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

Airway Clearance Questions Flashcards

1
Q

What are the goals of airway clearance techniques?

A

Goals:

  • optimize airway patency
  • increase ventilation-perfusion matching
  • promote alveolar expansion
  • improve gas exchange
  • clear out secretions

These goals ensure effective management of respiratory conditions by improving lung function.

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2
Q

What are the indications for airway clearance techniques?

A

Indications:

  • retained secretions in central airways
  • impaired mucociliary transport
  • excessive pulmonary secretions
  • ineffective or absent cough

These indications highlight the need for clearing obstructions to improve respiratory efficiency.

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3
Q

Describe the characteristics of obstructive lung diseases.

A
  • Obstructive lung diseases include chronic inflammation and mucus that narrows small airways, making exhalation difficult.
  • Examples: COPD, asthma, chronic bronchitis, bronchiectasis, and cystic fibrosis.
  • Symptoms include dyspnea, productive cough, and hyperinflation.
  • These features impair airflow and necessitate airway clearance.
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4
Q

What are the contraindications for postural drainage?

A

Contraindications:

  • intracranial pressure >20 mmHg
  • active hemorrhage
  • recent spinal or thoracic surgery
  • rib fractures
  • pulmonary embolism.

Monitoring for these ensures safety during therapy.

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5
Q

What is the Active Cycle of Breathing (ACB)?

A

ACB involves a series of breathing maneuvers to promote secretion clearance and thoracic expansion.

Phases include:

  • breathing control
  • thoracic expansion exercises
  • forced expiratory techniques

It emphasizes patient independence in managing secretions.

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6
Q

What is autogenic drainage, and how is it performed?

A

- Autogenic drainage uses controlled breathing to mobilize secretions without postural drainage or coughing.

- It consists of three phases:

  • unsticking (small breaths)
  • collecting (medium breaths)
  • evacuating (large breaths)

- Each phase is repeated until secretion movement is noted.

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7
Q

Describe the role of percussion in airway clearance techniques.

A
  • Percussion involves rhythmic clapping of the chest to loosen mucus in lung segments.
  • It is performed during inhalation and exhalation, lasting 3–5 min. per lobe.
  • This aids mucociliary clearance by dislodging secretions.
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8
Q

What is vibration, and how does it complement percussion?

A
  • Vibration involves fine, tremulous action applied to the chest wall during exhalation, aiding mucus movement toward the central airways.
  • It complements percussion by further loosening secretions for effective clearance.
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9
Q

What are the steps of a directed cough?

A

Steps:

  • deep inspiration beyond tidal volume
  • breath-hold (2–3 seconds)
  • contraction of abdominal muscles to increase intrathoracic pressure
  • forceful expulsion through an open glottis

This sequence ensures effective clearance of secretions.

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10
Q

When is huffing preferred over directed coughing?

A
  • Huffing is preferred when coughing is too painful, such as in post-operative patients.
  • It involves open glottis exhalation in short bursts, minimizing intrathoracic pressure while clearing secretions.
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11
Q

What is high-frequency airway oscillation, and what devices are used?

A
  • High-frequency airway oscillation combines positive expiratory pressure with vibrations to mobilize secretions.
  • Devices like Acapella and Flutter are used.
  • The procedure includes slow inhalation, breath-holding, and exhalation through the device.
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12
Q

What are the expected outcomes of airway clearance techniques?

A

Outcomes:

  • easier secretion clearance
  • increased sputum production
  • improved breath sounds
  • better oxygen saturation
  • resolution of localized infiltrates

These indicate therapy effectiveness.

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13
Q

What is supplemental oxygen titration, and when is it indicated?

A
  • Titration adjusts oxygen delivery to maintain SpO2 ≥ 90%.
  • Indicated for PaO2 < 55mmHg or SaO2 < 88% on room air.
  • Proper titration supports functional performance and prevents hypoxemia.
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14
Q

What is the Trendelenburg position, and when is it contraindicated?

A
  • Trendelenburg involves tilting the body with the head lower than the feet to aid secretion drainage from lower lung lobes.
  • Contraindicated in uncontrolled hypertension, recent meals, or aspiration risk.
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15
Q

How do you document supplemental oxygen use during therapy?

A

- Documentation includes

  • oxygen delivery system
  • flow rate
  • patient tolerance
  • vital signs before/during/after activity
  • recovery time.

- This ensures proper monitoring and compliance with therapy goals

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16
Q

Define Chronic Obstructive Pulmonary Disease (COPD).

