Bronchial hyigene Flashcards
What are the goals of Bronchial hyigene
- interrupt cycle of lung tissue destruction
- decrease infection and illness
- improve quality of life
- mobilize secretions and prevent accumulation
- improve efficiency and distribution of ventilation
- improve cardiopulmonary reserve
What are the 4 MOA that helps to get mucus out?
- soften secretion
- ->by hydrating airway by adding humidity or mucolytic - Loosen secretion
- ->use vibration technique to shake secretion out of the bronchial - Bronchodilation
- ->use medication to open up airway which assists coughing up mucus - Mucus expelling
- -> by coughing
What does mucus retention lead to?
mucus retention
mucus plugging/obstruction
lung infection
lung damage
What are the 2 indication for secretion clearance
- lung condition lead to excess sputum
- Acute: pneumonia, exacerbation of COPD, acute respiratory failure, acute lobar atelectasis
-Chronic: CF, bronchiectasis
- patient with difficulty clearing secretion and coughing
- immobile patients
- post-op patient with abdomen and thorax wounds that make them breath shallowly
- patient with neuromuscular disease (Guillian Barre, Amyotrophic lateral sclerosis, Myasthenia gravis)
What are 6 bronchial hygiene technique
- chest physiotherapy
- assisted cough maneuvers
- lung volume recruitment
- suctioning (ONT)
- sputum induction
- humidity therapy
What techniques are include in chest physiotherapy?
a) postural drainage
b) percussion
c) chest vibration
What is postural drainage
put pt in position that uses gravity to drain secretion into bigger bronchial for removal
What is the technique of postural drainage?
1) patient is position so that affected lung segment are superior to the carina
2) position is held 3-15 or as tolerated
3) total treatment time is 30 - 40 mins
4) cough method is used simultaneously to enhance removal
Who should be treated with postural drainage
its most effective for pt with excessive sputum production (<25 to 30ml/day)
what are some addition technique when using postural drainage
1) head angle should exceed 25 degree below horizontal line to achieve maximum effect
2) ensure systemic and airway hydration
What are the precautions of postural drainage
1) Positional desaturation
2) increase ICP
3) positional hypotension
4) bronchospasm
5) dysrhythmias
6) pulmonary hemorrhage
7) mobilizing secretion to other areas of lung, increasing frequency of suctioning
What are the relative and absolute contraindication of postural drainage
Relative: Injury - Cranial / opthalmic - thorax Disease - pulmonary - cardiovascular - abdominal
Absolute:
- unstabalized head/neck injury
- hemodyanmic instability
How often should a postural drainage be done
Q4-6hr PRN for mechanically ventilated pt
PRN for patient response to therapy
How to position critical care patients with postural drainage
- PD is used to improve V/Q matching in critical care patient
What is the expected outcome of secretion removal
- improve breaths sound
- less crackle
- improve chest x ray
What is another technique use to acompany postural drainage?
Cupping - a form of percussion technique for chest physiotherapy
How does it assist postural drainage?
use rhythmic shaking motion with cupping technique over affected area to loosen up the secretion
or using a mechanical device (palm cup percussors)
What is the cupping movement
1) Hand position 3 inches from chest
2) strike the chest in waving movement
What is the precautions for cupping
- -> dont do it on bony or breast tissue
- ->dont do it on people with bone problem like osteoporosis
- ->dont do it on people with thorax surgery or fracture ribs
What is the contraindication of cupping
Bone cancer Unstable angina Arrhythmias Skin graft Open wounds Bronchospasm
What is chest vibration
1) its vibration done using both hands during expiration
2) mehanical devices
What are some vibration devices
Thairapy vest
- a high frequency chest wall compression
- small volumes moving in and out of the vest to create the oscillatory motions ( 5 - 25 hz)
- use for 30 minutes
Flutter valve
- pep therapy
- acepella
Disadvantage of the thairpy vest
expensive and cumbersome
What are the types of cough
- acute
- chronic
- paroxysmal
- barking
- dry/hacking
- productive
- cough in the morning
- coughing with positional changes
What cause acute cough
- -> sudden onset
- ->short course
What cause chronic cough
- ->more than 3 wks
- ->caused by postnasal drips
- —Postnasal drip is extra mucus felt in the back of the nose and throat caused by the glands
What cause paroxysmal?
- ->periodic
- —frequent and violent coughing
- ->prolonged
- ->due to asthma, aspiration, left heart failure
What cause barking
- seal like cough
- croup
- ->swelling and narrowing in the voice box
What cause dry hacking
- viral infection
- irritant gases
- interstitial lung disease
What cause productive cough
- chronic bronchiectasis
- cystic fibrosis
- bronchitis
What causes cough in the morning
- chronic bronchitis
- smoking
What causes with positional change
- gastroesophageal reflex
- left heart failure
- bronchiectasis
What is the 4 main phases of cough
- irritant
- efferent signal
- respiratory pause
- glottis opens
What are some cough techniques that should be taught to patients
a. active cycle of breathing
b. forced expiratory technique
c. autogenic drainage
d. manually assisted cough
e. in-exsufflator machine
f. muscle training
Who should be taught on about coughing?
- post heart, abdomen, thorax patients
- trauma patient
- COPD patient
- post-ventilated pt
- ->muscles are weaker
What are the main indication of cough therapeutic technique?
