Chapter 44 Egans

Question 1

What is CPT used for?

Answer 1

Assist with clearing secretions from the airways

Question 2

Suctioning

Answer 2

Primary INVASIVE method for removing secretions

Question 3

How much secretion does a healthy individual produce a day?

Answer 3

10-100mL

Question 4

The 4 phases to a cough

Answer 4

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

Question 5

The following are defined

Answer 5

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

Question 6

What are the 4 types of irritation? with example.

Answer 6

Inflammatory- Infection
Mechanical- Foreign Bodies
Chemical- Irritating gases (smoke)
Thermal- Cold air

Question 7

What are some options to help with airway clearance?

Answer 7

CPT, Breathing retraining techniques, PEP, Vibratory PEP, High-Frequency oscillation devices, HFCWC, MIE, Various exercise protocols

Question 8

What does normal airway clearance require?

Answer 8

Patient airways, functional mucociliary escalator, adequate hydration, effective cough

Question 9

Where does mucociliary clearance normally occur?

Answer 9

Larynx down to the bronchioles

Question 10

What can a full obstruction cause?
(mucous plugging)

Answer 10

Hypoxemia due to shunting

Question 11

What can a partial obstruction cause?

Answer 11

Restrictive airflow, increased WOB and possibly air trapping, lung overdistension, V/Q imbalances

Question 12

What are the 3 chemical mediators that a released during an inflammatory response and what damage can they do?

Answer 12

• Leukotrienes, proteases, elastases
• Damage the airway epithelium and increase mucous production, resulting in a vicious cycle of worsening airway clearance

Question 13

Primary goal of ACT?

Answer 13

Assist patient to mobilize and remove retained secretions

Question 14

Acute and chronic conditions for ACT

Answer 14

Acute- copious secretions, inability to mobilize secretions, ineffective cough
Chronic- CF, bronchiectasis, ciliary dyskinetic syndromes, COPD with retained secreations

Question 15

How much sputum production must be produced for ACT to be considered working?

Answer 15

20-30mL a day

Question 16

Two well-documented preventative use of ACT

Answer 16

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

Question 17

5 general approaches to ACT

Answer 17

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

Question 18

CPT may be the most effective when how much sputum is produced?

Answer 18

25-30mL/day

Question 19

To achieve maximum secretion drainage with postural drainage and percussion the head-down positions should exceed what?

Answer 19

25 degrees below horizontal

Question 20

What should be monitored before, during, and after CPT?

Answer 20

Subjective responses(pain), arrhythmias, breathing patterns, sputum production, skin color, ICP (if monitored)

Question 21

How many inches should the bed be brought down to to reach a 25 degree angle?

Answer 21

16-18 inc

Question 22

How far can a tilt table go to?

Answer 22

45- degrees

Question 23

How long is a general PD treatment?

Answer 23

15min for a routine
30min for extended treatment

Question 24

How long does it take to determine the effectiveness of postural damage?

Answer 24

• 24 hours
• Reevaluate hospital patients 48-72hrs
• Reevaluate home patients- every 3 months

Question 25

What’s the triple S rule for PD?

Answer 25

Stop therapy, Stay with patient until Stabilized

Question 26

Mechanical percussion and vibration devices provide frequencies of what?

Answer 26

20-50Hz (Sometimes 120Hz)

Question 27

Describe FET

Answer 27

Big breath in, then say huff while exhaling

Question 28

3 most important aspect in teaching a patient to have an effective cough:

Answer 28

1) instruction on proper positioning
2) instruction on breathing control
3) exercise to strengthen the expiratory muscles

Question 29

Why could FET be beneficial to patients with COPD?

Answer 29

The technique reduces transpulmonary pressure and decreases airway compression or closure

Question 30

Goal of FET?

Answer 30

Help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse

Question 31

What helps keep the glottis open?

Answer 31

Huff cough

Question 32

Manually assisted cough

Answer 32

External application of pressure of the thoracic cage or epigastric region, coordinated with a forced exhalation

Question 33

Breathing control

Answer 33

Gentle diaphramatic breathing at normal tidal volumes for 5-10 seconds with relaxation of the upper chest and shoulders

Question 34

ACBT (Active cycle of breathing technique)

Answer 34

repeated cycles of breathing control, thoracic expansion, and FET

Question 35

Thoracic expansion

Answer 35

Helps loosen secretions, improves the distribution of ventilation, and provide the volume needed for FET

Question 36

MIE

Answer 36

Inspiratory: 30-50 cm H2O (1-3sec)
Expiratory: -30 to -50 cm H2O (2-3sec)

Question 37

PEP therapy

Answer 37

active expiration against a fixed orifice flow resister or variable orifice threshold resister capable of developing pressures of 10-20cm H2O

Question 38

OPEP (Oscillating PEP)

Answer 38

Provides rapid fluctuations in airway pressure as patient exhales

Question 39

Vibrations/ oscillations

Answer 39

Frequency: 10-30Hz
Amplitudes: 20-100torr
Flows of 10-25L/min

Question 40

IPV (Intrapulmonary percussion ventilation)

Answer 40

Uses a pneumatic device to deliver a rapid series of pressurized gas minibursts at rates of 200-300 cycles per min

Question 41

Percussion rate of Metaneb

Answer 41

170-230 breaths per min

Question 42

HFCWC (High Frequency Chest Wall Compression) (CF Patients)

Answer 42

1) variable air pulse generator
2) Nonstretch inflatable vest that wraps around patients entire torso

Question 43

HFCWC Therapy

Answer 43

30min session 2-6times per day at oscillatory frequencies between 5-25 Hz

Question 44

BCV (Biphasic Cuirass Ventilation)

Answer 44

1-999 oscillations per min
I:E ratios of 1:6 and 6:1
Pressures of -70 to 70 cm H2O
2 set cycles