question

normal cough reflex includes what phases

answer

irritation inspiration compression expulsion

question

necessary for normal airway clearance

answer

patent airway functional mucociliary escalator effective cough

question

can result in atelectasis which causes hypoxemia due to shunting

answer

mucous plugging

question

what can provoke a cough

answer

foreign bodies infection irritating gases

question

During the third or compression phase, __________________________________ cause glottic closure and a forceful contraction of the expiratory muscles.

answer

reflex nerve impulses

question

Partial obstruction can do what by restricting airflow

answer

increase the work of breathing lead to air trapping or overdistention cause ventilation/perfusion imbalances

question

Impairments of cough reflex

answer

irritation - anesthesia, cns depression, narcotic analgesics inspiration- pain, neuromuscular dysfunction, pulmonary restriction, abdominal restriction compression- laryngeal nerve damage, artificial airway, abdominal muscle weakness, abdominal surgery expulsion- airway compression, airway obstruction, abdominal muscle weakness, inadequate lung recoil(emphysema)

question

Causes of Impaired Mucocilliary Clearance in Intubated pts

answer

endotracheal or trach tube tracheobronchial suction inadequate humidification high FiO2 values drugs (opiates, narcotics) general anesthetics opiates narcotics underlying pulmonary disease

question

Conditions that can inhibit airway patency and cause abnormal clearance of secretions

answer

foreign bodies inflammation bronchospasm tumors mucus hypersecretion kyphoscoliosis

question

Conditions that lead to bronchiectasis

answer

chronic obstructive lung diseases foreign body aspiration obliverative bronchiolitis chronic airway infetion

question

The primary goal of airway clearance therapy is to help ________________________ and remove _________________ secretions, with the ultimate aim to improve gas exchange and reduce the work of breathing.

answer

mobilize, retained

question

indications for airway clearance therapy

answer

Acute conditions copious secretions inability to mobilize secretions ineffective cough Chronic conditions CF bronchiectasis cillary dyskinetic syndromes COPD pts with retained secretions

question

Sputum production must exceed ______________________ for airway clearance therapy to significantly improve secretion removal.

answer

20-30mL/day

question

Documented Preventive uses of airway clearance therapy

answer

body positioning and pt mobilization postural drainage, percussion, and vibration combined with exercise to maintain lung function in CF

question

Initial assessment of Need for airway clearance therapy

answer

Medical REcord hx of pulmonary problems causing increased secretions admission for upper abdominal or thoracic surgery consider: age hx of COPD obesity nature of procedure type of anesthesia duration of procedure presence of artificial tracheal airway chest radiograph indicating atelectasis results of pulmonary function tests ABG values or O2 sat Patient posture, muscle tone effectiveness of cough sputum production breathing pattern general physical fitness breath sounds VS, HR and rhythm

question

clinical signs that indicate that a pt is having problems with retained secretions

answer

loose, ineffective cough, labored breathing decreased/bronchial breath sounds (coarse inspiratory and expiratory crackles) tachypnea tachycardia fever

question

Five general approaches to airway clearance therapy are

answer

postural drainage therapy (including turning, percussion, and vibration) coughing and related expulsion techniques positive airway pressure adjuncts (PAP), PEP, CPAP, positive expiratory PAP high frequency compression/oscillation methods mobilization and exercise

question

application of gravity to achieve specific clinical objectives in resp care

answer

postural drainage therapy

question

Contraindications of postural drainage

answer

head and neck injury until stabilized active hemorrhage with hemodynamic stability ICp > 20mmHg recent spinal surgery active hemoptysis empyema bronchopleural fistula pulmonary edema assoc with heart failure aged, confused, or anxious patients who do not tolerate postition changes pulmonary embolism rib fx surgical wound or healing tissue

question

Complications of postural drainage

answer

hypoxemia increased intracranial pressure acute hypotension during procedure pulmonary hemorrhage vomiting or aspiration bronchospasm arrhythmias

question

Outcomes of postural drainage

answer

change in sputum production change in breath sounds change in VS pt subjective response to therapy change in ventilator variables change in ABG or O2 stats

question

The primary purposes of turning are to promote _____________________________, ___________________________, and ______________________ of secretions.

answer

lung expansion, improve oxygenation, prevent retention

question

What is the 2 contraindications to turning a pt

answer

unstable spinal cord injuries and traction of arm abductors

question

Preassessment of postural drainage includes

answer

check VS and ausculate the chest

question

how long should a postural drainage position be maintained

answer

3-15 min

question

Postural drainage should be terminated when

answer

pt has severe tachycardia irregular BP severe bradycardia vomiting or aspiration pulmonary hemorrhage bronchospasm

question

Percussion should not be done over what

answer

tender areas or sites of trauma surgery sites bony prominences (clavicles/vertebrae) fx ribs

question

Chest vibration is applied when

answer

throughout expiration only

question

Directed coughing is useful when

answer

bronchiectasis CF spinal cord injury

question

Contraindications to direct cough

answer

inability to control possible transmission of infection presence of elevated ICP or intracranial aneurysm presence of reduced coronary artery perfusion, such as in acute MI acute unstable head, neck, or spine injury

question

Hazards and complications of directed cough

answer

reduced coronary artery perfusion reduced cerebral perfusion incontinence fatigue rib or costochondral fx headache visual disturbances, including retinal hemorrhage broncospasm muscular damage or discomfort incisional pain evisceration anorexia, vomiting GERD spontaneous pneumothorax pneumomediastinum subcutaneous emphysema cough parxysms chest pain central line displacement

question

Ideal patient position for direct cough

answer

sitting position with one shoulder rotated inward adn the head and spine slightly flexed

question

After abdominal or thoracic surgery when pt is having difficulty developing a cough what can be done

answer

coordinate with pain medication using forced expiration technique splinting operative site (pillow)

question

When neuromuscular pt cannot develop a good cough what can be done

answer

placement of an artificial airway and removal of secretionsby tracheobronchial suctioning combine manual chest compression with suctioning use of mechanical insufflation-exsufflation

question

COPD cannot develop good cough what can be done

answer

instruct pt to slowly take in moderately deep breath nose have exhale through pursed lips while bending forward after doing this 3/4 times then encourage pt to bend forward and initiate short burst of air (huff, huff, huff) with their mouth open

question

The period of __________________ breathing and _________________ following the FET (huff cough) is essential in restoring _________________ volume and minimizing fatigue.

answer

diaphragmatic, relaxation, lung

question

another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained pts

answer

autogenic drainage

question

consists of repeated cycles of breathing control, thoracic expansion, and FET

answer

active cycle of breathing

question

sequence of active cycle of breathing

answer

relax and breathing control 3/4 throacic expansion exercises relax one or two FET (huffs)

question

During autogenic drainage, _____________ should be suppressed until all _______________ breathing phases are completed

answer

coughing, 3

question

Phases of autogenic drainage are

answer

Deep Breath Phase 1 (sharp deep breath) full inspiratory capacity maneuver followed by breathing at low lung volumes designed to unstick periphaerl mucus Phase2 (huff, huff) involves breathing at low to middle lung volumes to collect mucus in the middle airways Phase 3 (huff, huff) evacuation phase in which mucus is readied for expulsion from the large airways

question

The ________________________ helps prevent respiratory complications in pts with neuromuscular disorders

answer

mechanical insufflation-esufflation (MIE)

Egans: Chapter 43 Airway Clearance Therapy – Flashcards

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