Airway Clearance Questions Flashcards
What are the goals of airway clearance techniques?
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.
What are the indications for airway clearance techniques?
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.
Describe the characteristics of obstructive lung diseases.
- 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.
What are the contraindications for postural drainage?
Contraindications:
- intracranial pressure >20 mmHg
- active hemorrhage
- recent spinal or thoracic surgery
- rib fractures
- pulmonary embolism.
Monitoring for these ensures safety during therapy.
What is the Active Cycle of Breathing (ACB)?
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.
What is autogenic drainage, and how is it performed?
- 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.
Describe the role of percussion in airway clearance techniques.
- 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.
What is vibration, and how does it complement percussion?
- 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.
What are the steps of a directed cough?
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.
When is huffing preferred over directed coughing?
- 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.
What is high-frequency airway oscillation, and what devices are used?
- 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.
What are the expected outcomes of airway clearance techniques?
Outcomes:
- easier secretion clearance
- increased sputum production
- improved breath sounds
- better oxygen saturation
- resolution of localized infiltrates
These indicate therapy effectiveness.
What is supplemental oxygen titration, and when is it indicated?
- 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.
What is the Trendelenburg position, and when is it contraindicated?
- 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.
How do you document supplemental oxygen use during therapy?
- 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
Define Chronic Obstructive Pulmonary Disease (COPD).
- COPD is a progressive lung disease causing airflow limitation due to chronic inflammation and damage.
- Symptoms include chronic cough, dyspnea, and frequent respiratory infections.
What is the purpose of airway clearance techniques?
Airway clearance techniques are manual or mechanical procedures aimed at mobilizing and removing secretions from the airways to improve ventilation and gas exchange.
Define dyspnea.
Dyspnea is a subjective sensation of shortness of breath, commonly seen in obstructive and restrictive lung diseases.
What is the function of mucociliary transport?
- Mucociliary transport moves mucus and trapped particles out of the airways using cilia and mucus flow.
- Impairment can lead to secretion retention and infection.
Describe the purpose of percussion in airway clearance.
Percussion involves rhythmic clapping of the chest to loosen mucus in specific lung segments, facilitating its removal.
Define postural drainage.
Postural drainage involves positioning the body to use gravity to assist in draining secretions from specific lung segments toward central airways.
What is a directed cough?
A directed cough is a controlled expiratory maneuver designed to expel mucus from the airways by mimicking a natural cough.
Define huffing as an airway clearance technique.
Huffing is a forced expiratory technique using an open glottis to clear mucus with reduced pain compared to coughing.
What is the Active Cycle of Breathing (ACB)?
ACB is a sequence of breathing techniques that combines thoracic expansion and forced expiratory maneuvers to improve secretion clearance and lung expansion.
Define autogenic drainage.
Autogenic drainage is a self-directed breathing technique that mobilizes secretions by varying lung volumes and expiratory flow rates without coughing.
What is high-frequency airway oscillation?
A technique combining positive expiratory pressure with vibrations to mobilize mucus. Devices like Acapella and Flutter are commonly used.
What are the contraindications for postural drainage?
Contraindications include intracranial pressure >20 mmHg, active hemorrhage, recent spinal surgery, and pulmonary embolism.
What is the Trendelenburg position?
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.
Define supplemental oxygen titration.
Supplemental oxygen titration is the adjustment of oxygen flow rates to maintain adequate SpO2 levels (≥90%) during rest or activity.
What is hyperinflation of the lungs?
Hyperinflation refers to an abnormal increase in lung volume, often seen in conditions like COPD, resulting in impaired gas exchange.
What is a flail chest?
Flail chest is a condition where multiple rib fractures cause instability of the chest wall, impairing effective breathing.
What is the role of vibration in airway clearance?
Vibration is a fine, tremulous action applied to the chest wall during exhalation to move mucus toward central airways for clearance.
Define atelectasis.
Atelectasis is the collapse or incomplete expansion of lung tissue, often due to obstruction or compression.
What is auscultation in the context of respiratory therapy?
Auscultation involves listening to lung sounds with a stethoscope to identify abnormalities such as wheezes, crackles, or diminished breath sounds.
Define PaO2 and its clinical significance.
- 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.
How would you differentiate between COPD and asthma in terms of symptoms?
- 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.
What are the clinical indications for using huffing instead of directed coughing?
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.
Which airway clearance technique would you choose for a patient with poor tolerance to positional changes, and why?
- 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.
How do you decide between percussion and vibration during postural drainage?
- 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.
What modifications would you make to postural drainage for a patient with uncontrolled hypertension?
- Avoid Trendelenburg position to reduce the risk of increased intracranial pressure or cardiovascular strain.
- Use alternative positions to drain secretions without elevating the feet.
How would you manage a patient with an ineffective cough due to neurological impairment?
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.
Why might a patient with cystic fibrosis benefit more from high-frequency airway oscillation?
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.
What factors would you consider when titrating supplemental oxygen during exercise?
- 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.
How does auscultation guide the choice of airway clearance techniques?
- 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.
In which clinical scenarios is postural drainage contraindicated, and what are the alternatives?
- Contraindicated in intracranial pressure >20 mmHg, active hemorrhage, and recent spinal surgery.
- Alternatives include ACB, autogenic drainage, or oscillatory devices.
When should you stop an airway clearance session?
- Stop if the patient experiences significant distress, abnormal vital signs, or worsening symptoms (e.g., hypoxemia, tachycardia).
- Safety is prioritized over treatment completion.
How do you determine the most affected lung segment for postural drainage?
- 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.
What precautions should you take when performing percussion on a patient with osteoporosis?
Use gentle force or vibration instead of percussion to avoid fractures or pain. Monitor closely for patient discomfort or adverse reactions.
How would you adapt airway clearance techniques for a post-operative patient with abdominal surgery?
Use techniques like huffing or splinted coughing with a pillow to reduce strain on the surgical site while ensuring effective secretion clearance.
Why is breathing control important during the Active Cycle of Breathing?
Breathing control prevents hyperventilation, reduces fatigue, and prepares the patient for thoracic expansion exercises, improving overall technique effectiveness.
What is the purpose of the unsticking phase in autogenic drainage?
- The unsticking phase mobilizes secretions in smaller airways using low lung volumes and slow exhalation.
- This ensures clearance from peripheral lung regions.
How would you differentiate between high-pitched wheezes and crackles during auscultation?
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.
How does oxygen therapy differ in patients with chronic bronchitis versus emphysema?
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.
Why is it important to monitor vital signs before, during, and after supplemental oxygen use?
Monitoring ensures oxygen therapy is effective and safe, identifying adverse responses like hypoxemia, tachycardia, or hypercapnia. Adjustments can be made promptly based on findings.
How would you educate a patient on using an Acapella device for airway clearance?
- 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.
