CPT Flashcards
_____ involves the use of noninvasive techniques designed to help mobilize and remove secretions and improve gas exchange. Previously, airway clearance methods often were grouped under a broad category of techniques called ________
Airway clearance therapy, chest physical therapy (CPT).
Normal airway clearance requires a________
patent airway, a functional mucociliary escalator, and effective cough.
there are four distinct phases to a normal cough:
irritation, inspiration, compression, and
expulsion
Infection is a good example of cough stimulation caused by an ______ Foreign bodies can provoke a cough through _______. _______ can occur when irritating gases are inhaled (e.g., cigarette smoke). Finally, cold air may cause _____ of sensory nerves and produce a cough.
inflammatory process, mechanical stimulation, Chemical stimulation, thermal stimulation
During the third, or compression, phase, reflex nerve impulses cause _______ of the expiratory muscles. This compression phase is normally about _______and results in a rapid increase in pleural and alveolar pressures, often greater than_____ mm Hg
glottic closure and a forceful contraction, 0.2 seconds, 100
Full obstruction, or mucous plugging, can result in_______. By restricting airflow, partial obstruction can ________
atelectasis and impaired oxygenation secondary to shunting, increase the work of breathing and lead to air trapping, overdistention, and ventilation/perfusion (V/Q) imbalances
The presence of the tube in the trachea increases _____, whereas the cuff of the tube mechanically blocks the _______. In addition, movement of the tube tip and cuff can _________. Lastly, endotracheal tubes impair the compression phase of the cough reflex by preventing _______
mucus secretion, mucociliary escalator, cause erosion of the tracheal mucosa and impair mucociliary clearance further, closure of the glottis
Inadequate humidification can cause ______ of secretions, mucous plugging, and airway obstruction. High fractional inspired oxygen (FiO2) concentrations can impair _______, either directly or by causing ______.
thickening or inspissation, mucociliary clearance, acute tracheobronchitis
In CF, the_____ of the mucus is altered because of abnormal ______ transport. This alteration increases the ______ and impairs its movement up the respiratory tract.
solute concentration, sodium and chloride, viscosity of mucus
The most common conditions affecting the cough reflex are _____, including muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, myasthenia gravis, poliomyelitis, and cerebral palsy
musculoskeletal and neurologic disorders
The primary goal of airway clearance therapy is to help _________, with the ultimate aim to ________
mobilize and remove retained secretions, Improve gas exchange, promote alveolar expansion, and reduce the work of breathing
In treating acute respiratory conditions, _______ before airway clearance therapy may improve the overall effectiveness of the treatment both by opening the airways and by increasing the mucociliary activity.
inhaled bronchodilator therapy
For acute pulmonary infections, _______ after airway clearance therapy can lead to improved deposition of the antibiotic
inhaled antibiotics
Generally, sputum production must exceed _______for airway clearance therapy to improve secretion removal significantly
25 to 30 ml/day
The best-documented preventive uses of airway clearance
therapy includes _____
(1) body positioning and patient mobilization to prevent retained secretions in acutely ill patients
(2) CPT combined with physical activity to maintain lung function in patients with CF
Five general approaches to airway clearance therapy, which
can be used alone or in combination, include
(1) CPT;
(2) coughing and related expulsion techniques (including manual insufflation-exsufflation [MIE]);
(3) positive airway pressure (PAP) adjuncts (positive expiratory pressure [PEP], continuous PAP [CPAP], expiratory PAP [EPAP]);
(4) high-frequency compression/oscillation methods; and
(5) mobilization and physical activity
Postural drainage involves the use of _______to help mobilize secretions. The various body positions assumed are intended to drain secretions from each of the patient’s lung segments into the ______, where they can be removed by cough or suctioning
gravity and mechanical energy, central airways
This drainage is accomplished by simply placing the segmental bronchus to be drained in a more ____ position, permitting gravity to assist in the process. Positions generally are held for_____ minutes (longer in special situations) and modified as the patient’s condition and tolerance warrant
vertical, 3 to 15
______is most effective in conditions characterized by excessive sputum production (>25 to 30 ml/day). For maximum effect, head-down positions should exceed _______.
