Chapter 40 Flashcards
Problems that inhibit Irritation phase
Anthesia
CNS depression
Narcotic-analgesia
Problems that inhibit Inspiration phase
Pain
Neuromuscular dysfunction
Pulmonary restriction
Abdominal restriction
Problems that inhibit Compression phase
Laryngeal nerve damage
Artificial Airway
Abdominal muscle weakness
Abdominal surgery
Problems that inhibit Expulsion phase
Airway compression
Airway obstruction
Abdominal muscle weakness
Inadequate lung recoil
How does the mucociliary escalator work?
Ciliated epithelial cells normally move mucus via a coordinated wave of ciliary motion toward the trachea and larynx, where excess secretions can mbe swallowed or expectorated
What does the mucus blanket consist of?
2 layers - Gel and Sol
cilia
What affects the mucus blanket?
dehydration
Function of Gel layer
More gelatinous - captures particles
Outermost layer
Function of Sol layer
Fluid-like layer - provides motion of the mucus
Located underneath the gel layer
How does dehydration affect the layers?
Mucus becomes thick and heavy making it harder to expel.
What happens when the layers do not work properly?
Retains secretions
Causes of Impaired Mucocilary Clearance in intubated patients
Endotracheal or Tracheostomy tube Tracheobronchial suction Inadequate humidification High FiO2 values Drugs General anethethesics Opiates Narcotics Underlying pulmonary
Are elderly patients the most likely group to suffer from dehydration? Why?
Yes - Do not like to drink water prefer coffee or tea
When should you start bronchial hygiene therapy for a dehydrated elderly patient?
After being hydrated either by drinking water or IV
Why does high FiO2 impair mucociliary clearance?
Ciliary motion is slowed or stopped
Viscosity of the sol layer is increased
Directly or by causing acute tracheobonchitis
How do drugs such as opiates narcotics and barbiturates impact mucociliary clearance?
Depress the mucociliary transport and trigger irritation phase
How do the prescence of endotracheal tubes and tracheostomy tubes affect mucociliary clearance?
Inhibits the compression phase of the cough reflex by preventing closure of the glottis
Increases mucus secretions due to mechanically blocked the mucociliary escalator
Movement of tube causes erosion of the tracheal mucosa
Diseases associated with abnormal clearance
Cystic Fibrosis
Ciliary dyskinetic syndrome
Asthma
Bronchitis
Diseases associated with airway patency
Asthma
Chronic bronchitis
Acute infections
How does Cystic Fibrosis change the composition of mucus?
Inceases the viscosity of mucus
Impairs mucus movement up the respiratory tract
Kyphoscoliosis
Cause external compression of the airway
Ciliary Diskinetic syndrome
Cilia does not function properly.
How does musculoskeletal disease and neurologic disorders affect normal airway clearance?
Alter the four components of an effective cough
Goals of bronchial hygiene
Help mobilize and remove retained secretions
Improve gas exchange
Promote alveolar expansion
Reduce work of breathing
Indications of bronchial hygiene
Copious secretions
Acute respiratory failure with retained secretions
Acute lobar atelectasis
V/Q abnormalities causd by bilateral lung disease
Chronic diseases/conditions know to cause V/Q abnormalities and respiratory failure as a result of copious retained secretions
Cystic Fibrosis
Bronchiectasis
Ciliary dyskinetic syndrome
Chronic bronchitis
Disorders associted with retained secretions
Acute disease
Immobile patients
Post-Operative patients - general anesthesia,opiates/narcotics
Inadequate humidification
Acute exacerbations - COPD/CF/Bronchiectasis
Chronic disease - CF/Neuromuscular disorders
Immobility causes
muscle weakness and without body movement, secretions remain stagnant
Post-op patients are at risk due to
sedation and anesthesia
How do you determine if chest therapy is effective
Change in sputum production - Chest therapy must produce 25 to 30 ml per day - if not, then deemed ineffective
Change in vital signs
Change in chest radiography
Change in ventilator variables
Change in arterial gas values or O2 saturation
Change in breath sounds of lung fields being drained
Patient subjective response to therapy
Noraml airway clearancy
Patent airway
Normal cough reflex
Production of mucus, ciliary structure, and function
Before postural drainage, to prevent aspiration
Make patient cough
Make sure they haven’t eaten - perform 2 hours after eating or before a meal
Acute signs of retained secretions
loose, effective cough labored breathing pattern decreased or bronchial breath sounds coarse inspiratory and expiratory crackles trachypnea tachycardia
