Airway Clearance Therapy (ACT)
Three conditions that may cause internal obstruction or external compression of the airway lumen
A. Foreign body: External B. Tumor: External C. Secretions, bronchospasm, inflammation: Internal
Vibration techniques to loosen secretion
vibration moves secretions upward during exhalation
The two general approaches to oscillation
A. External-HFCC B. Internal-flutter
Secretion Managment Chest radiograph
Atelectasis or infiltrates
In explaining the therapeutic goal of PEP therapy to a patient, it would be most appropriate to say:
"This will help you cough more effectively."
Four phases of the normal cough
- Irritation -Inspiration -Compression weakness/ surgery -Expulsion weakness
Two obstructive lung diseases that result in excessive secretion of mucus and implairment of normal clearance
-Cystic fibrosis -Bronchiectasis
Describe the Expiratory cycle of MI-E in term of times and pressure
. Pressure is abruptly reversed to 30 to 50 cm H2O for 2 to 3 sec.
Give a recommended intervention for Bronchospasm complication of postural draining
. Stop. Position. O2. Request bronchodilator from physician.
IPV
. intrapulmonary percussive ventilation
MI-E
. mechanical insufflation-exsufflation
Two relative contraindication to turning
1. Severe diarrhea 2. Marked agitation (increased ICP, drop in BP, hypoxia, and arrhythmias)
Two absolute contraindication to turning
1. Unstable spinal cord injuries 2. Traction of arm abductors
How long should you wait to schedule postural drainage aftera patient eats? Why?
2 hr after meals or tube feedings to prevent aspiration and gastroesophageal reflux.
If postural drainage therapy is effective, how often should you reevaluate in the hospital
2 to 3 days for other hospitalized patients
What is the minimum range of time for effective application of postural draining therapy?
3 to 15 min
Four acute conditions in which bronchial hygiene is indicated
A. Copious secretions B. Acute respiratory failure with retained secretions C. Acute lobar atelectasis D. Unilateral lung disease
The well-documented preventive uses bronchial hygiene therapy
A. Copious secretions B. Acute respiratory failure with retained secretions C. Acute lobar atelectasis D. Unilateral lung disease
Four neurologic or musculoskeletal conditions that impair cough
A. Muscular dystrophy B. ALS C. Myasthenia gravis D. Poliomyelitis (and cerebral palsy, to name a few)
Five factors that must be documented after each postural drainage treatment
A. Position(s) used B. Duration C. Patient tolerance D. Subjective and objective indications of effectiveness (amount of sputum) E. Adverse reactions
Secretion Management History
A. Pulmonary problems known to increase sputum; also, for patients with upper abdominal or thoracic survey who have high risk due to COPD, obesity, age, and duration of the procedure.
Four of the benefits or advantages of the flutter valve as a secretion management tool.
A. Readily accepted by patients B. Inexpensive C. Fully portable D. Self-administered
What are the four indications for PAP adjuncts
A. Reduce air trapping in asthma and COPD. B. Mobilize retained secretions in cystic fibrosis and chronic bronchitis. C. Prevent or reverse atelectasis. D. Optimize delivery of bronchodilators in patients receiving bronchial hygiene.
Three examples of types of patients who may need modified cough techniques
A. Surgical B. COPD C. Neuromuscular disorders
Postural draining therapy includes up to components, not counting cough
A. Turning B. Postural drainage C. Percussion D. Vibration
What type of monitoring is essential regardless of the equipment used to deliver positive airway pressure to help mobilize?
Actual airway pressures, not set or intended pressures. Use a manometer at some point to see what is really going on.
Give a recommended intervention for Hypoxemia of the complications of postural draining
Administer oxygen (O2), or raise the FiO2. Reposition patient.
Example of "Expulsion weakness phase" impairment
Airway compression, obstruction, abdominal
Describe the inspiratory cycle of MI-E in term of times and pressure
An inspiratory pressure of 30 to 50 cm H2O is maintained for 1 to 3 sec.
Example of "irritation phase" impairment
Anesthesia, CNS depression, narcotics
What should you specifically monitor exercising patients with lung problems?
