Question Answer
What is the most important protective reflex? Cough
What are the 4 distinct phases to a normal cough? Irritation, inspiration, compression, and expulsion
What disease state is the airway permanently damaged, dilated, and prone to constant obstruction by retained secretions? bronchiectasis
What are the most common conditions that affect the cough reflex? Musculoskeletal and neurologic disorders
Before airway clearance therapy is started, what is something that may be administered to help improve the overall effectiveness of treatment? bronchodilator therapy
What are the five general approaches to airway clearnace therapy? 1. CPT 2. coughing 3. PAP 4. Hi Freq Compression/Oscillation Methods 5. Mobilization and physical activity
What is CPT? percussion, postural drainage and vibration
What type of therapy involves the use of gravity and mechanical energy to help mobilize secretions? Postural drainage
What should be used during postural drainage if hypoxemia is suspected? Pulse ox
How long should you administer postural drainage? 3-15 minutes
What should you do between positions? pause for relaxation and breathing control to prevent hypoxemia
When a patient is in the head down position, what should the patient avoid? Strenuous coughing to avoid ICP
Will there be an immediate production of secretions in doing postural drainage therapy? No, not always.
What type of breath sounds would an RT hear once postural drainage therapy has been administered? Breath sounds may worsen. You may hear coarse crackles after TX.
What is involved in application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices? percussion and vibration
How should hands be positioned when percussing? parallel to the ribs
What type of cough is a deliberate maneuver that is taught, supervised and monitored? direct cough
What type of patients may not be able to do the direct cough regimen? Obtunded, paralyzed, uncooperative patients, patients with COPD and neurologic, muscular and skeletal abnormalities. Also dehydration, thick secretions, artificial airways and depressants can thwart direct cough techniques.
In patients with muscle weakness, such as COPD patients and patient with neuromuscular disease, what must be done to help remove their secretions? Either suctioning or Mechanical insufflation-exsufflation
What is the term used for when a clinician can use his or her hands to support the area of incision during the expiratory phase of a cough? Splinting
What type of breathing method is useful for COPD patients that can’t get an effective cough? use pursed lip breathing while leaning forward
What are the 3 categories of chest percussors? Manual, Pneumatic and electrically powered devices
Stimulus that is sent to the medullary center in the brain due to an abnormal stimulus are what kinds of stimuli? Inflammatory, mechanical, chemical or thermal
Impaired airway clearance and retention of secretions can be a result of? any abnormality that alters airway patency such as mucociliary function, strength of the inspiratory or expiratory muscles, thickness of secretions, or effectiveness of the cough reflex
What are the results of mucus plugging? can result in atelectasis, impaired oxygenation secondary to shunting, WOB, air trapping, overdistention and ventilation/perfusion imbalanced
What do these following items effect? Endotracheal or trach tube, tracheobronchial suction, inadequate humidification, High fio2 values, drugs, general anesthetics, opiates narcotics, pulmonary disease Impaired mucociliary clearance in intubated patients
What disease has the solute concentration of the mucus is altered because of abnormal sodium and chloride transport. It increases the viscosity of mucus and impairs its movement up the respiratory tract. CF
What is the condition called where the respiratory tract cilia do not function properly? Ciliary dyskinetic syndrome
What is the disease where the airway is permanently damaged, dilated and prone to constant obstruction by retained secretions? bronchiectasis.
What is the primary goal of airway clearance therapy? to help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange, promote alveolar expansion and reduce WOB
These are all indication for what? Copious secretions, acute respiratory failure w/ retained secretions, acute lobar atelectasis and V/Q abnormalities caused by unilateral lung disease Airway clearance therapy
What are the clinical signs of patients with retained secretions? Audible abnormnal breath sounds, deteriorating arterial blood gases, chest xray changes
These are all significations for what kind of therapy? acute exacerbations of COPD, pneumonia without clinically significant sputum production, uncomplicated asthma No therapy needed
How much sputum production must be produced in order for therapy to be initiated? 25-30 ml per day for airway clearance therapy
What therapy uses gravity and mechanical energy to help mobilize secretions? postural drainage
How long are postural drainage positions done? 3-15 minutes
How often should postural drainage techniques be performed on critically ill patients and patients on mechanical ventilation? what about spontaneously breathing patients? every 4-6 hours. frequency should be determined by assessing patient response to therapy
To avoid gastroesophageal reflux and possiblity of aspiration, how long should you wait before treatment after a meal? 1 1/2 to 2 hours before or after feedings
What should you do as a therapist if you know the patient will be in pain during postural drainage therapy? give them pain meds with prescribed meds
Why should a patient avoid coughing when using the head down position during therapy? it markedly increases ICP
How long should TOTAL therapy time be? not to exceed 30 to 40 min
Whenever you observe an untoward patient response during therapy what should you do? follow the s rule…stop the therapy, stay with patient until they are stabilized
