Ch.44 Egans

Question 1

What is abnormal clearance?

Answer 1

Any abnormalities that alter:
• airway patency
• mucociliary function
• strength of breathing muscles
• thickness of secretions
• cough reflex
Can impair airway clearance leading to retention of secretions

Question 2

Retention of secretions results in:

Answer 2

• full obstruction or mucous plugging (atelectasis)
• partial obstruction

Question 3

What are causes of impaired mucociliary clearance in intubated pt’s?

Answer 3

Question 4

What is the primary goal of ACT?

Answer 4

To assist the pt to mobilize and remove retained secretions.

Question 5

Removal of these retained secretions may:

Answer 5

Improve gas exchange, promote alveolar expansion, and reduce WOB

Question 6

What are the indications for ACT?

Answer 6

Question 7

What are the 5 general approaches to ACT?

Answer 7

Can be used alone or in combination
1. CPT
2. Coughing and related expulsion techniques
3. PAP
4. High frequency oscillation devices
5. Mobilization and physical activity

Question 8

What is the initial assessment of need for ACT?

Answer 8

Question 9

What are some ACT techniques and devices?

Answer 9

• CPT includes percussion and PD
• Active cycle of breathing
• Autogenic drainage
• MIE
• PEP or OPEP
• High frequency positive airway pressure devices
• HFCWC
• Mobilization & physical activity

Question 10

What are some contraindications to the use of CPT?

Answer 10

• Empyema
• PE
• ICP > 20mmHg
• Bronchospasm
• Osteoporosis

Question 11

What is the Triple “S” rule?

Answer 11

Question 12

What are 5 complications with PD?

Answer 12

• Hypoxemia
• Increased ICP
• Pulmonary hemorrhage
• Bronchospasm
• Arrhythmias

Question 13

What is HFCWC?

Answer 13

An external (chest wall) application vest airway clearance system.

Question 14

How does HFCWC work?

Answer 14

Generator inflates and deflates the vest creating pressure pulse against the thorax that cause chest wall oscillations and move secretions forward.

Question 15

What are the 2 parts to HFCWC?

Answer 15

1. variable air pulse generator
2. a non stretch inflatable vest that wraps around the pts entire torso

Question 16

What are some key factors in selecting an airway clearance strategy?

Answer 16

Question 17

What are assessment outcomes after ACT?

Answer 17

Question 18

For volume controlled what do you set?

Answer 18

Vt, FiO2, PEEP, Flow

Question 19

What is controlled in volume controlled?

Answer 19

Volume

Question 20

Pressure ______ during volume controlled?

Answer 20

Varies

Question 21

T or F Volume and flow are constant during volume control?

Answer 21

True

Question 22

T or F Pressure changes during volume controlled?

Answer 22

True

Question 23

What can you run the risk of during volume controlled?

Answer 23

Barotrauma

Question 24

What happens during pressure controlled?

Answer 24

Pressure is constant and volume and flow will change

Question 25

What is the inspiratory pressure in pressure controlled?

Answer 25

Vt

Question 26

What do you set for pressure controlled?

Answer 26

RR, FiO2, PEEP, Ti

Question 27

What is the flow range for pressure controlled? What do we usually start with?

Answer 27

40-80; 60

Question 28

What are some common methods for delivering inspiration?

Answer 28

Question 29

What are ventilator control functions during inspiration?

Answer 29

Box 3.3