Mucus Clearance Flashcards
What is responsible for mucus clearance in healthy people?
The mucociliary escalator
Acute diseases can affect the efficacy of the mucociliary escalator. How are secretions cleared then?
Coughing is the primary mechanism for removing mucus
The huff cough is performed by taking several deep diaphragmatic breaths then squeezing the abdominal and thoracic muscles against a closed glottis and then forcefully coughing
False. The huff cough is performed by patients taking several deep breaths and then contracting their abdominal and thoracic muscles with the glottis and mouth open
Patients affected by neurological muscle disorders or paralysis can benefit from what?
Manual assisted cough
Place hands over diaphragm and have patient breath deeply, then coordinated their exhalation with pressure applied by the caregiver on the diaphragm
This breathing technique utilizes periods of relaxed diaphragmatic breathing followed by several deep breaths followed by huff coughing
Active cycle of breathing
The mechanical cough assist provides negative pressure solely during exhalation in order to assist a patient cough
False. The MIE device provides positive pressure during inhalation and negative pressure during exhalation in order to help stimulate a cough
Mechanical cough assist devices are suitable for patients with
Trauma
Muscular dystrophy
Myasthenia gravis
Poliomyelitis
Spinal cord injury
The cough assist provides positive and negative pressures of up to 30/-30 cm of water
False. The MEI provides positive and negative pressures of up to 60/-60 cm of water
How much inspiratory flow can an MIE device generate?
An MIE device can generate between 3.3 and 10 L/sec
The MIE cannot operate independently and must be manually actuated by an RT
False. The MIE can operate independently and manually
The MIE is not suitable for patients with and ET tube or Tracheostomy tube
False
The MIE can be administered with an oronasal mask, a mouthpiece, and ET tube or a tracheostomy tube
Would the MIE be suitable for patients suffering from active gross hemoptysis?
No.
What are the contraindications for MIE use?
Untreated pneumothorax
Hemodynamic instability
Intercranial pressures greater than 20 mmHg
Recent maxillofacial and skull surgery/trauma
Known or suspected tympanic membrane rupture
Describe bullous emphysema
Bullous emphysema is a condition characterized by damaged alveoli that distend to form large air spaces, especially in the uppermost portions of the lungs
What are hazards of using a cough assist device?
Bullous emphysema, known susceptibility to pneumothorax
Recent barotrauma
Individuals prone to airway closure (COPD)
Percussion, forced exhalation and postural drainage are all examples of what?
A Conventional chest physiotherapy
What is the clinical application for postural drainage?
Excessive sputum production that a patient is having difficulty clearin
v
Palpation-uneven thoracic movement
Percussion-area would sound dull
Xray-could potentially show a consolidation
The patient has secretions in their upper lobes in the anterior segments. What position should they be put in to optimize drainage? Where should the percussions be performed?
Supine
Pectoral region below the clavicle
A patient has secretions in the posterior segments of their upper lobes. How should you position them for optimal drainage? Where should the percussions be performed?
Sitting up, pillow in lap and bending forward as far as possible with arms out in front of them
Upper portion of the back between the shoulder blades
A patient has secretion in the apical segments of their upper lobes. How should they be positioned for chest PT? Where should the percussions be performed?
Sitting upright if possible, supported from the back with pillows, arms forward and hands on knees
Percussions should be performed on either side of the spine slightly above the shoulder blades
A patient has secretions in their lingula. How should they be positioned to optimize drainage? Where should percussions be performed?
They should be positioned in trendelenburg laying on their right side with the left side of their rib cage exposed
Percussions should be performed on the lower left anterior side of the rib cage below the pectoral
A patient has secretions in their right middle lobe. How should they be positioned to optimize drainage? Where should percussions be performed?
Trendelenburg, laying on their left side with right arm positioned out of the way
Percussions should be performed on the lateral middle section of the right side of the ribcage
A patient has secretions in the anterior segments of their lower lobes. What position should they be in to optimize drainage? Where should the percussions be performed?
Trendelenburg, on their right side
Percussions should be performed on the lower lateral portion of the left side of the rib cage
A patient has secretions in the posterior basal segment of the lower lobes. What position should they be in to optimize drainage? Where should the percussions be performed?
Trendelenburg, prone. Tilt thorax according to which side has secretions.
