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CPT Final

What is necessary for normal airway clearance? Patent airway, functional mucociliary membrane, and an effective cough
What are the four normal phases of a cough? Irritation, Inspiration, Compression, Expulsion
What happens during the irritation phase of a cough? Abnormal stimuli provoke sensory fibers in the airway
What happens during the inspiration phase of a cough? Once stimulated, the brain generates a signal to the respiratory muscles to initiate deep inspiration
What happens during the compression phase of a cough? The glottis closes and the vocal cords contract to shut the larynx; expiratory muscles contract resulting in a rapid increase in pleural and alveolar pressure, often greater than 100 mmHg
What happens during the expulsion phase of a cough? Glottis opens producing a large pressure gradient between the alveoli and the airway opening; with continued contraction of expiratory muscles, pressure gradient causes violent, expulsive flow of air from the lungs
What types of stimuli can provoke a cough? Inflammation (infection), Mechanical (foreign body), Chemical (irritant gases/smoke), Thermal (cold air)
What are the causes of impaired mucociliary clearance in intubated patients? Endotracheal tube/trach tube, tracheobronchial suction, inadequate humidification, high FiO2 values, drugs, general anesthetics, opiates, narcotics, underlying pulmonary disease
What is the definition of chest physiotherapy? Refers to a diverse group of techniques designed to improve respiratory efficiency by: mobilizing secretions, preventing or reversing atelectasis, and enhancing the efficiency and condition of respiratory muscles
What are the goals of bronchial hygiene/CPT? To move bronchial secretions to the central airways via: gravity (postural drainage), external manipulation of the chest (percussion), and to eliminate secretions by cough (cough assistance) or aspiration with a catheter (suction)
What factors should be considered when assessing the need for airway clearance therapy Medical record – Hx of pulmonary problems, admission report (surgery/age/history), presence of artificial airway, CXR, PFT’s, ABG’s, patient assessment (vitals/posture/BS/breathing pattern/sputum production/general fitness)
What are the indications for retained secretions? Lack of sputum, labored breathing, fever, increased crackles or rhonchi, wheezing or diminished breath sounds
What is the primary objective of turning? Promoted lung expansion, improve oxygenation, prevent retention of secretions
What are the ABSOLUTE contraindications for postural drainage? Head/neck injury until stabilized, active hemorrhage with hemodynamic instability
What "plumbing" problems are associated with turning? Ventilatory disconnection, accidental extubation, accidental aspiration of ventilator circuit condensate, disconnection of vascular lines or urinary catheters
What can be caused by mucus plugging? Atelectasis, retained secretions, consolidation
When should manual vibrations be applied during the breath? During expiration
What is Diaphragmatic breathing? Helps to increase the contractile force of the abdominal muscles
What is FET - huff coughing? 1-2 forced expirations of middle to low lung volumes that rapidly expels air through an open glottis
What is a manual cough? What type of patient would it be performed on? Used on patients with spinal cord injuries or in disease states where abdominal muscles are weak; have patient take 3 deep breaths, on the third exhalations apply pressure inward and upward below diaphragm as the patient coughs
What is ACB? Cycles of breathing control, thoracic expansion, and FET
What is the ACB sequence? 1. Breathing control, 2. 3-4 Thoracic expansion, 3. Breathing control, 4. 3-4 Thoracic expansion, 5. Breathing control, 6. 1-2 FETs, 7. Breathing control
What is Autogenic drainage? Patient is in the sitting position, uses varying lung volumes and expiratory flows to promote drainage
What is Phase 1 of Autogenic drainage? Unsticking: full inspiratory capacity maneuver through the nose, with a 2-3 second breath hold, follows by breathing at low lung volumes until secretions are felt or heard – 10-20 breaths
What is Phase 2 of Autogenic drainage? Collection: breath at low to middle lung volumes until secretions are felt or heard; 10-20 breaths; instruct patient to breathe through the secretions and push the secretions up the airways
What is Phase 3 of Autogenic drainage? Evacuating: take a series of larger breathes near vital capacity and take several huff coughs
What diseases are associated with chronic production of large volumes of sputum that would benefit from CPT? Chronic bronchitis, cystic fibrosis
What volume of mucus is required for airway clearance to be used? 25-30 ml/day
What are the hazards/complications of PDT? How would you handle them? Hypoxemia, Increased ICP, Acute hypotension during the procedure, pulmonary hemorrhage, pain/injury to muscles, ribs, or spine, vomiting/aspiration, bronchospasm, dysrhythmias; if complication arise, STOP tx, return to resting position, notify DR
What are the postural drainage positions? REVIEW IMAGE FROM LECTURE; gravity is used to move secretions to the center of body and up and out
How long should each postural drainage position be maintained? 3-15 minutes
What would indicated a successful PDT outcome? Improved sputum production and lung sounds, patient subjective response to therapy, change in vitals, CXR, ABGs or sats, change in ventilator variables
On what areas should percussion NOT be performed? Tender sites or sites of trauma, bony prominences
What are the contraindications for PAP therapy? PTs unable to tolerate increased WOB, ICP > 20 mmHg, hemodynamic instability, acute sinusitis, active hemoptysis, untreated pneumothorax, known/suspected tympanic membrane rupture, recent trauma to head/face, epistaxis, esophageal surgery, nausea
What does PEP therapy involve? Involves active expiration against variable flow resistance
What pressure should be reached during PEP therapy? 10-20 cmH2O
What is the definition of oscillation? Rapid, vibratory movement of small volumes of air back and forth in the respiratory tract
What are the parts of the HFCWC (vest)? Variable air-pulse generator, inflatable vest
What is IPV? Pneumatic device that delivers a series of pressurize mini bursts at rates of 100-225 cycles per min (1.6 to 3.75 Hz) via mouthpiece
What are the brand names of airway oscillating devices? Flutter Valve, Quake, Acapella
What are the segments of the Right Upper Lobe (RUL)? Apical, Posterior, Anterior
What are the segments of the Right Middle Lobe (RML)? Later, Medial
What are the segments of the Right Lower Lobe (RLL)? Superior, Medial basal, Anterior basal, Posterior basal, Lateral basal
What are the segments of the Left Upper Lobe (LUL)? Apical-posterior, Anterior, Superior lingula, Inferior lingula
What are the segments of the Left Lower Lobe (LLL)? Superior, Anterior-Medial basal, Later basal, Posterior basal
Created by: ashconrad417
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