bronchial hygiene homework

List three conditions that may cause internal obstructions or external compression of the airway lumen.

A. Foreign body: External B. Tumor: External C. Secretions, bronchospasm, inflammation: Internal

Compare the effects of full and partial airway obstruction caused by retained secretions. A. Full obstruction, or (blank) plugging results in (blank) B. Partial obstruction increases (blank) of breathing and leads to air (blank)

A. Mucus; atelectasis and shunt B. Work; trapping

two goals for ACT

1. improve gas exchange by removing retained secretions 2. reduce WOB by alveolar expansion

How long should you wait to schedule postural drainage after a patient eats? Why?

2 hr after meals or tube feedings to prevent aspiration and gastroesophageal reflux.

What is the minimum range of time for effective application of postural drainage therapy?

3 to 15 min

List two absolute and two relative contraindications to turning

A. Absolute 1. Unstable spinal cord injuries 2. Traction of arm abductors B. Relative 1. Severe diarrhea 2. Marked agitation (increased ICP, drop in BP, hypoxia, and arrhythmias)

Give a recommended intervention for each of the complications of postural drainage listed below. Complication A. Hypoxemia B. Increased ICP C. Acute hypotension D. Pulmonary bleeding E. Vomiting F. Bronchospasm G. Cardiac dysrhythmias

A. Administer oxygen (O2), or raise the FiO2. Reposition patient. B. Stop. Restore patient position. Consult physician. C. Stop. Restore patient position. Consult physician. D. Stop. Restore position. Give O2. Get physician NOW! E. Stop. Suction. O2. Position. Airway. Physician ASAP. F. Stop. Position. O2. Request bronchodilator from physician. G. Stop. Position. Give/increase O2 and contact physician.

Describe the two cycles of MI-E in terms of time and pressure. A. Inspiratory B. Expiratory

A. An inspiratory pressure of 30 to 50 cm H2O is maintained for 1 to 3 sec. B. Pressure is abruptly reversed to -30 to -50 cm H2O for 2 to 3 sec.

Describe the two well-documented preventive, or prophylactic, uses of bronchial hygiene therapy.

A. Body positioning and patient mobilization may be effective to prevent retained secretions in acutely ill patients. B. Exercise and postural drainage, percussion, and vibration have been shown to be effective prophylaxis for patients with cystic fibrosis.

Describe the three repeated cycles of the ACB technique A. B. C.

A. Breathing control B. Thoracic expansion C. FET or huff cough

List 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

List two obstructive lung diseases that result in excessive secretion of mucus and impairment of normal clearance.

A. Cystic fibrosis B. Bronchiectasis

List 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)

List 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

Give a brief explanation of the significance of each factor listed below Factor: A. History B. Airway C. Chest radiograph D. Breath sounds E. Vital signs

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. B. Presence of artificial tracheal airway C. Atelectasis or infiltrates D. Decreased, crackles, rhonchi E. Fever, tachypnea, and tachycardia

Positive airway pressure is popular way to help mobilize secretions. What art the four indications for PAP adjuncts according to the AARC Clinical Practice Guidelines?

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.

Standard directed cough must frequently be modified. Give three examples of types of patients who may need modified cough techniques.

A. Surgical B. COPD C. Neuromuscular disorders

Postural drainage therapy includes up to four components, not counting cough. What are they?

A. Turning B. Postural drainage C. Percussion D. Vibration

How long does it take to determine the effectiveness of postural drainage? If therapy is effective, how often should you reevaluate in the hospital? In the home? A. How long? B. Reevaluate hospital patients? C. Reevaluate home patients

A. Up to 24 hr B. 2 to 3 days for other hospitalized patients C. Every 3 months for home

What type of monitoring is essential regardless of the equipment used to deliver positive airway pressure to help mobilize secretions?

Actual airway pressures, not set or intended pressures. Use a manometer at some point to see what is really going on.

AD

Autogenic Drainage

Describe percussion and vibration as techniques to loosen secretions. Are they really effective?

Both involve application of mechanical energy to the chest wall. In theory, percussion jars loosen the stuck secretions, while vibration moves secretions upward during exhalation. Effectiveness is unclear.

Discuss bronchial hygiene therapy for chronic lung conditions. How much sputum needs to be produced daily for the therapy to be useful? What are three typical diseases that we treat?

Bronchial hygiene therapy for chronic conditions has proved to be effective if copious sputum production is present. Examples include cystic fibrosis, bronchiectasis, and, in some patients, chronic bronchitis. In general, sputum production must exceed 25 to 30 ml/day for bronchial hygiene therapy to be significantly helpful.

four techniques used for airway clearance therapy

CPT PEP IPV MIE

Airway clearance therapy

CPT PEP vibratory PEP FFCWC

HZ

Hertz

IPV

Intrapulmonary percussive ventilation

What is the primary problem with autogenic drainage?

It is difficult to teach/learn.

What special form of cough assistance is used with patients who have neuromuscular conditions?

Manually assisted cough-exerting pressure on the lateral ribs or epigastrium

MIE

Mechanical insufflation-exsufflation

List the four phases of the normal cough Give examples of impairments of each Phase A. B. C. D. Impairments A. B. C. D.

Phase A. Irritation B. Inspiration C. Compression D. Expulsion Impairments A. Anesthesia, CNS depression, narcotics B. Pain, neuromuscular dysfunction, restriction C. Laryngeal damage, artificial airway, abdominal D. Airway compression, obstruction, abdominal weakness

How would you position a patient (ideally) 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 is splinting?

Supporting the area of an incision (abdominal or thoracic)

Describe the forced expiratory technique (FET)

The FET or huff cough has the patient take a moderately large breath then exhale rapidly while saying "huff." The back pressure generated assists in preventing bronchiolar collapse. This enhances secretion removal, particularly in patients with obstructive lung disease.

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.

two indications for ACT

atelectasis copious secretions

CPT

chest physical therapy

CPAP

continuous positive airway pressure

EPAP

expiratory positive airway pressure

HFCWC

high frequency chest wall compression

four complications of ACT

hypoxemia increased ICP fractured ribs bronchospasm

ICP

intracranial pressure

four contraindications for ACT

pneumothorax esophageal surgery bronchospasm increased ICP

PEP

positive expiratory pressure