What kind of breath sounds may you hear after therapy? coarse crackles. breath sounds may get worse due to the secretions moving into the larger airways.
What kind of treatment is an application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices? percussion and vibration
In what direction should hands be positioned when doing percussion? parallel to the ribs
What are potential problems with mechanical vibration devices? noise, excess force, electrical shock and mechanical failure
Why is coughing or suctioning pertinent in airway clearance therapy? because these therapies only help to move secretions into the central airways
What kind of percussion devices can you use? manual, electrically powered and pneumatic devices
What are the six adjunctive breathing techniques? Directed cough (controlled cough) Diaphragmatic breathing Unilateral chest expansion Acute chest expansion Pursed-lipped breathing Forced expiratory technique (FET
what is a cough called that is taught, supervised and monitored? directed cough
In what area of the lungs is cough most effective? central not peripheral
What kind of patients is a directed cough technique not useful? obtunded, paralyzed or uncooperative patients. It could also not be useful in patients that have advanced COPD or severe restrictive disorders including nerologic, muscular or skeletal abnormalities
What are the 3 most important aspects involved in patient teaching with directed cough? 1. instruction in proper positioning, 2. instruction in breathing control and 3. exercises to strengthen the expiratory muscles
In what way can a COPD patient that has an increased chance of airway collapse due to excessive force coughing help to enhance expulsion thru coughing? the patient should exhale with moderate force thru pursed lips while bending forward. After 3-4 times of this maneuver, the patient should bend forward and do short staccato like bursts of air. this minimizes airway collapse. this is called huffing
In patients with neuromuscular conditions, what 3 options are there to help them get rid of retained secretions since cough is hard for them to obtain? 1. placement of an artificial airway, 2. manually assisted cough and 3. MIE
What consists of one or two forced expirations of middle to low lung volume without closure of the glottis, followed by a period of diaphragmatic breathing and relaxation? huff cough or FET, forced expiratory technique
What maneuver may a patient do to help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse? Huff cough, or FET, forced expiratory technique
What technique consists of repeated cycles of breathing control, thoracic expansion, and FET? Active cycle of breathing technique ACBT
What technique uses the diaphragmatic breathing to mobilize secretions by varying lung volumes and expiratory airflow in 3 distinct phases? Autogenic drainage AD
What are known as artificial cough machines, cough assist devices or coughlator? MIE, mechanical insufflation-exsufflation
What device delivers a positive pressure breath of 30 to 50 cm H2O over a 1-3 second period and then reversed to -30 to -50 cm H20 via a face mask or tracheal airway? MIE, mechanical insufflation-exsufflation
What type of adjunct is used to help mobilize secretions and treat atelectasis but can never be used alone? Positive airway pressure. 1. CPAP, 2. EPAP 3. PEP
What term refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract? oscillation
What device acts as a physical mucolytic enhancing cough clearance of secretions by its high frequencies? oscillation
What are the 2 general approaches to oscillation? external chest wall application and airway application
What is external application of oscillation referred as? high frequency chest wall compression HFCWC
What does airway application of oscillation methods include? dthe flutter valve and intrapulmonary percussive ventilation
What device uses a two part system with a variable air pulse generator and a nonstretch inflatable vest that covers the patient’s entire torso? high frequency chest wall oscillation
What are the hertz ranges for high frequency chest wall oscillators? 5 – 25 hz
how long do you typically perform HFCWO 30 min
What device is an airway clearance device that uses a pneumatic device to deliver a series pressurized gas minibursts at rates of 100 to 225 cycles per min to the resp tract, usually via a mouthpiece? Intrapulmonary percussive ventilation, IPV
What is a popular approach to PEP therapy? the flutter valve.
What kind of devices are believed to work based on the principle of collateral ventilation, which suggests that airflow can occur between adjacent lung segments thru the canals of Lambert and thru the pores of Kohn? Airway oscillating devices that produce PEP with oscillations in the airway during expiration
What airway clearance device can decrease viscoelasticity of mucus within the airways modifying mucus and allowing it to be cleared more easily by cough? flutter valve
What advantage does the Acapella have over the flutter valve? it can be used in any position
What are the appropriate airway clearance techniques that may be used for CF, ciliary dyskinesia syndrome, bronchiectasis? PDPV
What is the recommended airway clearance technique for a patient with atelectasis? PEP, PDPV, ACBT
What is the recommended airway clearance technique for a patient with asthma with mucus plugging? Exercise, PEP, PDPV, Flutter valve HFO
What is the recommended airway clearance technique used for a patient with neurologic abnormalities? PDPV, suction, MIE
What is the recommended airway clearance technique used for a patient with musculoskeletal weakness such as muscular dystrophy, myasthenia gravis and poliomyelitis? PEP, MIE
Endotrach or trach tube, inadequate humidification, High fio2 values, drugs, anesthetics, opiates, narcotics, and pulmonary disease are all causes of what in intubated patients? impaired mucociliary clearance