Assess for fatigue and O2 desaturation
During the initial treatment, a PEP device is set to deliver a pressure of 15 cm H2. The patient complaint complains of dyspnea and can maintain exhalation only for a short period of time. What should the RT recommend
Decrease the PEP level to 10 cm H2O
Secretion Managment Breath sounds
Decreased, crackles, rhonchi
Active patient participation is an important part of what kind of following procedures?
Directed cough technique, Positive expiratory pressure(PEP)
If postural drainage therapy is effective, how often should you reevaluate in the home
Every 3 months for home
The well-documented prophlactic uses bronchial hygiene therapy
Exercise and postural drainage, percussion, and vibration have been shown to be effective prophylaxis for patients with cystic fibrosis.
The benefits of adding exercise as a mobilization technique
Exercise enhances sputum clearance. It also improves aeration and ventilation perfusion relationships. Finally, exercise may improve fitness, self-esteem, and quality of life.
Secretion Managment vital signs
Fever, tachypnea, and tachycardia
An RT is preparing a patient with bronchiectasis for discharge. Which of the following techniques would be most appropriate for self-administer therapy in the home?
Flutter
The way IPV delivers gas to the air to airway
IPV gives minibursts of pressurized gas at 100 to 225 cycles/min. During the bursts, a positive airway pressure is maintained. The patient or therapist controls the duration of the percussive burst
Percussion techniques to loosen secretion
In theory, percussion jars loosen the stuck secretions
Example of "compression weakness/ surgery phase" impairment
Laryngeal damage, artificial airway, abdominal
What special form of cough assistance is used with patients who have neuromucular conditions?
Manually assisted cough-exerting pressure on the lateral ribs or epigastrium
Full obstruction, or _____ plugging, results in _____
Mucus; atelectasis and shunt
A COPD patient with left lower lobe infiltrates is unable to tolerate a head-down position for postural drainage. What action would be recommended?
Notify the physician and suggest a different secretion management technique.
Example of "inspiration phase" impairment
Pain, neuromuscular dysfunction, restriction
Secretion Managment Airway
Presence of artificial tracheal airway
A patient is receiving postural drainage in the Trendelenburg position. The Patient begins to cough uncontrollably. What action should the RT take at this time?
Raise the head of the bed
A patient is lying on her left side, turned one-quarter toward her back, with the head of the bed down. What division of the lung is being drained?
Right middle lobe
How would you position a patient for an effective cough?
Sitting upright, head slightly flexed, with arms and feet supported; if the patient cannot sit up, at least raise the head of the bed.
What technique could you use to decrease the pain associated with cough in a postoperative patient?
Splinting
Give a recommended intervention for Cardiac dysrthmias complication of postural draining
Stop. Position. Give/increase O2 and contact physician
Give a recommended intervention for Increased ICP complication of postural draining
Stop. Restore patient position. Consult physician
Give a recommended intervention for Acute Hypotension complication of postural draining
Stop. Restore patient position. Consult physician.
Give a recommended intervention for Pulmonary bleeding complication of postural draining
Stop. Restore position. Give O2. Get physician NOW!
Give a recommended intervention for vomiting complication of postural draining
Stop. Suction. O2. Position. Airway. Physician ASAP
What is splinting?
Supporting the area of an incision (abdominal or thoracic)
Compare manual and mechanical methods of percussion and vibration
The ultimate selection of the best way to percuss or vibrate may be patient preference. Machines do not get tired and deliver very consistent therapy. Manual percussion by a skilled practitioner may be preferred.
How long does it take to determine the effectiveness of postural drainage
Up to 24 hr
Partial obstruction increase_____ of breathing and leads to air ______
Work; trapping and poor V ̇⁄Q ̇
ACTB
active cycle of breathing therapy
AD
autogenic drainage
CPT
chest physical therapy
CPAP
continuous positive airway pressure
EPAP
expiratory positive airway pressure
FET
forced expiratory technique
HZ
hertz
HFCWC
high-frequency chest wall compression
ICP
intracranial pressure
PEP
positive expiratory pressure
PDPV
postural drainage, percussion, and vibration
