

42
Q

what is the equipment needed for breath staking?

A

-mask w/ 1 way valve
-ambu bag
-10ml syringe
-may or may not need a nose clip
-info leaflet for patient

43
Q

what are the instructions for breath staking use?

A

-person sitting comfortably, up straight
-+/- nose clips
-put mouth piece in or hold face mask
-take a deep breath in whilst squeezing bag
-hold breath
-immediately take another breath on top of first breath
-take 3-4 breaths in this way
-remove mask and breath out / cough

44
Q

what are indications for breath stacking?

A

-paralytic or restrictive disorders
-MND
-MS
polio

45
Q

what is rib springing?

A

-a compressive technique
-stimulates deeper inspiration
-stimulates a cough
-mobilises secretion

46
Q

what pts is rib springing suitable vs not suitable for?

A

-suitable - pts w/ atelectasis, paralysis
-not suitable - rib fractures, undrained pneumothorax, osteoporosis

47
Q

what is high frequency chest wall oscillation?

A

-where pulses of pressure are applied to chest wall by an inflatable vest
-helps to expel mucous like mini coughs

48
Q

what are indications for HFCWO?

A

CF or NM conditions

49
Q

what are examples of inhaled therapies that can be used before ACT’s?

A

-bronchodilators eg salbutamol
-mucolytics
-airway hydrators
-inhaled steroids / anti-biotics

50
Q

what are things to consider when choosing an adjunct?

A

-age and condition of pt
-severity of lung disease
-compliance to treatment
-ease of use/ comfort
-cost / availibility

RCV 1 - physio (17 decks)

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