Test 1 Ch.44 Eagans Airway Clearance Therapy Flashcards
Any abnormality that alters airway patency, ______________ function, strength of ____________ muscles, thickness of ____________, or effectiveness of the cough reflex, can impair airway clearance leading to ______________of secretions
mucociliary;
breathing;
secretions;
Retention
What can result from full or partial airway obstruction?
Retention of secretions
Full obstruction, or _________ __________ can result in ____________ which causes hypoxemia due to ____________
mucous plugging;
atelectasis;
shunting
This causes increased WOB and possibly leading to air trapping, lung distention, and V/Q mismatch
Partial obstruction
Full obstruction ——->atelectasis—>
shunt——>v/q mismatch
partial obstruction —-> increased WOB——>
air trapping——>v/q mismatch
What are some causes of impaired mucociliary clearance in intubated pts (8) (EDON)
- ETT or TT
- Tracheobronchial suction
- Inadequate humidification
- High Fio2 values
- Drugs
- Opiates
- Narcotics
- Underlying pulmonary disease
Uses non-invasive technique designed to assist in mobilizing secretions and removing secretions to improve gas exchange, is referred to as?
Airway clearance therapy (ACT)
Examples of strength of breathing muscles
any neuromuscular disease:
MG
GB
muscular dystrophy
paralysis of diaphragm
restrictive diseases
Example of mucociliary function
smokers (destroying cilia b/c of the breathing in of tar)
Examples diseases for having thickness of secretions (2)
- CF
- bronchiectasis
When Mucous plugging happens it blocks the entire alveoli and now
it does not expand properly
What are some indications for ACT in acute conditions? (3)
- Copious secretions
- Inability to mobilize secretions
- Ineffective cough
What are some indications for ACT in chronic conditions? (4)
- CF
- Bronchiectasis
- Cilary dyskinetic syndromes
- COPD pts w/ retained secretions
What is the primary goal of ACT?
To assist pts to mobilize and remove retained secretions
Removal of these retained will improve (3)
- gas exchange
- promote alveolar expansion
- reduce WOB
How do you determine the need for ACT?
Depends on the reviewal of the chart, medical history, CXR, Labs, assessing the pt’s current symptoms
What is the initial assessment of the need for ACT: medical record?
- History of pulmonary problems
- Increase secretions
- Admission for upper abdominal or thoracic surgery:
*Age (elderly)
*History of COPD
*Obesity
*nature of procedure
*Type of anesthesia - PFTs
- CXR
- ABG values/ o2 sats
What is the initial assessment of he need for ACT: patient (7)
- posture, muscle tone
- effectiveness of cough
- sputum production
- breathing pattern
- general physical fitness
- breath sounds
- vitals, HR rhythm
What are 5 general approaches to ACT, which can be used alone or in combination?
- CPT
- coughing and related expulsion techniques (mechanical insufflation- exsufflation)
- positive airway pressure (PAP) adjuncts
- HFCWO
- mobilization and physical activity
Contraindications to use of Use of Chest Physical Therapy (CPT)
- Head and neck until stabilized (A)
- Active hemorrhage w/ hemodynamic instability (A)
- ICP greater than 20 mm Hg (R)
- Active hemoptysis (R)
- Pulmonary embolism (R)
- Empyema (R)
- Osteomyelitis of the ribs (R)
- Distended abdominal
HFCWO devices are
passive oscillatory devices
The generator for a HFCWO _________ and deflates the vest creating _____________ pulses against the thorax, resulting in chest wall ____________ and moving __________ forward.
inflates;
pressure;
oscillations;
secretions
What are some key factors in selecting an airway clearance strategy
- pt’s motivation
- pt’s goals
- pt’s ability to comprehend—- literacy cognitive levels/ can they follow directions?
- physical limitations
- physician/ caregiver goals
- effectiveness of technique
- ease of learning and teching
