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Principles and Practices of Resp II > Bronchial Hygiene > Flashcards

Bronchial Hygiene Flashcards

1
Q

Patent airway

A

good breath sounds and strong effective cough

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2
Q

Effective cough

A

Volume and flow- which maintains a patent airway- able to clear secretions

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3
Q

COPD constrictive or obstructive?

A

obstructive

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4
Q

Effective cough steps

A
  1. Deep enough breaths (1-2 liters)
  2. Adequate lung recoil (emphysema would inhibit)
  3. Level of airway resistance (Bronchospasm-asthma pt)
  4. Strength of expiratory resp muscles
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5
Q

Expiratory respiratory muscles

A

Rectus abdominal muscles, External Abdominal obliques, Internal abdominal obliquus, Transverses abdominis muscles, Internal intercostals muscles

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6
Q

Four phases of cough

A
  1. Irritation 2. Inspiration 3. Compression 4. Expulsion
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7
Q

Irritation phase

A

Medullary response

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8
Q

Inspiration phase

A

1-2 liters

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9
Q

Compression phase

A

Glottis Closure, Expiratory muscle contraction-0.2 seconds, Increased pleural and alveolar pressure

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10
Q

Expulsion Phase

A

Glottis opens, Mucus is displaced from airway walls into the air stream, can be swallowed or expectorated

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11
Q

What stimulates us to cough?

A

Inflammation (infection), Mechanical (foreign body/ aspiration), Chemical (pollutant), Thermal (drastic change in temp)

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12
Q

Snowball effect

A

Mucus plugging, atelectasis, impaired oxygenation, increased WOB, Air trapping-overdistention, infection, inflammatory response

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13
Q

Cough Impairment

A

Anesthesia, narcotics. Inadequate pain control, artificial airway- lose compression of cough, Neurologic and or physical dysfunction, inadequate lung recoil, surgery

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14
Q

Primary Goal and indication for bronchial Hygiene therapy

A
  1. Help mobilize and remove retained secretions 2. improve gas exchange and reduce work of breathing- collateral ventilation through Pores of Kohn, canals of lambert
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15
Q

Indications

A
  1. Pt produce copious amounts of secretion
  2. Pt unresponsive to coughing techniques
  3. Reduce air trapping
  4. Prevent or treat atelectasis
  5. pt immobile
  6. Optimize delivery of bronchodilator
  7. pt in acute resp failure with clinical signs of retained secretions
  8. Chronic conditions that need continuous secretion removal
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16
Q

Pt unresponsive to coughing techniques=

A

secretions retained/ stuck

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17
Q

copious amounts of secretions=

A

more than 30ml. day/ 100cc

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18
Q

Acute respiratory failure, clinical signs of retained secretions=

A

Adventitious breath sounds, deteriorating arterial blood gases, CXR changes, Physical assessment

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19
Q

Chronic conditions that need continuous secretion removal

A

Cystic fibrosis, Bronchiectasis, Ciliary dyskinectic syndromes, chronic bronchitis

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20
Q

Ciliary Dyskinectic

A

Cilia doesnt work

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21
Q

Mucus production and bronchial hygiene

A

Normal pulmonary tract mucus production is approx 100ml per day and is usually swallowed or reabsorbed in the airway, Bronchial hygiene is appropriate for pt who produce more than 30mL of sputum per day and have trouble clearing it

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22
Q

Sputum color

A

Purulent, clear, mucoid, and hemoptysis

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23
Q

Purulent

A

Infection, containing pus. Yellow, green, rusty, red currant jelly

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24
Q

Mucoid

A

over production of mucus do to exacerbation- asthma

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25
Q

Hemoptysis

A

blood streaked or frank

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26
Q

frank

A

all red mucus, get help= BAD!= active hemorrhaging

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27
Q

Mucous amount

A

scant and copious

28
Q

scant

A

few teaspoons (moderate)

29
Q

Copious

A

shot glass to a pint or more

30
Q

Mucous consistency

A

Thin/ thick, Tenacious, Frothy

31
Q

Tenacious

A

Extremely sticky

32
Q

Frothy

A

foamy

33
Q

Contraindications, absolute

A

Unstable head or neck injury (postural drainage), active hemorrhage with hemodynamic instability

34
Q

Relative Contraindications

A

Unable to tolerate increased WOB, ICP> 20mmHg, Unstable hemodynamics, Active hemoptysis, Untreated pneumothorax, Tympanic membrane rupture, Facial/ oral/skull surgery or trauma, Epistaxis, Esophageal surgery, nausea

35
Q

Epistaxis

A

Nosebleed

36
Q

Hazards and Complications

A
  1. Pulmonary barotrauma 2. Increased ICP 3. Decreased venous return 4. Breakdown of skin 5. Air swallowing 6. Claustrophobia 7. Hypoventilation and hypercapnea
37
Q

