Secretions Management Flashcards
How would you know a patient has excessive secretions?
Auscultation- bronchial breathing (consolidation)
Productive cough
Patient history
Chest x-ray, white areas (consolidation)
Decreased exercise tolerance, increased breathlessness
What is breathing control?
Tidal volume breathing at a patients own respiratory rate and volume
Patient encouraged to breath with the lower chest, using a diaphragmatic breathing pattern
- greater ventilation occurs in the base of the lung
- use of diaphragm- fatigue resistance fibres
- relaxes accessory muscles
How would you facilitate BC and what is its affect?
By placing either the patients/therapists hand over the diaphragm to encourage lower breathing and upperchest/ shoulder relaxation
Allows recovery from fatigue, oxygen desaturation or signs of bronchospasm and relieves breathlessness which may be generated during active components of cycle
Duration depends on patients rate of recovery
How long do you complete ACBT?
Minimum of 10 minutes
- 2 cycles of a non productive/dry sounding huff
- if patient refuses
- medically unstable- if stats change
- adverse effects e.g. patient vomits
What is thoracic expansion exercises?
Deep breathing exercises with an emphasis on slow, controlled inspiration through the nose
Active inspiration with larger than normal volume breath often combined with a 3-second end inspiratory breath hole
What’s the theory behind TEE?
Collateral channels of ventilation- active and deeper volume inspiration facilitates these channels to areas peripheral to retained secretion
Alveolar interdependence- during inspiration expanding alveoli exert forces on adjacent alveoli encouraging recruitment of lung units
High lung volumes achieved during TEE generate greater expanding forces between alveoli and assist in re-expanding lung tissue
How long do you complete TEE for?
3-4 deep breathes to minimise hyperventilation or fatigue in breathless patients
How can we facilitate TEE?
Proprioceptive feedback- patients/ therapists hands placed on area of chest wall where movement is to be encouraged
Explain sniff during TEE?
Sniff- an additional increase in lung volume at end of deep inspiration
Not appropriate for hyperinflated/ breathless patients
Useful for surgical patients who need further motivation to increase lung volume
What is FET?
Forced expiration technique
Combination of 1-2 huffs and BC
Huff is with an open glottius and involves less effort
Huffing from low lung volumes (small breath) move peripherally situated secretions towards the mouth
High lung volumes (bigger breath) huff used to clear from upper airways
Explain the equal pressure points theory for FET?
Where airway pressure = pleural pressure
Proximal to this point, towards the mouth airway pressure falls below pleural pressure = dynamic compression and a narrowed airway
What follows FET and why?
BC to minimise the increase in airflow obstruction and fatigue
Patient with fatigue, bronchospasm or unstable airways may require a longer rest period
What are the collateral ventilation pathways?
Bronchiolar- alveolar canal of Lambert
Interbronchiolar channel of martin
Interalveolar pore of Kohn
