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Acute Care and Rehab > Respiratory treatments > Flashcards

Respiratory treatments Flashcards

1
Q

Why use ACBT?

A
  • To loosen and clear secretions from the lungs and reduce risk of infection.
  • Improve ventilation in the lungs
  • Improve the effectiveness of a cough
  • Can be performed in both sitting or a postural drainage position
     Should be a comfortable position either way
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2
Q

What are the stages of cough

A

 Epiglotis closes
 Diaphragm and muscles force out
 COPD don’t have ability to force air out airway

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3
Q

What does breathing control do?

A
  • Breathing control relaxes airways and helps to relieve wheezing and tightness that can occur after coughing or when breathless
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4
Q

When is it important to do breathing control?

A

 Important to do breathing control between more active components such as cough and huff

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5
Q

What does deep breathing / thoracic expansion exercise do?

A
  • Deep breathing / TEE helps to focus breathing on inspiration this aids in the loosening of secretions. Active inspiration with hold and passive, relaxed and unforced expiration.
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6
Q

What does huff / FET do?

A
  • Huffing helps to move secretions towards the mouth so that a cough (/suctioning) can remove sputum. Should alter between medium and high volume huff to maximise secretion clearance.
     Medium for lower down secretions, high for higher up secretions
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7
Q

What is the benefit of ACBT?

A
  • Will help with relaxation, relieving breathlessness
  • Helps remove secretions and decrease WOB
  • Reduce risk of infection or chance of worsening
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8
Q

How should ACBT started?

A
  • Start with normal breathing for 2-3 cycles / 3-4 repetitions
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9
Q

How is breathing control performed?

A
  • Hand on stomach gentle rise and fall diaphragm
  • Ideally in through nose and out mouth
  • Can use pursed lip breathing
  • Gradually slow breaths
  • 3-5 cycles
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10
Q

How is thoracic expansion exercises completed?

A
  • Relax chest and shoulders
  • Hands on ribs
  • Take long slow and deep breath in through nose
  • Hold breath 2-3s
  • Gentle and relax breath out
  • Repeat 3-5 times if let headed back to breathing control
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11
Q

How is huff completed?

A
  • Medium or high volume
  • Medium normal in long out
  • High deep in quick out
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12
Q

What are precautions for ACBT?

A
  • Inadequate pain control if needed
  • Bronchospasm
  • Acute, unstable head, neck or spinal surgery
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13
Q

What are contraindications for ACBT?

A
  • Pt not spontaneously breathing
  • Unconscious patient
  • Patient that can’t follow instructions
  • Agitated or confused patient
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14
Q

What other aspects may need to be done for safety for ACBT?

A

Ensure if light headed back to breathing control and don’t continue with TEE or move to huff

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15
Q

What are possibly progressions and regressions for ACBT?

A
  • Should be around 10 minute and till chest feels clear
  • Normally 1-2x a day
  • When greater sputum more often and for less time
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16
Q

Why use acapella?

A
  • Helps to clear secretions
  • If patient has ineffective cough
  • If have:
     Mucus- producing respiratory conditions such as:
     Atelectasis
     Bronchitis
     Bronchiectasis
     CF
     COPD
    Asthma
     Respiratory weakness
     Mechanical ventilation
     Neonatal respiratory distress syndrome
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17
Q

What is an acapella device?

A
  • An Oscillatory positive expiratory pressure device
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18
Q

What does acapella do?

A
  • Creates vibrations in airways helping to loosen secretions and move them centrally
  • Acapella creates high frequency oscillation and PEP by counterweighted lever and magnet
  • 2 models green for patients who can sustain at least 3s expiratory flow >15L blue for those with <15L/min expiratory flow
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19
Q

How should an acapella be used?

A
  • Cycles of relaxed breathing / light brathing control
  • Deep breath in and then into acapella device
  • Can do continued cycles
  • If wants to cough and clear allows
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20
Q

What are the benefits of ACBT?

A
  • Clears secretions
  • Done in either side lying or sitting
  • Can be done at very low expiratory flow
21
Q

What are the contraindications to ACBT?

A

Untreated pneumothorax
Hemoptysis

22
Q

Specific safety questions

A

If pt needs break or wants to cough allow
Wary of light headedness

23
Q

Progressions and regressions

A
  • More repetitions of breathing control
  • Increase resistance on device / decrease
24
Q

Why perform a bed to chair transfer?

A
  • Improved positioning
  • Increases lung volume
  • Improved positioning and some techniques can only be performed in sitting or are more effective in sitting
  • Sitting also better for orientation if the patient is frail
  • Can be easier to dress in sitting again important if frail / elderly -> end PJ paralysis
25
Q

What is the underlying theory of bed to chair transfer?

A
  • E.g. COPD pts have flattened down lung
  • Seated position can aid dome of diaphragm form – improving breathing
  • Forward leaning in chair
     Can fix accessory muscles and dome
26
Q

What is the benefit of performing bed to chair transfer?

A
  • Better position for treatment
  • Improve in WOB through increased lung volume
27
Q

What are contraindications for bed to chair transfer?

