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