A
  • COPD is a progressive lung disease causing airflow limitation due to chronic inflammation and damage.
  • Symptoms include chronic cough, dyspnea, and frequent respiratory infections.
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17
Q

What is the purpose of airway clearance techniques?

A

Airway clearance techniques are manual or mechanical procedures aimed at mobilizing and removing secretions from the airways to improve ventilation and gas exchange.

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18
Q

Define dyspnea.

A

Dyspnea is a subjective sensation of shortness of breath, commonly seen in obstructive and restrictive lung diseases.

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19
Q

What is the function of mucociliary transport?

A
  • Mucociliary transport moves mucus and trapped particles out of the airways using cilia and mucus flow.
  • Impairment can lead to secretion retention and infection.
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20
Q

Describe the purpose of percussion in airway clearance.

A

Percussion involves rhythmic clapping of the chest to loosen mucus in specific lung segments, facilitating its removal.

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21
Q

Define postural drainage.

A

Postural drainage involves positioning the body to use gravity to assist in draining secretions from specific lung segments toward central airways.

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22
Q

What is a directed cough?

A

A directed cough is a controlled expiratory maneuver designed to expel mucus from the airways by mimicking a natural cough.

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23
Q

Define huffing as an airway clearance technique.

A

Huffing is a forced expiratory technique using an open glottis to clear mucus with reduced pain compared to coughing.

24
Q

What is the Active Cycle of Breathing (ACB)?

A

ACB is a sequence of breathing techniques that combines thoracic expansion and forced expiratory maneuvers to improve secretion clearance and lung expansion.

25
Q

Define autogenic drainage.

A

Autogenic drainage is a self-directed breathing technique that mobilizes secretions by varying lung volumes and expiratory flow rates without coughing.

26
Q

What is high-frequency airway oscillation?

A

A technique combining positive expiratory pressure with vibrations to mobilize mucus. Devices like Acapella and Flutter are commonly used.

27
Q

What are the contraindications for postural drainage?

A

Contraindications include intracranial pressure >20 mmHg, active hemorrhage, recent spinal surgery, and pulmonary embolism.

28
Q

What is the Trendelenburg position?

A

A body position with the head lower than the feet, used to drain secretions from lower lung lobes. Contraindicated in certain conditions like hypertension and aspiration risk.

29
Q

Define supplemental oxygen titration.

A

Supplemental oxygen titration is the adjustment of oxygen flow rates to maintain adequate SpO2 levels (≥90%) during rest or activity.

30
Q

What is hyperinflation of the lungs?

A

Hyperinflation refers to an abnormal increase in lung volume, often seen in conditions like COPD, resulting in impaired gas exchange.

31
Q

What is a flail chest?

A

Flail chest is a condition where multiple rib fractures cause instability of the chest wall, impairing effective breathing.

32
Q

What is the role of vibration in airway clearance?

A

Vibration is a fine, tremulous action applied to the chest wall during exhalation to move mucus toward central airways for clearance.

33
Q

Define atelectasis.

A

Atelectasis is the collapse or incomplete expansion of lung tissue, often due to obstruction or compression.

34
Q

What is auscultation in the context of respiratory therapy?

A

Auscultation involves listening to lung sounds with a stethoscope to identify abnormalities such as wheezes, crackles, or diminished breath sounds.

35
Q

Define PaO2 and its clinical significance.

A
  • PaO2 refers to the partial pressure of oxygen in arterial blood.
  • Normal values are 80-100 mmHg.
  • A drop below 55 mmHg indicates the need for supplemental oxygen.
36
Q

How would you differentiate between COPD and asthma in terms of symptoms?

A
  • COPD typically presents with chronic productive cough, dyspnea, and frequent respiratory infections, often linked to smoking.
  • Asthma involves episodic wheezing, shortness of breath, and reversible airway obstruction, often triggered by allergens.
37
Q

What are the clinical indications for using huffing instead of directed coughing?

A

Huffing is indicated for patients with pain or post-operative restrictions, as it avoids the high intrathoracic pressure associated with coughing. This technique ensures effective secretion clearance without additional discomfort.

38
Q

Which airway clearance technique would you choose for a patient with poor tolerance to positional changes, and why?

A
  • Autogenic drainage is ideal as it avoids the need for positional changes, using controlled breathing to mobilize secretions.
  • This minimizes patient discomfort while maintaining efficacy.
39
Q

How do you decide between percussion and vibration during postural drainage?