Postural drainage, 25 degrees below horizontal
In patients in critical care, including patients on mechanical ventilation, postural drainage should be performed every _____ as indicated. In spontaneously breathing patients, frequency should be determined by _______
4 to 6 hours, assessing patient response to therapy
To avoid gastroesophageal reflux and the possibility of aspiration, treatment times should be scheduled before or at least _______
1 and half hour to 2 hours after meals or tube feedings
Because postural drainage positioning predisposes patients to _______, pulse oximetry should be considered if hypoxemia is suspected
arterial desaturation
Generally, to obtain the proper head-down position, the clinician must
lower the head of the bed by at least _______ to achieve the desired 25-degree angle.
16 to 18 inches
A _____ allows precise positioning at head-down angles up to 45 degrees.
tilt table
Absolute Contraindication of Postural drainage
Head and Neck injury until stabilized
Active hemorrhage with hemodynamic instability
What is the total treatment time of postural drainage
30-40 mins.
Typically, the clinician may initially note _______ before therapy that changes to ______ after treatment. This change is due to the loosening of secretions and their movement into the larger airways, an intended purpose of the therapy
diminished breath sounds and crackles, coarse crackles
the postural drainage order should be reevaluated at least every ______ for patients in critical care and at least every ____ for other
hospitalized patients. Patients receiving home care should be reevaluated at least every ______ or whenever their status changes
48 hours, 3 days, 3 months
_______ involve application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices.
Percussion and vibration
In theory, _____ should help loosen secretions from the
tracheobronchial tree, making them easier to remove by coughing or suctioning. ______should aid the movement of secretions toward the central airways during exhalation.
percussion, Vibration
The clinician performs manual percussion with his or her hands in a ________
cupped position, with fingers and thumb, closed
The clinician rhythmically strikes the chest wall in a _______, using both hands alternately in sequence with the elbows partially flexed and wrists loose
waving motion
Ideally, the clinician should percuss back and forth in a ______ pattern over the localized area for ______
circular, 3 to 5 minutes.
These devices have both frequency and percussion force control. Most units provide frequencies up to ______
20 to 30 cycles per second, or 20 to 30 Hz
______is a deliberate maneuver that is taught, supervised, and monitored. It aims to mimic the features of an _______ in patients who are too weak to produce a forceful expiratory maneuver.
Directed cough, effective spontaneous cough
______ can thwart efforts to implement an effective directed cough regimen
systemic dehydration; thick, tenacious secretions;
artificial airways; or the use of a central nervous system
depressants
For patients with pain or patients subject to bronchiolar collapse, it is probably best that they be shown how to “stage” their expiratory
effort into ______
two or three short bursts
______ is an external application of pressure to the thoracic cage or epigastric region, coordinated with forced exhalation. In this technique, the patient takes as deep inspiration as possible, assisted as needed by the application of positive pressure via a self-inflating bag or intermittent positive pressure breathing device.
Manually assisted cough
At the end of the patient’s inspiration, the clinician begins
exerting pressure on the ______
lateral costal margins or epigastrium
Manually assisted cough with pressure to the lateral costal
margins is contraindicated in patients with _______. Manually assisted cough using epigastric pressure is contraindicated in ________
osteoporosis or flail chest, unconscious patients with unprotected airways, in pregnant women, and in patients
with acute abdominal pathology, abdominal aortic aneurysm, or hiatal hernia
____ is a modification of the normal directed cough. ____, consists of one or two forced expirations of middle to low lung volume without _____, followed by a period of _____
FET, FET, or huff cough, closure of the glottis, diaphragmatic breathing and relaxation.
The goal of this method is to help clear secretions with less change in _____ and less likelihood of _______
pleural pressure, bronchiolar collapse.
To help keep the glottis open during FET, the patient is taught to _______ during expiration. The period of diaphragmatic breathing and relaxation following the forced expiration is essential in _________.
phonate or “huff”, restoring lung volume and minimizing fatigue
ACBT consists of repeated cycles of ________
breathing control, thoracic expansion, and FET
Breathing control involves gentle _______ with relaxation of the upper chest and shoulders. This phase is intended to help prevent _______
diaphragmatic breathing at normal tidal volumes for 5 to 10 seconds, bronchospasm
The thoracic expansion exercises involve ______, approaching vital capacity, with ______, which may be accompanied by percussion, vibration, or compression. The thoracic expansion phase is designed to help ________.
deep inhalation, relaxed exhalation, loosen secretions, improve the distribution of ventilation, and provide the volume needed for FET
ACBT seems to minimize or prevent the _______ so common during postural drainage, at least in patients with CF
O2 desaturation
ACBT is not useful with _______
young children (<2 years old) or critically ill patients.
