Respiratory Therapy 1 - Exam 3

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shughes06
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47244
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Respiratory Therapy 1 - Exam 3
Updated:
2010-11-29 17:14:38
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Respiratory Therapy
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Chest Physiotherapy, Hyperinflation Techniques, Airway Care/Emergency
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  1. Goals of Chest Physical Therapy
    • Prevent accumulation of secretions
    • Improve mobilization
    • Improve ventilation
  2. Indications for Chest Physical Therapy
    • Accumulated or retained secretions
    • Ineffective cough
    • Ciliary dysfunction
    • Prophylactic care of patients
  3. Techniques Promoting Bronchial Hygiene
    • Postural Drainage
    • Percussion
    • Vibration
  4. Contraindications for Chest Physical Therapy
    • Unstable cardiovascular system
    • Unstable pulmonary system
    • Unstable post-op status
    • Absolute contraindications
    • ~ Head/Neck injury
    • Relative contraindications
    • ~ ICP > 20 mmHg
    • ~ Empyema
    • ~ Rib fractures
  5. Contraindications for Percussion
    • Subcutaneous emphysema
    • Recent skin graft
    • Burns or open wounds
    • Lung contusion
    • Osteomyelitis of ribs
    • Osteoporosis
  6. Hazards for Vibration
    • Rib cage trauma
    • Soft tissue trauma
  7. Hazards for Chest Physical Therapy
    • Hypoxemia
    • Cardiovascular instability
    • Hemorrhage, hemoptysis
    • Fracture ribs
    • Increased ICP
    • Dyspnea
  8. Percussion
    Technique of clapping the chest wall with cupped hands
  9. Vibration
    Isometric manuever performed with the arm and hand that is performed on exhalation only
  10. Effective Pulmonary Clearance
    • To move secretion, must get air behind secretions to mobilize
    • To allow for distribution of inhaled air, breath hold is extremely important
    • To avoid airway closure, exhale in a manner that does not cause dynamic collapse of airway
  11. Pulmonary Clearance Techniques
    • Postural Drainage and Percussion
    • Positive Expiratory Pressure (PEP)
    • Oscillation PEP
    • Autogenic Drainage
    • High Frequency Chest Wall (HFCWC)
    • Intra-pulmonary Percussive Ventilation
  12. Postural Drainage
    Method used to remove pooled secretions by positioning the patient to allow gravity to assist in the movement of secretions.
  13. PEP Devices
    • Therapep
    • Resistex
    • PariPEP
  14. PEP
    Exhale against a resistance to hold airways open and promote secretion movement up the airway
  15. Huff Cough
    • Critical part of all forms of pulmonary clearance
    • Goal is to maintain open airway without inhibiting secretion movement
  16. Coaching Huff Cough
    • Take a deep breath, hold briefly, huff out air (similar to fogging up glass)
    • Toward the end of exhalation have patient cough to clear secretions
  17. Performing PEP
    • Sit upright, back straight, NO SLOUCHING
    • Take in slightly larger than tidal volume breath
    • Hold breath for 2-3 seconds
    • Exhale through mouth against the resistance (Should be slightly active, maintaining pressures between 10-20 cm H20
    • Repeat for 10 breaths
    • Perform good huff cough and allow patient to expectorate secretions
    • Repeat for 6 full cycles of 10 breaths each
  18. Performing Oscillating PEP
    • Sit up straight
    • Take in larger that tidal volume breath, but not TLC
    • Hold breath for 2-3 seconds
    • Exhale normally through device beyond normal level, but not entirely
    • Cheeks should be kept flat
    • Repeat for 10-15 breaths or until secretion movement is detected
    • When patient is ready to cough, have them take in full breath and actively exhale through the device
    • At the end of exhalation, patient should cough and expectorate
    • Repeat the entire process until secretions have cleared (15-20 minutes or 6 cycles)
  19. Autogenic Drainage Goal
    To move secretions from smaller airways to larger airways so they can be easily expelled
  20. 3 Phases of Autogenic Drainage
