Methods to Clear Secretions Flashcards
Cough
- Necessary for eliminating repiratory obstruction and keeping the lungs clear
- May be reflexive or voluntary
- Effective to the 7th generation of bronchi
- Ciliated cells in bronch raise secretions so they can be cleared with a cough
Mechanism “cough”
- Deep Inspiration
- Closure of glottis (elongated space between vocal cords)
- Contraction of mm’s of chest wall, abdoment, and pelvic floor to increase intrathoracic and intra-abdominal pressure
- Glottis opens
- Rapid expulsive exhalation
Factors that decrease cough effectiveness
- Decreased inspiratory capacity
- Inability to forcibly expel air
- Decreased action of cilia
- Increase in the amount or thickness of mucus
Decreased inspiratory capacity secondary to
- Pain, rib fracture, chest trauma, recent thoracic or abdominal surgery)
- Specific mm weakness affecting diaphragm or accessory mm’s of inspiration
- Respiratory depression (associated general anesthesia or pain meds)
Inability to forcibly expel air secondary to
- SCI above T12
- Myopathic disease and weakness
- Tracheostomy
- Critical illness resulting in excessive fatigue
- Chest wall or abdominal incision
Decreased action of cilia secondary to
- General anesthesia and intubation
- COPD associated with decreased number of ciliated epithelial cells
- Smoking
Increase in the amount or thickness of mucus caused by
- Cystic fibrosis
- Chronic Bronchitis
- Pulmonary Infections
- Dehydration
- Intubation
Teaching and effective cough
- Relaxed comfortable position, sitting straight up or leaning forward is usually best position, head/neck should be neutral or slightly flexed
- Demonstrate sharp, deep double cough and proper abdominal mm action
- Have pt place hands on abdomen and perform 3 huffs to feel contraction of abdominal mm’s
- Have pt practice making K sounds to experience tightening of vocal cords, closing glottis, and contracting abdominal mm’s
- Can be asked to protrude tongue while coughing to clear airway and have less resistance to air expulsion
- When all actions have been put together, ask pt to take a deep but relaxed inspiration, followed by a sharp double cough
Precautions
- Never allow pt to suck air in by gasping
- Avoid uncontrolled coughing spasms
- Avoid forceful coughing with pt’s who have history of CVA or aneurysm, use huff instead
- Be sure pt coughs in somewhat erect posture
Gasping
- Increases work
- Causes fatigue
- increase turbulence and airway resistance, which can cause bronchospasm and may push mucus or foreign object deep into airway
Patients with incision or pain should be instructed to _____ area with pillow or blanket held firmly over area
- Splint
Postop pts who tend to spling may repond better to a series of __ coughs - a small breath followed by small _____, a _______ breath followed by a harder ______ and finally a really deep breath and a _____ cough
- 3
- cough
- bigger
- cough
- hard
Asthmatics who tend to _____ the ______ phase almost into a _____ can be instructed not to _____ but say ha ha ha ha
- Prolong
- Expiratory
- Wheeze
- Cough
Emphysema pt’s who tend to ____ air generally ____ more effectively with lower volumes and less _____ techniques, a really ____ breath and _____ cough may ______ air trapping and exhaust them
- Trap
- Cough
- Stressful
- Deep
- Hard
- Increase
Pt’s with air trapping, _____ coughing may be beneficial, ask pt to give ___ short easy _____ (kuh kuh kuh) and then 3 ____ (huh huh huh) in a very breathy manner
- Pump
- 3
- Coughs
- Huffs
