Egans: Chapter 43 Airway Clearance Therapy – Flashcards

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normal cough reflex includes what phases
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irritation inspiration compression expulsion
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necessary for normal airway clearance
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patent airway functional mucociliary escalator effective cough
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can result in atelectasis which causes hypoxemia due to shunting
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mucous plugging
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what can provoke a cough
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foreign bodies infection irritating gases
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During the third or compression phase, __________________________________ cause glottic closure and a forceful contraction of the expiratory muscles.
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reflex nerve impulses
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Partial obstruction can do what by restricting airflow
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increase the work of breathing lead to air trapping or overdistention cause ventilation/perfusion imbalances
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Impairments of cough reflex
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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)
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Causes of Impaired Mucocilliary Clearance in Intubated pts
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endotracheal or trach tube tracheobronchial suction inadequate humidification high FiO2 values drugs (opiates, narcotics) general anesthetics opiates narcotics underlying pulmonary disease
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Conditions that can inhibit airway patency and cause abnormal clearance of secretions
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foreign bodies inflammation bronchospasm tumors mucus hypersecretion kyphoscoliosis
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Conditions that lead to bronchiectasis
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chronic obstructive lung diseases foreign body aspiration obliverative bronchiolitis chronic airway infetion
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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.
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mobilize, retained
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indications for airway clearance therapy
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Acute conditions copious secretions inability to mobilize secretions ineffective cough Chronic conditions CF bronchiectasis cillary dyskinetic syndromes COPD pts with retained secretions
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Sputum production must exceed ______________________ for airway clearance therapy to significantly improve secretion removal.
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20-30mL/day
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Documented Preventive uses of airway clearance therapy
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body positioning and pt mobilization postural drainage, percussion, and vibration combined with exercise to maintain lung function in CF
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Initial assessment of Need for airway clearance therapy
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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
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clinical signs that indicate that a pt is having problems with retained secretions
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loose, ineffective cough, labored breathing decreased/bronchial breath sounds (coarse inspiratory and expiratory crackles) tachypnea tachycardia fever
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Five general approaches to airway clearance therapy are
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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
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application of gravity to achieve specific clinical objectives in resp care
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postural drainage therapy
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Contraindications of postural drainage
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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
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Complications of postural drainage
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hypoxemia increased intracranial pressure acute hypotension during procedure pulmonary hemorrhage vomiting or aspiration bronchospasm arrhythmias
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Outcomes of postural drainage
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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
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The primary purposes of turning are to promote _____________________________, ___________________________, and ______________________ of secretions.
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lung expansion, improve oxygenation, prevent retention
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What is the 2 contraindications to turning a pt
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unstable spinal cord injuries and traction of arm abductors
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Preassessment of postural drainage includes
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check VS and ausculate the chest
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how long should a postural drainage position be maintained
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3-15 min
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Postural drainage should be terminated when
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pt has severe tachycardia irregular BP severe bradycardia vomiting or aspiration pulmonary hemorrhage bronchospasm
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Percussion should not be done over what
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tender areas or sites of trauma surgery sites bony prominences (clavicles/vertebrae) fx ribs
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Chest vibration is applied when
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throughout expiration only
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Directed coughing is useful when
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bronchiectasis CF spinal cord injury
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Contraindications to direct cough
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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
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Hazards and complications of directed cough
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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
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Ideal patient position for direct cough
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sitting position with one shoulder rotated inward adn the head and spine slightly flexed
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After abdominal or thoracic surgery when pt is having difficulty developing a cough what can be done
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coordinate with pain medication using forced expiration technique splinting operative site (pillow)
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When neuromuscular pt cannot develop a good cough what can be done
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placement of an artificial airway and removal of secretionsby tracheobronchial suctioning combine manual chest compression with suctioning use of mechanical insufflation-exsufflation
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COPD cannot develop good cough what can be done
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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
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The period of __________________ breathing and _________________ following the FET (huff cough) is essential in restoring _________________ volume and minimizing fatigue.
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diaphragmatic, relaxation, lung
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another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained pts
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autogenic drainage
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consists of repeated cycles of breathing control, thoracic expansion, and FET
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active cycle of breathing
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sequence of active cycle of breathing
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relax and breathing control 3/4 throacic expansion exercises relax one or two FET (huffs)
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During autogenic drainage, _____________ should be suppressed until all _______________ breathing phases are completed
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coughing, 3
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Phases of autogenic drainage are
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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
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The ________________________ helps prevent respiratory complications in pts with neuromuscular disorders
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mechanical insufflation-esufflation (MIE)
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