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CP Exam II
PT Associated with Airway Clearance Dysfunction
| Term | Definition |
|---|---|
| Airway Clearance | removal of secretions from the airways |
| Normal Airway Clearance Depends on... | patent airways mucocillary escalator expiratory flow |
| Diseases of Airway Clearance Dysfunction | Cystic Fibrosis COPD Bronchiectasis *Any # of conditions that impair normal airway clearance - often in acute care or rehab settings - surgery, chest trauma, weakness, etc. |
| Secretion Mobilization | deep breathing (inspiratory muscle trainer) positive expiratory pressure (PEP) devices oscillatory PEP devices manual airway clearance high-frequency chest wall oscillation |
| Secretion Removal | cough forced expiratory technique suction |
| Effective Coughing Requires... | - large inspiration follow by glottis closure - increased abdominal pressure by contracting expiratory muscles - sudden opening of the glottis allows high expiratory air flow to shear mucus, which expels it toward the mouth |
| Ineffective Coughing | - inability to effectively close glottis (e.g., CVA) - weak inspiratory effort leading to low volume of inspired air or weak expiratory effort (e.g., neuromuscular disease, weakness, pain due to surgery/trauma) - premature airway closure |
| Outcome Measures for Effective Mobilization/Removal of Secretions | - sputum clearance or mobilization - improved gas exchange (SaO2, ABG) - chest x-ray - auscultation (air entry, decreased wheezes & crackles) |
| Patient Airways...Essential | - must have adequate inspiration to get good exhalation - secretion removal may need to begin with deep breathing to open closed airways |
| Facilitating Inspiration | 1. Determine cause (pain, fear, respiratory muscle weakness) 2. Address the cause ( time treatment around pain medications, braching) |
| Addressing Cause of Low Inspired Volume | - incentive spirometers (volume type, flow type) - sustained maximal inspiration (< 3 seconds) - special concerns for COPD - give air time to diffuse into distal alveoli (exhalation helps push blockages out) |
| Incentive Spirometers | must consider... - pts posture (inhale = thoracic ext.) - exhale before attempting inspiration - avoid rapid, high inspiratory flow rate - sustained maximal inspiration - coordinate treatment with pain meds |
| Inspiratory Muscle Training | has a valve you must develop a certain pressure against - forces you to produce a higher pressure to inhale air |
| Walking & Exercise | increases ventilation |
| Positive Expiratory Pressure (PEP) | - positive airway pressure during exhalation created to allow unimpeded inspiration - air comes out at slower rate keeping pressure in airways elevated (back pressure) - rationale: pos. pressure prevents atelectasis (collapse) & helps move secretions |
| Oscillatory PEP | - flutter device creates oscillating PEP for airway patency & collateral ventilation - oscillation loosens airway secretions & decreases sputum viscosity |
| Acapella | similar to oscillatory PEP |
| High-Frequency Chest Wall Oscillation | - intermittent compressive pressure @ certain frequency that is designed to optimize secretion clearance via biased airflow & enhancing cilia action - vibration helps to loosen secretions & then patient coughs them up |
| Manual Airway Clearance | - percussion (chest PT) is rhythmically striking the chest wall over specific lung segments - usually done in a postural drainage position |
| Postural Drainage | - uses different body positions to facilitate gravitational drainage from lung segments (no voluntary effort required) - rationale: gravity pull on secretions, more negative pressure surrounding non-dependent lung segments - maintain position 10-20 min |
| Postural Drainage Contraindications | increase intracranial pressure unstable CV Status GI feeds vomiting or aspiration pulmonary edema positional intolerance no head down in infants with CF |
| Active Cycle of Breathing Technique | BC 20-30 sec normal -> 3-4 deep breath w/ TE -> BC -> 3-4 deep breaths w/ TE -> BC -> huff cough -> effective coughing *goal = mobilize & expel mucous |
| Forced Expiratory Technique (FET) | - glottis remains open - huff at mid to low volumes followed by force expiration using abdominal muscles to facilitate excretion & decrease probability of airway collapse |
| Forced Expiratory Technique (FET) Indications | - people with compromised airway stability (CF, COPD) - people with difficulty coughing due to chest wall or intrathoracic pain |
