Respiratory Illnesses/Passy-Muir Flashcards
What is pneumonia?
inflammation of the lungs
What causes pneumonia?
bacterial or viral infection
What are symptoms of pneumonia?
chest pain, fever, shaking, chills, shortness of breath
Which population is at greater risk for penumonia?
the elderly, 75 y/o and over
What does nosocomial refer to?
acquired in the hospital
T/F there is a vaccine for pneumonia
T
How is pneumonitis different from pneumonia?
pneumonitis = aspirating gastric contents from vomiting pneumonia = aspirated bacteria/virus
Which patients are at more risk for pneumonitis?
post-surgery with decreased level of alertness
Between pneumonitis and pneumonia, which is the illness that is usually witnessed?
pneumonitis
Which muscles are used for respiration?
diaphragm (primary), intercostals, abdominal
Phases of swallow according to Passy Muir:
anticipatory, oral prep, oral, pharyngeal, esophageal
What is the pattern in healthy adults for timing swallows?
at mid-exhalation; follow each swallow with exhalation
Why do normal, healthy individuals follow a respiration pattern?
the pattern assures there is sufficient air pressure below the VFs during swallow to inhibit aspiration of food residue after the swallow
How are breathing and swallowing related?
they are considered a “shared system” in terms of anatomy, timing, pressures, and CNS control
How can normal breathing be interrupted?
by illness, medications, tracheostomy, and mechanical ventilation
Individuals with which illnesses are more at risk for respiration interruption?
neuromuscular, COPD, restrictive disease
What are some diagnostic tools to document aspiration?
bedside eval, FEES, MBS
What are the signs and symptoms of aspiration?
wet sounding voice, drooling, multiple swallows, coughing while eating, recurrent RLL pneumonia
What are some goals that RCP and SLPs share?
communicate, manage secretions (oral and tracheal), tolerate cuff deflation, swallow without signs and symptoms of aspiration, participate in weaning and rehab efforts, be liberated from continuous mechanical ventilation, decannulate
What does it mean to decannulate?
to remove the tracheostomy
What does a Passy-Muir valve do?
restore normal physiology by reconnecting the upper and lower airway and closed system
What are some clinical benefits of the Passy-Muir valve?
restoration of speech/com, secretion management, taste/smell, oxygenation/reduce atelectasis, weaning/decannulation time, infection control, QOL
What can the SLP suggest to improve her client’s swallow on Passy-Muir?
cuff deflation, diet mod (textures, method), posture/position during and after eating, timing of the swallow, strengthening maneuvers
With whom is the SLP co-treating clients using Passy-Muir valve?
RCP
In what percentage of healthy individuals does aspiration occur?
50%
When does aspiration typically happen?
at night
In what portion of the lungs does aspiration pneumonia most commonly occur?
lower right lobe
What percentage of acquired pneumonia is considered “aspiration pneumonia”?
15%
What is the leading cause of death in individuals with dysphagia?
aspiration pneumonia
What are some risk factors to acquiring aspiration pneumonia?
poor oral health, reduced swallowing frequency and cough effectiveness, decreased physical condition, undernutrition, illnesses
What is COPD?
chronic obstructive pulmonary disease
What is an open tracheostomy tube?
there is no obstruction
What are the physiologic changes in tracheotomy?
no activation of smell/taste without air flow, sensation/secretion management
How do you explain the normal airway?
closed and pressurized system
Where is the cuff?
below the level of the VFs
What is the incident of individuals with a cuff that aspirate?
45-65%
What are some complications that can occur with a tracheotomy?
tracheal wall injury, esophageal impingement (reflux), laryngeal tethering
Who invented the Passy-Muir valve?
a patient named David Muir
The external diaphragm is closed at rest, when does it open?
when air is taken in
What are benefits of “no-leak”?
restores voice and ability to communicate, restores airflow and sensation/sense of taste and smell, impacts swallowing and may reduce aspiration, restoring physiologic positive pressure (improved gas exchange, o2 sat levels), improves secretion management, facilitates effective cough, reduce suction needs
What are the patient selection guidelines?
awake and alert, medically stable, manage complete cuff deflation, thin and easily suctioned secretions, patent airway (when the cuff is deflated there needs to have enough room for the air to move around and out)
What are some important pre-placement considerations?
have a plan, block the time, reassure the patient, pick a good time, paint control, reduce interference
When does the cuff have to be deflated?
when it is being placed
How should the patient be positioned when placing a valve?
as straight up as possible (45-90 degrees)
How do you assess airway patency?
deflate cuff, ask patient to inhale, finger occlude and speak or cough on exhalation
How can you tell is there is breath stacking?
when you hear a whoosh out of the tracheostomy tube when you take it off
Why does breath stacking happen?
something happened with the airflow that it didn’t get out of the mouth or nose
How can you troubleshoot breath stacking?
downsizing valve, using a different brand
What is a foam cuff?
they can re-inflate on their own; you can’t use a valve on them
What is endotracheal tube?
the tube that goes into your mouth and through the vocal folds
How long should you where an endotracheal tube?
no more than 14 days
