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Theory and Principles of Respiratory Care > RCP 120 Unit 4 > Flashcards

RCP 120 Unit 4 Flashcards

1
Q

-Lung Expansion Therapy

A

-Incentive spirometry (I.S.)

-Continuous Positive Airway Pressure (CPAP)

-Intermittent Positive Pressure Breathing (IPPN)

-EZPAP

-Deep breathing and cough

-Frequent Positioning

-Early ambulation

-Best choice is what will accomplish what is needed at least cost!!
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2
Q

-Incentive Spirometry

A

-Designed to mimic natural sighing, performed using devices which provide a visual cue.

-Basaic maneuver-SMI- sustained maximal inspiration

	-Slow deep inspiration from FRC to total lung capacity, followed by 3-5 second breath hold

	-Drop in transpleural pressure causes a negative pressure in the alveoli and gas flows into the alveoli
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3
Q

-Incentive Spirometry
-Indications

A

-Any condition predisposing patient to development of atelectasis

	-Presence of atelectasis

	-Presence of restrictive lung condition and pr dysfunctional diaphragm
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4
Q

-Incentive Spirometry

-Contradictions

A

-Patient who cannot follow directions/ coordinate treatment

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5
Q

-Incentive Spirometry

-Hazards/ complications

A

-Ineffective if not used correctly

	-Hyperventilation in patients perform too fast

		-Tingling fingers, numbness around mouth, have patients to slow their breathing down

	-Bronchospasm

	-Pain
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6
Q

-Incentive Spirometry

-Devices

A

-Volume or flow oriented using visual cue/ indicator

	-Simple to operate

	-Inexpensive
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7
Q

-Incentive Spirometry

-Giving treatment -Planning
A

-Assess and identify patients before surgery

		-Determine desired outcomes
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8
Q

-Incentive Spirometry

Giving Treatment -Implementation

A

-Effective patient teaching

		-RT set initial effort and correct technique as required

		-Diaphragmatic breathing at slow to moderate rates

		-instruct in breath hold, very important

		-Rest between breaths

		-5-10 maneuvers per hour
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9
Q

-Incentive Spirometry

Giving Treatment Follow up

A

-Ensure correct technique

		-Encourage use

		-Increase goal until at predicted value
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10
Q

-Intermittent Positive Pressure Breathing (IPPB)

A

-Application of inspiratory positive pressure to the spontaneously breathing patient as an intermittent or short term therapy

-Gas pushed into alveoli by positive pressure, followed by passive exhalation (mask or mouthpiece)
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11
Q

-Intermittent Positive Pressure Breathing (IPPB)

-Indications

A

-May be useful for atelectasis if patient doesn’t respond to IS or other positive pressure therapies

	-Slow deep breaths with little patient effort followed by inspiratory hold
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12
Q

-Intermittent Positive Pressure Breathing (IPPB)

-Contraindications

A

-Untreated pneumothorax, recently oral/ facial surgery

	-Relative contraindications

		-ICP>15mmHg

		-Active hemoptysis		

		-Hemodynamic instability
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13
Q

-Intermittent Positive Pressure Breathing (IPPB)

-Hazards and complications

A

-Barotrauma

		-Gastric distention

		-respiratory alkalosis, breathing too fast’

		-Nosocomial infection

		-Nausea

	-Patients with high resp rate (tachypnea) should not use IS or IPPB

-
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14
Q

-CPAP

A

-Continuous positive airway pressure- set pressure during both inhalation and exhalation

-Intermittent CPAP- used to treat atelectasis

	-Exact mechanism to treat atelectasis is unknown

		-recruitment of alveoli

		-Decreased WOB

		-Improved distribution of ventilation

		-Increase in efficiency of secretion removal
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15
Q

EZPAP

A

-A positive airway pressure device that is used as lung expansion therapy

-Its connected to a flowmeter (ait of O2) adjusted to a flow of 5-10 LPM

-EZPAP amplifies the input of air or oxygen by approximately four times by taking advantage of thee Coanda effect

-Flow is adjustable until the desired expiratory airway pressure is reached

-The patient is instructed to breathe normally through a mouthpiece or mask

-Added benefit that neb tx can be given simultaneously
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16
Q

-Lung expansion Therapy

A

-Selecting appropriate lung expansion modality

	-Best is always safest, simplest, most effective for the patient

	-Patient must be alert or will need to do IPPB

	-For IS- Patient must be alert or will need to do IPPB

	-If patient has excess secretions , use PEP therapy

	-Last resort, intermittent CPAP therapy
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17
Q