 

Egan’s Chapter 40 Practice Questions:

 

1. The Acapella:: Has customizable frequency and flow resistance, Can be used in any posture, Is NOT as portable as flutter

2. Adding exercise to mobilization and coughing can:: Enhance mucus clearance, Improve V/Q matching, Improve pulmonary function, Result in oxygen desaturation

3. Aerosol drug therapy may be added to a PEP session by means of:: Handheld nebulizer, MDI (attached to one-way valve inlet of the system).

4. Before starting postural drainage what assessments should be completed?: Patients vital signs, Chest auscultation

5. Bronchial hygiene methods:: Postural drainage therapy (including percussion and vibration), Positive airway pressure (PAP), Oscillation

6. Bronchial hygiene would not be beneficial to patients with what condition(s)?: – Acute exacerbation of COPD

7. Chronic conditions that may cause copious secretions and indicate the need for bronchial hygiene include:: Cystic Fibrosis, Bronchiectasis, Chronic bronchitis

8. Clinical procedure for PAP therapy:: Instruct the patient to: Take in a breath that is larger than normal, but do not completely fill lungs, Exhale actively, but NOT forcefully, Perform 10 – 20 breaths, Repeat cycle four to eight times, not to exceed 20 minutes

9. Clinical signs there is a problem with retained secretions include:: Loose, ineffective cough, Labored breathing pattern, Course inspiratory and expiratory crackles, Fever

10. Compression frequency and flow bias:: Determine the effectiveness of the therapy

11. Contraction of the expiratory muscles happens:: during the third or compression phase

12. Contraindications for directed cough include:: Patients with pathogens transmitted by droplets (TB), Presence of an elevated ICP, Poor coronary artery perfusion, Spinal cord injury

13. Contraindications for PAP adjuncts to bronchial hygiene therapy include:: ICP >20 mmHg, Untreated pneumothorax, Recent facial, oral, skull surgery or trauma

14. Directed cough is useful in helping maintain bronchial hygiene in patients with:: Patients with CF, Patients with bronchiectasis, Patients with spinal cord injury

15. Documentation of postural drainage therapy should include:: Position(s) used, Time in each position, Patient tolerance, Amount and consistency of sputum produced, Any untoward effects observed

16. During the exsufflation phase of MI-E the pressure:: is abruptly reversed to -30 to -50 cmH2O and maintained for 2-3 seconds.

17. Factors that may hinder an effective cough include:: Severe restrictive disorders (COPD), Fear of pain, Systemic dehydration, Thick, tenacious secretions, Artificial airways, Use of CNS depressants

18. Factors that provoke a cough:: Infection, foreign bodies, irritating gases

19. The first phase of autogenic drainage on a spirogram:: Involves a full inspiratory capacity maneuver, followed by breathing at low lung volumes

20. Four Phases of a normal cough:: irritation, inspiration, compression, expulsion

21. Hazards and complications of PAP adjuncts to bronchial hygiene therapy include:: Pulmonary barotrauma, Increased ICP, Decreased venous return

22. The head down position may need to be modified in patients with:: Unstable cardiovascular status, Hypertension, Cerebrovascular disorders, Dyspnea

23. HFCWO is performed:: In 30 minute therapy sessions, At oscillary frequencies between 5 and 25 hertz, Between one and six therapy sessions may occur per day

24. High-frequency chest wall oscillation (HFCWO) is accomplished by using a two part system:: 1) variable air pulse generator, 2) non-stretch inflatable vest

25. How long should a patient remain in an indicated position during postural drainage?: 3 to 15 minutes

26. If a patient experiences hemoptysis during postural drainage therapy what action(s) should be taken?: Stop therapy, Return patient to previous resting position, Administer or increase FIO2, Contact physician

27. If a patient is experiencing hypoxemia during postural drainage therapy what action(s) should be taken?: Administer or increase FIO2

28. If the procedure causes a vigorous cough, the patient should:: Get into a sitting position until the cough subsides

29. Indications for directed coughing include:: Pulmonary complications, Bronchial hygiene, To obtain sputum specimens

30. Indications for PAP adjuncts to bronchial hygiene therapy include:: To reduce air trapping, To aid in mobilization of retained secretions, To prevent or reverse atelectasis, To optimize delivery of bronchodilators in patients receiving bronchial hygiene therapy