Hypercapnia

A

high CO2

38
Q

Assessment of outcome

A
  1. change in sputum 2. change in breath sounds 3. change in vitals 4. change in CXR 5. change in ABG’s/ labs
39
Q

Coughing techniques

A

Directed cough, Manually assisted cough, splinting, forced expiratory technique (FET) or “huff coughing”, Active cycle breathing (ACB), Autogenic drainage (AD), Cough assist (Insuflattor/ Exuflattor)

40
Q

Manually Assisted cough (quad cough)

A
  1. Manual thrust similar to heimlich maneuver, performed during expiration splinting
41
Q

ACB

A

Active cycle breathing 1. Relaxation and breathing control 2. Thoracic expansion exercises 3. Huff cough

42
Q

AD

A

Autogenic drainage 1. Varying lung volumes with controlled expiratory flows 2. Cough is suppressed until you complete a cycle 3. Moving secretions from the small, med, large airways 4. Mucus rattle

43
Q

Cough Asisst (insuflattor/ exuflattor)

A
  1. Delivers a positive pressure for 2-3 seconds followed by an abrupt change into expiration created with a neg pressure (mimics a cough)
44
Q

PEP Therapy

A

Active expiration agains variable flow resistance, preventing airway collapse during exhalation

45
Q

Patient instruction during PEP Therapy

A
  1. Have pt sit up 2. Instruct them to take a slightly larger than norm breath 3. Exhale actively but not forceful (through mouthpiece or mask) 4. Have the pt perform 10-20 breaths per cycle 5. have pt cough 6. Evaluate for independent use (if apparatus allows)
46
Q

Therapeutic pressures on PEP therapy

A

10-20 cm H2O, pressure is measured with manometer

47
Q

How many breath cycles on PEP therapy

A

repeat: 4-8 cycles

48
Q

PEP I/E ratio

A

1:3 or 1:4

49
Q

Total treatment time on PEP therapy

A

no more than 20 minutes

50
Q

PD (postural drainage)

A

Invovled the use of gravity to help move resp tract secretions from distal lung lobes or segments into the larger central airway where they can be removed via coughing or suctioning

51
Q

Head down positions should exceed

A

25 degrees below horizontal (hess- 12 inches for lingula/ RML and 18 inches for lower lobes)

52
Q

Perform PD

A

every 4 to 6 hours or as ordered, must have adequate hydration for secretion mobility

53
Q

How many PD positions? (times)

A

approx 11 positions are possible each position is held for 5 to 10 minutes, total treatment time is typically 20-30 minutes up to one hour

54
Q

PD scheduled when

A

before meal or more than 1 hour after mules or tube feeding. coordinate with pain medications. can be done with percussion therapy

55
Q

Special Beds for rotating/ turning a pt

A

Rotorest, Rotoprone. Triadyne. May also provide percussion. Prone position

56
Q

Rotorest/ triadyne

A

bed that holds body and rotates

57
Q

Concerns of PD

A

may need to modify positions, Medically intensive pt

58
Q

Contraindications of PD

A

Absolute- unstable spinal cord injuries, Traction of arm abductors, Emphysema, Bronchopleural fistula, Pulmonary embolism, Large pleural effusion

59
Q

Hazards specific to PD

A

hypoxemia (positional), acute hyptension, pulmonary hemorrhage, pain or injury to muscles/ribs/ spine, Vomiting and aspiration, bronchospasm, arrhythmias

60
Q

Percussion and vibration involves

A

the application of mechanical energy to chest wall by the use of either hands or various electrical or pneumatic devices- Percussion should loosen secretion- vibration should aid in the movement of secretions toward the central airways

61
Q

Hand clapping

A

Cupped position-fingers and thumb closed which creates a cushion of air when striking pt, rhythmically strike the chest wall with loose wrists, alternating hands , percuss in circular pattern over a localized area for 3-5 minutes, avoid bony prominences

62
Q

Vibration

A
  1. Performed during exhalation, vibrating the chest wall with hands 2. Mechanical and pneumatic machines provide frequencies of up to 20-30 Hz
63
Q

Oscillatory PEP and high frequency chest wall compression/ oscillation

A

vest, flutter, acapella, IPV (intrapulmonary percussive ventilation), Metaneb

64
Q

IPV

A

Intrapulmonary percussive ventilation- a pneumatic device that delivers a series of pressurized gas mini-bursts at a rate of 100 to 225 cycles per min usually with a mouthpiece, contains nebulizer, maintains constant PAP, the percussion is controlled by the pt or person giving the treatment

65
Q

A pneumatic device that delivers a series of pressurized gas mini-bursts at a rate of

A

100-225 cycles per minutes usually with a mouthpiece

66
Q

Selecting bronchial hygiene

A
  1. Pts motivation/ compliance/ goals 2. physician/ caregiver goals 3. Effectiveness of technique 4. pts learning ability 5. Skill of therapist/ availability, work required 6. disease process 7. Equipment 8. cost

Principles and Practices of Resp II (5 decks)

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