Unit 1 - Bronchial Hygiene Therapy Flashcards
Airway clearance therapy uses what?
Noninvasive techniques to improve gas exchange
Normal clearance requires three things:
Patent airway, Functional mucocilary escalator, effective cough
What can an effective cough do?
Move mucus from lower airways to upper airways (to be coughed out)
Abnormal clearance is any abnormality that alters: 5 factors:
Airway patency, Mucocilary function, Breathing muscle strength, secretion thickness, cough reflex
Normal clearance 4 steps to cough:
Irritation, Inspiration, Compression, Expulsion
Retention of secretions may result in two things:
Full obstruction or mucus plugging, partial obstruction that restricts airflow.
Full obstruction results in what?
Atelectasis - causes hypoxemia due to shunting.
Partial obstruction can do what?
Increase WOB, Air-trapping, lung over-distention, and V/Q imbalances.
Diseases associated with abnormal clearance:
CF, Bronchiectasis, Neuromuscular diseases
Intubated patients may have these factors associated with impaired mucocilary clearance:
Endo or trach tube, Tracheobronchal suction, Drugs, high FiO2 values, Opiates, underlying pulmonary diseases.
Indications for airway clearance therapy for ACUTE conditions?
copious secretions, inability to mobilize secretions, ineffective cough.
Indications for airway clearance for CHRONIC conditions?
CF, Bronchiectasis, ciliary dyskinetic syndromes, COPD patients with retained secretions.
Who could benefit from airway clearance therapy?
Acutely ill patients, CF
Physical findings that determine the need for airway clearance?
Loose, ineffective cough, Labored breathing pattern, Coarse inspir. & expir. crackles, Tachypnea/Tachycardia, Fever
Five ways or approaches to doing airway clearance?
CPT, Cough, Positive Airway pressure, High frequency compression, physical activity or mobilization.
What is Chest Physical Therapy (CPT)?
Use of positioning & gravity; cupped hand striking; mechanical vibrations.
What are some limitations to CPT?
May not tolerate Trendelenburg position (if dyspnea), dependent on appropriate positioning, requires help of caregiver.
How long does caregiver perform CPT?
3 - 5 minutes on each affected area/lobe.
Factors to assess Airway clearance methods? Did it work?
Change in: sputum production, breath sounds, dyspnea level, vital signs, chest radiograph, ABG results, ventilator variables.
What items need to be documented & followed up in airway clearance methods?
Positions used, time in positions, patient tolerance, indicators of effectiveness, any bad effects observed.
What is a directed cough?
Deliberate cough that is taught, supervised, and monitored. Mimic the spontaneous cough.
Who can’t use directed cough?
Obtunded, paralyzed, or uncooperative patients.
What is Forced Expiratory Technique (FET)?
Modification of directed cough - “HUFF cough”; one or two forced expirations of middle to low lung volumes without closure of glottis.
What is FET goal?
To clear secretions with less change in pleural pressure and less bronchial collapse.
FET is most helpful to what patients?
COPD, CF, bronchiectasis
What is Manual Assisted Cough?
External application of pressure to the thoracic cage or epigastric region with forced exhalation.
Who benefits from Manual Assisted Cough?
Patients with neuromuscular conditions that cannot generate forceful expulsion.
What are the steps to Active Cycle of Breathing Technique?
Relaxation & Breathing control, 3-4 thoracic expansion exercises, repeat twice, then at least 1 huff cough (FET), and repeat relaxation/breathing control.
Positive Airway Pressure is used to treat?
Atelectasis and mobilize secretions.
The three types of Airway pressure devices:
Continuous PAP (CPAP), expiratory PAP (EPAP), and positive pressure (PEP)
Physical activity therapy should result in 4 things:
Increased tidal ventilation, increased heart rate, increased cardiac output, and improved physical conditioning.
The PEP device uses what flow?
fixed or variable orifice expiratory flow restrictor to generate expiratory pressures of 10 to 20 cmH2O as patient actively exhales through device.
What is high frequency Compression or Osscillation?
Vest: inflates/deflates, creating pressure pulses against the thorax that cause chest wall oscillations and move secretions forward.
Intrapulmonary percussive ventilation does what?
Rapid series of pressurized gas minibursts to the airway at rates of 100 to 225 cycles per minute.
What is bronchial hygiene therapy?
Non-invasive techniques to improve gas exchange and promote, mobilize, and remove secretions.
Characteristics of CF?
Increased sputum viscosity, increased mucus volume & impaired clearance.
Who typically gets CF?
Children and young adults
Characteristics of Bronchiectasis?
Mucostasis, retained secretions, loss of mucuciliary escalator and repeated pneumonia.
Who typically gets Bronchiectasis?
Adults with history of lung infection
Three ways to rotate the body along the longitudinal axis?
Self-turning, caregiver turning, rotational beds
Roto rest bed is done for two reasons if patient is?
Sedated, paralyzed
Contraindications of Rotobed?
Morbidly obese, rib fractures, cervical spine injuries
Dolphin Mattress does what?
Keeps mucus and secretions moving in the lungs.
What position should the “good” lung be in?
Down always. “Good down, bad up”
Contraindications of Chest PT?
Intercranial pressure, spinal cord injury, Feeding tubes, Burns/wounds, Combative, osteoporosis, rib fractures.
What is Autogenic Drainage?
Modified coughing technique: breathing pattern that varies lung volume and expiratory flow in three different phases.
Mechanical insufflation exsufflation (MIE) technique does what?
Blow first, then suck last. Pressure in then pull back out.
* Good for cardiac patients.
Where is the flutter Valve used?
At-home patients
Acapella is used for how long?
10 - 20 minutes
