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DPT 770 - Cardiopulmonary II & Lymphatics > Airway Clearance Interventions > Flashcards

Airway Clearance Interventions Flashcards

1
Q

Define obstructive lung disease.

A

Obstructive lung disease is characterized by chronic inflammation and narrowed airways.

  • Making it difficult to exhale air completely.

- Examples

  • COPD
  • Emphysema
  • Asthma
  • Chronic Bronchitis
  • Bronchiectasis
  • Cystic Fibrosis
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2
Q

What is the purpose of postural drainage?

A

Postural Drainage:

  • Uses gravity to drain secretions from specific lung segments toward central airways for easier removal.
  • Improves ability to clear out secretions in lower lobes thatcannot be cleared with cough or other breathing techniques.
  • Often combined with other airway clearance techniques.
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3
Q

Define percussion and vibration in airway clearance.

A

Percussion:

  • Involves rhythmic clapping on the chest to loosen mucus.
  • Should last for several minutes and should not be painful (3-5 min/lobe, 100-480/minute).
  • Purpose to loosen up mucus and increase mucociliary clearance

Vibration:

  • Applies a fine, tremulous action during exhalation to aid mucus clearance.
  • Completed for 3-5 exhalations
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4
Q

What is…

  • Active Cycle of Breathing (ACB) = ?
  • Phases = ?
A

Active Cycle of Breathing (ACB):

- A series of breathing maneuvers performed to independently clear secretions and improve thoracic expansion.

- Phases:

  • (1) Breathing control: Performs diaphragmatic breathing at normal tidal volume for 5-10 seconds
  • (2) Thoracic expansion exercises: 3-4 deep, slow, relaxed inhalations to inspiratory reserve volume with passive exhalation. Can include 3 second hold at top of full inhalation.
  • (3) Forced expiratory technique: 1-2 huffs at mid to low lung volumes
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5
Q

What is…

  • Autogenic drainage = ?
  • Phases = ?
A

Autogenic Drainage:

  • A controlled breathing technique to mobilize secretions without coughing or postural drainage, using varying lung volumes and expiratory flows.
  • More beneficial for patients who cannot tolerate postural drainage patients or increased thoracic pressure.

Phases:

1) Unsticking phase (Small Breath):

  • Slowly breath in through the nose at low-lung volumes followed by a 2-3 second breath hold to allow collateral ventilation to get to air behind the secretions
  • Then exhale down into expiratory reserve volume
  • Repeat 2-3 times

2) Collecting Phase (Medium Breath):

  • Tidal volume breathing, interspersed by 2-3 second breath-holds
  • Repeat 2-3 times

3) Evacuating Phase (Large Breath):

  • Deeper inspiration from low-to-mid inspiratory reserve volume
  • Hold breath for minimum of 3 seconds, then an active but not forced expiration through an open glottis
  • Huffing technique can be used as well in this phase
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6
Q

.

A

.

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7
Q

What does hypoxemia mean?

A

Hypoxemia refers to low oxygen levels in the blood

  • PaO2 (partial pressure of oxygen) < 55 mmHg, or
  • SaO2 (oxygen saturation of hemoglobin) < 88% on room air
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8
Q

What is the purpose of a directed cough?

A

A directed cough aims to expel mucus and secretions from the airways by using a series of controlled breathing and coughing techniques.

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9
Q

What is a contraindication for postural drainage?

A
  • elevated intracranial pressure
  • recent spinal surgery
  • pulmonary embolism
  • rib fractures
  • active hemorrhage
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10
Q

What is high-frequency airway oscillation?

A

High-frequency Airway Oscillation:

  • Devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways
  • Common devices: acapella and flutter
    .
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11
Q

Define the Trendelenburg position in airway clearance.

A

Trendelenburg Position:

  • Optimal for facilitating secretion drainage from the lower lobes of the lung
  • Supine with foot of bed elevated so head is declined below feet.
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12
Q

What are the main goals of airway clearance techniques?

A
  • Optimize airway patency
  • Increase ventilation and perfusion matching
  • Promote alveolar expansion and ventilation
  • Improve gas exchange
  • Clear out secretions
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13
Q

.

A

.

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14
Q

What are the primary components of a directed cough?

A

Effective cough stages:

  • Inspiration greater than tidal volume, maximal inhale as possible
  • Closure of glottis with holding breath for 2-3 seconds.
  • Contract the abdominal and intercostal muscles to produce increased intrathoracic pressure against the closed glottis.
  • Sudden opening of the glottis and forceful expulsion of the inspired air by coughing sharply 2-3 times
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15
Q

How does the huff technique differ from a cough?