    • Unsticking - Small Airways
    • Collecting - Mid-Sized Airways
    • Evacuation - Large Airways
  21. Performing Autogenic Drainage
    • Sit upright
    • Place hands on front and back of chest
    • Instruct patinet to take a deep breath in and exhale fully (well into ERV)
    • Take in small volume of air and hold for 3 seconds
    • Huff air out through mouth (slightly active), keeping airways open
    • Repeat until you hear secretions move ( crackling sound)
    • Have patient take in a deeper breath to mid sized airways and hold for 3 seconds
    • Huff air out in the same manner
    • Repeat at this volume until you can feel or hear secretions
    • Encourage patient not to cough until the end of the last phase
    • Have patient take in full breath and hold for 3 seconds
    • Huff air out through mouth in same manner, being conscious of keeping airways open
    • Once secretion have accumulated in large airways, have patient take in full breath and perform a huff cough to expectorate
    • Repeat the cycles until chest feels clear
  22. High Frequency Chest Wall Oscillation
    • Uses the rapid compression and release of the chest wall to loosen secretions from the airway wall and decrease the viscosity of the secretions
    • Uses compression frequencies of 5-25 Hz, but only up to 15 Hz for therapeutic reasons
  23. HFCWO Devices
    • The Vest airway clearance system by Hil-Rom
    • The MedPulse Respiratory Vest System
    • The InCourage system by Respirtech
  24. Oscillating PEP Devices
    • Flutter
    • Acapella
    • Cornett
  25. Incentive Spirometry
    • Mimic natural sigh
    • Encourage patient to take slow deep breaths
    • Device provides visual clue for patient
  26. IPPB
    • Intermittent Positive Pressure Breathing
    • Application of positive pressure to spontaneously breathing patients
  27. Equipment for Incentive Spirometry
    • Voluime - Oriented Devices
    • Flow - Oriented Devices
  28. Equipment for IPPB
    • Positive Pressure Machine
    • PR-2
    • Bird Mark 7 or 8
    • AP-5
  29. Goals and Indications for Incentive Spirometry
    • Presence of Pulmonary Atelectasis
    • Presence of Conditions Predisposing to Atelectases
    • Presence of Restrictive Lung Defect
  30. Goals and Indications for IPPB
    • General: Patient cannot voluntarily cough effectively and take a deep breath
    • Specific: If patient's vital capacity is less than 15 ml/kg or ispiratory capacity is less than 33%
    • Therapeutic: treat and prevent atelectasis
  31. Contraindications for Incentive Spirometry
    • Unconscious patient
    • Patient who can not use incentive spirometer after instruction
    • Patient unable to generate adequate inspirations - Vital capacity less than 10 ml/kg or Inspiratory capacity less than 1/3 of the predictid normal
  32. Contraindications of IPPB
    • Tension pneumothorax
    • ICP> 15 mmHg
    • Hemodynamic instability
    • Active Hemoptysis
    • Air Swallowing
    • Nausea
  33. Hazards and Complications Associated with Incentive Spirometry
    • Hyperventailation
    • Discomfort
    • Pulmonary Barotrauma
    • Hypoxemia
    • Exacerbation of Bronchospasm
    • Fatigue
  34. Hazards and Complications Associated with IPPB
    • Increased mean airway pressure
    • Pulmonary Barotrauma
    • Nosocomial Infection
    • Hyperoxia
    • Decrease venous return
    • Gastric distension
  35. Describe the Procedure for Incentive Spirometry
    • Determine need
    • Select appropriate equipment
    • Determine initial goal of where on the Chart they need to be
    • Patient instructed to inspire slowly and deeply
    • Then exhale normally
    • Allow patient to rest
    • Then repeat
    • 5-10 sustained maximal inspirations per hour
  36. Describe the Procedure for IPPB
    • Knowledgeable well trained therapist
    • Relaxed, informed, cooperative patient
    • Concept of goals
    • Pressure-limited machine
    • Appropriate cough/breathing instruction
    • Honest evaluation of therapy
    • Treatment length 15 to 20 minutes
  37. Monitoring IPPB Therapy Machine Performance
    • Sensitivity
    • Peak Flow and Setting
