Airway Clearance, Postural Drainage, Assisted Cough, & Breathing Techniques Flashcards
1
Q
Describe the grading for the 7 point dyspnea scale
A
- 1 = no trouble at all
- 2 = a tiny bit
- 3 = a little
- 4 = some
- 5 = quite a bit
- 6 = a lot
- 7 = very much trouble
2
Q
Being _____________ and ___________ is the physiological body position
A
- Upright and moving
3
Q
When body positions that are initially beneficial to the patient are assumed for too long, they eventually compromise _____________________ and offset any benefit
A
- Oxygen transport
4
Q
How often should turning be performed
A
- Every 2 hrs
5
Q
Effects of recumbent supine position
A
- Deleterious to oxygen transport
- Predispose the pt to airway closure & increased work of breathing
- May stimulate diuresis & lead to orthostatic intolerance due to fluid loss
6
Q
Effects of side-lying position
A
- Arterial blood gases improve in pts with unilateral lung disease w/good lung down
7
Q
Effects of prone position
A
- May reduce work of breathing
- Better ventilation of the dorsal lung regions
- Improvement in ventilation/perfusion matching
8
Q
Where are you trying to move the secretions toward when performing postural drainage techniques
A
- Toward the Angle of Louis
9
Q
Preparation for postural drainage
A
- Use electric beds to position more easily
- Be familiar with all lines 7 tubes, allow slack
- Have help as needed
- Use foam wedges or pillows for positioning
- Nebulized bronchodilators or mucolytics before postural drainage
- Specimen cup for sputum after cough
10
Q
Treatment with postural drainage
A
- Maintain position for 5-10 min or longer if tolerated
- Most affected lobes should be addressed first
- Take deep breathes & cough after each position & following treatment
- Mobilization of secretions could occur up to 1hr later
11
Q
Contraindications for postural drainage
A
- Intracranial pressure (ICP) >20mm Hg
- Head and neck injury until stabilized
- Active hemorrhage with hemodynamic instability
- Recent spinal surgery (e.g., laminectomy) or acute spinal injury
- Active hemoptysis
- Empyema
- Bronchopleural fistula
- Pulmonary edema associated with heart failure (HF)
- Large pleural effusions
- Pulmonary embolism
- Older, confused, or anxious patients
- Rib fracture, with or without flail chest
- Surgical wound or healing tissue
12
Q
Contraindications for Trendelenburg position
A
- Patients in whom increased ICP is to be avoided
- Uncontrolled HTN
- Distended abdomen
- Esophageal surgery
- Recent gross hemoptysis related to recent lung carcinoma
- Uncontrolled airway at risk for aspiration
13
Q
Describe airway percussion technique
A
- Rhythmical force applied with cupped hands against thorax over involved lung segments
- Performed during both inspiratory & expiratory phases of breathing
- Handheld mechanical pressures can also be used
14
Q
Treatment with percussion
A
- Position the hand in the shape of a cup with fingers and thumb adducted
- Keep wrists neutral
- Hollow sound should be heard
- Even steady rhythm between 100 and 480 beats per minute
- Equal force and pressure—slow rate of dominant hand to match non-dominant
- Do not percuss over bony prominences
- Do not perform over breast tissue
- One handed self percussion can be taught for areas that are reached comfortably
15
Q
Advantages & disadvantages of percussion
A
- May enhance secretion clearance and shorten the treatment
- Not well tolerated postoperatively
- Contraindicated in those with osteoporosis or coagulopathy
- Extended periods of time and on an ongoing basis can result in injury to the caregiver
- Minimal price for mechanical device
16
Q
Describe vibration & shaking
A
- Performed only during the expiratory phase of breathing
- Start with peak inspiration & continue until the end of expiration
- The compressive forces follow the movement of the chest wall
- Both techniques require the assistance of a caregiver, but a mechanical vibrator may be used in place of manual vibration
17
Q
What is the mechanism of action for vibration & shaking
A
- Enhance mucociliary transport from the periphery of the lung fields to the central airways, also increased chest wall displacement and stretch of the respiratory muscles
18
Q
Describe vibration technique
A
- Gentle, high frequency force
- Delivered through sustained co-contraction of caregiver’s UEs
- Hands must be placed side by side or on top of each other
- Frequency of manual vibration is b/w 12-20 Hz
19
Q
Describe shaking technique
A
- Moer vigorous in nature
- Described as a bouncing maneuver
- At peak inspiration apply a slow rhythmic bouncing pressure to the chest wall until the end of expiration
- Hands follow the movement of the chest as the air is exhaled
- Frequency of shaking is 2 Hz
20
Q
Advantages and disadvantages of vibration and shaking techniques
A
- Enhances mobilization of secretions with postural drainage
- Patient cannot apply these techniques without assistance
21
Q
Considerations with vibration and shaking techniques
A
- Mechanically ventilated: coordinate with ventilator-controlled exhalation
- Rapid respiratory rate: apply vibration or shaking only during every other exhalation
- Limited chest wall compliance: vibration will probably be better tolerated than shaking
- Mechanical vibrators may be used by the unattended pt, although only limited attention can be paid to the posterior portions of the lungs
22
Q
Relative contraindications for vibration and shaking techniques
A
- Hemoptysis
- Untreated tension pneumothorax
- Platelet count below 20,000 per mm3
- Unstable hemodynamic status
- Open wounds, burns in the thoracic area
- Pulmonary embolism
- Subcutaneous emphysema
- Recent skin grafts or flaps on thorax
23
Q
What are the 4 stages of a cough
A
- Inspiration (irritation)
- Glottal closure (inspiration)
- Increased intrathoracic & intra-abdominal pressure (compression)
