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RT Test 2

wwallace rt test 2

QuestionAnswer
Pressure range for PEP 10 to 20 cmH2O
Pressure range for flutter valve 10 to 25 cmH2O
What type Pt benefit most for IPV intrapulmonary percussive ventilation- CF pt who needs meds delivered
What is an IVP airway clearance technique that uses a pneumatic ventilator t deliver a series of small VT’s at high frequency, acts like internal CPT, mostly used to deliver meds to CF
What is MIE mechanical insufflations exsufflation, artificial cough machine, used mostly for pts with neuromuscular, usually at home, press plus 30 to 50 1 to 3 secs then neg 30 to 50 2 to 3 secs, oral nasal mask or trach
What pt benefits most from MIE neuromuscular ie muscular dystrophy myasthenia gravis etc. caustion with spinal shock and avoid abdominal distention with decreased insufflations pressure
8 complications of CPT and actions to be taken hypoxemia, increased intracranial press, hypotention, pulm hemorrhage, pain or injury to muscle ribs or spine, vomit or aspiration, bronchospasm and arrhythmias...follow 3 S rule, stop stabilize stay
What action should be taken for pt who has potential for hypoxemia during CPT admin higher FIO2
What action should be taken if a pt becomes hypoxic during CPT stop, return to resting position, give 100 percent O2, call doc
What action should be taken if a pt has increased intracranial press or gets hypotention during CPT stop, return to resting position, call doc
What action should be taken for a pt who has a pulm hemorrhage during CPT stop, return to resting position, call doc, admin O2, maintain airway til doc comes
What action should be taken for a pt who has pain or injury to muscle ribs or spine during CPT stop, use care return to resting position, call doc
What action should be taken for a pt who vomits or aspirates during CPT stop, clear airway (suction prn) admin O2, return to resting position, call doc
What action should be taken for a pt who has a bronchospasm during CPT stop, return to resting position, admin or increase O2, call doc, admin bronchodilators
What action should be taken for a pt who has arrhythmias during CPT stop, return to resting position, admin or increase O2, call doc
4 complications of PEP pulm barotraumas, increased ICP, cardio probs (hypotention), rash, air swallowing, aspirations, increased WOB
3 phases of autogenic drainage and what happens in each phase 1. Full inspiration followed by breathing at low lung volume to unstuck periph 2. Breathing at low to middle volumes collects mucus in middle airways, 3 evacuation, middle to large volume then huff
4 contraindications of PEP no absolutes, sinusitis, ear infection, epitaxis (nose blead, recent head or face surgery
Frequency range for high frequency chest wall oscillation 5-25 hz (vest)
Frequency range for high frequency chest wall compression is 15 hz for flutter and 1.6 to 3.75 hz for IPV
Describe directed cough mimics directed cough, shoulders forward, head and spine flexed, good teaching instruct on control and exercise muscles for neuro, splint for pain
What is manually assisted cough alternative to directive cough, used for pt who is to week for directive, RT uses pressure to help with expulsion
Describe staccado cough short low output series of coughs, use splint, helps with pain
Describe huff cough open glottis, say huuufff, used in CF, bronchiectisis and emphysema
4 phases of a cough and what happens in each phase 1 irritation, impulse to medulla, 2inspiration, breath in 1-2 liters, 3 compression, glottis close, contraction, alveolar pressure up, (100 mmhg) 4 expulsion, glottis opens press change and contraction expels 500 mph
4 mechanisms that hinder a cough and examples irritation cns, inspiration pain or restriction, compression surgery or nerve damage, expulsion obstruction weakness copd
Absolute pre and post assessments for postural drainage pt vitals (HR RR SPO2) and auscultation to confirm outcome
How do you instruct a pt for PEP therapy explain Huff, inspiration larger thatn normal, but not full, active exhale but not forcefull, pap of 10-20 (use nuemometer), I:E is 1 to 3 10 to 20 breaths if they are still alive, 2 to 3 huffs repeat 4 to 8 times or 20 minutes
Describe ACB active cycle breathing 1. relax and control breathing then 3 or 4 expansion breaths, 2 repeat, 3 repeat then 1 or 2 huff coughs relax control and done
