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Boards: Cardiopulmonary & Lymphatic > Pulmonary Secretion Removal > Flashcards

Pulmonary Secretion Removal Flashcards

1
Q

Pulmonary Positioning: Upright/Sitting

Chest Expansion/Vertical Lung Height

A
  • 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
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2
Q

Functional Reserve Capacity by Position

A

Sitting > Prone/Sidelying > Supine

sidelying > in nondependent lung

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3
Q

Pulmonary Positioning: Prone Positioning

Chest Expansion

A
  • 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*
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4
Q

Pulmonary Positioning: Supine

A
  • lateral diameter is increased
  • diaphragm moves toward the head, resulting in increased abdominal pressure
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5
Q

Pulmonary Positioning: Sidelying

A
  • 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)
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6
Q

Breathing Exercises: Increase expiratory force or cough

A

train the inspiratory muscles using resistane during inspiration with devices or manually

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7
Q

Breathing Exercises: Improve gas exchange and increase lung volume

A
  • diaphragmatic breathing,
  • segmental breathing
  • maximal inspiratory effort
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8
Q

Breathing exercises: Decrease Dyspnea and increase Efficiency

A
  • Pursed lip breathing
  • pacing of breathing within the activity
  • diaphragmatic breathing
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9
Q

Indications for Airway Clearance:

A
  • 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
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10
Q

Chest Techniques: COUGH

A

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”
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11
Q

Chest Techniques: Forced Expiration

A

1-2 forced expirations with relatively low lung volumes while glottis is NOT closed

used with COPD patients

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12
Q

Chest Techniques: Assisted Cough

A

similar to Heimlich maneuver

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13
Q

Secretion Removal: Percussion

A

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
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14
Q

Secretion Removal: Shaking

A

follows inspiration with a “bouncing” of the rib cage

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15
Q

Secretion Removal: Vibration

A

Performed with an isometric cocontraction of the arms applied to the thorax

usually performed in conjunction with Postural draining and other techniques

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16
Q

Secretion Removal: Postural Drainage

A

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.
17
Q

Secretion removal: Active cycle of Breathing

A

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
18
Q

Secretion Removal: Autogenic Drainage

A

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
19
Q

Secretion Removal: Flutter Valve

A

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
20
Q

Secretion Removal: Positive Expiratory Pressure PEP

A

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
21
Q

Breathing Exercises: Diaphragmatic Breathing

A

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
22
Q

**Breathing Exercises: **Segmental Breathing

A

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
23
Q

Breathing Exercises: Sustained Maximal Inspiration (SMI)

A

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
24
Q

Breathing Exercises: Pursed Lip Breathing

A

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

Boards: Cardiopulmonary & Lymphatic (17 decks)

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