- Glottal opening & expulsion
24
Q
Describe huffing
A
- Alternative to coughing
- Deep inspiration followed by a forced expiration without glottal closure
- Often used in post-operative pts who find coughing to be too painful
25
Q
Describe breath stacking
A
- Pt independently performs inspiration to maximal inspiratory capacity
- Hold their breath
- Take 2-3 more breaths on top of the initial breath to increase vital capacity
- follow with a cough
26
Q
Describe chest compression
A
- For a pt with a neuromuscular weakness
- Therapist or a family member can assist with a chest compression to assist the cough during exhalation
27
Q
Describe the costophrenic assist cough technique
A
- Performed in any position
- Therapist place hands on costophrenic angles of the rib cage
- At the end of pt’s exhale provide a quick manual stretch down & in toward pt’s navel
- Have pt hold it & just a moment before asking the pt to actively cough, therapist applies a strong pressure again
- Most commonly used for pts with weak or paralyzed intercostal or abdominal muscles
28
Q
Describe the abdominal thrust cough technique (Heimlich-type)
A
- Therapist places heel of hand at the patients navel
- Patient takes in a deep breath and holds it
- As the patient is instructed to cough, the therapist quickly pushes up and in under the diaphragm
- Only use when the pt doesn’t respond to other techniques
29
Q
Why can the abdominal thrust technique be uncomfortable
A
- Abrupt nature
- Concentrated area of contact
- Force may cause GER
30
Q
What are the steps to airway suctioning
A
- Administer supplemental oxygen to the patient via manual resuscitator bag or mechanical ventilator to increase arterial oxygenation.
- Monitor oxygen saturation with a pulse oximeter.
Document drops in oxygen saturation below 90% and continue bagging with 100% O2 until saturation is above 90% before continuing.
- Monitor oxygen saturation with a pulse oximeter.
- Adjust the pressure on the suction apparatus to 100 to 150 mm Hg, as needed.
- Connect the vent end of the catheter to the suction tubing.
- Don sterile gloves. Remove the catheter packaging without causing contamination; maintain sterility of any part of the catheter that will touch the patient’s trachea.
- Disconnect the patient from the ventilator or oxygen source.
- Give five to 10 breaths via manual resuscitator bag.
- Quickly and gently insert the catheter into the tracheal tube without applying suction. The diameter of the catheter should be no larger than one-half of the diameter of the airway.
- Stop advancing the catheter once gentle resistance is met at the level of the carina or one of the mainstem bronchi. Apply suction by placing a finger over the catheter vent.
- Then, while applying suction, withdraw the catheter slowly, rotating the catheter to optimize the exposure of the side holes to the secretions.
- Reconnect the patient to the oxygen source and reinflate the patient’s lungs with the manual resuscitator bag or the ventilator for 5 to 10 breaths.
- Repeat steps 6 through 9 until the airway is cleared of secretions, the patient is too fatigued to continue, or intolerance develops.
31
Q
Describe the anterior chest compression assisted cough technique
A
- Therapist puts one arm across the pectoralis region to compress the upper chest
- Other arm placed parallel on the lower chest or abdomen
- Inspiration is facilitated first
- Followed by a hold
- Force is applied
- Down and back on the upper chest
- Up and back on the lower chest
- Effective for patients with very weak chest wall muscles
32
Q
Describe the coutner-rotation assist cough technique
A
- Position hands over the shoulder and pelvis
- Therapist gently assists inhalation and exhalation
- Repeat 3-5 cycles
- Patient then takes as deep a breath as possible and holds it
- Therapist commands them to cough out as hard as possible while they forcefully compress the chest in a diagonal pattern
33
Q
What are the benefits of the counter-rotation cough assist technique for patients with low cognitive functioning
A
- Natural inhibitor of high tone
- Mobilizer for a tight chest
- Rotation can be a vestibular stimulator
34
Q
Describe the self assisted prone on elbows technique
A
- Have patient position prone on elbows
- Instruct them to bring head and neck back as far as possible, inhale maximally, cough out while throwing head forward and down
35
Q
Describe the self assisted short sitting cough technique
A
- Patient places one hand over the wrist and places them in her lap
- Patient extends backwards while inhaling maximally, followed by a strong voluntary cough
- Patient uses their hands like in the Heimlich to mimic the abdominal muscles
- Good for those who are in a wheelchair
- Effective for patients with weak diaphragms or abdominal musculature
36
Q
Describe the self assisted long sitting cough technique
A
- Patient in long sitting with UE support
- Patient is instructed to extend their body backwards while inhaling maximally
- Therapist tells them to cough as the patient moves their upper body into completely flexed posture
37
Q
Describe the self assisted quadruped cough technique
A
- Patient gets in quadruped
- Rock forward while looking up when inhaling
- Cough as they quickly rock back on their heels with flexed head and neck
- Used most commonly in multipurpose activity to increase balance, strength, coordination, and functional use of breathing patterns
- For patients with generalized or spotty weakness throughout
38
Q
What is the cough assist T70
A
- Machine that patients can use to self-assist cough at their own homes
- Very expensive – many insurances do not cover
- Patient using the CoughAssist
39
Q
Inspiration movement strategies
A
- Trunk extension
- Shoulder flexion/abduction/ER
- Upward eye gaze
40
Q
Expiration movement strategies
A
- Trunk flexion
- Shoulder extension/adduction/IR
- Downward eye gaze
