P7 - Gas Exchange 2 (Basic Adjuncts) Flashcards
What are the primary goals of positioning/mobility in respiratory care?
Increase lung volumes and optimize ventilation/perfusion (V/Q) ratio.
What is ACBT and what techniques can be added to enhance its effectiveness?
Active Cycle of Breathing Technique (ACBT) is a breathing exercise that can be enhanced by adding holds and sniffs to deep breaths.
What manual techniques can physiotherapists perform for patients with sputum retention?
Percussion, vibrations, and shakes.
What is the main function of a flutter device in airway clearance?
It aids sputum clearance by producing oscillations and positive expiratory pressure (PEP).
Which respiratory conditions can benefit from the use of a flutter device?
COPD, Asthma, Bronchiectasis, and Cystic Fibrosis (CF).
What is the PEP range generated by the flutter device?
10-25 cm H2O.
Name two conditions where the flutter device is contraindicated.
Undrained pneumothorax and large bullae.
Describe the correct technique for using a flutter device.
Sit comfortably, inhale through the nose beyond normal tidal volume, then exhale through the flutter device with lips tightly sealed around the mouthpiece for 10-15 breaths, followed by FET (Forced Expiratory Technique) and coughing to clear secretions.
What are the primary uses of an incentive spirometer?
To prevent atelectasis, encourage lung expansion, and aid in sputum clearance.
How does the incentive spirometer increase lung volumes?
By encouraging slow, deep inhalations which increase transpulmonary pressure and inspiratory volumes.
What are some common indications for using an incentive spirometer?
Postoperative risk of pulmonary complications, atelectasis, weak respiratory muscles, and conditions predisposing to pulmonary atelectasis.
What are some contraindications for using an incentive spirometer?
Patient inability and poor cognition.
Explain how Positive Expiratory Pressure (PEP) works.
PEP provides resistance during exhalation, preventing airway collapse and encouraging collateral ventilation.
For which patients is PEP therapy particularly useful?
Patients with COPD, Asthma, bronchiectasis, or cystic fibrosis, and those unable to clear secretions effectively.
What is the correct technique for using a PEP mask?
nhale to maximal tidal volume, exhale through the mask for 3-5 seconds while maintaining a constant pressure of 20 cm H2O on the manometer.
What are the main indications for using a flutter or acapella device?
Excessive/retained secretions, atelectasis, and chronic respiratory conditions like CF, bronchiectasis, and chronic bronchitis.
What is the difference between the flutter and acapella devices?
The flutter uses a metal ball to generate oscillations, while the acapella uses a plastic reed to create oscillatory resistance during exhalation.
How often should the acapella device be used for optimal sputum clearance?
8-10 breaths, combined with FET/huff, repeated 2-3 times per day.
What are the contraindications for using PEP therapy?
Undrained pneumothorax, large bullae, active TB, cardiac instability, and frank haemoptysis.
How does oscillatory PEP help with sputum clearance?
The oscillations shake the airway walls, loosening mucus, while the PEP splints open the airways to prevent collapse.
What does “collateral ventilation” mean in the context of PEP therapy?
It refers to air moving into poorly ventilated areas of the lungs through smaller airways, improving lung inflation and sputum clearance.
What is the role of end-inspiratory holds in using an incentive spirometer?
They maintain airway patency, preventing or reversing atelectasis and aiding sputum clearance.
What is the proper technique for using an incentive spirometer?
Sit upright, breathe out normally, seal lips around the mouthpiece, inhale slowly and deeply, hold the breath for 5 seconds, then exhale slowly.
What are the steps in respiratory treatment related to positioning and mobility?
Positioning and mobility aim to increase lung volumes and optimize ventilation-perfusion (V/Q) matching.
What is the purpose of adding “holds” and “sniffs” to deep breaths in ACBT?
Holds and sniffs can enhance the effectiveness of deep breathing by promoting greater lung expansion and aiding sputum clearance.
What are the main indications for using an Acapella device?
Excessive secretions, atelectasis, chronic respiratory conditions (CF, bronchiectasis, chronic bronchitis), and difficulty clearing secretions independently.
How does the Acapella device work during exhalation?
A plastic reed inside oscillates, creating pressure changes that combine oscillatory resistance with positive expiratory pressure (PEP).
What is the difference in use between the flutter and Acapella devices?
The flutter must be held in a specific angle to change oscillation frequency, whereas the Acapella can be used in any position, including lying down.
What is the role of a manometer in PEP therapy, particularly when using devices like Aerobika?
A manometer measures the expiratory pressure, ensuring it stays within the therapeutic range of 10-25 cm H2O.
How many breaths are typically performed when using the Aerobika device for airway clearance?
Between 5-10 breaths, combined with FET or huffing, repeated cycles for 10-15 minutes, 2-4 times per day.
What feature of the Aerobika device allows it to be used with nebulisers?
The Aerobika device can attach to a nebulizer to deliver medication while performing airway clearance therapy.
What are the common conditions treated using an Aerobika device?
COPD, asthma, bronchiectasis, cystic fibrosis, and any condition where mucus clearance is impaired.
What is the purpose of the equal pressure point (EPP) in PEP therapy?
The EPP ensures that airway pressures are equalized at a point that prevents collapse, promoting sputum clearance without airway compression.
Why is PEP therapy recommended for patients with chronic bronchitis?
PEP therapy helps to clear mucus, prevent airway collapse, and improve lung ventilation in patients with excessive mucus production and obstructive conditions like chronic bronchitis.
What are some hazards or complications of using an incentive spirometer incorrectly?
Hyperventilation, discomfort from pain, hypoxia due to interruption of oxygen therapy, and bronchospasm.
What is the role of collateral ventilation in PEP therapy?
