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CardioPulm Exam 2 > Exam 2: Airway Clearance Dysfunction > Flashcards

Exam 2: Airway Clearance Dysfunction Flashcards

1
Q

What is the life expectancy with CF?

A

40.6 y/o

mainly affects Caucasians of european decent

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2
Q

What is another name for CF?

A

genetic bronchiectasis

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3
Q

What are the general characteristics of CF?

A

due to genetic mutation of CFTR gene the sodium and chloride channels are switched

this pulls water into the airway walls- this makes mucus thick and sticky and destroys cilia

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4
Q

What happens to excess mucus in the airways?

A

pts will usually get an infection in this mucus stuck in airways resulting in inflammation of the airways due to immune response thus creating more mucus

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5
Q

What is another major complications from CF?

A

damage to pancreas leads to pancreatic insufficiency which is the pancreas not being able to produce enzymes to break down fat

without supplemental enzymes this usually leads to malnutrition

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6
Q

What are the 6 areas to focus on with patients with CF?

A
  1. airway clearance- get rid of mucus
  2. aerobic training- can be as effective as AC
  3. postural re-education- due to anterior hypertrophy
  4. anaerobic training
  5. strength training
  6. balance and urinary incontinence- due to increased abdominal pressure from coughing
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7
Q

Why is aerobic training effective in AC?

A

turbulent air moving during exercise helps mucus move proximally

it also switches the pumps back to normal

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8
Q

What other type of pathologies receive ACT?

A

bronchiectasis, chronic bronchitis, recurrent pneumonia, asthma, pneumonitis

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9
Q

What is airway clearance?

A

consists of removal of secretions or debris away from patients airways

no one way proven better than another

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10
Q

What are three types of ACT that are usually combined?

A

percussion, vibration and postural drainage

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11
Q

What are three airway devices used for ACT?

A

High Frequency Chest Wall Oscillation, Positive Expiratory Pressure, Oscillatory PEP: Flutter and Acapella devices

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12
Q

What are three additional types of ACT?

A

active cycle of breathing, autogenic drainage, forced expiratory technique: Huffing

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13
Q

What is the science behind percussion?

A

sends pressure waves into body help clearing mucus on chest wall

usually last 2-5 minutes, over a thin layer of clothes

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14
Q

What is vibrations?

A

shaking of the chest wall while a patient breaths out - called high frequency

low frequency called shaking

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15
Q

What is the literature on postural drainage by itself?

A

in pts with CF has been shown to move mucus very slowly

however with vibrations and percussions, has been the gold standard

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16
Q

What are possible side effects of percussions etc.?

A

increased intracranial pressure, short term decreased PaO2, decreased CO, short term decreased FEV1, hemoptysis, bronchoconstrcition, GERD, Dyspnea

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17
Q

What are some cardiac considerations with percussion etc.?

A

chest wall pain, unstable angina, hemodynamic instability, low platelet count, unstable arrhythmias

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18
Q

What are MS considerations with percussion etc?

A

osteopo, spinal fusions (acute), rib fractures, immediate post op thoracic surgery

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19
Q

What are pulmonary considerations with percussions etc?

A

hemoptysis, bronchospasm, severe dyspnea, pneumothorax

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20
Q

What other considerations with percussions etc?

A

cancer, skin grafts, burns, open wounds, thoracic infection

21
Q

What are positives with percussions etc.?

A

effective with all patients with all types of secretions, gold standard of ACT, can be done with home care in MA, increased adherence,
can be done with cognitively impaired or unconscious patients

22
Q

What are negatives with percussions etc.?

A

multiple side effects, pts can be indpt with treatment, may worsen bronchiectasis with GERD, time intensive

23
Q

What is the active cycle of breathing?

A

combination of several different techniques in phases designed to mobilize and clear secretions

24
Q

What are the three different techniques combined in active cycle of breathing?

A
  1. breathing control
  2. thoracic expansion
  3. forced expiratory technique
25
Q

What is the sequence in ACB?

A
  1. BC
  2. TE
  3. BC
  4. TE
  5. FET

then repeat

26
Q

What is breathing control in ACB?

A

diaphragmatic breathing for 30-60 seconds

27
Q

What is thoracic expansion?

A

tactile and verbal cues for lateral costal expansion for 15-30 seconds

28
Q

What is Forced expiratory technique?

A

to clear secretions, fog up window with 2-3 huffs then BC for 15 seconds then huff again if no secretions mobilized after 1st huffs

this keeps airways open

29
Q

What is FET excellent for?

A

decreasing the effort of chronic cough

30
Q

What are positives of ACB?

A

great for dz that produce secretions, effective in pts with bronchospasm, indpt and with no cost, less time intensive

31
Q

What are negatives with ACB?

A

FET can sometimes cause bronchospasm, pts must be cognitively able to do this, low adherence

32
Q

What is autogenic drainage?

A

self administered technique in which patients breath at different volumes to loosen, collect and evacuate secretions

33
Q

What are three components of autogenic drainage?

A
  1. loosening phase
  2. Collection phase
  3. Evacuation phase
34
Q

What is the loosening phase?

A

DB at tidal volumes for 30 seconds followed by pt breathing at low lung volumes with one second inhalation holding a 2-3 second breath at top of each inspiration

mobilizes secretions from distal airways

35
Q

What is the collection phase?

A

breath in for 2 seconds and hold for 2-3 seconds

breathing becomes deeper and moves into mid lungs and secretions are mobilized from mid sized airways

36
Q

What is evacuation phase?

A

breathing becomes deeper with 3 second inhalation and long exhalation

secretions being collected in central proximal airways

37
Q

What are positives for autogenic drainage?

A

technique works with all dz that produce secretions, effective in pts with bronchospasm, indpt with no costs, effective technique yields tremendous results

38
Q

What are negatives for autogenic drainage?

A

can cause bronchospasm, difficult to learn, may cause dyspnea when first learning, low adherence

39
Q

What is High Frequency Chest Wall Oscillation?

A

HFCWO, the “vest” cost around 16,000$

40
Q

How does the vest work?

A

pressure from vest moves secretions towards proximal airways, also thins out mucus

41
Q

What are the settings for the vest?

A

frequency between 12-16 Hz

time is 20-30 mins

42
Q

What is most important thing to remember with the vest?

A

this should not be done as a passive treatment, should stop every 3-5 mins to cough pr perform huff/FET

43
Q

What are positives of the vest?

A

typically well tolerated, effective for maintenance of chronic secretions, easy to use

44
Q

What are negatives of the vest?

A

expensive, decreased adherence over time, used as passive tx, less portable

45
Q

What is Positive Expiratory pressure?

A

the pt breaths against 10-20 cm H20 pressure with mask or mouth piece

pressure stabilizes airways preventing collapse

46
Q

What is important of posture during PEP?

A

if relaxed on elbows it will relax muscles of breathing

47
Q

What is method of PEP?

A

pt performs Dia breathing followed by 2-3 breath hold, then exhales through the device keeping pressure between 10-20 cm

10-20 breaths performed then Huff/FET

cycle repeated 3-5 times

48
Q

What population does PEP work well with?

A

post op pts with atelectasis, dz with both acute and chronic secretions, obstructive dz with trapped air

CardioPulm Exam 2 (6 decks)

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