A

- Huff: Good alternative to cough if coughing is too painful

- Steps to huffing

  • Sit up in upright position
  • Take a deep breath in through an open mouth
  • Hold for 1-2 seconds
  • Forcefully and quickly exhaling 2-3 bursts of air without glottis closure

- Tips for huffing

  • Huffing sound as if patient was saying “Hu-Ff” or “Ha Ha Ha” (Hu = vibration of mucus / Ff = abdominal contraction)
  • Longer sounds help for smaller airways, shorter sounds help with larger airways
  • Splinting can be used to assist with tolerance
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16
Q

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A

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17
Q

What are the phases of the Active Cycle of Breathing (ACB)?

A

The phases include:

  • breathing control
  • thoracic expansion exercises
  • forced expiratory technique
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18
Q

What are contraindications for percussion and vibration techniques?

A

Contraindications include recent thoracic surgery, burns, open wounds, osteoporosis, and active bronchospasms.

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19
Q

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A

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20
Q

How does high-frequency airway oscillation improve airway clearance?

A

It combines positive expiratory pressure and vibrations to mobilize mucus and enhance secretion clearance.

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21
Q

What is the role of supplemental oxygen in pulmonary interventions?

A

Supplemental oxygen:

  • improves oxygen saturation
  • supports exercise tolerance
  • reduces dyspnea

in patients w/ hypoxemi

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22
Q

How would you differentiate between the huff and cough techniques?

A
  • Huffing uses forceful exhalation without glottis closure, reducing pain and strain.
  • Coughing involves glottis closure and higher intrathoracic pressure to expel mucus.
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23
Q

What are the differences between Active Cycle of Breathing (ACB) and autogenic drainage?

A

ACB incorporates controlled breathing, thoracic expansion, and forced expiration, while autogenic drainage relies on varying expiratory airflow without coughing or postural changes.

24
Q

When would postural drainage be contraindicated?

A

Postural drainage is contraindicated in conditions like elevated intracranial pressure, recent spinal surgery, active hemorrhage, or pulmonary embolism.

25
Q

Which airway clearance technique would you choose for a patient with osteoporosis?

A

Gentler techniques like huffing or autogenic drainage are preferred to avoid the potential harm caused by percussion or vibration.

26
Q

How would you modify airway clearance for a postoperative patient with incisional pain?

A

Use splinting with a pillow to support the incision during coughing or huffing and opt for techniques that minimize thoracic pressure, such as autogenic drainage.

27
Q

Why is the Trendelenburg position used in airway clearance, and when should it be avoided?

A

It uses gravity to drain lower lung segments but should be avoided in cases of uncontrolled hypertension, CHF, or risk of aspiration.

28
Q

How does high-frequency airway oscillation differ from manual percussion?

A
  • High-frequency oscillation uses devices like acapella to combine positive expiratory pressure with vibrations.
  • Manual percussion involves rhythmic clapping with the hands.
29
Q

What is the purpose of combining percussion with postural drainage?

A
  • Percussion loosens mucus, making it easier for gravity in postural drainage to move secretions toward the central airways.
30
Q

Why might a patient with chronic bronchitis benefit from autogenic drainage?

A

It allows secretion mobilization without coughing, reducing strain and improving secretion clearance in patients with mucus hypersecretion.

31
Q

What are the key considerations when titrating supplemental oxygen during activity?

A

Monitor oxygen saturation levels (≥90%), adjust flow rates as needed, and use breathing exercises like pursed-lip breathing to optimize oxygen use.

32
Q

How would you instruct a patient to perform a directed cough?

A

Guide them to:

  • Inspiration greater than tidal volume, maximal inhale as possible
  • Closure of glottis with holding breath for 2-3 seconds
  • Contract the abdominal and intercostal muscles to produce increased intrathoracic pressure against the closed glottis
  • Sudden opening of the glottis and forceful expulsion of the inspired air by coughing sharply 2-3 times
33
Q

What are the phases of autogenic drainage, and what is the purpose of each?

A

Phases include unsticking (small breaths to mobilize secretions), collecting (tidal breathing to move secretions upward), and evacuating (large breaths to clear secretions).

34
Q

Why might a patient prefer high-frequency airway oscillation over traditional techniques?

A

It is less physically demanding, more comfortable, and can be performed independently, making it suitable for patients with limited mobility.

35
Q

How do you decide the order of lung segments to treat in postural drainage?

A

Prioritize the most affected segments based on patient symptoms, imaging findings, and auscultation results.

36
Q

How can a therapist ensure infection control during airway clearance?