Percussions should be performed on the lower posterior portion of the ribcage
A patient has secretions in the lateral basal segments of the lower lobes. What position should they be in to optimize drainage? Where should the percussions be performed?
Trendelenburg. On the side opposite to the affected region
Percussions should be performed on the lower lateral region of the rib cage
A patient has secretions in the superior segments of the lower lobes. What position should they be in to optimize drainage? Where should the percussions be performed?
Prone, with a pillow under the hips
Percussions should be performed between and slightly below the shoulder blades
T/F: For cystic fibrosis and bronchiectasis, the caregiver should perform 1-2 minutes of percussions per affected region.
False. For CF and bronchiectasis the caregiver should provide 5 minutes of percussion for each affected region
How should you guide a patient to breathe during vibrations?
Inhale slowly and deeply. Coordinate patients breathing with vibrations and pressure. Have patient slowly exhale through pursed lips
Following chest PT, what should you instruct the patient to do?
Rest and take diaphragmatic breaths while trying to cough using abdominal muscles to expectorate secretions
T/F: When performing percussion, your hand should be balled up into a fist to ensure efficient energy transference into the patient
False. The percussion should be formed with a cupped hand, as if you were holding water, with the palm facing down
The cupped hand curves to the chest wall and traps a cushion of air to soften the blow]
Sounds kind of like a horse galloping
Which areas should you NOT perform percussion over?
Spine
Sternum
Stomach’
Lower ribs or back to prevent injury to the speel on the left, the liver on the right and the kidneys in the lower back
When should chest PT/PD not be performed?
After meals
When a patient is nauseous
When a patient cannot tolerate percussion or the positioning
Trendelenburg can be extremely uncomfortable for some patients
OPEP devices are designed to
Use oscillatory positive pressure to loosen secretions while performing LET
Why are OPEP devices useful for patients with difficulty clearing secretions?
The airflow oscillations create turbulence with a shearing effect on the secretions adhering to airway walls
Shear forces can also decrease the viscoelastic properties of mucus making it easier to mobilize
T/F: A OPEP can not be used with a tracheostomy tube
False. An OPEP device can be used with a mouthpiece, tracheostomy tube and a oronasal mask (resuscitation mask)
T/F: Patients performing OPEP should take slow, very deep breaths and perform and end inspiratory breath hold for 2-3 seconds prior to exhaling through the device
False. The patient should slowly take a breath slightly greater than tidal volume and perform an end inspiratory breath hold for 2-3 seconds before exhaling through the device
T/F: One cycle with the OPEP consists of 5 breaths through the device
False. One cycle consists of 6-10 breaths through the device
What should follow each cycle of exhalations through the OPEP device?
Huff cough and breathing control
1-3 hugg coughs depending on the fatigue level of the patient
How many cycles should an OPEP treatment consist of?
6-10 cycles
What are the hazards associated with OPEP?
May increase the WOB
Risk of claustrophobia
Minimal risk of gastric distention
What are the advantages of OPEP?
Easy to use
Patients can use them independently
Not time consuming
Cheap
List common OPEP devices
Flutter
Coranet
VPEP
Aerobika
Quake
Acapella
This OPEP device uses a counterweight and a magnet to incorporate a wide range of flow rates
Acapella
This OPEP device uses a steel ball to interrupt air flow as the patient exhales
Flutter
This OPEP device uses a flexible piece of tubing inside a shaft which whips back and forth randomly as the patient exhales through the device
Coronet
The metaneb provides what kind of ventilation to the patient?
Intrapulmonary percussive ventilation
T/F: The metaneb operates pneumatically at 20-30 psi to deliver small bursts of high flow gas at 100-300 cycles per minute
False. The metaned pneumatically operates at 50 psi to deliver small bursts of high flow gas at 100-300 cycles/min
T/F: The metaned operates pneumatically at 50 psi to deliver small bursts of high flow gas at 300-500 cycles per minute
False>The metaned pneumatically operates at 50 psi to deliver small bursts of high flow gas at 100-300 cycles/min
Airflow bursts from the metaneb can result in airway pressure changes of ….?
