Suppurative lung disorders Flashcards
What is suppurative inflammation?
Infam process producing purulent exudate + liquification necrosis & death of associated lung tissue
What is CSLD? Chronic suppurative lung disease
Wet productive cough > 8wks
Persistent & recurrent infections
Poor clearance
S&S of CSLD?
Exertional dyspnoea, coughing wheezing, tightness in chest, growth failure, Hyperinflation -barrel chest, clubbing, ausc. amphoric, Chest xray - opacities, hyperinflation
Pathophys of CSLD
Patho not removed
-> further infection & secretion production
-> tissue destruction.
->Further impairment of MCC + Smooth mm to distorted floppy airways.
= decreased secretion clearance
Impairments of CSLD
Excessive secretion movement & clearance issues
Types of CSLD
Cystic fibrosis, bronchiectasis, lung abscesses
Define bronchiectasis general path
abnormally dilated, distorted thick-walled medium-sized bronchi that are chronically inflamed and infected by bacteria.
Which pop group is most affected by bronchiectasis?
Indigeous Aus kids. 147/10,000
Aetiology of CF: genetic & acquired
Genetic: CF & Kartagener.
Acquired: TB, pneumonia, inhaled foreign bodies, tumours
Airway clearance techniques for CSLD
- ACBT (+ postural drainage) & oscillating peps (therapep, acapella, flutter) (plus postural drainage & FET)
- Postural drainage
- FET should be taught
Airway techniques & education
Made aware of airway clearance techniques available.
Encouraged to be independent with chosen clearance technique.
Pt preference & treatment must be taken into account.
Physio for CF
Prophylactic removal of secretions.
Preventative strategies
Assist with removal of infected secretions
Maintain & improve lung function
Evidence for secretion clearance in CF
Treatment based on patient preference.
Aerobic activity should be considered an adjunctive to therapy for additional health benefits.
What PT interventions can we use?
PEP, flutter or acapella, postural drainage, percussion or vibrations, nebulised saline or hypertonic saline, ultrasonic nebulisation, exercise
Mechanism of a lung abscess
Aspiration > small cavities > encapsulated >erodes tissue >bronchopulmonary fistula > drainage of secretions
S&S of lung abscess
Febrile, leukocytosis, putrid sputum, amphoric breath sounds, empyema (pus in pleural space), fatigue.
Precautions for lung abscess
Take care not to perforate encapsulated LA.
If draining secretions, care not to spread thru lungs.
Encourage compliance with medication
Interventions for difficulty clearing
Huff & Cough
Increase lung volumes (DBE)
Interventions for excessive secretions
PD, Percussion, vibrations, shaking, ACBT, FET, PEP, flutter, Acapella, Exercise, Hypertonic & nebulised saline
Describe FET (combined techniques)
1-2 huffs + breathing control
What is breathing control
‘Relaxed tidal breathing using the lower chest and encouraging relaxation of the upper chest and shoulders
Define ACBT
FET + TEE =
TEE (DBE) + BC + Huff + BC - repeat
ACBT used in which pop groups?
COPD, non-CF bronchiectasis, excessive secretions, CF.
What is PEP / TheraPEP?
Applies resistance via mouthpiece or mask & results in back pressure through airways.
May increase expiratory flow in the peripheral airways > annular flow
Mechanism of action for PEP
Aeration of alveoli through collateral channels
Theory of PEP
reduces dynamic closure during expiration - splinting airways open
Effects of oscillation devices
Optimise airflow (13Hz)
Maximise exp. flow
Decrease viscosity of mucus
Augmentation of cilial beat (12Hz)
Stimulate spontaneous coughs
Aspects of postural drainage
Gravity driven drainage
Bronchus perpendicular to floor
What is the PD position for the RM lobe?
LSL 15 degree head down tilt, 1/4 off supine
Precautions for head down tilt
Unstable haemodynamics: HTN (BP>150/100) arrythmias.
Stomach issues: oesophageal surgery, GORD, just eaten, hiatus hernia.
Pneumonectoomy (dont lie on operated side).
Common sense: orthopnea, head injury, patient distress, pulmonary oedema, severe obesity, head/neck surgery, facial trauma, cerebral aneurysm.
Percussion
Rhythmic tapping of hands 1-2 per second
Proposed physiological effects
increased exp. flow.
Oscillation of expiratory flow (augment cilial beat, decreased viscosity of mucus.
Mechanical loosening secretions
Stimulate spontaneous coughing
Precautions C/I for manual techniques
Bones, bleed & bronchospasm. Specifically:
Ribs - #, flail, rib cancer,
Frank haemoptysis
OP
Burns, surgical incision or IC drain
Severe bronchospasm
Severe pleuritric pain
Very low platelets
What is autogenic drainage
Unstick secretions - large exhale then small breath in, abdominal breath. Hear secretions start to crackle. Resist any desire to cough.
Repeat for at least 3 breaths. Then change to medium breaths x 3. Evacuate secretions - when the crackles are louder still, take long, slow, full breaths into your absolute maximum inspiration, continuing to take small breaths out x 3