| Pursed Lip Breathing | - helps control dyspnea - creates small pack pressure (gentle prolonged exhalation) - contributes to: keeping airways open, facilitates air movement of pulmonary system |
| Oxygen Therapy Physiology | - PaO2 is sensitive & non-specific indication of gas exchange - FiO2 is the same at all altitudes, pp O2 changes - normal PaO2 decreases with age - body does not store oxygen - high levels of supplemental oxygen causes tissue damage |
| Indications for Supplemental Oxygen | - hypoxemia - increased work of breathing - increased myocardial demand - pulmonary hyertension |
| Signs & Symptoms of Hypoxemia | - cyanosis - progressive loss of cognitive & motor function - impaired judgement - decreased exercise tolerance - headache - breathlessness or severe dyspnea - palpitations - angina - restlessness - tremors |
| What is Oxygen Therapy? | - Increases PaO2 (increases difference between pressure in alveoli & blood) - decreased hypoxemia (reduces vasoconstriction of pulmonary vasculature) - if pt is on O2: FiO2 x 500 = expected PaO2 *if ABG shows PaO2 = 95 mmHg, assume hypoxemia off O2 |
| Supplemental Oxygen | - fraction of O2 is raised by ~4% for each 1 L/min of O2 supplied - typically delivered via Nasal Cannula at rates of 1-5 L/min (FiO2 = 0.24-0.4) - masks are used for high delivery rates (FiO2 > 0.4) or if concerned about reliability of delivery |
| Oxygen Concentrator | - air passes through filer & oxygen is pulled in a reservoir - home concentrators are on wheels but heavy to move - must have max flow rate of 5L - requires electrical power |
| Types of Oxygen Concentrators: Portable | max flow rate 2-3L/min & battery operated |
| Types of Oxygen Concentrators: Liquid | - 99.5% pure oxygen - -297°F - converts back to gas when exposed to warmer temps - needs to be stored in special tank for cold - cheaper/less bulky - not for short term use |
| Types of Oxygen Concentrators: Compressed Gas E Cylinder | - 3 ft tall, 8 lbs, 2200-3000 PSI O2 gas (5-6 hours @ 2 L/min) - 0.25-25 L/min range - made of aluminum rather than steel (lighter) |
| Types of Oxygen Regulators: Continuous Flow | - continuous flow during inspiration & expiration - recommended with higher O2 flow rates |
| Types of Oxygen Regulators: Pulsed | - bolus of O2 upon inhalation - tank lasts longer - requires double lumen nasal cannula to sense inhalation |
| Low Flow Oxygen | - increases FiO2 above room air - O2 is mixed with room air (dilutes amount of O2) |
| High Flow Oxygen | - delivers increase FiO2 @ rates of 40-60 L/min via nasal cannula or mask - constant FiO2 up to 1.0 - requires wall connection - oxygenation not dependent on patients breathing pattern - reduces need for intubation or non-invasive ventilation |
| Indications for High Flow Oxygen | indicated in patients with chronic hypoxia, increased work of breathing, & hypoventilation |
| Advantages of High Flow O2 | decreased O2 dilution washout of waste gases decreased respiratory rate increased tidal volume & end expiratory volume positive end expiratory pressure facilitates secretion clearance decrease dev. of bronchial hyper-response symptoms |
| Heat Humidification | added to most higher flow rates of O2 or pt. is on O2 for longer period because O2 dries out airways (especially mucosa) |
| Physical Therapist Role in Oxygen Therapy | - oxygen considered a drug requiring MD order - APTA reports they are unaware of laws limiting PT's in use of or titration O2 - know your state laws - always check for specific orders - communicate - maintain pt.'s SpO2 > 90% |
| PT's Role in Oxygen Therapy pt. 2 | - assists with titration of O2 - develop exercise prescription with O2 adjustments as needed - educate patient on oxygen adjustments with activity |
| Medicare Coverage | PaO2 < 55 mmHg at rest SpO2 < 88% at rest More lenient criteria if SpO2 < 88% & SpO2 improves w/ supplemental O2 |
| Oxygen Toxicity: Exudative Phase | damage to the alveolar-capillary membrane increased permeability to fluid, protein, electrolytes leading to pulmonary edema - capillaries clogged with platelets, interstitial inflammation |
| Oxygen Toxicity: Proliferative Phase | fibroblasts & epithelial cells proliferate collagen deposited in interstitium |
| Oxygen Toxicity: Recovery Phase | can lead to scarring *If severe enough can cause Acute Respiratory Distress Syndrome |
Created by:
Cummings226134
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