A
  • Percussion is used to loosen mucus from airway walls, while vibration is applied during exhalation to mobilize mucus.
  • Both are often used together, but vibration is gentler and suitable for more fragile patients.
40
Q

What modifications would you make to postural drainage for a patient with uncontrolled hypertension?

A
  • Avoid Trendelenburg position to reduce the risk of increased intracranial pressure or cardiovascular strain.
  • Use alternative positions to drain secretions without elevating the feet.
41
Q

How would you manage a patient with an ineffective cough due to neurological impairment?

A

Techniques like manually assisted coughing or mechanical insufflation-exsufflation can help generate sufficient force to clear secretions in patients with weak or absent cough reflexes.

42
Q

Why might a patient with cystic fibrosis benefit more from high-frequency airway oscillation?

A

Devices like Acapella or Flutter combine vibration and positive expiratory pressure, which enhance secretion mobilization and are well-suited for the thick mucus characteristic of cystic fibrosis.

43
Q

What factors would you consider when titrating supplemental oxygen during exercise?

A
  • Monitor SpO2 to maintain ≥90%, adjust flow rates based on activity intensity, and assess for symptoms of hypoxemia or dyspnea.
  • Document changes and patient responses to ensure safety.
44
Q

How does auscultation guide the choice of airway clearance techniques?

A
  • Abnormal lung sounds like crackles suggest retained secretions, guiding the use of techniques like postural drainage or high-frequency oscillation.
  • Wheezes may indicate the need for bronchodilators before clearance.
45
Q

In which clinical scenarios is postural drainage contraindicated, and what are the alternatives?

A
  • Contraindicated in intracranial pressure >20 mmHg, active hemorrhage, and recent spinal surgery.
  • Alternatives include ACB, autogenic drainage, or oscillatory devices.
46
Q

When should you stop an airway clearance session?

A
  • Stop if the patient experiences significant distress, abnormal vital signs, or worsening symptoms (e.g., hypoxemia, tachycardia).
  • Safety is prioritized over treatment completion.
47
Q

How do you determine the most affected lung segment for postural drainage?

A
  • Identify the segment based on imaging (e.g., chest x-ray) or auscultation findings (e.g., decreased breath sounds or crackles).
  • Target therapy to maximize secretion clearance.
48
Q

What precautions should you take when performing percussion on a patient with osteoporosis?

A

Use gentle force or vibration instead of percussion to avoid fractures or pain. Monitor closely for patient discomfort or adverse reactions.

49
Q

How would you adapt airway clearance techniques for a post-operative patient with abdominal surgery?

A

Use techniques like huffing or splinted coughing with a pillow to reduce strain on the surgical site while ensuring effective secretion clearance.

50
Q

Why is breathing control important during the Active Cycle of Breathing?

A

Breathing control prevents hyperventilation, reduces fatigue, and prepares the patient for thoracic expansion exercises, improving overall technique effectiveness.

51
Q

What is the purpose of the unsticking phase in autogenic drainage?

A
  • The unsticking phase mobilizes secretions in smaller airways using low lung volumes and slow exhalation.
  • This ensures clearance from peripheral lung regions.
52
Q

How would you differentiate between high-pitched wheezes and crackles during auscultation?

A

High-pitched wheezes indicate airway narrowing or obstruction, often in asthma. Crackles suggest fluid or secretions in the airways, common in pneumonia or heart failure.

53
Q

How does oxygen therapy differ in patients with chronic bronchitis versus emphysema?

A

Chronic bronchitis patients may require higher flow rates to address hypoxemia from mucus retention. Emphysema patients often need lower rates to prevent CO2 retention due to reduced alveolar elasticity.

54
Q

Why is it important to monitor vital signs before, during, and after supplemental oxygen use?

A

Monitoring ensures oxygen therapy is effective and safe, identifying adverse responses like hypoxemia, tachycardia, or hypercapnia. Adjustments can be made promptly based on findings.

55
Q

How would you educate a patient on using an Acapella device for airway clearance?

A
  • Instruct the patient to seal lips around the mouthpiece, inhale slowly to 75% of full breath, hold for 2–3 seconds, and exhale through the device for 3–4 seconds.
  • Demonstrate proper technique and emphasize the importance of coughing after 10–20 breaths to clear secretions.

DPT 770 - Cardiopulmonary II & Lymphatics (14 decks)

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