Respiratory interventions Flashcards
Cough
- Components (Figure out what portion of cough is impaired, can be more than one)
- Deep inhale
- Inspiratory hold
- Forceful cough
- Problematic inhale
- Interventions as per inspiratory‐focused breathing exercises
- Problematic inspiratory hold
- Instruct in correct technique
- Problematic forceful cough
- Address cause underlying reduced force generation and instruct/facilitate forceful cough
Progressive Volume with Cough
- progressive inhalation helpful if having trouble with deep inhale
- small inhale, exhale out & repeat a little more
- progress to big deep inhale and cough with 3 steps
- dont exhale on 3rd-blow out cough
Sputum Assessment
-
Sputum collection and containment (need to know how much)
- Emesis basin, tissue, specimen jar, yankauer suction, traditional suctioning
-
Color
- Improving or worsening trends
- Hemoptysis (bright red could be new injury) versus old blood (old injury) versus blood‐tinged/streaks (could be upper airway- might need intervention for bronchospasm)
-
Consistency
- Thick versus thin (thick harder to clear)
-
Quantity
- Size / number of “plugs” (dime, quarter dize) –ex 6 dime sized mucus plus
- Total volume (how many mucus plugs)
-
Odor
- Malodorous versus odorless (waft smell to face)
Problematic Forceful Cough
- Secondary to muscular weakness
- Assisted coughs (hand used to help contract muscle to expel air) –ex SCI patient
- Positioning and compensatory strategies
- Secondary to pain
- Huff
- Splint
- Stacked coughs (terminal cough)
- Progressive force coughs (intermittent coughs)
- Cough leads to bronchospasm (cough be upper airway irritation and see blood tinged sputum)
- Huff (keeps glottis open)
Types of coughs
-
Positioning and Compensatory Strategies
- can facilitate exhale
- might just need to position better- forward flex of trunk
-
Huff
- cough while keeping glottis open
-
Splinted Cough
- can use pillow on lap against incision
-
Stacked Cough (Terminal Cough)
- big breath in, hold, gradually increase cough on exhale. maybe 2-3 coughs. but dont want breath in on them.
- increase force but dont breath in
-
Progressive Force Coughs (Intermittent Coughs)
- can exhale
- small medium large coughs
***productive if force increasing or some secretions come up
When would a huff be selected over a traditional cough?
- Huff for someone with upper airway irritation to decrease irritation
- when cough & glottis closes can produce pressure in pelvic floor. can lead to UI from force generation of coughing
- If UI, teach them huff to dec force
- to dec brochospasm (asthma), huff will reduce
Secretion‐Clearance Interventions
- Postural drainage / percussion / vibration
- Positive expiratory pressure
- Active cycle of breathing
- Autogenic drainage
- High frequency chest wall oscillation
- Suctioning
**these others can help. Coughing not always best
Percussion and Vibration: Precautions and Relative Contraindications
- Over fractured rib or flail segment
- Over metastatic bone cancer
- Over osteoporotic regions
- Unstable cardiovascular status
- Untreated pulmonary embolism
- Subcutaneous emphysema within neck and trunk
- Over recent skin graft or fragile wounds
- Conditions wherein positioning for treatment is contraindicated
- Significant hemorrhage risk
- Over regions with lung neoplasms
PD: Right/left upper lobe anterior apical segment
Seated, slightly reclined
PD- ANT: Right/left upper lobe anterior segment
Supine
PD-ANT:Right middle lobe medial segment
Supine, 15 degrees of trendelenburg, quarter turn to left
PD-ANT: Left lingula superior segment
Supine, 15 degrees of trendelenburg, quarter turn to right
PD-ANT: Left lingula inferior segment
- Supine, 15 degrees of trendelenburg, quarter turn to right
PD -ANT: Right/left lower lobe anterior segment
Supine, 20 degrees of trendelenburg
PD- Post: Right/left upper lobe posterior apical segment
Seated, slight forward flexion
PD- POST: Right upper lobe posterior segment
Prone, quarter turn to right
PD- Post: Left upper lobe posterior segment
Prone, head of bed elevated, quarter turn to left
PD- Right/left lower lobe posterior superior segment
Prone
PD- POST: Right/left lower lobe
posterior inferior
segment
Prone, 20 degrees of trendelenburg
PD- LAT: Right middle lobe lateral segment
Supine, 15 degrees of trendelenburg, quarter turn to left
PD- LAT: Left lingual lateral segment
Supine, 15 degrees of trendelenburg, quarter turn to right
PD- LAT: Right lower lobe lateral segment
Left sidelying, 20 degrees of trendelenburg
PD- LAT: Left lower lobe lateral segment
Right sidelying, 20 degrees of trendelenburg
Postural Drainage and Percussion
- typically 3 to 5 mins per segment
- utilize sputum
- percuss lungs & check for crackles
- cupping motions, wrists loose
- can stand front of back
Vibration
- following percussion
- up and down vibratory motion
- breath in, vibrate way out
Aside from the findings listed in the relative contraindications and precautions for percussion and vibration, when might this intervention be less appropriate?
- passive process
- they dont need to be active
- might be less appropriate for someone cognitively intact
- could do more active form of airway clearence
Positive Expiratory Pressure
- Created within the lungs via use of instrumentation (devices) for exhalation resistance
- Splits airway open to enable air flow behind accumulated secretions
- Can be combined with instrumentation providing oscillation in addition to positive pressure
- Oscillations assist in mobilizing secretions
- Referred to by brand names (i.e. Acapella and Flutter)
***allows air to seep behind mucus. cough or huff greater chance to force mucus out
Acapella
- adjustable
- exhale into devide
- oscilltation goes down into lungs
- shouldnt be able to exhale really long. would mean too easy
- keep cheeks tight
Active Cycle of Breathing
- Goal is secretion mobilization
- Cycle of alternating breathing control (BC) breaths with thoracic expansion (TE) breaths
- BC: Gentle title volume breathing to minimize the work of breathing; similar to diaphragmatic breathing
- TE: 2‐3 deep inspirations approaching IRV
- Concludes in a cough
Active Cycle of Breathing
- controlled (normal breaths) to larger breaths (TE) thoracic expansion
Autogenic Drainage
- Pattern of controlled breathing of different volumes to mobilize secretions
- Large inhale to IRV followed by a slow “sigh” (exhale to RV)
- Inhale TV‐sized breath → breath hold → exhale
- Repeat until audile crackles
- Increase breath size to slightly larger than TV‐sized breaths → breath hold → exhale same volume as inhale
- Repeat until audible crackles
- Increase breath size to near IRV → breath hold → exhale same volume as inhale
- Repeat until audible crackles
- Cough/ huff
***helps clear secretions. breathing through different volumes of lungs. cough at end
What patient population is most appropriate for instruction in autogenic drainage or active cycle of breathing?
- not typically someone with pneumonia
- greta for cystic fibrosis!
High Frequency Chest Wall Oscillation
- Pneumatic chest percussion and vibration
- Patient wears an inflatable vest connected to an external power source
- Can adjust frequent of compression as well as force
- Needs to be done in conjunction with a cough
Suctioning
- Yankauer suctioning provides oral cavity secretion clearance
- Least invasive
- Tracheal suctioning (traditional or in‐line technique) enables airway secretion clearance within upper airway
- Oral
- Nasal
- Tracheal
