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CPT Flashcards

1
Q

What does ACT stand for?

A

airway clearance techniques

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2
Q

define ACT

A

manual or mechanical procedures that facilitate mobelization and clearance of secretions from the air ways

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3
Q

name the different ACT (6 techniques)

A

-postural drainage
- percussion
-vibration
-cough techniques
-manual hyperinflation
-airway suctioning

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4
Q

What are the goals of ACT? (3 goals)

A

-optimize airway opening or unobstruction
-prmote alveolar expansion and ventilation
-increase gas exchange

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5
Q

What is the indication for trying to optimize airway openings or un-obstruction?

A

exessive pulmonary secretions

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6
Q

When would promoting alveolar expansion and ventilation be a goal?

A

when a pt has an ineffective or absent cough

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7
Q

increasing gas exchange is a goal for pt with

A

impaired mucociliary transport

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8
Q

how can you facilitate the mobelization of secretions?

A

by using one or more airway clearance
techniques with acutely ill patients

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9
Q

Why is it important to examine the pt before, during, and after treatment (monitoring VS)?

A

to judge the
patient’s tolerance and the treatment’s effectiveness

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10
Q

Can ACT be performed right after the pt is done eating?

A

No, ACT should be performed before or at least 30 minutes after the end of a meal or tube feeding (tube feedings should be interrupted ahead of intervention).

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11
Q

Why is it advised that Pain control and inhaled bronchodilator medications be given before ACT?

A

to enhance the outcome of the TX

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12
Q

Inhaled antibiotic medications will have a better affect when they are given before or after ACT?

A

they have a better affect after the procedure

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13
Q

what is the purpose of postural drainage (PD) ?

A

to mobilize secretions and ASSIST with draining them from each lung segment, but it does not clear them out

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14
Q

What is PD?

A

it is the assumption of 1 or more body positions that allows gravity to assist with draining
secretions from each of the patient’s lung segments

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15
Q

How does PD drain secretions from the lung?

A

by arranging the bronchus to be perpendicular to the floor and using gravity to drain them

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16
Q

what can be done when a patient presents with a condition that qualifies as a
precaution or relative contraindication to PD?

A

The PD positions can be modified when

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17
Q

How long does each position have to be maintained if PD is used exclusively?

A

5 to 10 minutes or longer if tolerated

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18
Q

What segment should be given priority to be treated first?

A

the most affected lung segments

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19
Q

What should the pt be encouraged to do while in the PD position and between positions?

A

-to take a deep breath in the PD position
-to cough between poitions as secreations are mobelized (or sucction)

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20
Q

What are the safety precaustions for PD? (there are 5)

A

-massive obesity
-massive ascites
-large pleural effusion
-pulmonary edema
-hemoptysis

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21
Q

What are some PD contraindications? (7 contraindications)

A

-recent eye surgery
-recent head trauma
-recent spinal fusion or injury
-recent esophgeal anastomosis
-increased intercranial pressure
-hemodynamically unstable
-diaphragmatic hernia

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22
Q

What is the aim of chest percussion?

A

loosening retained secretions, which can be performed manually or with a mechanical device

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23
Q

Explain how manual chest percussion is performed?

A

it is done by rhythmical clapping with c-cupped hands over the affected lung segment

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24
Q

true or false

Mechanical percussion has been found to be similar in effectiveness to manual percussion

A

true

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25
Q

true or false

Percussion should be performed during inspiration and expiration

A

true

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26
Q

What is the rate of chest percussion per minute?

A

100-180 time per minute

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27
Q

What is the amount of force needed when performing chest percussion?

A

The amount of force need not be excessive and should be adjusted to promote patient comfort

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28
Q

What areas should be avoided during chest percussion?

A

Clapping on bony prominences should be avoided

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29
Q

what are the different ways vibration can be performed?

A

manually or a mechanical device

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30
Q

What is the hand placment for performing vibration?

A

The palmar aspect of the hands are in full contract with the patient’s chest wall, or one hand may be overlapping the others

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31
Q

Is vibration applied at the end of expiration or inspiration?