-Bronchial Hygiene Therapy

-Normal Airway Clearance

A

-Patient airway

	-Functioning Mucociliary escalator

		-From larynx through respiratory bronchioles

		-Mucus goblet cells, submucosal glands, Clara cells, fluid from tissues which move into airways
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18
Q

-Bronchial Hygiene Therapy

-Effective cough

A

-Phase one, irritation (inflammatory, mechanical, chemical, or thermal)

	-Phase two- inspiratory (normally 1-2L in adult)

	-Phase three, compression (glottic closure and forceful contraction of respiratory muscles)

	-Phase four- expulsion release as glottis opens (Cough)
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19
Q

-Bronchial Hygiene Therapy

-Abnormal airway clearance

-Impairment of normal clearance

A

-Anesthesia/ Narcotic analgesics, pain, restrictive lung disease, respiratory or abnormal muscle weakness or disease, artificial, airway obstructions, CNS depression/ Nerve damage, over distention of lungs/ inadequate lung recoil

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20
Q

-Bronchial Hygiene Therapy

-Abnormal airway clearance

Retained secretions

A

-Mucus plugging

		-Infectious process if pathogens present

			-inflammation response=damage to tissues and increase mucus production
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21
Q

-Bronchial Hygiene Therapy

-Abnormal airway clearance

-Inspissated secretions

A

disease process or bypassed upper airway (Inadequate humidification)

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22
Q

-Bronchial Hygiene Therapy

-Abnormal airway clearance

-Diseases contributing to abnormal clearance

A

-Internal obstruction or external compression of airways

		-Foreign bodies, tumors, thoracic deformities, bronchospasm, mucus plugging, obesity

-Cystic fibrosis

-Ciliary dyskinetic syndrome

-Bronchiectasis

-Musculoskeletal and neurological disorders

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23
Q

-Indications for Therapy

-Acute conditions

A

-Copious secretions, acute respiratory failure with signs of retained secretions, acute lobar atelectasis

-Not helpful for

-Acute exacerbation of COPD, pneumonia without significant sputum production, uncomplicated asthma

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24
Q

-Indications for Therapy

-Chronic conditions

A

-Cystic fibrosis, bronchiectasis, chronic bronchitis- if sputum production is . 25-30ml per day

25
Q

-Indications for Therapy

-Prevent retention of secretions

A

-Prevent retention of secretions

	-Body positioning and patient mobilization’

-Determining the need

	-Adequate patient assessment, CXR often a useful tool
26
Q

Methods for Bronchial Hygiene

A

• Five methods

  • 1) Postural drainage therapy (turning, percussion, and vibration), 2)coughing, 3)positive airway pressure therapy, 4)high-frequency compression/oscillation, IPV, 5)mobilization and exercise

• These five methods can be used alone or in combination with one another

27
Q

Postural Drainage Therapy

A

• Use of gravity and mechanical means to mobilize secretions

• Includes turning, percussion, and vibration (often referred to as CPT, PPD or pulmonary toileting)

• Turning

  • Rotation of the body along a longitudinal axis
  • Patient may do on own, have help, or be in a specialized bed
  • Supine vs. prone
  • Two absolute contraindications

• Unstable spine

• Traction of arm abductors

28
Q

Postural Drainage Therapy

• Relative contraindications of positioning

A
  • Severe diarrhea, rise in ICP, drop in BP of >10%, severe agitation, worsening dyspnea, hypoxia, cardiac arrhythmias
29
Q

Postural Drainage Therapy

• Hazards and complications

A
  • Hypoxemia, pain or injury to muscles, ribs, spine, vomiting and aspiration, plumbing problems - ventilator circuit disconnect, aspiration of condensation in ventilator circuit, IV lines, urinary catheters, chest tubes
30
Q

Postural Drainage Therapy

• Proning

A
  • Used in treatment of patients with ALI (acute lung injury)
  • Improves oxygenation without hurting hemodynamics
  • Not shown to improve survival
  • Improvement in blood flow/recruitment of atelectatic areas
  • Good lung down phenomenon- gravity takes blood to area of best ventilation
31
Q

Postural Drainage Therapy Gravity

A

• Use of gravity to help move secretions from distal areas into central airways; remove by suction or cough

• Place segmental bronchus in a vertical position relative to gravity

• Positions

  • Held 5-10 minutes (per position)
  • Modified as patient tolerates

• Most useful if patient is producing 25-30ml/day of sputum

• Not successful without adequate hydration

32
Q

Postural Drainage Therapy • Technique

A
  • Identify proper lobes/segments

• Physician order, CXR, breath sounds, may need to modify position

  • Schedule before or 1-2 hours after eating
  • Coordinate treatment times with pain meds
  • Monitor all lines attached to patient for pulling/disconnection
  • Pre-treatment assessment