Major factor in contributing to retained secretions ineffective cough, absent or increased sputum production, lobored breathing, decreased BS, crackle, rhonki, tachypnea, tachycardia, fever
Frequency when using IPV 1.6 to 3.75 hz
Who controls percussive cycle in IPV (used with bland aerosol or meds) pt or rt controls
How long does the vest therapy usually last 30 mins
Vest therapy may not be as effective as postural drainage or percussion in what pt CF
Position for greatest lung expansion dangling
clinical signs observed with retained secretions audible breath sounds, deteriorating ABG, xray with infiltrates or consolidation, atelectasis, VQ abnormalities
Areas never to be percussed tender areas, site of trauma or surgery or bony spot
Normal airway clearance requires patent (clear) airway, functioning mucociliary escalator (cilia) and effective cough
Mucociliary clearance mechanism operates from respiratory bronchioles to larynx, we then swallow or spit
Ciliated epithelial cells move secretions via coordinated wave toward the larynx
Why is the cough important it is a protective reflex that keeps a patent airway
The 4 distinct phases of a normal cough are irritation (can be mechanical, chemical, thermal, inflammatory), inspiration (1 to 2 liters), compression (rapid rise in press), expulsion (500 mph displaces mucus from air walls)
Abnormal airway clearance is any abnormality that alters patent airway, mucociliary escalatory, normal cough, or causes retained secretions
Partial airway obstruction can cause increase WOB, air trapping, over distention, and V/Q mismatch (vent/perfusion imbalance)
Which one of the 4 phases of a normal cough can retained secretions interfere with ? all ¬タモ retained secretions cause an ineffective clearance
Mechanisms impairing the cough irritation phase anesthesia, cns depression
Mechanisms impairing the cough inspiration phase pain, neuromuscular dysfunction, pulm or abdominal restriction
Mechanisms impairing the cough compression phase laryngeal nerve damage, artificial airway, abs muscle weakness, ab surgery
Mechanisms impairing the cough expulsion phase airway compression, airway obstruction, ab weakness, inadequate lung recoil (emphysema)
Diseases associated with abnormal clearance of mucus tumor, abnormality, bronchospasm (asthma, bronchitis) CF, Dyskintic Syndrome (impaired cilia)bronchiectisis, poor cough reflex (ALS, MD, etc)
Most common conditions affecting cough reflex are ALS, muscular dystrophy, myasthenia gravis, poliomyelitis, cerebral palsy, and spinal muscular atrophy
The primary goal of bronchial hygiene therapy is to mobilize and remove retained secretions with the ultimate goal of improving gas exchange and reducing WOB
Acute conditions for bronchial hygiene therapy are acutely ill with copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by lung disease
Acute conditions that do not need bronchial hygiene therapy are COPD, pneumonia and uncomplicated asthma
Chronic conditions that usually require bronchial hygiene therapy CF, bronchiectisis, ciliary dyskinetic Syndromes and chronic bronchitis
When getting sputum production info from a patient, use language a pt like Chris can understand, how many buggers in a shot glass? 25 to 30 mL or one fluid ounce
What are the best documented preventive uses of bronchial hygiene therapy body positioning and patient mobilization for acute and PVPD with exercise for CF
PDPV is postural drainage and percussion vibration therapy
5 methods of bronchial hygiene are 1 postural drainage, 2 coughing and expulsive techniques, 3 PAP adjunct (PEP, CPAP and EPAP), 4 high frequency compression oscillation (vest and flutter) 5 mobilization and exercise
The 3 types of postural drainage are 1 turning 2 Percussion (on exhalation) 3 vibration
Turning ration of the body on its longitudal axis, aka kinetic therapy or continuous lateral rotational therapy, pt can do it, care giver can or rotational bed, purpose is to expand lungs and improve oxygenation, mobilize secretions, never with traction, head or
Relative contraindications of turning severe diarrhea, agitation, increased ICP, decreased BP, dyspnea, hypoxia, arrhythmias
Proning and acute lung injuries improves oxygentation w/o affecting hemodynamics and lower FIO2 press on vent, may also decrease further lung injury associated with positive pressure vent in ARDS pt