A

At the end of a deep inspiration (so your hands would move in with expiration)

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32
Q

In what cases could vibration be a useful alternative to percussion?

A

in acutely ill patients whith chest wall discomfort or pain

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33
Q

What are some precautions to take for percussion and vibration?

A

-anxiety
-rib fracture
-osteoporosis
-coagulopathy
-RECENT pacemaker replacement
-tumor obstruction of airways
-metastatic cancer of ribs
-conclusive or seizure disorder
-uncontrolled bronchospasm

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34
Q

What are some contraindications to take for percussion and vibration?

A

-hemoptysis
-pulmonary embolism
-recent skin grafts or flaps on thorax
-subcutaneous emphysema
-open wound, burns in the thoracic area
-unstable hemodynamic status
-untreated tension pneumothorax

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35
Q

a cough can be one of two types

A

voluntary or reflexive

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36
Q

If retained secretions remain untreated, what can they progress to?

A

-atelectasis
-hypoxmia
-pneumonia
-potentially respiratory failure

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37
Q

What is the first stage of an effective cough?

A

-an inspiration greater than tidal volume (deep breath)

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38
Q

what is the second stage of an effective cough?

A

-the cloture of glottis (hold)

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39
Q

What is the third stage of an effective cough?

A

-the abdominal and intercostal muscle contract (creating positive intra-thoracic pressure)

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40
Q

What is the fourth stage of an effective cough?

A

-sudden opening of the glottis and the forceful expulsion of the inspired air

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41
Q

what should the patient do along with a deep inspiration in order to have an effective voulntary cough?

A

-trunk extension
-momentary hold
-a series of sharp expirations while the trunk moves into flexion

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42
Q

what is a safety precaution that should be taken when teaching a patient with surgicla incisions how to effectively cough?

A

-the incisions should be splinted with a pillow or a rolled towel (during the expiratory phase)

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43
Q

how is huffing done?

A

a deep inhale that is expelled by saying “haa”

44
Q

huffing could be used for patient with …

A

a weak cough

45
Q

If a patient lacks the ability to contract their abdominal muscles to cough, where do they get the force to exhale air?

A

they get the force to exhale from the therapists hand, which is a type of assisted coughing

46
Q

name a type of reflexive cough technique

A

tracheal tickle / stimulation

47
Q

how is a tracheal tickle done?

A

the application of a quick inward and downward pressure on the trachea at the suprasternal notch to elicit a cough reflex

48
Q

What are the different coughing techniques?

A

-active effective cough
-assisted cough
-tracheal tickle (reflexive)
-active breathing cycle (forced expiratory technique)

49
Q

What are some mechanical devices for airway clearance?

A

-mechanical chest vibrator
-insufflator-exsuflflator
-high-frequency chest wall oscillation (HFCWO)
-vibratory (ascillating) positive expiratory pressure (acapella, flutter)

50
Q

What are some devices used to give vibratory (ascillating) positive expiratory pressure?

A

-acapella
-flutter

51
Q

What airway clearance device is gravity-dependent?

A

flutter

52
Q

In the acapella device, what happens the closer the magnet gets to the plug?

A

more expiratory resistance, PEP and amplitude are generated

53
Q

what instructions are given to a pateint for using a flutter device?

A

-they should sit straight with back slightly extended
-inhale 2-3 times greater than normal
-place flutter on mouth perpindicular to the floor
-exhale twice the flow of a normal exhalation
-then let the pt take some loosening breaths (deep breath, hold 2-3 sec, exhale through the device)

54
Q

mention some breathing strategies? (there are 8)

A

-pursed lip breathing
-paced breathing
-stacked breathing
-diaphragmatic controlled breathing
-upper chest inhibiting technique
-lateral costal (segmental) breathing
-thoracic mobelization (expansion) techniques
-butterfly technique

55
Q

What are the effects of pursed lip breathing?