    • FiO2 Ordered
    • I:E Ratio
    • 40-60 lpm
  38. Monitoring IPPB Therapy Patient Response
    • RR and Expired Volume
    • HR and Rhythm
    • Sputum Production
    • Skin Color
    • Subjective Response to Therapy
  39. Follow Up of IPPB - Pre and Post Treatment Assessment
    • Vital Signs
    • Sensorium
    • Breath Sounds
    • Sputum Production
    • Positive and Negative Effects
  40. Indications for use of an Artificial Airway
    • Prevent/relieve upper airway obstruction
    • Protect airway from aspiration
    • Facilitate suctioning
    • Provide sealed, closed system for mechanical ventilation/ CPAP
  41. Oropharyngeal Airway
    • Prevent/relieve upper airway obstruction
    • Poorly tolerated in alert patients
    • Use in unconscious patients
  42. Nasopharyngeal Airway
    • Prevent/relieve upper airway obstruction
    • Facilitate suctioning
    • Alternate every 24 hours between right and left nares
  43. Oroendotracheal Tube
    • Easy to insert
    • Short-term intubation
    • Larger tube size than nasal
  44. Nasoendotracheal Airway
    • Easy to stabilize
    • Easy to suction
    • Well tolerated
  45. Tracheostomy Tube
    • No complications of upper airway/ glottis
    • Easy to suction
    • Easy to stabilize
    • Best tolerated artificial airway
  46. Tracheal Buttons
    • Used to maintain patency of tracheal stoma
    • Patient can be suctioned in an emergency
  47. EOA, EGOA
    Placed in esophagus and used to suction stomach
  48. Complications Associated with a Nasopharyngeal Airway
    • Sinusitis
    • Otitis Media
    • Nasal Necrosis
  49. Complications Associated with an Oroendotracheal Tube
    • Poorly tolerated
    • Difficult to stabilize
  50. Complications Associated with a Nasoendotracheal Airway
    • Tips move
    • Small tube
  51. Complications Associated with a Tracheostomy
    • Bleeding
    • Pneumothorax
    • Infection
  52. Indications for Cuffs
    • Mechanically ventilate patient
    • protect airway from aspiration
  53. Hazards of Cuffs
    • @ 30 mmHg - Cessation of arterial blood flow
    • @ 18 mmHg - Obstruct venous flow
    • @ 5 mmHg - Inhibit lymphatic flow
    • Mucosal edema and redness
    • Mucosal ischemia and necrosis
    • Mucosal inflammation
    • Exposure to cartilage
    • Tracheal ring destruction
  54. High-Volume, low-pressure cuffs
    • Cuffs of choice
    • Inflates Evenly
    • Produces low lateral tracheal wall pressure
    • Can herniate over end of tube
  55. Low-volume, high-pressure cuffs
    • Small contact on tracheal wall
    • Inflates unevenly
    • Exceeds safe pressures
  56. Cuff Inflation Technique
    • Minimal Leak Technique (MLT) - Maintain seals except at max inspiratory pressure
    • Minimal Occluding Volume (MOV) - Matain seal @ peak inspiratory pressure
  57. Airway Suctioning
    • Invasive procedure that involves insertion of a small catheter into the airways
    • Application of a vacuum to aspirate secretions of foreign material
  58. Indications for Airway Suctioning
    • Gurgling expiratory sounds
    • Visible secretions
    • Inability to cough
    • Sputum induction
  59. Hazards of Airway Suctioning
    • Hypoxemia
    • Arrhythmias
    • Hypotension
    • Lung Collapse
    • Cardiac Arrest
    • Infection
  60. Describe Suctioning Technique
    • Sterile technique
    • Preoxygenate
    • Insert catheter w/out suction
    • Apply suction only during removal
    • No longer than 10-15 seconds
    • Reoxygenate and ventilate
  61. Suction Pressures
    • Adults: 100-120 mmHg
    • Children: 80-100 mmHg
    • Infants: 60-80 mmHg
  62. Proper Catheter Size for Suctioning
    Should not be greater than 1/2 the internal diameter of the artificial airway
  63. Indications for Manual Resuscitation
    • Support Ventilation
    • Respiratory Arrest
    • CPR
    • Suctioning
    • Patient Transport
  64. Hazards for Manual Resusicitation
    • Unrecognized equipment failure
    • Gastric distension
    • Aspiration
    • Diminished cardiac output
  65. Trendelenburg
  66. Reverse Trendelenburg
  67. Sims'
  68. Fowler's
  69. Prone
  70. Supine

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