Plumbing problems and turning always drain vent tubes first, caution with vent disconnection, accident extubation, accidental aspiration of vent condensation, , IV¬タルs, and urinary catheters
Postural drainage is the use of gravity to help move secretions from lobes or segments into central airway, by placing the segmental bronchi to be drained in a vertical position relative to gravity for 3 to 15 minutes
How long should the position be held in postural drainage 3 to 15 minutes
How much sputum does effective postural drainage produce 25 -30 mL/day (1 fluid ounce or 1 shot glass)
Postural drainage technique identify lobe or segment, position pt, avoid aspiration wait 1.5 hrs after food, coordinate treatment with pain meds, explain procedure, take baseline (HR, RR, SPO2, BS), check wiring tubing ect rail up, pt comfortable, restore pt posit,document/follow up
Initial assessment of need for bronchial hygiene therapy from medical records includes history of pulm probs with secretions, admission for upper abdom or thoracic surg, artificial trach, Cxr with atelectasis or infiltrates, PFTs with decreased flow (not enough to cough), ABG or SpO2 values
Initial assessment of need for bronchial hygiene therapy from Patients include posture and muscle tone, ineffective cough, sputum, breathing pattern, physical fitness, breath sounds and vitals
Percussion and vibration refers to mechanical energy to the chest wall by hands, electrical or pneumatic devices to augment secretion clearance. Percussion jars it loose, vibration helps move it along
Documentation and follow up includes pt position, time in position, tolerance, objective and subjective response to tx, sputum color consistency, volume odor and any bad effects of treatments
Directed cough mimics spontaneous cough, helps voluntary control reflex, compensate for physical limits
What is the most effective way to clear the central airways coughing
What is the most effective way to clear the peripheral airways cilia
What are the three important factors for good patient teaching instruction of proper positioning, instruction of breathing control, exercises to strengthen expiratory muscles
Directed cough patient position place pt in sitting position, shoulders rotated inward, head and spine slightly flexed, forearms relaxed or supported, support feet (raise head of bed if needed)
Directed cough technique good deep inspiration, bear down against glottis (straining like stool)
Manually assisted cough applying press to thorax coordinating with forced exhalation
Forced expiratory technique (HUFF cough) a modification to the directed cough, one or two forced expirations of middle to low lung volumes with out closure of glottis, followed by diaphragmatic breathing and relaxation
Active cycle of breathing FET including breathing exercises, and thoracic expansion.
ACB sequence relaxation and breathing control, 3 to 4 thoracic exercises, relax and bc, 3 to 4 thoracic exercise, relax and bc, 1 or 2 huff coughs, relax and breath control
Thoracic expansion exercises big expansive inhalation with relaxed exhalation (may include percussion, vibration or compression)
ACB breathing control involves repeated cycles of breathing control, thoracic expansion and huff or FET
Autogenic drainage is modification of directed cough pt uses 3 phases of inspiration capacity to unstuck, collect and evacuate
Mechanical insufflation exsuffation artificial cough machine, in at 30 to 50 for 1 to 3 seconds then abruptly reversed at negative 30 to 50 for 2 to 5 seconds
PAP adjuncts mobilize secretions and treat atelectasis, CPAP, EPAP, PEP
PEP positive expiratory pressure for post op atelectasis, good for cf and bronchiectisis exhale through valve at 10 to 20 cmh20
Therapeutic effects of PEP improves distribution of inspired volume, prevents airway collapse, generates pressure distal to mucus obstruction
Contraindication to PEP sinusitis, ear infection, nose bleed or epitaxis facial or head surgery, active hempotysis
How long for PEP therapy no more than 20 mins, active but not forcible breathing
What is an effective alternative to postural drainage and percussion that a pt can perform independently with few side effects? PEP
How do you clean a flutter valve disassembled after each use and rinsed in water wash in soap every 2 days and disinfect by soaking in 1 to 3 solution of vinegar and water for 15 mins dry and reassemble
Created by: williamwallace