Pulmonary intervention airway clearance Flashcards
what are the four airway clearance techniques
coughing
huffing
percussions
vibrations
what medications are airway clearance techniques commonly used with?
mycolytics and expectorants
how would one perform a huff
a breath in slowly through the nose holding for 3 sec exhale with mouth open- fog mirror
small breath by long exhale (small airways to large airways)
deep breath short forceful breath (large airway out of the lungs)
how does one perform a cough?
forceful exhale of air
there are 4 stages of a cough
1. a person must take a deep inhale to increase the tital volume
2. the epiglottis will close and the abdominal and intercostals with contract
3. the epiglottis suddenly opens
4.expulsion of air and muscus through the treachea and out the mouth
what is a splinted cough?
Surgical patients: instruct pts to splint their incision by applying pressure over it with a pillow or blanket roll during expiratory phase of the cough
what is an assisted cough
spinal cord injuries- PT assisted cough
MSK/Neuromuscular conditions- pt assisted cough
what is percussion targeting directly? what are they used with? what is important when completing them?
chest percussion is aimed at tossing retained secretions can be performed manually or with a mechanical device.
used with postural drainage techniques
identification of the target lung segment is important
what is manual percussion and how is it performed?
rhythmical clapping with cupped hands over the affected lung segment
always with a protective layer over the skin
air is trapped between the cupped hand and the patients chest
a hallow thumping sound should be produced
no slapping sounds
how are vibrations and shaking performed?
manually or with a mechanical device
used with postural drainage to clear secretions from affted lung segments
palmar surface of your hand on the patients chest wall
other hand is overlapping the other hand
at the end of a deep inhalation the pt will use force on the patients chest wall and slowly oscillate through the end of expiration
repeat until secretions are mobilized and alternate with percussion
what re the relative contradictions to percussion vibration and shaking
hemoptysis
pneumothorax
platelet count of <20,000 per mm3
unstable hemodynamic status
open wounds or burns
pulmonary embolism
subcutaneous emphysema
recent skin graft
what are the precautions when performing percussions, vibrations, and shaking
uncontrolled bronchospasm
osteoporosis
rib fracture
metastatic cancer to the ribs
obstruction of airways
coagulopathy
convulsive or seizure disorder
recent pacemaker
what is active cycle breathing? what’s the purpose?
series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion
self care management
purpose:
lossen and clear secretions from the lungs
improve ventilation in the lungs
improve effectiveness of a cough
what are three main phases of active cycle breathing?
- breathing control: diaphragmatic breathing- slow and controlled breathing using abdominals in the nose out the mouth- airway relaxation
- deep breathing exercises or thoracic expansion exercises: postural drainage is a deep inhale and relaxed exhale at vital capacity- loosen secretions
- huffing or forced expiatory technique (FET) movement of secretions
what is the precaution of active cycle breathing ?
splinted post-op incision
breathing control is used for what purpose?
used to relax the airways and relive the symptoms of wheezing or tightness
use between active exercise for relaxation the airways
use when there is shortnesss of breath, fear, signs of bronchospasm, anxiety or in a panic
duration is dependent on symptoms
the technique typically takes 6 breathing cycles
what are the instructions given to a patient when using ACB
Breathe in and out gently through your nose if you can
if your patient cannot breathe through their nose, instruct you patient to use ‘pursed lip breathing’ through their mouth instead
Relax with each breath- through shoulders
Gradually try to make the breaths slower
Breathing control should continue until the person feels ready to progress to the other stages in the cycle
what re deep breathing and thoracic expansion exercises used for
focus on inspiration and to help loosen lung secretions
what are the instructions to the patient for ACB
relax chest and shoulders
take a slow and deep breath through the nose
at the end of the breath hold for 2-3 seconds- inspiratory hold
breathe out gently and relaxed like a sigh
don’t force the air out and perform 3-5 times
what re the two types of huffing
medium volume huff
high volume huff
what does ACB facilitate?
facilitates a maximal inspiration use proprioceptive feedback
place your hands on the thoracic cage
what is a medium volume huff do?
moves secretions from the lower airways
what does a high volume huff do?
moves secretions in the upper airway
don’t repeat more than 2 times without a break due to related huffing can cause the chest to get tight.
how does postural drainage help chest pt?
use gravity to move mucus from the lungs into the throat
The patient will lie or sit in various positions target to each area of the lung.
the part of the lung is drained using percussion, shaking, vibration and gravity
what are the signs of sine during exercise
Dyspnea with activity
Increase HR > 20-30 bpm above resting
HR decrease below resting
SBP increase > 20-30 mm Hg above resting
SBP decrease > 10 mm Hg below resting
SpO2 below indicated level
SOB or RR not able to tolerate
ECG changes or chest pain
nonverbals- color change, diaphoresis, increased accessory muscle use, agitation
Dyspnea relief position: Arms supported, patient leans forward OR lean against a wall