• Vital signs

• Pulse Oximetry- should be monitored throughout therapy

• Auscultation

Positions (see handout)

  • Head down - at least 12-18 inches
  • Support all joints and bony areas with pillows/towels
  • Maintain positions for 5-10 minutes as tolerated
  • Allow rest between positions
  • Discourage strong coughing in head down positi
  • Continually monitor patient for any problems
33
Q

Postural Drainage Therapy

• Post treatment assessment

A
  • See above plus subjective responses
  • Breath sounds may worsen after therapy
  • Reevaluate therapy at least every 48-72 hours
34
Q

Postural Drainage Therapy

• Documentation

A
  • All positions used
  • Time in each position
  • All assessment - pre and post
  • Sputum production - amount, color, consistency
  • Follow up 1-2 hours later with patient/nurse
35
Q

Postural Drainage Therapy

• Contraindications for CPT/PPD positioning

A 
- Absolute contraindications

• Head and neck injury until stabilized

• Active hemorrhage or hemo-dynamically unstable

36
Q

Postural Drainage Therapy

  • Relative contraindications
A

• ICP > 20 mmHg, active hemoptysis, pulmonary embolism, rib fracture - with or without flail chest, large pleural effusion, CHF, confused or combative patient, distended abdomen, uncontrolled airway at risk for aspiration

37
Q

Postural Drainage Therapy

• Hazards/Complications

A
  • Hypoxemia, increased ICP, acute hypotension, pulmonary hemorrhage, pain or injury to muscles, ribs, spine, vomiting/aspiration, bronchospasm, and arrhythmias
  • NOTE: If negative patient response - stop therapy, return patient to original position, stay with patient until STABILIZED, consult physician (take other steps as needed - place patient on 02 and adjust accordingly if hypoxic, suction and clear airway if vomiting, etc.)
38
Q

Percussion and Vibration

A

• Application of mechanical energy to the chest wall by hand or other electrical/pneumatic device

• Augments secretion clearance

• Percussion - jar secretions loose/Vibration - move secretions toward central airways

39
Q

Percussion and Vibration

• Manual percussion

A
  • Cupped hands with fingers and thumb closed
  • Traps cushion of air between chest and hands
  • Rhythmically strike in a waving motion, alternating both hands with elbows partially flexed and wrists loose
  • Percuss back and forth in a circular area for 3-5 minutes
  • Avoid tender areas or bony areas
  • Slower, relaxed rate are tolerated by patient and therapist
40
Q

Percussion and Vibration

• Manual vibration

A
  • Sometimes used with percussion but is limited to exhalation
  • Lay one hand on the chest wall over the involved area and place the other hand over top
  • After patient takes a deep breath, exert slight-to-moderate pressure and initiate a rapid vibratory motion of the hands through exhalation
41
Q

Percussion and Vibration

• Mechanical percussion and vibration

A
  • Electrical and pneumatic devices
  • Have a frequency and force control knob
  • Potential problems

• Noise, excess force, mechanical failure, no evidence they are better than RT, but these don’t tire out RT

Coughing Techniques

42
Q

Coughing Techniques

A 
 • Effective cough is an essential component of all bronchial hygiene therapy

• Directed cough

  • Deliberate maneuver to mimic a spontaneous cough
  • Cannot make a person clear secretions if no sputum is present
  • Clears from central and NOT peripheral airways
  • Standard technique

• First establish clinical need

• Assess patient for factors that could limit success of directed cough

  • Neurological factors, uncooperative patient, pain or fear of pain, systemic dehydration, CNS depression, COPD or restrictive disorder - may limit ability to generate an effective cough
43
Q

Coughing Techniques - Positioning

A

• Sitting position preferred or semi-fowlers if unable to sit

  • Breathing control (technique) for directed cough

• Instruct patient to take a deep breath, then hold the breath, using abdominal muscles to force air against a closed glottis the explosive release as glottis opens

• Have patient take several deep breaths before next cough effort

44
Q

Coughing Techniques • Modifications in technique

A

Splinting - place hand or pillow over incision site and apply gentle pressure while coughing

  • Manually assisted cough - external application of pressure to chest cage or epigastric region coordinated with forced exhalation
45
Q

