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Pulmonary Final > Respiratory interventions > Flashcards

Respiratory interventions Flashcards

1
Q

Cough

A
  • 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
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2
Q

Progressive Volume with Cough

A
  • 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
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3
Q

Sputum Assessment

A
  • 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)
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4
Q

Problematic Forceful Cough

A
  • 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)
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5
Q

Types of coughs

A
  • 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

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6
Q

When would a huff be selected over a traditional cough?

A
  • 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
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7
Q

Secretion‐Clearance Interventions

A
  • 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

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8
Q

Percussion and Vibration: Precautions and Relative Contraindications

A
  • 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
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9
Q

PD: Right/left upper lobe anterior apical segment

A

Seated, slightly reclined

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10
Q

PD- ANT: Right/left upper lobe anterior segment

A

Supine

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11
Q

PD-ANT:Right middle lobe medial segment

A

Supine, 15 degrees of trendelenburg, quarter turn to left

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12
Q

PD-ANT: Left lingula superior segment

A

Supine, 15 degrees of trendelenburg, quarter turn to right

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13
Q

PD-ANT: Left lingula inferior segment

A
  • Supine, 15 degrees of trendelenburg, quarter turn to right
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14
Q

PD -ANT: Right/left lower lobe anterior segment

A

Supine, 20 degrees of trendelenburg

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15
Q

PD- Post: Right/left upper lobe posterior apical segment

A

Seated, slight forward flexion

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16
Q

PD- POST: Right upper lobe posterior segment

A

Prone, quarter turn to right

17
Q

PD- Post: Left upper lobe posterior segment

A

Prone, head of bed elevated, quarter turn to left

18
Q

PD- Right/left lower lobe posterior superior segment

A

Prone

19
Q

PD- POST: Right/left lower lobe
posterior inferior
segment

A

Prone, 20 degrees of trendelenburg

20
Q

PD- LAT: Right middle lobe lateral segment

A

Supine, 15 degrees of trendelenburg, quarter turn to left

21
Q

PD- LAT: Left lingual lateral segment

A

Supine, 15 degrees of trendelenburg, quarter turn to right

22
Q

PD- LAT: Right lower lobe lateral segment

A

Left sidelying, 20 degrees of trendelenburg

23
Q

PD- LAT: Left lower lobe lateral segment

A

Right sidelying, 20 degrees of trendelenburg

24
Q

Postural Drainage and Percussion

A
  • typically 3 to 5 mins per segment
  • utilize sputum
  • percuss lungs & check for crackles
  • cupping motions, wrists loose
  • can stand front of back
25
Q

Vibration

A
  • following percussion
  • up and down vibratory motion
  • breath in, vibrate way out
26
Q

Aside from the findings listed in the relative contraindications and precautions for percussion and vibration, when might this intervention be less appropriate?

A
  • passive process
  • they dont need to be active
  • might be less appropriate for someone cognitively intact
  • could do more active form of airway clearence
27
Q

Positive Expiratory Pressure

A
  • 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

28
Q

Acapella

A
  • adjustable
  • exhale into devide
    • oscilltation goes down into lungs
  • shouldnt be able to exhale really long. would mean too easy
  • keep cheeks tight
29
Q

Active Cycle of Breathing

A
  • 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
30
Q

Active Cycle of Breathing

A
  • controlled (normal breaths) to larger breaths (TE) thoracic expansion
31
Q

Autogenic Drainage

A
  • 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

32
Q

What patient population is most appropriate for instruction in autogenic drainage or active cycle of breathing?

A
  • not typically someone with pneumonia
  • greta for cystic fibrosis!
33
Q

High Frequency Chest Wall Oscillation

A
  • 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
34
Q

Suctioning

A
  • 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

Pulmonary Final (6 decks)

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