31. In order for bronchial hygiene therapy to significantly improve secretion removal, sputum production must exceed:: 30mL/day (1 fluid ounce or a “shot glass full” )

32. Intra-pulmonary Percussive Ventilation (IPV) is:: An airway clearance technique that uses a pneumatic device to deliver a series of pressurized gas minibursts at rates of 100 to 225 cycles per minute

33. Key considerations in assessing a patient for CPT include:: Posture, muscle tone, Effectiveness of cough, Sputum production, Breathing pattern, Cardiovascular stability

34. Lab data and other essentials needed for assessment of need for bronchial hygiene therapy include:: Chest x-ray, PFT results, ABG values or oxygen saturation

35. MI-E is not effective with a oronasal mask if:: There is a fixed airway obstruction, There is glottic collapse during exsufflation

36. Monitoring of PAP adjuncts to bronchial hygiene therapy include:: Breath sounds, Sputum production ( color, quantity, consistency, odor), Peak flow or FEF (forced expiratory flow)

37. Mucus plugging can result in:: atelectasis, shunting, hypoxemia

38. Normal airway clearance requires:: patent airway, an effective cough, functional mucociliary escalator

39. Oscillation refers to:: The rapid vibratory movement of small volumes of air back and forth in the respiratory tract

40. Partial obstruction can:: Increase work of breathing, lead to air trapping, lead to V/Q imbalances

41. A patient recovering from anesthesia may have an impairment of which phase(s) of the normal cough reflex?: -Irritation

42. A patient with abdominal muscle weakness may have an impairment of which phases(s) of the normal cough reflex?: Compression, Expulsion

43. A patient with an artificial airway may have an impairment of which phase(s) of the normal cough reflex?: Compression

44. A patient with neuromuscular dysfunction may have an impairment of which phase(s) of the normal cough reflex?: Inspiration

45. PEP helps move secretions into the larger airways by:: Filling under-aerated or non-aerated segments via collateral ventilation, Preventing airway collapse during expiration

46. PEP therapy involves:: Expiration against a variable flow resistance

47. Post-op assessment of need for bronchial hygiene includes:: Age, History, Nature of procedure, Type of anesthesia, Duration of procedure

48. Postoperative directed coughing technique can be enhanced by:: Pain medication, Splinting, Forced Expiratory Technique (FET)

49. Postural drainage is most effective:: In conditions characterized by excessive sputum production, In head down positions that should exceed 25 degrees, With adequate systemic hydration

50. Postural drainage should be considered in all situations EXCEPT::: Patients with chronic obstructive lung disease

51. Postural drainage should be terminated for all responses EXCEPT:: – Complaint of discomfort

52. Postural drainage therapy uses gravity to:: Help mobilize secretions, Improve V/Q balance, Normalize FRC (functional residual capacity)

53. Potential outcomes of postural drainage therapy include:: Change in breath sounds, Change in chest x-ray, Change in ABG values

54. Preventative uses for bronchial hygiene therapy include:: Prevent retained secretions, Maintain lung function in Cystic Fibrosis

55. Properly performed chest vibration lasts:: Throughout expiration

56. Strenuous coughing in a head down position can cause:: Markedly increased ICP

57. The three most important aspects of patient teaching for directed cough include:: Instruction in proper positioning, Instruction in breathing control, Exercises to strengthen the expiratory muscles

58. Turning poses the risk of “plumbing” problems, what are “plumbing” problems?: Ventilator disconnection, Accidental extubation, Accidental aspiration of ventilator condensate, Disconnection of vascular lines

59. A typical MI-E treatment session lasts:: Until secretions are cleared and the vital capacity (VC) and SpO2 return to baseline

60. Use of the flutter valve is:: Readily excepted by patients, Fully portable, Does not require caregiver assistance

61. What are the ABSOLUTE contraindications for postural drainage therapy?: Unstable head or neck injury, Active hemorrhage or hemodynamic instability

62. What are the benefits of proning patients?: Shifts blood flow away from shunt regions increasing areas with normal V/Q balance, Redistributes blood flow, Decreases further lung injury

63. What are the hazards and complications of postural drainage therapy?: Increase ICP (intra-crainial pressure), Acute hypotension, Arrhythmias

64. What are the primary goals of bronchial hygiene therapy?: Help mobilize and remove retained secretions, Improve gas exchange, Reduce the work of breathing

65. What are the steps for ACB (Active cycle of breathing)?: 1) Relaxation and breathing control, 2) Three or four thoracic expansion exercises, 3) Perform one or two FET’s (huffs)

66. What can cause impaired mucociliary clearance in intubated patients?: Tracheobronchial suction, Inadequate humidification, High FIO2 values