A

-decrease patient’s symptoms of
dyspnea.
-It slows a patient’s respiratory rate
-decreasing the resistive pressure drop across the airway, thus decreasing airway collapse during expiration.

56
Q

Where does airway collapse during expiration occur?

A

in the advanced stages of COPD

57
Q

How is pursed lip breathing done?

A
  • inhale through the nose for a couple of seconds with the mouth closed
  • exhale slowly over 4-6 sec through the lips held in a whistling or kissing position
58
Q

define paced breathing

A

“volitional coordination of breathing during activity.”

59
Q

What is the strategy of paced breathing during rythmic activities compared to non-rythmic activities?

A

-During rhythmic activities, breathing can be coordinated with the rhythm of the activity
-During nonrhythmic activities, the patient can be instructed to breathe in at the beginning of the activity and out during the activity.

60
Q

a breathing technique that can be combined with pursed lip breathing or diaphragmatic breathing

A

paced breathing

61
Q

what can paced breathing help with?

A

control RR and associated feelings of dyspnea in an acute care setting

62
Q

What is stacked breathing?

A

a series of deep breaths that build on top of the previous breath without expiration until a maximal volume tolerated by the patient is reached.

63
Q

In stacked breathing, each inspiration is accompanied by …

A

a brief inspiratory hold

64
Q

What is the purpose of diaphragmatic breathing?

A

decrease accessory muscle use and increase recruitment of the diaphragm.

65
Q

What are the different ways (cues) used to teach a patient how to perform diaphragmatic controlled breathing?

A

-verbal cues
-tactile cues

66
Q

What is the easiest postion to do diaphragmatic controlled breathing?

A

supine (pt should be instructed on how to do this technique in all positions)

67
Q

In diaphragmatic controlled breathing, what position can help facilitate the use of the diaphragm?

A

posterior pelvic tilt

(ICU pt: a towel roll under the patient’s ischial tuberosities)

68
Q

What are the three diaphragmatic controlled breathing techniques?

A

-verbal and tactile cues
-the sniffing technique
-the scoop technique

69
Q

For the sniffing and scooping techniques of diaphragmatic controlled breathing, how should the pt be positioned?

A

-gravity eliminated, either side lying or semi-fowler position with a posterior pelvic tilt

70
Q

In diaphragmatic controlled breathing, why should the patient’s hands be positioned on the abdomen?

A

for proprioceptive feedback

71
Q

What is the progression of the sniffing technique?

A

-sniff 3x then exhale slowly (observe for abdominal rise- give feedback)

-sniff 2x and exhale slowly

-progress to 1 slow sniff

72
Q

The sniffing technique is used for what types of patients?

A

ICU patients with incisions, lines, and drains

73
Q

How is the scooping technique performed?

A

-after exhalation, the therapist scoops the hand up and under the anterior thorax, (giving a slow stretch)

-then, instructs the patient to “breathe into my hand“ during inhalation, you will resist the patient’s belly expansion

73
Q

In the scooping technique, the therapist places a hand on the patient’s abdomen and allows two to three breathing cycles to occur. Why is that?

A

to become familiar with the patient’s breathing pattern

73
Q

How many times should the scooping technique be performed?

A

two or three sets of 10 repetitions once or twice a day

73
Q

What is the order of diaphragmatic controlled breathing techniques, from most difficult to least difficult?

A

-verbal and tactile cuing
-the sniffing technique
-the scoop technique

74
Q

What can the upper chest inhibiting technique help with?

A

it can help recruit the diaphragm during inhalation

75
Q

When should the upper chest-inhibiting technique be used?

A

should be used only after other techniques have been attempted

76
Q

What is the patient’s position for performing lateral costal breathing?

A

side-lying position with the involved side up
-arm on the involved side into an abducted position to the level of the head

77
Q

How is lateral-costal breathing performed?

A
  • therapist gives a stretch before inspiration
    -continues giving resistance through the inspiratory phase
    (stretch then continue the pressure)
78
Q

What is a contraindication for lateral costal breathing?

