week 10

Question 1

Is the presence of mucus in the airways normal?

Answer 1

yes

Question 2

What does sputum refer to?

Answer 2

excess tracheobronchial secretions which are cleared from the airway by coughing or huffing

Question 3

Why is mucus important?

Answer 3

helps insulate and prevent drying out of the airways
Helps trap and protect the lungs from dust, pollen, pollutants, viruses and bacteria

Question 4

What is mucoid?

Answer 4

clear white and frothy mucus (normal)

Question 5

What is mucopurulent?

Answer 5

green/yellow tinged mild infection/initial stages of infection

Question 6

What is brown mucus?

Answer 6

old infection/old blood

Question 7

What is bright red mucus?

Answer 7

frank blood

Question 8

What is pink and frothy blood?

Answer 8

pulmonary oedema

Question 9

What are the key components for normal mucocillary clearance?

Answer 9

cillia
aqueous sol layer
viscous gel layer

Question 10

What is the mucocillary escalator?

Answer 10

the movement of mucus up and out of the respiratory tract, mucus traps particles and cilia propel mucus up and out of the lungs

Question 11

Name some factors that affect mucociliary clearance mechanism

Answer 11

age
smoking
immobility
inflammation
anaesthetic agents
narrowed airways
height/presence of cilia
depth of sol layer
prolonged coughing
properties of mucus
embarrassment
hypercapnoea

Question 12

What are the risks of impaired mucocillary clearance?

Answer 12

overwhelming infection
major atelectasis
impaired gas exchange
airflow limitation

Question 13

What are the goals of airway clearance?

Answer 13

to reduce airway obstruction
to improve mucocillary clearance
to improve ventilation and gaseous exchange

Question 14

What is Active cycle of breathing?

Answer 14

A breathing technique which helps move excess secretions and improve ventilation in the lungs

Question 15

What are the 3 components of ACBT?

Answer 15

breathing control
deep breathing exercises
huffing

Question 16

What is breathing control used for?

Answer 16

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

Question 17

What is breathing control?

Answer 17

Gentle normal breathing using the abdomen

Question 18

What instructions should you give to the patient for breathing control?

Answer 18

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

Question 19

In what stage of ACBT is the principle of collateral ventilation utilised?

Answer 19

Deep breathing exercises

Question 20

What is deep breathing thought to do?

Answer 20

Increase lung volume
increase ventilation
decrease airway resistance
increase surfactant secretion
aid V/Q matching
decrease dead space
increase diffusion
increase oxygen saturation

Question 21

What instructions should you give to the patient for deep breathing?

Answer 21

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

Question 22

What is a huff?

Answer 22

exhaling through an open mouth and throat instead of coughing

Question 23

What does huffing help with?

Answer 23

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

Question 24

What should huffing not be?

Answer 24

so forced that it causes wheezing or tightness in the chest

Question 25

How is huffing initially taught to a patient?

Answer 25

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

Question 26

Explain how a huff works

Answer 26

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

Question 27

What instructions should be given to a patient for huffing?

Answer 27

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

Question 28

How do you prevent secretion thickening?

Answer 28

systemic hydration by oral or intravenous fluids
inhalation of vapour
nebulisation by inhalation of an aerosol

Question 29

What is ventilation?

Answer 29

the process of moving gas in and out of the lungs/alveoli

Question 30

What is respiration?

Answer 30

the process of moving oxygen and carbon dioxide between air and blood

Question 31

what two primary defence mechanisms do the lungs protect themselves with?

Answer 31

the mucociliary transport system
coughing

Question 32

For coughing to be effective, what does it require a person to be able to do?

Answer 32

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