Chapter 40 Airway Clearance Therapy

Slides:

Advertisements

Similar presentations

Biphasic Cuirass Ventilation (BCV)

Advertisements

Pre-Hospital Treatment Using the Respironics Whisperflow

An Overview of Cough & Cough Assessment Sally Cozens Respiratory Specialist Physiotherapy.

Scintigraphic Assessment of Radio-Aerosol Pulmonary Deposition With the Acapella Positive Expiratory Pressure Device and Various Nebulizer Configurations.

Bronchopulmonary Hygiene CRT 3? = 2% RRT 3?. Upper Lobes –bed flat or sitting RML or LLingula –foot of bed elevated 15° Lower Lobes –Foot of bed elevated.

Initiation and Modification of Therapeutic Procedures

Chapter 50 Cardiopulmonary Rehabilitation

“Airway Clearance Devices” Why we use them with Bronchiectasis

Cystic Fibrosis (Mucoviscidosis)

1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license.

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings. RESPIRATORY SYSTEM: EXCHANGE OF GASES CHAPTER 10 RESPIRATORY SYSTEM: EXCHANGE.

Bronchial Hygiene Therapy II

Auscultation: Listening to breath sounds with a stethoscope

 Inspiratory Phase  Compressive Phase  Glottis closing  Building of pressure  Expiratory Phase (glottis opening)

O2 Therapy, Lung Expansion Therapy & Airway Clearance

Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 29 Assessment of the Respiratory System.

1 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 42 Postoperative Atelectasis.

LUNG FUNCTION IN HEALTH AND DISEASE: SPIROMETRY Sultan Ayoub Meo MBBS, PGC Med Ed, PG Dip Med Ed, M.Phil, Ph.D Professor, Department of Physiology, College.

Cystic Fibrosis and Physiotherapy Linda Lapointe P.T. CHEO March 3 rd, 2015.

Airway Clearance Techniques

Hill-Rom Respiratory Care Lung and Airway Clearance Therapies Hill-Rom Services PTE Ltd. All rights Reserved - Vinay Joshi.

Chapter 39 Lung Expansion Therapy

Preparation for postural drainage

Objectives Discuss the principles of monitoring the respiratory system

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. Chapter 42 Mechanical Ventilators.

Management of Patients With Chronic Pulmonary Disease.

Manual Therapy and Postural Drainage

Respiratory Failure Sa’ad Lahri Registrar Dept Of Emergency Medicine UCT / University of Stellenbosch.

NONINVASIVE POSITIVE PRESSURE VENTILATION NIPPV ADELYN MITCHELL, RN, BSN, CEN, BSRC NURS 5303 INFORMATION AND TECHNOLOGY.

Chapter 51 Respiratory Care in Alternative Settings

An Intervention for airway clearance, is a means of mobilizing secretions in one or more lung segments to the central airways by placing the patient in.

MECHANICAL VENTILATION

Respiratory System.

Chapter 13 Respiratory Sys – Disorders & Development.

Bronchial Hygiene Therapy

Respiratory Pleural and Thoracic Injury. Pleural injury : Normal physiology- visceral, parietal pleura & pleural space.

Respiratory Equipment Most Often Used in Hospice Care Mark Schroedel, CRT Walgreens Home Care.

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Emphysema Abnormal distention of air spaces beyond the terminal bronchioles with.

The Human Body in Health and Illness, 4 th edition Barbara Herlihy Chapter 22: Respiratory System.

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings. Kuliah ke-2 RESPIRATORY SYSTEM: EXCHANGE OF GASES PowerPoint ® Lecture Slide.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Diagnosis #1 Impaired Gas Exchange related to decreased oxygen supply secondary to bronchiectasis and atelectasis as evidenced by: ◦ increased.

CHEST PHYSIOTHERAPY (CPT) PREPARED BY: DR. IRENE ROCO ASST. PROFESSOR.

Respiratory care.

1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Chapter 1 Contemporary Nursing Practice.

