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Midterm 2021 > Bronchial Hygeine And IS > Flashcards

Bronchial Hygeine And IS Flashcards

1
Q

Normal clearance of secretions for effective cough

A
  1. Irritation
    * stimulates sensors
    * chemical, thermal, inflammatory
  2. Inspiration
  3. Compression
  4. Expulsion
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2
Q

Retention of secretions

A 
Artificial airways 
Inadequate humidification 
High FiO2’s 
Paralytic, anesthetics 
Mucus plugging, can cause atelectasis and infection
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3
Q

Examples of impairments in compression phase of cough

A

Artificial airway

Abdominal surgery

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4
Q

Goals for bronchial hygiene

A

To mobilize secretions and remove retained secretions
— immobile patients
— chronic lung disease

To improve gas exchange
—treats atelectasis caused from retained secretions

To reduce work of breathing

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5
Q

Bronchial hygiene indications

A

Cystic fibrosis
Ciliary dyskinesia syndrome
Bronchiectasis
Chronic bronchitis

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6
Q

Bronchial hygiene therapy bedside signs and symptoms of the need for bronchial hygiene

A

Ineffective cough

Decreased breath sounds, crackles, and/or rhonchi

Fever

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7
Q

Methods of bronchial hygiene therapy

A 
Postural drainage 
Chest percussion 
Coughing and deep breathing 
Positive airway pressures 
Breathing exercises (diaphragmatic breathing, segmental breathing, pursed lips breathing)
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8
Q

What is the primary purpose of turning a patient

A

Improves oxygenation

Place the bad lung up which improves V/Q relationship

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9
Q

Turning indications

A

Poor oxygenation associated with position (unilateral lung disease [bad lung up])

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10
Q

Turning absolute contraindications

A

Worsening of SpO2

Unstable spinal cord injury

Traction of arm abductors

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11
Q

Postural drainage uses gravity and mechanical energy to

A

Mobilize secretions

Improve V/Q balance

Normalize FRC

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12
Q

Postural drainage is best for

A

Excessive secretions >25 ml/day

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13
Q

Modify the trendelenberg with the condition

A

Decreased SpO2

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14
Q

What should be assessed to establish the need for postural drainage therapy

A

Decreased breath sounds and/or crackles and/or rhonchi suggesting secretions in the airway

Abnormal chest X ray consistent with atelectasis, mucus plugging, or infiltrates

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15
Q

Postural drainage indications

A

Evidence of difficulty clearing secretions
Presence of atelectasis
Diagnosis of diseases such as CF, bronchiectasis, cavitation lung disease

Presence of foreign body in airway
External manipulation of the thorax to assist the movement of secretions by vibrations

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16
Q

All positions are contraindicated for

A

ICP
Empyema
Large pleural effusions

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17
Q

Trendelenburg position is contraindicated for

A

Empyema

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18
Q

Hazards of postural drainage

A 
Hypoxemia 
Increased ICP
Acute hypotension
Pulmonary hemorrhage 
Pain or injury to muscles, ribs, or spine 
Vomiting and aspiration 
Bronchospasm 
Dysrhythmias 
Headache, dizziness
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19
Q

Lung segment

Apical (anterior upper ) segments of both upper lobes

A

Semi-Fowler’s position with the head of the bed raised 45 degrees

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20
Q

Lung segment

Anterior segments of both upper lobes

A

Patient supine with the bed flat

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21
Q

Posterior (posterior apical) segments of both upper lobes

A

Patients sitting up and leaning forward

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22
Q

Right middle lobe (medial and lateral segments)

A

Patient 1/4 turn from supine with right side up and foot of the bed elevated 12”

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23
Q

Lingular segment of left upper lobe (superior and inferior segments)

A

Patient 1/4 turn from supine with left side up and foot of the bed elevated 12 “

24
Q

Superior segments of both lower lobes

A

Patient prone with bed flat and pillow under abdomen

25
Q

Anterior segments of bot lower lobes

A

Patient supine with foot of bed elevated 20”

26
Q

Posterior segments of both lower lobes

A

Patient prone with foot of bed elevated 20”

27
Q

Right lateral segment of right lower lobe

A

Patient directly on left side with right side up and the foot of the bed elevated 20”

28
Q

Left lateral segment of right lower lobe

A

Patient directly on right side with left side up and the foot of the bed elevated 20”

29
Q

What rule do you follow when you see an adverse patient response during postural drainage therapy