67. What can limit a coughs effectiveness?: In some patients with COPD, high pleural pressures during a forced cough may compress the smaller airways

68. What common conditions affect the cough reflex?: Muscular dystrophy, Amyotrophic lateral sclerosis, Cerebral palsy

69. What common drugs can impair mucocilliary clearance in intubated patients?: General anesthetics, Opiates, Narcotics

70. What conditions can lead to bronchiectasis?: Chronic obstructive lung diseases, Aspiration, Bronchiolitis, Chronic airway infection

71. What diseases alter normal mucociliary clearance?: Cystic fibrosis, Ciliary Dyskinetic syndromes

72. What factors can impair airway patency?: Foreign bodies, Tumors, Inflammatory changes, Bronchospasm

73. What is the ABSOLUTE contraindication to turning?: Unstable spinal cord injuries

74. What is the ideal position for directed cough?: Patient should be in a sitting position with one shoulder rotated inward and the head and spine slightly flexed

75. What is the primary purpose of turning?: Promote lung expansion, Improve oxygenation, Prevent retention of secretions

76. What is the recommended airway clearance technique for patients with cystic fibrosis, ciliary dyskinesia, bronchiectasis or infants?: PDPV (postural drainage, percussion, vibration)

77. What is the recommended airway clearance technique for patients with neurologic abnormalities?: PDPV (postural drainage, percussion, vibration), MI-E (mechanical insufflation – exsufflation)

78. What postural drainage position would be used for a patient an abscess in the right middle lobe?: Right lateral segment

79. What postural drainage position would be used for a patient with aspiration pneumonia in the superior segments of the left lower lobe?: Superior segments

80. What postural drainage position would be used for a patient with aspiration pneumonia of the anterior upper lobes?: Anterior Segments

81. What postural drainage position would be used if a chest x-ray shows infiltrates in the posterior?: Posterior segments

82. When percussing, areas that should be avoided include:: Tender areas, Sites of trauma, Incision sites, Bony prominences, Fractured ribs

83. When positioning a patient for postural drainage it is important to:: Inspect any monitoring leads, IV tubing, and O2 therapy equipment connected to the patient to ensure its proper function during the procedure.

84. When using flutter, patients can control the pressure by:: Changing their expiratory flow

85. When using the AD (autogenic drainage) technique coughing should be suppressed until:: All three breathing phases are completed

 

Egan’s Chapter 40 Test Bank:

 

1. Active Cycle of Breathing Technique (ACBT): Airway clearance strategy consisting of repeated cycles of breathing control and thoracic expansion, followed by the forced expiratory technique

2. Autogenic Drainage (AD): Modification of directed coughing, beginning with low lung volume breathing, inspiratory breath holds, and controlled exhalation and progressing to increased inspired volumes and expiratory flows

3. Bronchiectasis: Abnormal condition of the bronchial tree characterized by irreversible dilation and destruction of the bronchial walls

4. Chest Physical Therapy: Collection of therapeutic techniques designed to aid clearance of secretions, improve ventilation, and enhance the conditioning of the respiratory muscles; includes positioning techniques, chest percussion and vibration, directed coughing and various breathing and conditioning exercises

5. Ciliary dyskinetic Syndromes: Conditions in which respiratory tract cilia so not function properly

6. Describe the initial irritation phase: An abnormal stimulus provokes sensory fibers in the airways to send impulses to the medullary cough center in the brain

7. Directed cough: A deliberate 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 forceful expiratory maneuver

8. Forced expiratory Technique (FET): Modification of the normal cough sequence designed to facilitate clearance of bronchial secretions, while minimizing the likelihood of bronchiolar collapse

9. Hertz (Hz): Unit of measurement for frequency

10. High frequency chest wall compression (HFCWC): Mechanical technique for augmenting secretion clearance; small gas volumes are alternately injected into and withdrawn from a vest by an air pulse generator at a fast rate, creating an oscillatory motion against the patient’s thorax

11. How does mucous plugging form: Retention of secretions

12. How does postural drainage work: By the use of gravity and mechanical energy to help mobilize secretions

13. How do you know if a patient is having issues with retained secretions: Physical findings such as a loose, ineffective cough, labored breathing pattern, decreased or bronchial breath sounds, coarse inspiratory and expiratory crackles, tachypnea, tachycardia, or fever may indicate a potential problem with retained secretions. A chest radiograph often shows atelectasis and areas of increased density in such cases

14. How do you manage a patient that consistently de sats with each postural drainage therapy: Pre oxygenate them

15. How long should the RT perform CPT: 3 to 5 minutes

16. How long should the RT perform postural drainage: Positions are generally held for 3 to 15 minutes and modified as the patients condition and tolerance warrant