Pneumonia Egan’s Chapter 22. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Introduction Infection involving the.

Slide Respiratory Sounds Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings  Sounds are monitored with a stethoscope  Bronchial.

Mechanical Ventilation 1

Respiratory System Chapter 23. Superficial To Deep  Nose  Produces mucus; filters, warms and moistens incoming air.

ELAINE N. MARIEB EIGHTH EDITION 13 Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slide Presentation by.

PT Intervention I: Cardiopulmonary rehabilitation

Management of Patients With Chronic Pulmonary Disease

Motor neuron disease.

Chest Tubes Charlotte Cooper RN, MSN, CNS. Thoracic Cavity Lungs Mediastinum – Heart – Aorta and great vessels – Esophagus – Trachea.

Pulmonary rehabilitation in a patient with disturbed airway clearance Sema Savcı.

Copyright © 2006 by Mosby, Inc. Slide 1 Chapter 30 Myasthenia Gravis Figure Myasthenia gravis. Inset, Atelectasis, a common secondary anatomic alteration.

1 Respiratory System. 2 Main functions: Provide oxygen to cells Eliminate carbon dioxide Works closely with cardiovascular system to accomplish gas exchange.

Chapter 13 The Respiratory System. Respiratory Sounds  Monitored with stethoscope  Normal Sounds  Bronchial sounds – air in trachea and bronchi  Vesicular.

L U N G COMPLIANCE ? Physiology Unit.

Active Cycle of Breathing (p , )

Copyright © 2006 by Mosby, Inc. Slide 1 Chapter 44 Postoperative Atelectasis Figure Alveoli in postoperative atelectasis. A, Total alveolar collapse.

Pulmonary Function Tests Pulmonary Function Tests Marcus A. Nesbeth PA-C June 19, 2009.

Promoting Oxygenation

Lung function in health and disease

Management of Pulmonary Conditions

You could ventilate a patient

Auscultation: Listening to Breath Sounds with a Stethoscope

Presentation transcript:

Chapter 40 Airway Clearance Therapy Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Learning Objectives Describe how normal airway clearance mechanisms work and the factors that can impair their function. Identify pulmonary diseases associated with abnormal clearance of secretions. State the goals and clinical indications for bronchial hygiene therapy. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Learning Objectives (cont.) Describe the proper technique and potential benefit of each of the following. Postural drainage Directed coughing and related expulsion techniques Positive expiratory pressure (PEP) therapy High-frequency compression/oscillation methods Mobilization and exercise Evaluate a patient’s response to airway clearance therapy. Modify airway clearance therapies on the basis of patient response. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Introduction Airway clearance therapy involves noninvasive techniques to help mobilize secretions and improve gas exchange Broad application of airway clearance therapy is costly & ineffective Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Physiology of Airway Clearance Normal clearance Normal airway clearance requires a(an) Patent airway Functional mucocilary escalator Effective cough Effective cough can move mucus from lower airways to upper airway Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Normal Clearance Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Physiology of Airway Clearance (cont.) Abnormal clearance Abnormalities in airway patency, mucuciliary function, strength of breathing muscles, thickness of secretions or cough reflex can lead to mucus retention Mucus plugging can lead to atelectasis, pneumonia, & hypoxemia Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

All of the following can lead to excess mucus retention, except: Vocal cord paralysis Inspissated secretions Impaired mucocilary escalator Loss of cough reflex Answer: A Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Physiology of Airway Clearance (cont.) Diseases associated with abnormal clearance Internal or external compression of airway lumen (e.g., asthma, lung cancer) Cystic fibrosis Bronchiectasis Neuromuscular diseases can cause a weak cough Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

General Goals & Indications Airway clearance therapy for acute conditions Acutely ill patient with copious secretions Patient in acute respiratory failure with clinical signs of retained secretions Patient with acute lobar atelectasis Patient with hypoxemia due to lung infiltrates Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

