Chapter 44 Egans Flashcards
What is CPT used for?
Assist with clearing secretions from the airways
Suctioning
Primary INVASIVE method for removing secretions
How much secretion does a healthy individual produce a day?
10-100mL
The 4 phases to a cough
Irritation- abnormal stimulus provokes sensory fibers in the airways to send impulses to the medullary cough center in the brain
Inspiration- after impulses are received, the cough center generates a reflex stimulation of the respiratory muscles to initiate a deep inspiration
Compression- Reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles (.2sec)
Expulsion- the glottis opens and a large pressure gradient between the lungs and the atmospheric pressure exists. Together with the continued contraction of the expiratory muscles, the pressure gradient causes a violent, expulsive high velocity of airflow from the lungs. The high-velocity gas flow, combined with dynamic airway compression, creates a huge shear force that displaces mucus from the airway walls into the air stream. Mucus and foreign material are expelled from the lower airways to the upper airway, where they can be expectorated or swallowed
The following are defined
ACBT-Active cycle of Breathing
PEP-Positive Expiratory Therapy
AD-Autogenic Drainage
PDPV-Postural Drainage Percussion and Vibrations
CPT-Chest Physical Therapy
CPAP-Continues Positive Airway Pressure
EPAP-Expiratory Positive Airway Pressure
FET-Forced expiratory Technique
HRCWC-High Frequency Chest Wall Compression
HZ-Hertz
ICP-Intracranial Pressure
IPV-Intrapulmonary Percussive Ventilation
MIE-Mechanical Insufflation-Exsufflation
What are the 4 types of irritation? with example.
Inflammatory- Infection
Mechanical- Foreign Bodies
Chemical- Irritating gases (smoke)
Thermal- Cold air
What are some options to help with airway clearance?
CPT, Breathing retraining techniques, PEP, Vibratory PEP, High-Frequency oscillation devices, HFCWC, MIE, Various exercise protocols
What does normal airway clearance require?
Patient airways, functional mucociliary escalator, adequate hydration, effective cough
Where does mucociliary clearance normally occur?
Larynx down to the bronchioles
What can a full obstruction cause?
(mucous plugging)
Hypoxemia due to shunting
What can a partial obstruction cause?
Restrictive airflow, increased WOB and possibly air trapping, lung overdistension, V/Q imbalances
What are the 3 chemical mediators that a released during an inflammatory response and what damage can they do?
- Leukotrienes, proteases, elastases
- Damage the airway epithelium and increase mucous production, resulting in a vicious cycle of worsening airway clearance
Primary goal of ACT?
Assist patient to mobilize and remove retained secretions
Acute and chronic conditions for ACT
Acute- copious secretions, inability to mobilize secretions, ineffective cough
Chronic- CF, bronchiectasis, ciliary dyskinetic syndromes, COPD with retained secreations
How much sputum production must be produced for ACT to be considered working?
20-30mL a day
Two well-documented preventative use of ACT
1) Body positioning, mobilization to prevent retained secretions in acutely ill patients
2) ACT combined with physical activity to maintain lung function in patients with CF
5 general approaches to ACT
1) CPT
2) Coughing and related expulsion techniques (MIE)
3) PAP adjuncts (PEP, vibratory PEP, high-frequency PAP devices)
4) High-frequency oscillation devices
5) Mobilization and physical activity
CPT may be the most effective when how much sputum is produced?
25-30mL/day
To achieve maximum secretion drainage with postural drainage and percussion the head-down positions should exceed what?
25 degrees below horizontal
What should be monitored before, during, and after CPT?
Subjective responses(pain), arrhythmias, breathing patterns, sputum production, skin color, ICP (if monitored)
How many inches should the bed be brought down to to reach a 25 degree angle?
16-18 inc
How far can a tilt table go to?
45- degrees
How long is a general PD treatment?
15min for a routine
30min for extended treatment
How long does it take to determine the effectiveness of postural damage?
- 24 hours
- Reevaluate hospital patients 48-72hrs
- Reevaluate home patients- every 3 months
What’s the triple S rule for PD?
Stop therapy, Stay with patient until Stabilized
Mechanical percussion and vibration devices provide frequencies of what?
20-50Hz (Sometimes 120Hz)
Describe FET
Big breath in, then say huff while exhaling
3 most important aspect in teaching a patient to have an effective cough:
1) instruction on proper positioning
2) instruction on breathing control
3) exercise to strengthen the expiratory muscles
Why could FET be beneficial to patients with COPD?
The technique reduces transpulmonary pressure and decreases airway compression or closure
Goal of FET?
Help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse
What helps keep the glottis open?
Huff cough
Manually assisted cough
External application of pressure of the thoracic cage or epigastric region, coordinated with a forced exhalation
Breathing control
Gentle diaphramatic breathing at normal tidal volumes for 5-10 seconds with relaxation of the upper chest and shoulders
ACBT (Active cycle of breathing technique)
repeated cycles of breathing control, thoracic expansion, and FET
Thoracic expansion
Helps loosen secretions, improves the distribution of ventilation, and provide the volume needed for FET
MIE
Inspiratory: 30-50 cm H2O (1-3sec)
Expiratory: -30 to -50 cm H2O (2-3sec)
PEP therapy
active expiration against a fixed orifice flow resister or variable orifice threshold resister capable of developing pressures of 10-20cm H2O
OPEP (Oscillating PEP)
Provides rapid fluctuations in airway pressure as patient exhales
Vibrations/ oscillations
Frequency: 10-30Hz
Amplitudes: 20-100torr
Flows of 10-25L/min
IPV (Intrapulmonary percussion ventilation)
Uses a pneumatic device to deliver a rapid series of pressurized gas minibursts at rates of 200-300 cycles per min
Percussion rate of Metaneb
170-230 breaths per min
HFCWC (High Frequency Chest Wall Compression) (CF Patients)
1) variable air pulse generator
2) Nonstretch inflatable vest that wraps around patients entire torso
HFCWC Therapy
30min session 2-6times per day at oscillatory frequencies between 5-25 Hz
BCV (Biphasic Cuirass Ventilation)
1-999 oscillations per min
I:E ratios of 1:6 and 6:1
Pressures of -70 to 70 cm H2O
2 set cycles
