sputum retention theory Flashcards
What are the 3 requirements for a normal muco-ciliary clearance?
- ) Normal MCT system and environment
- ) effective cough
- ) expiratory airflow
What is sputum retention?
The inability to clear secretions
Potential causes of sputum retention?
Pain Increased work of breathing Pathology ineffective cough bronchospasm dehydration
Potential symptoms of sputum retention?
Fever Moist cough change in sputum production change in nature of sputum chest pain incontinence from cough breathlessness
Objective signs of sputum retention
moist cough crackles, wheeze, reduced air on auscultation crackles on palpation Pulmonary function tests reduced oxygen levels
Define Bronchiectasis
chronic inflammation and dilation of the bronchi, damaging the cilia and disrupting MCT system. It can be brought on from infections and pneumonia. Antibiotics and steriods and other medication can treat it, also exercise and breathing rehabilitation.
Asides from coughing, what other airway clearance techniques are there?
Postural Drainage Manual techniques such as percussion, shaking, vibrations and rib springing Suction Active cycle of breathing Autogenic drainage Devices Positive expiratory pressure (PEP) Oscillating PEP Machines Cough assist Non invasive ventilation Intermittent positive pressure breathing via BIRD or NIPPY CLEARWAY 2 Exercise
In order to move secretions, how much should the PEFR be compared to the PIFR? and what should the PEFR velocity be?
PEFR should be at least 10% larger and at least 30-60 L-min velocity
What is equal pressure point (EPP)?
When pleural pressure and airway pressure are equal
Larger inspirations brings EPP and choke point closer to mouth, which will create an effective secretion removal.
What is choke point?
When pleural pressure is greater than airway pressure which results in a narrowing of airways. This results in speeding up of E airflow, which creates shearing stresses and turbulant flow and squeezes secretions mouthwards.
What is pendulluft airflow and how can you achieve it?
When air moves into obstructed areas of lungs. This can be achieved by a 3-second hold following inspiration. It is effective in reducing atelectasis (lung collapse), also can useful for the redistribution of surfactant and decreasing surface tension within the alveoli and aiding re-inflation of lung units
How does oscillation affect airflow?
- Increasing expiratory flow rate
- Mechanical stimulation of ciliated cells due to oscillation of airway or chest wall at frequencies of 5–17 Hz which have been proposed improve tracheal mucus clearance Altering the rheology of mucous (this means changing the viscosity so it thinner and easier to move)
What are the 3 components of active cycle of breathing techniques (ABCT)?
Breathing control (BC) at tidal volume
Thoracic expansion exercise (TEE) big inspiration and hold
huffing
What are the benefits of deep inspiration?
utilizes interpendence (expanded alveoli) collateral ventilation (reduces resistance between channels, so air can get behind secretions and increase ventilation) pendelluft flow (mentioned earlier) surfactant redistribution (reduce tension and risk of collapse)
What is collateral ventilation
Where alveolar structures are ventilated through channels that bypass normal airways