5-35 cm of water
Describe the ways that the Metaneb aids in secretion clearance
The fast bursts provided by the metaneb loosens and frees mucus from the airway walls
The metaneb delivers a mist to make mucus less sticky
The high flow rate encourages deep breather which helps air to get around and behind trapped mucus
Describe the effects of the metaneb on secretions during inspiration
The metaneb creates shear forces that loosen secretions from the airway walls
Describe the effects of the metaneb on secretions during expiration
Creates asymmetrical flow pattern that augments the movement of secretions in a cephalad direction
The MetaNeb is effective because it allows patients to simultaneously recieve:
LET
Mucus Clearance
Aerosol therapy
T/F: Patients with COPD should not be put on the Metaneb
False. The Metaneb can be used to deliver aerosolized bronchodilators to COPD patients
When giving a metaneb treatment, the caregiver should switch between (blank) and (Blank) every 2.5 minutes
CPEP and CHFO
T/F: A Metaneb can be used with a mouthpiece, oronasal mask, or a tracheostomy tube
True
When using a metaneb, how should the patient breath?
The patient should inhale normally and exhale slowly through the mouthpiece or mask
What can be done if the resistance is too high and the patient is becoming fatigued?
The resistance can be adjusted on near the mouthpiece by changing the resistance setting. 3 dots is the highest resistance and 1 dot is the lowest resistance
How many cycles of CPEP should a patient receive in a singular metaneb treatment?
2 cycles of CPEP and 2 cycles of CHFO
List relative contraindication for IPV
Increased intracranial pressure
TE fistula
Hemodynamic instability
Active hemoptysis
nausea
You are about to give a patient a metaneb treatment and they mention that they are feeling nauseous, what should you do?
Assess their vitals and give them some time to start to feel better. Report that they were nauseous and you are concerned about potential aspiration
T/F: An untreated pneumothorax is a relative contraindication for IPV therapy
False. An untreated pneumothorax is an absolute contraindication for IPV therapy
T/F: The vest generates positive transrepiratory pressure by compressing the chest externally to cause short, rapid expiratory flow pulses
False. The vest generates negative transrepiratory pressure by compressing the chest externally to cause short, rapid expiratory flow pulses
How does the vest generate short bursts of expiratory flow?
By rapidly inflating and compressing the thorax creating a short expiratory burst and then rapidly deflating allowing elastic recoil to return the lungs to their FRC
The vest has 2 frequencies ranges. What is the goal with low frequencies?
Loosen secretions from the walls of the conducting airways
The vest has 2 frequencies ranges. What is the goal with mid-level frequencies?
Mobilize secretions in cephalad direction toward central airways
What is the range of inflation pressures for the HFCWC?
5-20 cm of water
T/F: Use of the vest can lead to hypoventilation and hypercarbia
True
Hazards associated with HFCWC and HFCWO include
Increased WOB
Cardiovascular compromise
Pulmonary barotrauma
Skin irritation
This device utilized a chest cuirass to generate biphasic changes in transrepiratory pressure
HFCWO
The HFCWO can be used to simulate a cough and propel secretions towards the oropharynx. What else can the HFCWO device be used for
Allow for control of inspiration and expiration ie non invasive ventilatory support
Contraindications for HFCWC and HFCWO include
Untreated pneumothorax
Hemoptysis
Hemodynamic instability
Intracranial pressure greater than 20 mmHg
Chest or spinal trauma
Surgical incision or trauma to thorax
The best position for a patient taking a jet nebulizer treatment is
Sitting up
The highest pressure a positive expiratory therapy device (PEP) can deliver is
20 cm of water
T/F: Mechanical cough-assist devices should be used on patients with acute illnesses
False
The procedure for an Active Cycle of Breathing
Huff coughs at low volume followed by Huff coughs at a high volume
OPEP devices combine positive pressure with airway vibrations or oscillations during
Exhalation
T/F: During high-frequency chest wall compression (HFCWC) (the Vest) treatment positive or negative pressure pulses or both, get air behind secretions and move them toward the larger airways, where they can be coughed up and expectorated
True
The typical high-frequency chest wall compression (HFCWC) (the Vest) treatment lasts
15-30 minutes
T/F CPAP can be applied invasively
True
Mr. E. is recovering from an pneumonectomy. The physician orders lung expansion therapy (LET). Which LET therapies could the respiratory therapist choose?