A

Follow the triple s rule

Stop the therapy

Stay with the patient

Stabilize the patient

30
Q

Assessment of outcome in bronchial hygiene therapy

Change in ventilator variables

A

Airway resistance

Peak pressures

31
Q

Monitoring patient during bronchial hygiene therapy

A

Sputum production and cough effectiveness
— color, consistency, amount

SpO2

Modify therapy if needed

32
Q

Percussion and vibration help to

A

Shake the secretions toward the central airways during exhalation

33
Q

What are the four components of an effective cough

A

Irritation

Inspiration

Compression

Expulsion

34
Q

What is a directed cough

A

A deliberate maneuver to mimic spontaneous cough

35
Q

Directed cough indications

A

The need to aid the removal of retained secretions from central airways

The presence of atelectasis

Prophylaxis against post-operative complications

Routine part of bronchial hygiene for CF, bronchiectasis, chronic bronchitis, necrotizing pulmonary infection, spinal cord injury

Integral part of bronchial hygiene therapy’s
—postural drainage, PEP therapy, incentive spirometry, aerosol therapy

To obtain sputum specimens for diagnostic analysis

36
Q

For directed cough technique, patient needs to have

A

Hydration

Pain control

Be able to sit at bedside with feet on floor or sit them up and bend their knees

37
Q

Hazards and complications of directed cough

A

Incisional pain, evisceration

Coordinate with pain medications

38
Q

Assessment of need for directed cough

A

Spontaneous cough that fails to clear secretions

Ineffective spontaneous cough

Post operative patients

Long term care patients with tendency to retain airway secretions

Presence of ETT or trach tube

39
Q

Positive airway pressure (PAP)

Indications

A

To reduce air trapping in asthma and COPD
To aid in mobilization of retained secretions
To prevent or revers atelectasis
To optimize delivery of bronchodilators in patients receiving bronchial hygiene therapy

40
Q

Hazards and complications of PAP

A

Fatigue, shorten treatment time and continue with SVN

Barotrauma

Increased ICP

Cardiovascular compromise

Skin break down and discomfort from mask

Air swallowing, vomiting, aspiration

Claustrophobia

Increased WOB that may lead to hypoventilation and hypercapnia

41
Q

Bronchial hygiene therapy PAP

What is PEP for

A

Great for CF patients or to treat air trapping

Can be used with SVN for patient who need medication and have documented atelectasis

42
Q

Flutter valve

A

Good for CF patients, especially if they cannot tolerate chest physical therapy

43
Q

Chest wall compression

A

Increases patient compliance to bronchial hygiene therapy, especially in the home

44
Q

Resorption atelectasis

A

When lesions or mucus plugs are present in the airways and block ventilation to the affected region (nitrogen is absorbed and not replaced)

45
Q

Passive atelectasis

A

Caused from patients breathing shallow

Anesthesia, sedatives, bed rest, painful deep breathing

46
Q

Who is lung expansion therapy good for

A

Upper abdominal or thoracic surgery patients

Best time to orient patient is prior to surgery

47
Q

Clinical signs of atelectasis

A

Increased RR

Breath sounds have fine, late inspiratory crackles.

48
Q

The trans pulmonary pressure gradient can be increased by

A

Decreasing surrounding pleural pressures

49
Q

What is IS designed to mimic

A

Natural sighing, by encouraging patients to take slow, deep breaths through their mouths

50
Q

What is an SMI

A

A slow, deep inhalation after normal expiration (in other words they begin the breath at FRC)

They should have a 5-10 second breath hold

51
Q

Indications for lung expansion therapy

A

Treating existing atelectasis

Presence of conditions predisposing to atelectasis, upper abdominal surgery, thoracic surgery, COPD surgery patients

Presence of a restrictive lung defect with quadriplegic and/or dysfunctional diaphragm

52
Q

IS contraindications

A

Unconscious or obtruded patients

Patients unable to cooperate

Vital capacity <10 ml/kg

Inspiratory capacity < 1/3 predicted normal

53
Q

Hazards of IS

A

Hyperventilation and respiratory alkalosis

54
Q

Incentive spirometry outcome assessment

A

Absence or improvement in the signs of atelectasis

Decreased RR

Normal HR

Temperature should normalize

Breath sounds should clear and/or improve

Normal chest X-ray

Increased SpO2, PaO2, and or PAO2

Increased VC and peak expiratory flow rate

55
Q

Flow oriented IS equipment calculation of approximate volume inspired

A

of spheres raised x total #seconds

56
Q

IS instructions

A

Exhale normally

Take deep slow breath through mouthpiece, keeping flow indicator in proper position

Hold breath 5 - 10 seconds once lungs are full

Wait 30 seconds to 1 minute between attempts

Repeat procedure 5-10 times every hour

Midterm 2021 (5 decks)

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