week 10 Flashcards
Is the presence of mucus in the airways normal?
yes
What does sputum refer to?
excess tracheobronchial secretions which are cleared from the airway by coughing or huffing
Why is mucus important?
helps insulate and prevent drying out of the airways
Helps trap and protect the lungs from dust, pollen, pollutants, viruses and bacteria
What is mucoid?
clear white and frothy mucus (normal)
What is mucopurulent?
green/yellow tinged mild infection/initial stages of infection
What is brown mucus?
old infection/old blood
What is bright red mucus?
frank blood
What is pink and frothy blood?
pulmonary oedema
What are the key components for normal mucocillary clearance?
cillia
aqueous sol layer
viscous gel layer
What is the mucocillary escalator?
the movement of mucus up and out of the respiratory tract, mucus traps particles and cilia propel mucus up and out of the lungs
Name some factors that affect mucociliary clearance mechanism
age
smoking
immobility
inflammation
anaesthetic agents
narrowed airways
height/presence of cilia
depth of sol layer
prolonged coughing
properties of mucus
embarrassment
hypercapnoea
What are the risks of impaired mucocillary clearance?
overwhelming infection
major atelectasis
impaired gas exchange
airflow limitation
What are the goals of airway clearance?
to reduce airway obstruction
to improve mucocillary clearance
to improve ventilation and gaseous exchange
What is Active cycle of breathing?
A breathing technique which helps move excess secretions and improve ventilation in the lungs
What are the 3 components of ACBT?
breathing control
deep breathing exercises
huffing
What is breathing control used for?
to relax the airways and relieve the symptoms of wheezing and tightness which normally occur after coughing or breathlessness
Can also help when experiencing SOB, fear, signs of bronchospasm, anxiety
What is breathing control?
Gentle normal breathing using the abdomen
What instructions should you give to the patient for breathing control?
rest your hand lightly on your stomach
breath in and out quietly and gently through your nose if you can
as you breathe in your stomach should rise
In what stage of ACBT is the principle of collateral ventilation utilised?
Deep breathing exercises
What is deep breathing thought to do?
Increase lung volume
increase ventilation
decrease airway resistance
increase surfactant secretion
aid V/Q matching
decrease dead space
increase diffusion
increase oxygen saturation
What instructions should you give to the patient for deep breathing?
take a long, slow, deep breath in through your nose if you cane
Breathe out gently through your mouth
try to breathe right down to the bottom of your lungs, expanding your ribcage
If it is comfortable for you to do so, a short three-second hold at full expansion
aim to do three to four deep breaths before returning to breathing control
What is a huff?
exhaling through an open mouth and throat instead of coughing
What does huffing help with?
helps move sputum from the smaller airways to the larger upper airways, from where they are removed by coughing as coughing alone can’t remove sputum from small airways
What should huffing not be?
so forced that it causes wheezing or tightness in the chest
How is huffing initially taught to a patient?
The patient is instructed to take a medium breath in and out with mild to moderate force and extended expiratory flow, with the glottis open
Explain how a huff works
during a huff, pleural pressure becomes positive and equal to airway pressure at a point called the equal pressure point
From the EPP, to the mouth, the pressure outside the airway is greater than that within the airway
This creates narrowing and a squeezing action which moves progressively towards the mouth
What instructions should be given to a patient for huffing?
take a normal breath in then with your mouth open as if you are steaming up a mirror breathe out steadily but with some force, trying to empty out right to the bottom of your lungs
How do you prevent secretion thickening?
systemic hydration by oral or intravenous fluids
inhalation of vapour
nebulisation by inhalation of an aerosol
What is ventilation?
the process of moving gas in and out of the lungs/alveoli
What is respiration?
the process of moving oxygen and carbon dioxide between air and blood
what two primary defence mechanisms do the lungs protect themselves with?
the mucociliary transport system
coughing
For coughing to be effective, what does it require a person to be able to do?
inspire large volumes
generate high intrathoracic pressure by contracting the abdominal and expiratory muscles
close the glottis
have airways that dynamically narrow but dont completely collapse
