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RT Test 2
wwallace rt test 2
| Question | Answer |
|---|---|
| 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
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