Collateral ventilation allows poorly ventilated lung areas to receive airflow through smaller airways, enhancing lung expansion and sputum clearance.
What is a common postoperative use for the incentive spirometer?
The incentive spirometer is used to prevent pulmonary complications, such as atelectasis, after upper abdominal or thoracic surgeries.
What types of patients may not be suitable candidates for using an incentive spirometer?
Patients with poor cognition or inability to follow instructions are contraindicated for incentive spirometer use.
What is Forced Expiratory Technique (FET) and when is it used?
FET is a controlled breathing maneuver used after performing airway clearance exercises (e.g., after using flutter, acapella, or aerobika devices) to clear mucus by huffing or coughing.
In PEP therapy, why is it important to maintain a pressure of 20 cm H2O on the manometer?
Maintaining this pressure ensures optimal PEP, which helps keep the airways open, preventing collapse and aiding sputum clearance.
What are some key precautions when using PEP or oscillatory devices?
Avoid use in patients with undrained pneumothorax, large bullae, active TB, cardiac instability, or frank haemoptysis.
How should a patient be positioned when using a flutter, acapella, or aerobika device for best results?
The patient should ideally be seated, with a forward lean if needed, but these devices can also be used in lying or side-lying positions.
Why is dynamic compression of the airways a concern during forced expiration, and how do PEP devices address this?
Dynamic compression can collapse small airways, making it harder to clear mucus. PEP devices create back pressure that prevents airway collapse during expiration.
What are the recommended breath cycles when using flutter, Acapella, or Aerobika devices for airway clearance?
Typically, 10-15 breaths are performed, followed by FET or a huff, then coughing to clear secretions.
What is the primary goal of breathing exercises in respiratory care?
To increase lung volumes and improve oxygenation by optimizing ventilation-perfusion (V/Q) matching.
What are the key benefits of using manual techniques like percussion, vibrations, and shaking in patients with sputum retention?
These techniques help loosen and mobilize mucus, making it easier for the patient to clear their airways
What is the primary function of Positive Expiratory Pressure (PEP) devices?
PEP devices help splint open the airways, preventing collapse and aiding in sputum clearance by producing positive expiratory pressure.
What is the importance of maintaining a PEP of 10-25 cm H2O during therapy?
It prevents airway collapse while allowing the Equal Pressure Point (EPP) to help with sputum clearance and collateral ventilation.
How does PEP therapy prevent dynamic airway compression?
By providing positive pressure during exhalation, PEP keeps the airways open, preventing their collapse and aiding mucus movement upwards.
What is the correct inhalation technique when using an incentive spirometer?
Breathe in slowly and deeply through the mouthpiece, ensuring the piston rises steadily, followed by an end-inspiratory hold for at least 5 seconds.
Why should a patient take brief 3-second rests between breaths while using an incentive spirometer?
To avoid hyperventilation and allow for better control over lung expansion without causing fatigue or discomfort.
What is the significance of the “outer yellow indicator” in an incentive spirometer?
It marks the patient’s best effort, which serves as a goal to achieve or surpass during subsequent breathing exercises.
Why is PEP therapy particularly useful for patients with chronic respiratory conditions like cystic fibrosis or bronchiectasis?
PEP therapy helps to maintain open airways and promotes effective mucus clearance, which is crucial in managing chronic conditions with frequent mucus buildup.
What are the contraindications for the use of a flutter device?
Undrained pneumothorax, large bullae, active tuberculosis (TB), cardiac instability, and frank haemoptysis.
What technique should be used to clear secretions after using a flutter or acapella device?
The Forced Expiratory Technique (FET) or a huff, followed by a cough, to effectively clear loosened secretions.
Why is the flutter device effective in airway clearance?
It combines oscillatory resistance with PEP, which loosens mucus and prevents airway collapse, making it easier for the patient to clear their airways
What is a key difference in technique between using a flutter and an Acapella device?
The flutter device needs to be held at specific angles to adjust oscillations, while the Acapella device can be used in any position, including lying down.
How does the plastic reed inside an Acapella device function during exhalation?
It oscillates to create pressure changes that combine with PEP, helping to mobilize secretions for easier clearance.
What is the purpose of attaching a manometer to a PEP device like the Aerobika?
To measure and ensure the patient is maintaining the correct expiratory pressure during therapy.
Why is it important to inhale to maximal tidal volume before exhaling through a PEP device?
Inhaling maximally ensures that the lungs are fully inflated, which optimizes the effectiveness of the PEP in clearing secretions.
What are the main indications for using PEP devices in respiratory therapy?
Excessive or retained secretions, atelectasis, and chronic respiratory conditions like cystic fibrosis, bronchiectasis, and chronic bronchitis.
What are the key hazards or complications associated with improper use of an incentive spirometer?
Hyperventilation, discomfort due to pain, hypoxia from interrupted oxygen therapy, bronchospasm, and fatigue.
How does PEP therapy encourage collateral ventilation in the lungs?
By keeping the airways open, PEP allows air to move into poorly ventilated areas of the lungs, promoting better overall ventilation.
What is the Equal Pressure Point (EPP) in PEP therapy, and why is it important?
EPP is the point where intrapleural and alveolar pressures equalize, preventing airway collapse and promoting effective sputum clearance.
What technique is used to prevent airway collapse during PEP therapy?
Resisted expiration through the PEP device helps prevent airway collapse by maintaining positive pressure throughout exhalation.
What are some common hazards or complications of using PEP devices if not used correctly?
Discomfort, hyperventilation, exacerbation of bronchospasm, and airway instability if pressures are not monitored correctly.
What should patients do between breath cycles when using a flutter, Acapella, or Aerobika device?
Take brief rests and perform forced expiratory techniques (FET) or huffing to help clear secretions effectively.