A

partial or whole lung removal forbidden from lying on that side

79
Q

How is bilateral chest expansion performed?

A

patient in a semi-reclined or sitting position, where the therapist places both hands on the lateral aspects of the rib cage and gently applies pressure against the ribs during inspiration (patient can also be taught to perform this exercise independently)

80
Q

Who are thoracic mobelization (expansion) techniques used for?

A

patients with restricted thorax mobility

81
Q

Why is it necessary to incorporate simple thoracic mobilization techniques for patients with restricted thorcic mobility?

A

to increase the ability of the thorax to expand during breathing

82
Q

(thoracic mobelization)

How can the mobility of the anterior chest wall be improved?

A

Placing a towel roll vertically down the thoracic spine while the patient is in a supine position

83
Q

(thoracic mobelization)

How can the mobility of the lateral chest wall be improved?

A

Placing the patient in side-lying over a towel roll

84
Q

What can be added to each thoracic mobelization position to increase mobility of the chest wall?

A

upper extremity movement (passivly or actively)

85
Q

How is the buttefly technique performed?

A

the therapist breathes audibly with the patient. With inhalation, the therapist brings the patient’s arms into increased shoulder flexion and lowers the arms during exhalation

86
Q

Why does the therapist slow the audible breathing pattern and the facilitation of shoulder movement in the butterfly technique?

A

to encourage an increased tidal volume and decreased respiratory rate (MV= RRxTV)

87
Q

The therapist can incorporate diagonal movements while doing butterfly technique, what does It do?

A

Facilitates intercostal and oblique abdominal muscles contraction

88
Q

What is the difference between mechanical devices for airway clearance and inspiratory muscle training devices?

A

-airway clearance devices are used during expiration to clear airways

89
Q

What are the indications for using IMT devices?

A

patients who exhibit signs and symptoms of decreased strength or endurance of the diaphragm and intercostal muscles

90
Q

What are some signs that indicate decreased strength or endurance of the diaphragm and intercostal muscles?

A

-decreased chest expansion
-decreased breath sounds
-decreased tidal volumes
-uncoordinated breathing patterns
-shortness of breath
-bradypnea

91
Q

Patients with respiratory muscle weakness or fatigue may have such diagnoses as?

A

-COPD
-acute spinal cord injury
-Guillain—Barré syndrome
-amyotrophic lateral sclerosis (ALS)
-patients on mechanical ventilation to improve weaning from ventilation

92
Q

what is the goal of IMT?

A

to increase the ventilatory capacity and decrease dyspnea

93
Q

What does the overload principle that applies to endurance muscle training require?

A

low loads over a long period of time (spicifically refers to training the muscles for the function they are to perform)

94
Q

In muscle endurance training, what does reversibility mean?

A

it is the loss of effects (of training) over time if training is discontinued

95
Q

Why does weakness of the diaphragm lead to a decrease in the air inhaled?

A

because weakness of the diaphragm decreases the negative inspiratory pressure

96
Q

How much of the diaphragm’s strength is lost daily while the patient is on mechanical ventilation?

A

5%

97
Q

How is the resistance of IMT devices increased?

A

by decreasing the radius of the device’s airway

98
Q

at high level resistance, IMT devices could have adverse affects, name some

A

-dyspnea
-drop in O2 saturation

99
Q

how long is an IMT sesseion?

A

15-30 min twice a day

100
Q

name some IMT devices

A

-the P-flex
-threshold

101
Q

What are the uses of an incentive spirometer?

A

-practice diaphragmatic breathing
-stimulate a cough
-replenish surfactant which is lost due to atelectasis

102
Q

How often should the patient use an incentive spirometer?

A

10x every hour (to replenish surfactant)

103
Q

What is the instruction given to a patient on how to use an incentive spirometer?

A

deep, slow, and relaxed inspirations through the mouth piece

104
Q

Early mobilization has been shown to be as effective as deep breathing exercises after what surgeries?

A

gallbladder and cardiac bypass surgery

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