Pulmonary Secretion Removal Flashcards
Pulmonary Positioning: Upright/Sitting
Chest Expansion/Vertical Lung Height
- vertical lung height and anteroposterior expansion are the greatest in this position
- mechanical compression of lungs is minimal
- most comfortable position for those with pulmonary complications
Functional Reserve Capacity by Position
Sitting > Prone/Sidelying > Supine
sidelying > in nondependent lung
Pulmonary Positioning: Prone Positioning
Chest Expansion
- decreased anteroposterior expansion of abdomen
- lateral diameter increased (upright)
- *pts with pathology in the SUPERIOR and POSTERIOR segments of the lower lobes may have increased oxygenation*
Pulmonary Positioning: Supine
- lateral diameter is increased
- diaphragm moves toward the head, resulting in increased abdominal pressure
Pulmonary Positioning: Sidelying
- anteroposterior expansion increased
- lateral expansion decreased
- affected side is positioned on top
- *if patient has bronchopleural fistula, avoid prolonged periods with the affected lung uppermost if the patient is on positive pressure ventilation. (could lead to leakage through fistula)
Breathing Exercises: Increase expiratory force or cough
train the inspiratory muscles using resistane during inspiration with devices or manually
Breathing Exercises: Improve gas exchange and increase lung volume
- diaphragmatic breathing,
- segmental breathing
- maximal inspiratory effort
Breathing exercises: Decrease Dyspnea and increase Efficiency
- Pursed lip breathing
- pacing of breathing within the activity
- diaphragmatic breathing
Indications for Airway Clearance:
- Retained secretions in central airways
- prophylaxis against post operative pulmonary complications
- obtain sputum for diagnostic results
- difficulty clearning secretions
- atelectasis cause by or suspected by mucus plugging
Chest Techniques: COUGH
when air is forcefully expelled after deep inhalation and closing of the glottis
- to assist - compress the trachea just above the sternal notch or encourage pt to “huff”
Chest Techniques: Forced Expiration
1-2 forced expirations with relatively low lung volumes while glottis is NOT closed
used with COPD patients
Chest Techniques: Assisted Cough
similar to Heimlich maneuver
Secretion Removal: Percussion
Cupped hands are rhythmically applied to thorax
Procedure:
- explaination to pt
- place pt in postural drainage position
- cover area to be percussed with towel
- percuss over thorax area that corresponds with involved lung segment
- 3-5 min of percussion per postural drainage position
Secretion Removal: Shaking
follows inspiration with a “bouncing” of the rib cage
Secretion Removal: Vibration
Performed with an isometric cocontraction of the arms applied to the thorax
usually performed in conjunction with Postural draining and other techniques
Secretion Removal: Postural Drainage
placing patient in varying positions for optimal gravity drainage and increased expansion of the involved segment.
- indications:
- increased pulm secretions
- aspiration
- atelectasis or collapse
- Procedure:
- explaination to pt
- place pt in position
- observe for signs of intolerance
- duration up to 20 min per position.
Secretion removal: Active cycle of Breathing
an independent program to assist in removal of more peripheral secretions that coughing may not clear
- controlled diaphragmatic breathing
- thoracic expansion exercise w/w/o percussion or shaking
- controlled diaphragmatic breathing
- repeat until pt believes secretions can be cleared
- inhale at a resting tidal volume
- huff from high lung volume or cough to clear
- controlled breathing
- repeat cycle
Secretion Removal: Autogenic Drainage
independent program to sense and clear peripheral secretions without irritation from coughing
- unstick phase: quiet breathing
- collect phase: breathing at mid lung volumes to affect secretions in middle airways
- evacuation: breathe mid-high lung volumes to clear secretions from central airways
Secretion Removal: Flutter Valve
device that vibrates on exhalation to improve airway clearance with intermittent, positive expiratory pressure
- breathe in normally
- exhale through valve 5-10x
- breathe in normally
- 3 sec hold at top of inspire, forceful expire through device 2-3x
- huff or cough to clear
Secretion Removal: Positive Expiratory Pressure PEP
positive expiratory resistance via face mask to help remove airway secretions
- High pressure: 50-120 cm H20
- Low pressure: 10-20 cm H20
- patient breathes at tidal volumes with mask in place for 10 breaths
- mask removed
Breathing Exercises: Diaphragmatic Breathing
Used to increase ventilation, improve gas exchange, decrease work of breathing, faciliate relaxation, maintain or improve mobility of chest wall
- explanation
- semi-reclined position (Fowler’s position)
- PT hand over subcostal angle of thorax
- apply gentle pressure throughout the exhalation
- increase to firm pressure at end of exhalation
- ask pt to inhale against resistance of PT hand
- release pressure allowing full inhalation
- progress to independence of therapist hand in upright sitting, standing walking and stair climbing
**Breathing Exercises: **Segmental Breathing
used to improve ventilation to hypoventilated lung segments, alter regional distribution of gas, maintain or restore functional residual capacity, maintain or improve mobility of chest wall
*innappropriate for intractable hypoventilation until medical situation is resolved
- explanation
- position to facilitate inhalation
- apply gentle pressure to the thorax over area of hypoventilation during exhalation
- increase to firm pressure just prior to inspiration
- ask pt to breathe in against the resistance of therapists hands
- release resistance allowing a full inhalation
Breathing Exercises: Sustained Maximal Inspiration (SMI)
To increase inhaled volume, sustain or improve alveolar inflation, or maintain/restore FRC
_*can use incentive spirometers*_
- inspire slowly through nose or pursed lips to max inspiration
- hold max inspiration for 3 sec
- passively exhale the volume
- 7-10x/day
Breathing Exercises: Pursed Lip Breathing
Used to reduce respiratory rate, increase tidal volume, reduce dyspnea, decrease mechanical dysadvantages of impaired ventilatory pump, improve gas mixing for COPD, facilitate relaxation
- slowly inhale through nose or mouth
- passively exhale through pursed lips
- additional hand pressure applied to abdomen to gently prolong expiration
- Inspiration to Expiration = 1:2
