Term
| airway clearance techniques- goals |
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Definition
remove airway secretions
improve gas exchange |
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Term
| normal airway clearance depends on? |
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Definition
patent arways
functional mucociliary transport system
effective cough |
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Term
| cough mechanisms- stages of cough |
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Definition
irritation
inspiration
compression
exhalation |
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Term
| causes of abnormal airway clearance |
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Definition
mucus plugging, tumors, foreing bodies
artificial airways
infections |
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Term
abnormal airway clearance
causes of complete obstruction |
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Definition
| atelectasis, impaired gas exchange (shunting) |
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Term
abnormal airway clearance
partial obstruction |
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Definition
| increase WOB, air trapping, airflow restriction, V/Q mismatch |
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Term
| causes of impaired mucociliary clearance in intubated patients |
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Definition
tracheostomy or endotracheal tube
tracheobranchial suction
inadequate humidification
high FIO2
drugs- anesthetics, opiates, narcotics
pulmonary diseases |
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Term
| causes of ineffective coughs |
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Definition
neuromuscular disorders
pain
weakness
pulmonary disease
reduced expiratory flow
artificial airways |
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Term
| impairments for irritation |
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Definition
CNS depression
anesthtics
anelgesics and narcotics |
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Term
| impairments for inspiration |
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Definition
pain
neuromuscular dysfunction
pulmonary restrictions
abdominal restrictions |
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Term
| impairments for compression |
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Definition
artificial airways
abdominal weakness
laryngeal nerve damage
abdominal surgery |
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Term
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Definition
airway obstruction
airway restriction
abdominal weakness
inadequate lung recoil |
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Term
| disorders affecting airway clearace |
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Definition
bronchioectasis
cystic fibrosis
chronic bronchitis
ciliary dyskinetic syndrome
neuromuscular diseases |
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Term
| how do you manage thick secretions? |
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Definition
adequate systemic hydration- most effective method
bland aerosol- large volume nebulizer
mucolitics- dornase alpha and acetylcystine |
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Term
| types of bronchial hygiene |
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Definition
invasive bronchial therapy
noninvasive bronchial therapy
mechanical aids for bronchial hygiene and lung expansion |
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Term
| invasive bronchial hygiene |
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Definition
suctioning
nasotracheal
endotracheal |
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Term
| types of noninvasive bronchial hygiene |
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Definition
turning
postural drainage
percussion
vibration
directed cough
brathing techniques
mechanical aids for bronchial hygiene and lung expansion |
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Term
|
Definition
patients can turn themselves
be turned by care giver
rotational bed |
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Term
|
Definition
lung expansion
improve oxygenation
reduce retention of secretions
other purposes - reduce venostasis and prevention of skin ulcers |
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Term
| absolute contraindications of turning |
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Definition
unstable spinal cord injury
traction of arm abductors |
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Term
| relative contraindications of turning |
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Definition
diarrhea
increase in intracraneal pressure
marked agitations
large drops of blood pressure greater than 10%
hypoxia
worsening dyspnea
cardiac arrhythmias |
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Term
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Definition
ventilator disconnections
accidental extubation
aspiration of circuit condensate
disconnection of vascular lines and urine catheter |
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Term
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Definition
gravity is used to move secretions from dital lung segments to central airways.
patients positioned so that lung/segments are above the carina
each position maintained for 3 to 15 minutes |
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Term
|
Definition
hands in cupped position with closed thumbs
3 inches away from chest
strike chest in waving form with flexed elbows and loose wrists |
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Term
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Definition
controversy as to benefits of treatment
apparent benefit when combined with postural drainage
measure effectiveness by measuring amount of secretion and most effective in patients with copius secretions
lack of consensus as to how hard and how fast to strike chest |
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Term
|
Definition
used hands to create vibration motion over affected area.
vibrations aid movement of secretions to central airways.
