Pulmonary intervention airway clearance

Question 1

what are the four airway clearance techniques

Answer 1

coughing
huffing
percussions
vibrations

Question 2

what medications are airway clearance techniques commonly used with?

Answer 2

mycolytics and expectorants

Question 3

how would one perform a huff

Answer 3

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)

Question 4

how does one perform a cough?

Answer 4

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

Question 5

what is a splinted cough?

Answer 5

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

Question 6

what is an assisted cough

Answer 6

spinal cord injuries- PT assisted cough
MSK/Neuromuscular conditions- pt assisted cough

Question 7

what is percussion targeting directly? what are they used with? what is important when completing them?

Answer 7

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

Question 8

what is manual percussion and how is it performed?

Answer 8

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

Question 9

how are vibrations and shaking performed?

Answer 9

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

Question 10

what re the relative contradictions to percussion vibration and shaking

Answer 10

hemoptysis
pneumothorax
platelet count of <20,000 per mm3
unstable hemodynamic status
open wounds or burns
pulmonary embolism
subcutaneous emphysema
recent skin graft

Question 11

what are the precautions when performing percussions, vibrations, and shaking

Answer 11

uncontrolled bronchospasm
osteoporosis
rib fracture
metastatic cancer to the ribs
obstruction of airways
coagulopathy
convulsive or seizure disorder
recent pacemaker

Question 12

what is active cycle breathing? what’s the purpose?

Answer 12

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

Question 13

what are three main phases of active cycle breathing?

Answer 13

1. breathing control: diaphragmatic breathing- slow and controlled breathing using abdominals in the nose out the mouth- airway relaxation
2. deep breathing exercises or thoracic expansion exercises: postural drainage is a deep inhale and relaxed exhale at vital capacity- loosen secretions
3. huffing or forced expiatory technique (FET) movement of secretions

Question 13

what is the precaution of active cycle breathing ?

Answer 13

splinted post-op incision

Question 14

breathing control is used for what purpose?

Answer 14

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

Question 15

what are the instructions given to a patient when using ACB

Answer 15

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

Question 16

what re deep breathing and thoracic expansion exercises used for

Answer 16

focus on inspiration and to help loosen lung secretions

Question 17

what are the instructions to the patient for ACB

Answer 17

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

Question 18

what re the two types of huffing

Answer 18

medium volume huff
high volume huff

Question 19

what does ACB facilitate?

Answer 19

facilitates a maximal inspiration use proprioceptive feedback
place your hands on the thoracic cage

Question 20

what is a medium volume huff do?

Answer 20

moves secretions from the lower airways

Question 21

what does a high volume huff do?

Answer 21

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.

Question 22

how does postural drainage help chest pt?

Answer 22

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

Question 23

what are the signs of sine during exercise

Answer 23

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

Question 24

what does pursed lip breathing do?

Answer 24

Inhale through the nose for several seconds with mouth closed
Exhale slowly over 4-6 seconds through mouth – lips held in a whistle position
Used to decrease patient’s symptoms of dyspnea
Slows RR
Improve gas exchange

Question 25

what is the benefit to inspiratory hold techniques

Answer 25

Patient instructed to hold breath at end of inspiration for 2-3 seconds

Used to improve the flow of air into poorly ventilated regions of the lungs

Question 26

what is diagphamatic breathing?

Answer 26

Diaphragmatic Breathing strengthen your diaphragm and maximize breathing
Primary muscle of inspiration: ventilation is efficient and the oxygen consumption of the muscles of ventilation is low during relaxed (tidal) breathing. When a patient relies substantially on the accessory muscles of inspiration, the mechanical work of breathing (oxygen consumption ) increases and the efficiency of ventilation decreases.
Designed to improve the efficiency of ventilation, decrease the work of breathing, increase the excursion of the diaphragm, and improve gas exchange and oxygenation.

Question 27

what are the physiological effects of diaphragmatic breathing

Answer 27

Improves your core muscle stability

improves your body’s ability to tolerate intense exercise

slows your rate of breathing so that it expends less energy

lowers your heart rate & BP

improve respiratory capacity

Question 28

what is the technique for diaphragmatic breathing?

Answer 28

Technique:
Patient in hooklying position pillows can be used under your patient’s head and knees for support if needed
Place one hand on your patient’s upper chest and one on your patient’s abdomen
Instruct patient to breathe in slowly through the nose letting the air in deeply to the abdomen
The hand on your patient’s chest should remain still while the abdominal hand moves with each breath
Instruct your patient to contract his/her abdominal muscles through pursed lips to push all the air out
Used to improve hypoxia, tachypnea, atelectasis, anxiety, and pulmonary secretions