Incentive spirometry
Diaphragmatic breathing
Segmental breathing
A patient is wheezing, with coarse crackles and diminished breath sounds. The most efficient way to treat this patient would be with
Metaneb
T/F Bradypnia is a sign of atalectasis
False. Tachycardia is a sign of atelectasis
A post operative chest surgery patient has a weak cough and decreased breath sounds the therapist could try
Teaching patient to huff cough
IS
PEP
During a huff cough the therapist directs the patient to
Take 3 to 5 slow deep breaths by inhaling through the nose exhaling through pursed lips, and using diaphragmatic breathing. Then take a breath and squeeze it out by contracting the abdominal and chest wall muscles with the mouth open during exhalation.
T/F: During diaphragmatic breathing your abdomen expands during exhalation
False
During a directed cough the therapist directs the patient to
Take a deep breath, hold the breath, and use the abdominal muscles to force air against a closed glottis, then cough with a single exhalation
An elderly weak female patient with chronic obstructive pulmonary disease has a peak inspiratory flow of 20 L/min. The physician wishes to order a bronchodilator with a steroid BID (twice a day). The respiratory therapist recommends a(n):
Small Jet neb
A disadvantage of aerosol drug delivery includes
Higher systemic side effects
T/F: Incentive spirometry may be a volume or flow device
True
When initiating an incentive spirometry treatment, a respiratory therapist should instruct a patient to
Inhale slowly and deeply
Intrapulmonary percussive ventilation (IVP) clearance devices
Create positive changes in transrespiratory pressures to produce high frequency oscillations in the airways.
Mr. E. is recovering from an pneumonectomy. The physician orders lung expansion therapy (LET). Which LET therapies could the respiratory therapist choose
Incentive spirometry
Diaphragmatic breathing
Segmental breathing
What situations can cause atelectasis?
recent chest surgery
Are on bed rest
Have a poor cough
Have a history of lung disease
Have a neuromuscular disorder
A patient is wheezing, with coarse crackles and diminished breath sounds. The most efficient way to treat this patient would be with:
Metaneb therapy
Signs and symptoms of atelectasis include
Increased density and signs of volume loss on x-ray
Fine late-inspiratory crackles
Diminished breath sounds
Tachycardia
A patient has diminished breath sounds and coarse rales on auscultation. The therapist should choose a(n)
OPEP device
During a huff cough the therapist directs the patient to:
Take 3 to 5 slow deep breaths by inhaling through the nose exhaling through pursed lips, and using diaphragmatic breathing. Then take a breath and squeeze it out by contracting the abdominal and chest wall muscles with the mouth open during exhalation.
High frequency chest wall oscillation devices (HFCWO) also known as mechanical insufflation-exsufflation devices:
Use a rigid external enclosure or chest cuirass connected to a compressor.
A high flow chest wall oscillation (HFCWO) device may be used for noninvasive ventilation.
True
Mr. C. has an order for right lower lobe lateral basal segment chest physical therapy postural drainage (CPT/PD). How should the respiratory therapist position Mr. C. to receive treatment? Mr. C. should be:
In Trendelenburg on his left side.
Choose all that apply. A neuro-muscular patient with decreased breath sounds and secretions who is unable to cough effectively should be treated with
Cough assist
HFCWO
Oscillatory positive expiratory pressure (OPEP) devices:
Combine positive pressure during exhalation with airway vibrations.
During diaphragmatic breathing your abdomen expands during exhalation
False
During a directed cough the therapist directs the patient to
Take a deep breath, hold the breath, and use the abdominal muscles to force air against a closed glottis, then cough with a single exhalation
The interfaces for mechanical cough assist devices include
Mouth piece
Connection to a tracheotomy tube
Oronasal mask
A respiratory therapist can determine which segments of the lungs need lung expansion or mucous clearance therapy through
A physician’s order
Auscultation
Palpation
Percussion
Chest X-ray
Ms. D. has an order for chest physical therapy postural drainage (CPT/PD) to the lower lobes superior segments. How should the respiratory therapist position Ms. D. to receive treatment? Ms. D. should be:
Lying prone with the bed flat and a pillow at the hips.
A cystic fibrosis patient has a strong cough and thick secretions, the therapist should recommend:
HFCWC therapy
or chest PT