Coughing Techniques • Forced Expiratory Technique - Huff Cough

A
  • Sharp exhalations from high to mid lung volumes through an open glottis
  • To keep glottis open - patient says “huff” during expiration
  • Still important to inhale using diaphragm and rest after cough
46
Q

Coughing Techniques • Mechanical Insufflation-Exsufflation (MIE)

A
  • Known as the cough assist
  • Device that inflates the lungs with positive pressure followed by a negative pressure to simulate a cough
  • Treatment consists of 5 cycles followed by 20-30 seconds of normal breathing
  • For each cycle, the inspiratory pressure is 25-35 cmH20 for 1-2 seconds followed by expiratory pressure of -30 to -40 cmH20 for 1-2 seconds
  • Can be used with a mask, or mouthpiece
  • Shown effective in patients with neuromuscular disease
47
Q

Positive Expiratiry Pressure (PEP)

A

• Active exhalation against a variable flow resistance

  • Positive Pressure during exhalation using a one-way expiratory flow resistor…using a mask or mouthpiece
  • Expiratory flow resistor keeps end expiratory pressure from falling back to zero
  • Expiratory pressures range from 5-20 cmH20 at mid exhalation
48
Q

Positive Expiratiry Pressure (PEP)

• Indications for treatment

A
  • Reduce air trapping in asthma and COPD
  • Mobilize retained secretions for CF and chronic bronchitis
  • Optimize delivery of bronchodilators
49
Q

Positive Expiratiry Pressure (PEP)

• Contraindications

A
  • ICP > 20 mmHg, hemoptysis, recent surgery to mouth/face/skull, untreated pneumothorax, nausea and vomiting
  • Discontinue treatment if: sinusitis, epistaxis, or middle ear infection
50
Q

Positive Expiratiry Pressure (PEP)• Hazards and complications

A
  • Pulmonary barotrauma, hemodynamic compromise, skin breakdown and discomfort, air swallowing/vomiting/aspiration
51
Q

Positive Expiratiry Pressure (PEP) • Technique for PEP

A
  • Patient sitting comfortably upright
  • Adjust the expiratory resistor to the prescribed setting
  • Larger than normal breath but not to TLC
  • Using a tight seal, exhale gently (not forcefully) to a pressure of 5-20 cmH2O (mask or mouthpiece)
  • Exhalation should be three times longer than inhalation
  • Should perform 10-20 PEP breaths and 2-3 huff coughs
  • Each session is 10-20 minutes and should be performed 1-4 times per day

High Frequency

52
Q

High Frequency Conpression/ Oscillation

A

• Rapid vibratory movement of small volumes of air back and forth in the respiratory track

• High frequencies measures in Hz

53
Q

High Frequency Conpression/ Oscillation
• Two methods

A
  • External-high frequency chest wall compression

(HFCWC)

  • Applied to Airway

• Flutter

• Intra-pulmonary percussive ventilation (IPV)-see video on blackboard

54
Q

High Frequency Conpression/ Oscillation

• HFCWC

A
  • Two part system

• Variable air-pulse generator

• Inflatable vest that covers patients torso

  • 5-25Hz, 20 minute sessions, 1-6 times per day depending on need
  • Well known system - The Vest Airway Clearance

System

55
Q

High Frequency Conpression/ Oscillation

• IPV (Intrapulmonary percussive ventilation)

A
  • Creates positive changes by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall recoil for passive exhalation
  • 300-400 cycles per minute (1.7-5Hz for 15-20 minutes)
56
Q

Airway Oscillating Devices

A

• Alternative methods for bronchial hygiene

• Produce PEP with oscillations in the airway

• Promote patient independence and better compliance

57
Q

Airway Oscillating Devices• Flutter valve

A
  • Heavy steel ball sits in the bowl of “pipe” like device
  • As patient exhales, ball creates positive pressure of

10-25 cmH20

  • Pipe angle causes ball to “flutter” back and forth at about 15Hz
  • Disadvantage - position dependent, movement slightly upward or downward changes the vibration frequency
58
Q

Airway Oscillating Devices• Acapella “the pickle”

A
  • Uses a counterweighted plug and magnet to create airflow oscillations during expiratory flow
  • Has an adjustable resistor
  • Not position dependent and is considered easier to use for

patients(can give neb thru device)

59
Q

Airway Oscillating Devices• The Quake

A
  • Manually rotating handle that creates the oscillations
  • The frequency is controlled by how quickly the handle is rotated
  • Slow = low-frequency oscillation and high expiratory

pressure

  • Fast = high-frequency oscillation and low expiratory

pressure

  • Not position dependent

Theory and Principles of Respiratory Care (4 decks)

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