- removal of secretion from central airways
- reverse atelectasis
- prophylaxis against postoperative
- routine bronchial hygiene
- as a part of other therapy
What is the ACBT consist of
- breathing control
- breath at tidal volume for 5 -10 sec which helps to increase VC for a good cough
2.deep breathing (thoracic expansion)
3.huffing
(fogging up window)
- performed in a cycle until no more secretion
- might be used with postural drainge
What are the 2 types of huffing?
1) short and forceful
- ->moves sputum from upper chest to trachea
- ->use this when sputum is ready to come out
2) long and unforceful
- moves sputum up from bottom of the chest
- take small to medium breath in then huff
How is the deep breathing of ACBT performed?
1) take long, slow, deep breath in, through nose
2) breath out gently like a sigh
* do 3 -5 deep breath
* try 2-3 sec breath hold after inhalation
WHat is the huffing
Forced expiratory technique
- a force expiration at mid-low lung volumes with open glottis
what is the result of huffing
less bronchiolar collapse
helps moves sputum up the airway , helps to clear it easily
How to perform huffing
- exhale via open mouth
- squeeze air quickly from lungs
- use abdomen muscle to help squeeze breaths out, follow by breath control
What is autogenic drainage
- mobilizes mucus with breathing pattern
- no coughing until sequence is done
How many phases are there in autogenic drainage
phase 1:
a full inspiratroy capacity maneuver followed by breathing at low lung volumes
->unsticks peripheral mucus
- breathing at low to mid lung volumes to collect mucus in middle airways
- evacuation phase, mucus is readied for expulsion from large airways
What is the positioning for autogenic
position
sitting, shoulders internally rotated, head flex slightly and feet supported
How to do manually assisted cough
1,build up good tidal volume
-by small breaths
2.presses upwards on abdomen during exhalation to clear secretion
What are some modification done to manually assisted cough
for surguical patient
- splint with hands, pillow
for neurimuscular disease
- compress chest/diaphragm to get secretion out
COPD patient
- pursed lip breathing
- fet
What is the in fexsufflator cough machine
it improves peak cough expiratory flow rate
What is the normal peak cough expiratory flow rate
6-12 L/min
What is the cough expiratory flow rate in patient with NMD
unassisted: 1.81
assisted: 4.27
exsufflator: 7,47
What is the indication for cough assist T70
- secretion clearance for chronic lung condition
2. neuromuscular disease
What is the contraindication for cough assist
emphysema
pneumothroax
pneumo-mediaastinum
What does cough assist work
it loosens, mobilize, clear secretion via high frequency oscillatory vibration
- applies +ve pressure then shifts to -ve pressure
- the pressure produces high expiratory flowrate which clears secretion
What are the interface that cough assist can connect to
face mask, mouth piece, TT, ETT
Pressure of cough assist
insp
20-40 cmh2o for 1 - 2sec
exp
-20-40 cmh2o for 1 sec
pause
1-2sec
What is the purpose of muscle training
- adjuncts for secretion clearance
What are some muscle training devices
- insp muscle trainer
- ->breathing in 1 -way valve
- –>e.g. threshold IMT, PFLEX - exp muscle trainer
- ->resistance increases as patient gets stronger - physical condition
What is the indication of lung expansion therapy
- prevent atelectasis , especially in post op patient
2. assist with cough or secretion mobilization
What is the methods of lung expansion therapy
- breathing exercise
- incentive spirometry
- lung expansion therapies
- ->manual insufflation
- ->IPPB
- ->in/exsufflator
What is PEP therapy
- exhalation against fixed resistance
- sustained effort
- NO VIBRATION
range
-10-20 cmh2o
*can combine aerosol
What is OPEP
- patient exhales via a adjustable resistance level that creates back pressure felt at lung
Expiratory pressure stents airway open, opening up collapse alveoli
intermittent resistance creates oscillation pressure and increase expiratory flow—>helps to dislodge mucus to central and upper airway
What is indication of pursed lip breathing
for COPD patient as they gas trap due to early airway closure
–>it moves EPP so closure occurs at lower lung volumes
What is incentive spiroemetry?
- required sustained maximal inspiration (SMI)
- mimics yawning
- prevents or correct atelectasis
how to perform IS
slow inspiration from FRC to TLC with 5 - 10 sec breaths hold
what is some concern about IS
require active participation by patietn
must be performed frequently
What are 2 equipment for IS
flow dependent
volume dependentq
What is some recommendation for IS
- not recommended for pre-post op prevention of atelectasis ALONE
- not recommended for post upper abdomen surgery
What is the rationale or mechanism that helpe prevents atelectass
- increase transpulmonary pressure and inspiratory volumes
- improves resp muscle performance
- re establish pattern of deep periodic breahting
What are some lung expansion therapies
- manual insufflation
- ->via BVM with mask - mechanical ventilation
- ->IPPB
- ->CPAP,EPAP
3.cough machine, cough assist
WHat is the setting of IPPB?
- uses preset pressure to deliver a larger Vt than normal Vt
- pt breathing sponatenously for 15 - 20 mins,
- q 1 - 6h
Who should use IPPB?
NON intubated , patient controlled
