week 4

Question 1

In which layer do cilia beat

Answer 1

sol layer

Question 2

name some factors that affect the mucociliary clearance mechanism

Answer 2

age
smoking
immobility
inflammation
anaesthetic agents
narrowed airways
height/presence of cillia
depth of sol layer
prolonged coughing
properties of mucus
embarrassment
hypercapnia
dehydration
hypoxia

Question 3

when are secretions a problem

Answer 3

they are seen or heard to obstruct breathing
excessive, difficult to eliminate and/or causing distress
cause desaturation because of obstruction/atelectasis and poor ventilation

Question 4

what does purulent mean

Answer 4

containing pus

Question 5

name some techniques to remove excess secretions

Answer 5

ACBT
Autogenic drainage
Hydration
positioning
mobilisation
manual techniques
adjuncts
suctioning

Question 6

when choosing an airway clearance technique what must you consider

Answer 6

acuity of patient condition
excessive or retained secretions
understanding effects of technique
patient preference
hydration/humidification
does cough need to be augmented or supressed
indications and contraindications
how will you measure outcome and effectiveness

Question 7

what are respiratory adjuncts thought to do

Answer 7

stabilize airways
prevent premature airway closure
reduce gas trapping
homogenize distribution of ventilation
counteract early airway closure and force air through collateral channels so that it can get behind secretions
can be less tiring than ACBT for some

Question 8

name some of the complications of suctioning

Answer 8

hypoxia/hypoxemia
vasovagal stimulation/cardiac arrest/arrhythmias
tissue trauma to the tracheal and/or bronchial mucosa and/ir pulmonary haemorrhage/bleeding
atelectasis
bronchospasm
infection
increased ICP
increased or decreased blood pressure
interruption in mechanical ventilation
pneumothorax
psychological effects/anxiety

Question 9

what are the contraindications to NP suctioning

Answer 9

base of skull fractures or head injuries with damage to cubiform plate
suspected CSF leak
nasal fractures
stridor
severe bronchospasm

Question 10

what are the precautions for Np suctioning

Answer 10

tracheo-oesophageal fistula
cancer high in respiratory tract
cancer high in the GI tract
recent high GI or oesophageal surgery
tracheal anastomoses
pulmonary oedema
clotting disorders or unexplained haemoptysis or nasal bleeding
unstable CVS
high intercranial pressure
nasal polyps or occluded nasal passages

Question 11

when is NP and oral suctioning indicated

Answer 11

when the patient is unable to clear secretions and secretions are audible/visible despite the patients best cough effort
when secretions compromise oxygenation by decreasing SpO2/PaO2 below what is acceptable for the patient