A
  • Intracranial pressure >20 mm Hg
  • Head and neck injury if not stabilised
  • Active haemorrhage with haemodynamic instability
  • Recent spinal surgery
  • Acute spinal injury or active haemoptysis
  • Empyema
  • Bronchopleural fistula
  • Pulmonary edema associated with congestive heart failure
  • Aged, confused or anxious patient that won’t tolerate
  • Rib fracture
  • Surgical wound or healing tissue
28
Q

What are possible specific safety questions for bed to chair transfer?

A
  • If patient require walking aid or if hand hold is sufficient
29
Q

What are possible regressions or progressions for bed to chair transfers?

A
  • Regressions / progressions
  • Can reduce to sitting in chair less time
  • Sitting EOB instead
  • Can sit in chair for longer
30
Q

Why complete suctioning through geudel airway?

A

 Help remove secretions for pts that are unable to clear themselves
Help decrease risk of infection through removal of secretions
For patients with impaired cough due to excessive sedation or neurological involvement

31
Q

Why might patients need assistance maintaining their airway?

A

Sedated
Surgery
Significantly traumatic injury
Burns

32
Q

What pressure is suctioning performed at?

A

100-150 mmHG

33
Q

What is the process of performing suctioning through a geudel airway?

A
  • Wash hands and apply gloves
  • Tell patient what going to do
  • Apply appropriate PPE
  • Positioning for oral suctioning is slightly up bed and neck in hyperextension
  • Turn on machine
  • Close end of tube to check appropriate pressure and attach suctioning tube
  • Apply a second glove before touching the suctioning tube
  • Remove paper from inside of catheter paper
  • Insert through geudel airway into resistance
     Patient may cough
  • Pull up and pull through fingers (no more than 15 seconds)
  • Check vitals
  • Then wash in saline bath
  • If done wrap round hand and into glove
  • Wash hands

Auscultate before and after

34
Q

What are contraindications to geudel airway suctioning?

A

Orofacial surgery/trauma
 Recent oesophageal or tracheal surgery
 Acute neck, facial or head injury
 Severe coagulation defects or unexplained frank haemoptysis
 Laryngospasm (stridor)
 Also caution should be exercised to prevent gagging on the airway
 Severe bronchospasm
According to the Bradford Teaching hospitals clinical guideline

35
Q

What are benefits of airway suctioning via geudel airway?

A

Restore airway patency by separating tongue from posterior pharyngeal wall
Help maintain adequate oxygenation through providing avenue for ventilation
Provide access for removal of secretions in the upper airway via suctioning

36
Q

what should patient explanation include?

A

How long it will last
What it will feel like
Why you are doing it

37
Q

What are precautions in the use of orphangeal suctioning?

A

Bleeding risk (low platelets, raised INR, raised APTT, coagulopathy, warfarin)
Haemodynamic instability
Haemoptysis
Acute face, neck, or head injury
Septal deviation and/or prior nasal surgery
Children
False teeth
Recent oral surgery

38
Q

What are progressions and regressions for suctioning?

A

More repetitions of suctioning can be done if needed to clear more secretions.
Can be done more frequently or more times a day.
Number of passes is dependent on patient and should be increased and decreased as able.
Importance is to ensure

39
Q

What are contraindications to closed endotracheal suctioning?

A

No clear contraindications / adbsolute according to
According to the Bradford Teaching hospitals clinical guideline

40
Q

What are precautions to suctioning via endotracheal tube?

A

Raised intracranial pressure
Cardiac instability
CSF leak
Severe bronchospasm
Vagal sensitivity and pulmonary oedema
Frank haemoptysis or coagulopathy
According to the Bradford Teaching hospitals clinical guideline

41
Q

How long should suctioning be performed for?

A

Less than 15s

42
Q

How many times can a catheter be used in open suctioning?

A

According to the Bradford Teaching hospitals clinical guideline
A new sterile catheter and gloves should be used for each suction undertaken

43
Q

Why would closed suctioning be performed?

A

If a patient is on ventilation then suctioning must be performed if they have an endotracheal tube as the nature of ventilation prevents the ability to cough.

44
Q

What are general safety considerations for suctioning?

A

Can’t occur within hour and half of eating food
Why?
Risk of aspirating food

45
Q

What are the stages of conducting endotracheostomy closed suctioning?

A

Add filter to exhale port
Attach end to suction apparatus
1st 10cm is in dead space of kit
Aim for depth of around 20 cm total
Insert catheter to 20cm
Then unlock cap, and press to apply suctioning, slowly withdraw in straight motion,
Should take up to 10s to remove
Should use flush port in between suctioning to clean catheter.
Support apparatus to prevent removal of ET tube.

46
Q

What are the benefits of performing closed suctioning?

A

Reduces risk of staff exposure to aerosols produced by suctioning.
Can be used with ET tubes

47
Q

What size is appropriate for most ET tubes?

A

Size 12

48
Q

How is a closed suctioning catheter cleaned?

A

With syringe of saline through cleaning port whilst holding suctioning.

49
Q

Why implement a three-day walking program?

A

Acute Care and Rehab (8 decks)

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