17. Huff cough: Type of forced expiration with an open glottis to replace coughing when pain limits normal coughing

18. In patients in critical care, including patients are mechanical ventilation, postural drainage should be performed every ______________: 4 to 6 hours as indicated

19. Inspissation: Thickened or hardened through the absorption or evaporation of the liquid portion, as can occur with respiratory secretions when the upper airway is bypassed

20. Intrapulmonary percussive ventilation (IPV): Airway clearance technique that uses a pneumatic device to deliver a series of pressurized small volume breaths at high rates (1.6 to 3.75 Hz) to the respiratory tract, usually via a mouthpiece; usually combined with aerosolized bronchodilator therapy

21. Mechanical insufflation exsufflation (MIE): Mechanical device that provides an artificial cough by alternately applying positive pressure and negative pressure to the airway, also referred to as an in exsufflator

22. Mucous plugging: The partial or complete occlusion of the airway by thick mucous

23. Oscillation: Back and fourth motion; vibration or the effects of mechanical or electrical vibration

24. Positive expiratory pressure (PEP): Airway clearance technique in which the patient exhales against a fixed orifice flow resistor to help move secretions into the larger airways for expectoration via coughing or swallowing

25. Should bronchial hygiene be performed on an acute asthmatic patient: No

26. Splinting: Process of immobilizing, restraining, or supporting a body part

27. Sputum production must exceed __________ for airway clearance therapy to improve secretion removal significantly: 25 to 30 ml/day

28. What are acute conditions that indicate airway clearance therapy: Copious secretions, Acute respiratory failure with retained secretions, Acute lobar atelectasis, V/Q abnormalities caused by unilateral lung disease

29. What are chronic conditions that indicate airway clearance therapy: CF, Bronchiectasis, Ciliary dyskinetic syndromes, Chronic bronchitis

30. What are disorders associated with retention of secretions that indicate airway clearance therapy: Acute disease, Immobile patients, Postoperative patients related to effect of general anesthetics, opiates, and narcotics, Inadequate humidification, Acute exacerbations of COPD, CF, bronchiectasis, Chronic disease CF, neuromuscular disorders

31. What are some diagnostic tests to help determine the need for bronchial hygiene: Laboratory testing (pulmonary function testing), Radiologic evaluation, Physical assessment

32. What are some examples of compression that causes impairment of the cough reflex: Laryngeal nerve damage, Artificial airway, Abdominal muscle weakness, Abdominal surgery

33. What are some examples of expulsion that causes impairment of the cough reflex: Airway compression, Airway obstruction, Abdominal muscle weakness, Inadequate lung recoil (emphysema)

34. What are some examples of inspiration that causes impairment of the cough reflex: Pain, Neuromuscular dysfunction, Pulmonary restriction, Abdominal restriction

35. What are some examples of irritation that causes impairment of the cough reflex: Anesthesia, CNS depression, Narcotic analgesics

36. What are the 4 cough phases: Irritation, Inspiration, Compression, Expulsion

37. What are the causes of impaired mucociliary clearance in intubated patients: Endotracheal or tracheostomy tube, Tracheobronchial suction, Inadequate humidification, High FiO2 values, Drugs, General anesthetics, Opiates, Narcotics, Underlying pulmonary disease

38. What are the contraindications for postural drainage: Head and neck injury until stabilized, Active hemorrhage with hemodynamic instability, ICP greater than 20 mm Hg, Recent spinal surgery or acute spinal injury, Active hemoptysis, Uncontrolled hypertension, Uncontrolled airway at risk for aspiration, Bronchospasm, Esophageal surgery

39. What are the contraindications for the directed cough: Presence of elevated ICP, Presence of reduced coronary artery perfusion , such as MI, Inability to control possible transmission of infection from patients suspected to have pathogens transmittable by droplet nuclei (TB), Acute unstable head,neck,or spine injury

40. What are the indications for postural drainage: Turning, Inability or reluctance of patients to change body positions, Poor oxygenation associated with position, Potential for or presence of atelectasis, Presence of artificial airway, Evidence or suggestion of difficulty with secretion clearance, Difficulty clearing secretions, with expectorated sputum production greater than 25 to 30 ml/day, Evidence of suggestion of retained secretions in the presence of an artificial airway, Dx of diseases such as CF or bronchiectasis, Presence of foreign body in airway

41. What are the indications for the directed cough: Need to aid in the removal of retained secretions from central airways, Presence of atelectasis, Prophylaxis against postoperative pulmonary complications, Routine part of bronchial hygiene in patients CF, bronchiectasis, chronic bronchitis, necrotizing pulmonary infection, spinal cord injury, To obtain sputum specimens of Dx testing

