Bronchial Hygiene Therapy RCP111 Unit I
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| show | The use of "noninvasive" airway clearance techniques designed to help mobilize and remove secretions and improve gas exchange.
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| What are the primary mechanisms used for secretion removal? | show 🗑
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| What are the four stages of cough? | show 🗑
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| What are the main irritation stimuli? | show 🗑
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| What are factors that affect secretion removal? | show 🗑
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| show | Anesthesia
narcotics
CNS depression
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| A cough may be impaired by disruption to inspiration. | show 🗑
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| A cough may be disrupted to do disruption in compression. | show 🗑
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| show | Airway compression
Airway obstruction
Abdominal Muscle weakness
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| Inspiration | show 🗑
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| Compression | show 🗑
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| show | 500 mph.
Occurs when the glottis opens
A very high pressure gradient and it shears off mucus on the bronchial tree.
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| show | Dehydration
Temperature
Toxins
Smoking
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| Abnormal airway clearance can result in. | show 🗑
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| show | ET or tracheostomy tube
Tracheobronchial suction
Inadequate humidification
High Fi02 values
Drugs
Underlying pulmonary disease
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| show | tumors and foreign bodies
skeletal abnormalities
bronchospasm
ET Tubes
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| What is the goal of bronchial hygiene therapy? | show 🗑
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| What are the three indication for bronchial hygiene therapy? | show 🗑
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| show | copious secretions
acute respiratory failure with retained secretions.
Acute lobar atelectasis
V/Q abnormalities caused by unilateral lung disease.
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| show | Cystic fibrosis
Bronchiectasis
Ciliary dyskinetic syndromes
chronic bronchitis
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| Disorders associated with retention of secretions. | show 🗑
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| show | increased C02
Decreased O2
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| Ventilitory failure | show 🗑
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| The need for bronchial hygiene is assessed by | show 🗑
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| medical record | show 🗑
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| Patient | show 🗑
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| Sputum production must exceed what for bronchial hygiene therapy to significantly improve secretion removal? | show 🗑
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| show | chest physiotherapy
coughing techniques
PAP therapy
High Frequency Compression/Ossillation
Mobilization
Exercise
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| show | postural drainage
percussion
vibration
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| show | directed cough
huff coughing
forced expiratory technique
active cycle of breathing
autogenic drainage
manually assisted coughing
mechancial insufflation/exsufflation
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| show | CPAP
PEP
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| show | flutter
intrapulmonary percussive ventilation
vest
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| Chest physiotherapy involves | show 🗑
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| show | Patient positional so that secretions drain from specific segments and lobes of the lung toward gravity-dependent central airways, where it can be more easily removed with cough or suction.
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| show | Between 20-30 minutes
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| show | percussion and vibration
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| show | involves rapid clapping, cupping or striking of the external thorax directly over the lung segment drained with either cupped hands or mechanical device.
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| show | involves manually pressing in the direction that the ribs and soft tissues of the chest moves during exhalation.
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| show | Generally 5 minutes
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| When is vibration performed? | show 🗑
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| show | Inability to change body positon.
Poor oxygenation with unilateral lung disease.
Potential for atelectasis
Presence of artificial airway.
Difficulty with secretion clearance
Evidence of retained secretions/ foreign body
diagnosis of pulmonary diseas
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| show | The need for additional manipulation of the chest to assist in secretion removal.
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| Contraindications for all positions. | show 🗑
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| show | ICP>20 or potential for high ICP
uncontrolled hypertension
distended abdomen
esophageal surgery
hemoptysis
aspiration risk
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| show | subcutaneous air
recent epidural
recent skin grafts or flaps
burns/open wounds
pace maker
TB
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| show | lung contusion
bronchospasm
oseomyelitis of the ribs/osteoporosis
coagulopathy
chest wall pain
recent feedings
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| show | hypoxemia
increased ICP
acute hypertension
pulmonary hemorrhage
pain or injury to chest wall
vomiting or aspiration
bronchospasm
dysrhythmias
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| What are CPT considerations? | show 🗑
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| What are more CPT considerations | show 🗑
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| What might coughing techniques require? | show 🗑
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| show | Decrease in sputum
vitals improve
x-ray improves
sputum changes color
improved breath sounds
lab work
improved oxygenation
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| Directed cough indications include | show 🗑
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| show | obtunded, paralyzed, and uncooperative patients.
