• Retained pulmonary secretions may cause acute resp failure b/c movement of oxygen into the alveoli and removal of CO2 are blocked. Secretions can be monilized through effective coughing, adequate hydration, humidication, chest physiotherapy, airway suctioning and ambulation.
- • Effective Coughing:
- Augmented Coughing: place one or both hands on anterlateralbase of lungs, as the patient ends respiration and begins exration, move your hands forcfully upward, increasing abdominal pressure and facilitating the cough. This measure helps increase expiratory flow and thereby facilitates secretion clearance. Helps for neuromuscular weakness from exhaustion/disease and can’t generate enough airwaiy pressures.
- Huff Coughing: series of coughs while saying the word “huff” This technique prevents the glottis from closing during the cough. Patient’s with COPD generate higher flow rates with a hugh cough than is possible with normal couch. Effective in clearing only central airways but it may assist in moving secretions upwards.
- Staged cough: assist in mobilizing secretions. Pt. assumes sitting position, breathes three or four times and out through mouth and coughs while bending forward and pressing a pillow inward against the diagphragm.
Position pt. upright or 45 degree angle, maximize thoracic expansion to decrease dyspnea and improve secretion mobilization. Assists in venous pooling in dependent body areas. Upright lungs: ventilation and perfusion are best in the lung bases.
Lateral position may be used in pt With disease involving only one lung, “ good lung down”
: allows for improved V/Q matching in the affected lung. Pulm blood flow and ventilation are optimal in dependent lung areas, slows secretions to drain out of affected lung for suctioning. Side lying also good for pts whose tongue is aspiration risk.