42. What are the most common conditions that affect the cough reflex: Musculoskeletal disorders, Neurologic disorders, Muscular dystrophy, Amyotrophic lateral sclerosis, Spinal muscular atrophy, Myasthenia gravis, Poliomyelitis, Cerebral palsy

43. What are the three most important aspects involved in teaching a patient how to do a directed cough: Instruction in proper positioning, Instruction in breathing control, Exercises to strengthen the expiratory muscles

44. What conditions must exists for a patient to develop bronchiectasis: Chronic airway inflammation and infection can lead to bronchiectasis, a common finding in CF and ciliary dyskinetic syndromes. Other conditions that can lead to bronchiectasis include chronic obstructive lung disease, foreign body aspiration, and obliterative bronchiolitis

45. What does mucous plugging lead to: Mucous plugging can result in atelectasis and impaired oxygenation secondary to shunting. By restricting airflow, partial obstruction can increase the work of breathing and lead to air trapping, over distention, and ventilation/perfusion (V/Q) imbalances

46. What does normal airway clearance require: A patent airway, A functional mucociliary escalator, An effective cough

47. What impedes normal airway clearance: Any abnormality that alters airway patency, mucociliary function, strength of the inspiratory or expiratory muscles, thickness of secretions, or effectiveness of the cough reflex can impair airway clearance and cause retention of secretions

48. What is an example of cough stimulation caused by a mechanical stimulation: Foreign bodies

49. What is an example of cough stimulation caused by an inflammatory process: Infection

50. What is an example of cough stimulation caused by chemical stimulation: When irritating gases are inhaled such as cigarette smoke

51. What is an example of cough stimulation caused by thermal stimulation: Cold air

52. What is considered copious production of secretions: 25 to 30 ml/day, which is about 1 ounce or about the size of a shot glass

53. What is the amount of a deep inspiration taken in by a normal adult: 1 to 2 L

54. What is the primary goal of airway clearance therapy: To help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange, promote alveolar expansion, and reduce the work of breathing

55. What is the triple S rule: Whenever you observe an untoward patient response during postural drainage the RT should stop the therapy (return patient to original resting position) and stay with the patient until he/she is stabilized

56. What landmarks should the RT avoid during manual percussion: Avoid tender areas or sites of trauma or surgery, and one should never percuss directly over bony prominences, such as the clavicles or vertebrae

57. What position should the patient be in while performing the directed cough: The patient should assume the sitting position with one shoulder rotated inward and the head and spine slightly flexed. The patients feet should be supported to provide abdominal and thoracic support for the patient. If the patient is unable to sit up, the clinician should raise the head of the bed and ensure that the patients knees are slightly flexed with the feet braced on the mattress

58. What provokes a cough: Inflammatory, Mechanical, Chemical, Thermal

59. When should the postural drainage order be reevaluated: At least every 48 hours for patients in critical care and at least every 3 days for other hospitalized patients and every 3 months for patients receiving home care

60. Without an ____________________, most airway clearance techniques cannot succeed in fully clearing secretions.: Effective cough

61. Define bronchial hygiene therapy?: Bronchial hygiene therapy involves noninvasive airway clearance techniques to help mobilize secretions and improve gas exchange

62. What combined with exercise, bronchial hygiene therapy can improve functions in?: Cystic fibrosis PTs

63. What are the 3 things needed for normal airway clearance?: Patent airway (open airway), Functional mucocilliary escalator, Effective cough – an effective cough can move mucus from the lower airways to the upper airways

64. What are the 4 phases of a cough?: 1. Irritation – abnormal stimulus (inflammatory, mechanical, chemical, thermal) provokes sensory fibers in the airways to send impulses to the brains cough center. 2. Inspiration – Once impulses are recieved, the cough center generates a reflex stimulation to initiate deep inspiration. 3. Compression – reflex nerve impulses can cause glottic closure and a forecful contraction of the expiratory muscles. 4. Expulsion – glottis opens, the large pressure gradient causes a large expulsion of air

65. What is an abnormal clearance?: Abnormalities in airway patency, mucocilliary function, strength of breathing muscles or cough reflex can lead to mucus retention. Retention of secretions can result in full or partial airway obstruction.