Some restrictive disorders and advanced COPD
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| show | A delioberate maneuver that is taught, supervised and monitored. It aims to mimic the features of an effective spontaneous cough in patients who are too weak to produce a a forceful expiratory maneuver.
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| What might limit the success of directed cough? | show 🗑
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| show | Good patient teaching.
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| show | Instruction on proper positioning
insturction on breathing control
exercises to strengthen expiratory muscles.
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| show | Assume a sitting position with one shoulder rotated inward and the head/spine slightly flexed.
Teach the patient to inspire slowly and deeply through the nose.
Have patient bear down against the glottis while like you would with a bm.
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| show | diaphramatic breathing
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| show | Sharp forced exhalations without glottis closure.
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| FET is | show 🗑
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| During FET | show 🗑
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| FET goal is to | show 🗑
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| Why might FET not be possible with intubated patients? | show 🗑
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| The active cycle of breathing is | show 🗑
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| Step one of active cycle: repeated cycle of breathing | show 🗑
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| Step two of active cycle: Thoracic expansion | show 🗑
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| Step three of active cycle: FET | show 🗑
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| show | Can accompany with percussion and vibration.
Sitting position and beneficial with postural drainage.
It is not for children less than 2 or extremely ill
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| show | Staged breathing at different lung volumes.
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| show | In the 1960's for the asthmatic patient.
It is a modification for directed cough and can be done by themselves if trained.
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| How does it work? | show 🗑
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| show | moves secretions from smaller airways. Patient should prevent cough
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| Second Phase: COllecting | show 🗑
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| show | Moves secretions into large airw
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| Maunually assisted cough | show 🗑
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| show | It increases pressure in the thoracic cage
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| The mechanical insufflator-exsufflator | show 🗑
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| show | In the 1950's to help polio patients clear secretions.
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| How is the insufflator-exsufflator used now? | show 🗑
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| show | It delivers a positive pressure at 30 to 50 cm H20 for 1 to 3 seconds. Then removes at -30 to -50 cm H20 for 2-3 seconds.
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| How can the artificial cough machine be used? | show 🗑
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| Positive expiratory pressure is also know as | show 🗑
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| What is PEP therapy? | show 🗑
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| PEP has an expiratory pressure of | show 🗑
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| It is important to be aware of high PEP levels with obstructive diseases because | show 🗑
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| show | can be used with a nebulizer.
Was originated in Denmark.
Is not useful in Chronic bronchitis and kids less than 3.
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| What is a flutter valve? | show 🗑
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| show | It shears mucus from airway wall and facilitates mucus flow, prevents airway closure.
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| Active exhalations do what? | show 🗑
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| show | Hook up aerosol therapy but that can be done with the acapella?
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| What is intrapulmonary percussive ventilation (IPV)? | show 🗑
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| How many miniburst a minute? | show 🗑
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| show | 1993
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| How does it work? | show 🗑
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| show | It utilizes a small volume nebulizer type of system. High frequency intrapulmonary percussive nebulizer.
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| show | It consists of an inflatable vest which covers the thorax and is attached with hoses to an air-pulse generator.
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| show | It rapidly inflates and deflates from 5 to 25 times per second, creating a bias flow that moves secretions to the trachea.
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| show | A continues flow out.
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| show | It improves gas-liquid interactions decreasing viscosity of mucus.
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| What is the major factor contributing to retention of secretions? | show 🗑
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| show | Frequent position changes and exercises.
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| What must you consider with mobilization and exerecise? | show 🗑
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| show | Diaphragmatic breathing
inspiratory resistance training.
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| show | A device that acts like an inspiratory muscle resistor.
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| show | SVN therapy
Mucoactive agents
Bland aerosol therapy
suctioning
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