A

Use gloves, masks, and other barriers, and handle sputum with care to prevent transmission of infections.

37
Q

What are the expected outcomes of supplemental oxygen therapy during exercise?

A

Improved oxygen saturation, reduced dyspnea, and enhanced exercise tolerance with safe SpO2 levels maintained.

38
Q

When would you choose the Active Cycle of Breathing (ACB) over postural drainage?

A

Choose ACB for patients who can actively participate and prefer independent techniques without the need for specialized positions.

39
Q

How does pursed-lip breathing benefit patients during airway clearance?

A

It helps maintain airway patency, reduces work of breathing, and promotes efficient exhalation to support secretion clearance.

40
Q

What adjustments are needed for a patient with anxiety during airway clearance?

A

Use calming techniques, avoid positions that may increase discomfort, and provide clear explanations to reduce fear and enhance participation.

41
Q

Why is it important to monitor vitals before, during, and after airway clearance?

A

To assess patient response, ensure safety, and adjust techniques or intensity to avoid adverse effects such as hypoxemia or fatigue.

42
Q

A patient with cystic fibrosis reports difficulty clearing mucus. Which airway clearance technique would you recommend, and why?

A

High-frequency airway oscillation, such as using the acapella device, because it combines positive expiratory pressure and vibrations to mobilize mucus effectively.

43
Q

During a postural drainage session, the patient complains of dizziness. What is your immediate response?

A

Stop the session, assess vitals, reposition the patient to a more upright posture, and investigate potential causes like hypotension or discomfort.

44
Q

A patient has a recent history of rib fractures. Which airway clearance techniques should you avoid?

A

Avoid percussion and vibration techniques due to the risk of causing further injury or discomfort.

45
Q

A patient with COPD is unable to tolerate prolonged activity due to dyspnea. What adjustments would you make?

A

Incorporate interval training with frequent rest periods and focus on techniques like pursed-lip breathing to manage dyspnea.

46
Q

A patient recovering from abdominal surgery finds coughing painful. What alternative technique could you suggest?

A

Huffing, as it avoids glottis closure and reduces intrathoracic pressure, making it less painful while still clearing secretions.

47
Q

How would you assess the effectiveness of postural drainage?

A

Monitor for increased sputum production, improved breath sounds, better oxygen saturation, and patient-reported ease of breathing.

48
Q

A patient with asthma experiences bronchospasms during percussion. What should you do?

A

Discontinue percussion, provide a bronchodilator if prescribed, and consider alternative techniques like autogenic drainage or ACB.

49
Q

A patient with significant mucus retention in lower lung segments cannot tolerate Trendelenburg positioning. What is your plan?

A

Use alternative positions for lower lung drainage and incorporate techniques like autogenic drainage or ACB to assist clearance.

50
Q

What instructions would you give to a patient using an acapella device for airway clearance?

A

Seal lips around the mouthpiece, inhale slowly to 75% capacity, hold for 2-3 seconds, exhale through the device for 3-4 seconds, and repeat for 10-20 breaths followed by 2-3 coughs or huffs.

51
Q

A patient reports increased fatigue after airway clearance sessions. How would you modify the treatment?

A

Shorten session duration, reduce intensity, allow more rest periods, and monitor the patient’s response closely during therapy.

52
Q

A postoperative patient develops hypoxemia during therapy. What immediate actions would you take?

A

Stop therapy, provide supplemental oxygen as prescribed, perform breathing exercises like pursed-lip breathing, and reassess before continuing.

53
Q

How would you handle a situation where a patient refuses airway clearance due to discomfort?

A

Discuss alternative techniques, address their concerns, and adjust the therapy plan to accommodate their comfort and preferences.

54
Q

What adjustments are needed for a patient with high anxiety during airway clearance sessions?

A

Use calming techniques, avoid complex or stressful procedures, and provide clear explanations to build trust and reduce anxiety.

55
Q

A patient’s oxygen saturation drops below 88% during activity. What steps should you take?

A

Pause the activity, provide supplemental oxygen, allow the patient to rest, and monitor SpO2 until it stabilizes above 90%.

56
Q

A patient using autogenic drainage struggles with the unsticking phase. What advice would you offer?

A

Encourage small, slow breaths through the nose, followed by a 2-3 second hold to allow collateral ventilation before exhaling slowly to expiratory reserve volume.

57
Q

How would you evaluate the success of an airway clearance program for a patient with chronic bronchitis?

A

Assess sputum production, ease of breathing, improved oxygen saturation, and patient-reported quality of life improvements.

DPT 770 - Cardiopulmonary II & Lymphatics (13 decks)

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