66. What are some diseases associated with abnormal clearance?: Asthma, lung cancer, kyphoscoliosis, chronic bronchitis, acute infections, Cystic fibrosis, Bronchiectasis, Neuromuscular diseases can cause a weak cough

67. What is the primary goal of bronchial hygiene therapy?: Help mobilize and remove retained secretions. The ultimate goal is to improve gas exchange and reduce the WOB

68. What is retention of secretions?: Retained secretions in the lungs/airways

69. What are the 5 methods of bronchial hygeine therapy?: 1. Postural drainage therapy, 2. Coughing and related expulsion techniques, 3. Positive airway pressure (PAP), 4. High-frequency compression/oscillation, 5. Mobilization and exercise

70. What is postural drainage therapy?: Involves the use of gravity and mechanical energy to mobilize secretions, Turning, postural drainage, percussion and vibration

71. What are some indications of postural drainage therapy?: Inability of the PT to change body position, Poor oxygenation associated with position, Potential or prescence of atelectasis, Prescence of an artificial airway, Difficulty clearing secretions, Evidence or difficulty with secretion clearance, Diagnosis or disease such as CF, bronchiectasis

72. What are some contraindications of postural drainage therapy?: Head and neck injury, Active hemorrhage with hemodynamic instability, ICP > 20mmHg, Recent spinal surgery or acute spinal injury, Active hemoptysis, Empyema (puss in pleural space), Bronchopleural fistula, Pulmonary edema associated with CF, Pulmonary embolism, Aged, confused or anxious PTs who do not tolerate position changes, Rib fracture, Large pleural effisions

73. What are the 2 absolute contraindications?: Head and neck injury until stabilized – spinal cord injury, Active hemorrhage with hemodynamic instability – traction of arm abductors

74. What is the prone position?: Face down

75. What does the prone position strategically treat PTs with?: Acute lung injury and ARDS

76. What are the 6 things that should be documented on an outcome assessment?: Change in sputum production, Change in breath sounds, Change in dyspnea level, Change in vital signs, Change in in chest radiograph/ABG results, Change in ventilator variables

77. What should be on the documentation and follow up?: Chart should include: Positions used, Time in positions, PT tolerance, Indicators of effectiveness, Any untoward effects observed

78. Define percussion and vibration?: The application of mechanical energy to the chestwall by use of the hands or various electrical or pneumatic devices. Vibration should aid in the movement of secretions toward the central airways during exhalation

79. Define a directed cough?: Deliberate maneuver that is taught, supervised and monitored. Aims to mimic the features of an effective spontaneous cough. It has little direct effect on PTs who do not produce sputum.

80. What are some indications of directed cough?: The need to aid in the removal of retained secretions from the central airways, Prescence of atelectasis, Routine part of bronchial hygiene with cystic fibrosis, bronchiectasis, chronic bronchitis, pulmonary infection and spinal cord injury

81. What are some contraindications of directed cough?: TB, Increased ICP, MI = heart attack, Unstable head, neck or spine, Flail chest or osteporosis

82. What are some hazards and complications with directed cough?: Reduced cerebral perfusion, Reduced coronary artery perfusion, Rib fracture, Headache, Bronchospasm, Vomitting, Chest pain, Central line displacement

83. Define FET or Forced Expiratory Technique?: Modification of the directed cough also called, Huff Cough. Consists of one or two forced expirations of middle to low lung volumes w/o closure of the glottis

84. What is Autogenic Drainage or AD?: Another modifcation of the directed cough designed to be performed independtly by trained PTs. PT uses diaphragmatic breathing to mobilize secretions and achieve a mucus “rattle” in sitting position

85. What is MIE or Mechanical Inexsuffilation-exsufflation?: Synchronizes with PTs breathing cycle. MIE devices apply to positive pressure of 30-50cm of H2O to the airway for 1-3 seconds. The device then abruptly reverses the airway pressure to -30 – -50 cm H2O.

86. What kind of PTs is MIE used on?: PTs with neuromuscular disorders; Adults only

87. What is Positive Airway Pressure Adjuncts?: Used to mobilize secretions and treat atelectasis. Used in combination w/ other airway clearance techniques

88. What is PEP?: Positive Expiratory Pressure. Involves active expiration against a variable flow resistance. PEP helps move secretions into larger airways by improving ventilation of underaerated segments and by preventing airway collapse during expiration

89. What is high frequency compression/oscilliation?: Rapid vibratory movement of small volumes of air back and fourth in the respiratory tract. Airway application: Flutter valve or acapella

90. What is the high frequency chest wall oscillation?: The vest. Typically a 30 min session at frequencies between 5-25Hz

91. Why is mobilization and exercise good for the PT?: Immobility is a major factor contributing to retention of secretions. Early mobilization and exercise are standard care for surgical PTs. Exercise improves overall gas exchange and lung function

92. What are some key factors in selecting a brnochial hygiene strategy?: PTs motivation, PTs goals, Physician/caregiver goals, Effectiveness of technique, PTs age, PTs ability to concentrate, Ease of learning and teaching, Skill of therapists/teachers, Fatigue or work required, Need for assisstants or equipment, Limitations of technique based on disease type and severity, Costs, direct and indrect, Desirability of combing methods

93. What is CXR?: Chest radiograph demonstrating atelectasis and infiltrates