no evidence of efficacy, no evidence of manual or mechanical application and no set frequency |
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Term
|
Definition
cough that is directed, taught and supervised
used when spontaneous cough is not adequate |
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Term
| directed cough - benefits |
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Definition
mimics an effective spontaneous cough effort
assists with voluntatry control of cough reflex
compensates for physical limittions that impair the cough reflex |
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Term
| three examples of directed cough |
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Definition
forced expiratory technique
huff coughing
manually assisted cough |
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Term
| directed cough- controlled cough |
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Definition
take three deep breath as deep as can be
cough firmly twice at the end of third deep inhalation
splinting (pillow of hands over injury) is used for patients with surgical incisions or injury |
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Term
| forced Expiratory technique |
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Definition
a modification of normal directed cough
1 to 2 forced exhalations from mid to low lung volumes without closing the glottis |
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Term
| forced expiratory technique- procedure |
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Definition
patient instructed to say huff during exhalation which keeps glottis open
followed by a period of diaphragmatic breathing and relaxation. |
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Term
| forced expiratory techniques points |
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Definition
restores lung volume and minimizes fatigue
goal is to clear secretions without changes in pleural pressure to lessen bronchial collapse
better airway clearance when combined with postural drainage thn normal directed cough technique
most useful in emphysema bronchioectasis and CF |
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Term
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Definition
| external application of pressure to chest or abdomen during forced exhalation |
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Term
| acute chest compressions- techniques |
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Definition
patient takes deep inhalation- accompanied by positive pressure liek IPPB or manual resuscitator
At the end of inhalation pressure is applied to thoracic cage or epigastric region |
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Term
| contraindications for acute chest compressions |
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Definition
flail chest
osteoporosis
unconscious patients with unprotected airways
pregnant women
patients with acute abdominal pathology
patients with abdominal aortic aneurysms
hietal hernia |
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Term
|
Definition
1) patients take 3 to 5 deep breaths
inhale though nose, exhale through pursed lips, diaphragmatic breathing
2) take in deep breath and hold for 1 to 3 seconds
3)exhale from mid to low lung voluems to clear secretions from periphery
4) take in normal breath and. contratc abdominal and chest wall muscles with the mouth open while saying huff
5)secretions enter larger airways exhale rapidly from mid to high lung volumes to clear secretions from more proximal airways
6) several relaxed diphragmatic breaths brefor next cough
7) apply manually assisted cough by applying mechanical pressure to toracic cage with forced exhalation |
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Term
| breathing techniques- diaphragmatic breathing |
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Definition
hands over rib cage at level of xiphoid proces
instruct patient to sniff to locate diaphragm
abdomen
distends during inspiration (expands)
flattens during expiration (contracts) |
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Term
| breathing techniques- unilateral chest expansion |
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Definition
place hand over midaxillary line
compression of opposite side of chest due to kiphosis
one side of the chest is expanded preferentially |
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Term
| breathing techniques- pursed lip breathing |
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Definition
patient instructed to take deep breath and exhale through pursed lips
this creates resistance to exhalation
keeps alveoli open longer and prevents air trapping
seen with SOB |
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Term
| BREATHING TECHNIQUES- ACTIVE CYCLE BREATHING |
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Definition
emphasizes that breathing exercises should always be included with FET
includes repeated cycles of breathing control, thoracic expansion and the FET |
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Term
| active cycle of breathing sequence |
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Definition
1) relaxation and breathing control
2) three to four cycles of thoracic expansion exercises
3)relaxation and breathing control
4) three to four cycles of thoracic expansion exercises
5) relaxation and breathing
6) 1 or 2 FET
7) RELAXATION and breathing |
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Term
| breathing techniques- autogenic breathing |
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Definition
3 phases of staged breathing at different lung volumes
performed until secfetions are elt in central airways
huff coghs used to clear secretions
requires patient cooperations- not for patients under 8 years old |
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Term
| mechanical aids to bronchial hygiene and lung expansion- includes |
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Definition
IPPB- intermittent positive pressure breathing
IS- incentive spirometry
PAP- positive airway pressure
High Frequency Oscillations
Mechanicall Insufflation/ Exsufflation |
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Term
| positive airway pressure includes? |
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Definition
Positive Expiratory Pressure- PEP
Expiratory Positive Airway Pressure- EPAP
Continuous Positive Airway Pressure
BIPAP- bi-level positive airway pressure |
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Term
| high frequency oscillations include? |
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Definition
high frequency oscillations of the airway- HFOA
High Frequency Chest Wall Oscillations- HFCWO |
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Term
| High Frequency Oscillations of the Airway- Intrapulmonary Percussive Ventilation |
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Definition
delivers positive pressure to the airways
100 to 225 cycles per minute
uses nebulizer for delivery of medicated aerosols
20 minute treatment
as effective as aerosol therapy plus percussion plus postural drainage
for stable patients with no side effects |
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Term
| the vest airway clearane generator- |
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Definition
variable air pulse generator with an inflatable vest
30 minutes treatment
6 to 20 Hz. |
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Term
| high frequency chest wall oscillator- the hayek oscillator |
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Definition
electrically powered noninvasive uses chest cuirass applied over chest wall
negative and positive pressure suring respiratory cycles
8-999 oscillations per minute
I:E ratio- 6:1 to 1:6
inspiration: +70 cm H2O
expiration: -70 cm H2O |
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Term
| mechanial insuxfflation-exsufflation |
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Definition
used to replace augment cough clearance
for patients with muscle weakeness or paralysis
delivers positive pressure breath
30 to 50 cm H2O OVER 1 TO 3 seconds
used with face mask or artificial airway
abrupt reversal of pressure
-30 to 50 cm of H2O OVER 2 to 3 seconds
cough generates mean peak expiratory flow of 7 L/m |
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Term
| mechanical insuxfflation-exsufflation- mechanisms |
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Definition
give 5 5 cycles of MIE
follow with spontaneous or assited breathing
repeat 5 more times |
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