________ is another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained patients.
Autogenic drainage (AD)
During AD, the patient uses _____ to mobilize secretions by varying lung volumes and expiratory airflow in ____ distinct phases
diaphragmatic breathing, three
Patients are taught to control their expiratory flows to prevent airway collapse while trying to achieve a ______ rather than a wheeze
mucous “rattle”
In the early 1950s, “artificial cough machines,” or MIE
devices were used to help patients with ______
polio clear secretions
The use of MIE devices (also called _______) has experienced a resurgence more recently, especially in patients with certain neuromuscular disorder
cough-assist device or “coughlator”
The MIE device delivers a positive pressure breath of ______ via a face mask or tracheal airway. The airway pressure is abruptly reversed
to _________. Peak expiratory “cough” flows obtained with this device are in the normal range (mean _____), far better than can be achieved with manually assisted coughing
30 to 50 cm H2O over a 1- to 3-second period, −30 to −50 cm H2O and maintained for 2 to 3 seconds, 7.5 L/sec
A typical treatment session consists of about ______of MIE followed by a period of ______ (to avoid hyperventilation). This process is repeated five or more times until secretions are cleared and the vital capacity and SpO2 return to baseline
five cycles, normal spontaneous or assisted breathing
MIE is contraindicated in patients with a ________
history of bullous emphysema, known susceptibility to pneumothorax or pneumomediastinum, or recent barotraumas
PEP therapy involves ______ against a variable
flow resistance. In theory, PEP helps move secretions into
the larger airways by ______. A subsequent______ maneuver allows the patient to generate the flows needed to expel mucus from blocked airways.
active expiration,(1) filling underaerated or nonaerated
segments via collateral ventilation and (2) preventing
airway collapse during expiration, huff or FET
In addition, PEP therapy cannot be used in ______
young children (<3 years old)
_____ refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract. At high frequencies (12 to
25 Hz), these oscillations act as a ________,” enhancing cough clearance of secretions.
oscillation, physical “mucolytic
There are two general approaches to oscillation: _______
external (chest wall) application and airway application
High-frequency chest wall oscillation is accomplished by
using a two-part system:
(1) a variable air-pulse generator
(2) a nonstretch inflatable vest that covers the patient’s
entire torso (Vest Airway Clearance System)
Typically, RTs perform ______ HFCWC therapy
sessions at oscillatory frequencies between_______. Depending on need and response, _______therapy sessions may occur per day
30-minute, 5 Hertz (Hz)and 25 Hz, one to six
__________ (inspiratory vs. expiratory) determine the effectiveness of HFCWC therapy
Compression frequency and flow bias
_____ is an airway clearance technique that uses a pneumatic
device to deliver a series of pressurized gas minibursts at
rates of __________ to the respiratory tract, usually via a ______
IPV, 100 to 225 cycles per minute (1.6 to 3.75 Hz), mouthpiece
The duration of each percussive cycle is manually controlled by the patient or clinician using a _____ button.
thumb
The manufacturer recommends a total treatment time of about _____
20 minutes
_____ changes are now standard preventive interventions for atelectasis and pneumonia in postoperative patients
Early mobilization and frequent position
_______ devices produce PEP with oscillations
in the airway during expiration. These devices are believed
to work based on the principle of ____________,
which suggests that airflow can occur between adjacent
lung segments through the canals of Lambert and through
the pores of Kohn.
Airway oscillating, collateral ventilation
The valve consists of a pipe-shaped device with a heavy steel ball sitting in an angled ___
Flutter valve, “bowl”
The pipe bowl is covered by a ________. When the patient exhales actively into the pipe, the ball creates a positive expiratory
pressure of between ____________. At the same time, the pipe angle causes the ball to flutter back and forth at about ____.
perforated cap, 10 cm H2O and 25 cm H2O, 15 Hz