General Goals & Indications (cont.) Airway clearance therapy to prevent retention of secretions May be useful in acutely ill patients when combined with patient mobilization Cystic fibrosis patients benefit from chest physical therapy combined with exercise to maintain lung function Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Determining the Need for Airway Clearance Therapy Physical findings such as: Loose, ineffective cough Labored breathing pattern Coarse inspiratory & expiratory crackles Tachypnea/tachycardia Fever Chest radiograph demonstrating atelectasis & infiltrates Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

All of the following findings would indicate a need for airway clearance therapy, except: Coarse secretions Pain Tachypnea Labored breathing Answer: B Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods Chest physical therapy Coughing & related expulsion techniques Positive airway pressure (PAP) High-frequency compression/oscillation Mobilization & exercise Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

All of the following are methods of airway clearance, except: Exercise Oscillation Chest physical therapy Low-frequency compression Answer: D Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Postural drainage therapy Involves use of gravity & mechanical energy to mobilize secretions Includes turning, postural drainage, & percussion & vibration Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Postural drainage Outcome assessment Change in sputum production Change in breath sounds Change in dyspnea level Change in vital signs Change in chest radiograph/ABG results Change in ventilator variables Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Decrease in sputum production All of the following are positive outcomes associated with performing postural drainage, except: Decrease in sputum production Breath sound change, diminished to wheezing Increase in SpO2 Decrease in dyspnea level Answer: A Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Postural drainage (cont.) Documentation & follow-up Chart entry should include Positions used Time in positions Patient tolerance Indicators of effectiveness Any untoward effects observed Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Postural drainage (cont.) Percussion & vibration Application of mechanical energy to chest wall by use of hands or various electrical or pneumatic devices Designed to aid in movement of mucus toward central airways during exhalation Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Percussion and Vibration Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Percussion and Vibration Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Coughing & related expulsion techniques Directed cough Deliberate maneuver that is taught, supervised, & monitored Aims to mimic features of effective spontaneous cough Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Directed cough (cont.) Not to be used in patients who are obtunded, paralyzed, or uncooperative Good patient teaching is critical Proper positioning of patient is important Technique may need to be modified in surgical patients, patients with COPD, & patients with neuromuscular disease Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Forced expiratory technique (FET) Modification of directed cough Also called “huff cough” Consists of one or two forced expirations of middle to low lung volumes without closure of glottis Goal is to clear secretions with less change in pleural pressure & less bronchial collapse Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Forced expiratory technique (FET) (cont.) Has been shown to increase sputum production, especially when combined with postural drainage Most useful in patients with COPD, cystic fibrosis, or bronchiectasis. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Active cycle of breathing (ACBT) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance (cont.) Autogenic drainage (AD) Patient uses diaphragmatic breathing to mobilize secretions by varying lung volumes & expiratory airflow in three distinct phases Patient should be in sitting position Coughing should be suppressed until all three phases are complete Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Autogenic Drainage Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

All of the following are part of Autogenic drainage therapy, except: Patient should be in supine position Coughing should be avoided until all 3 phases are complete Patient should be in semifowlers position Patient should use diaphragmatic breathing techniques Answer: A Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Mechanical insufflation-exsufflation (MIE) MIE devices apply positive pressure of 30 to 50 cm H2O to airway for 1 to 3 seconds Device then abruptly reverses airway pressure to –30 to –50 cm H2O Treatment sessions consist of about five cycles of MIE followed by normal spontaneous breathing Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

MIE Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Positive airway pressure adjuncts Used to mobilize secretions & treat atelectasis Used in combination with other airway clearance techniques Three applications are used: continuous PAP (CPAP), expiratory PAP (EPAP), & positive expiratory pressure (PEP) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Positive Airway Pressure Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) PEP therapy to clear secretions Involves active expiration against variable flow resistance Helps move secretions into larger airways by improving ventilation of underaerated segments & by preventing airway collapse during expiration Studies have shown mixed results Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) High-frequency compression/oscillation External (chest wall) application Airway application Flutter valve Intrapulmonary percussive ventilation Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

High-frequency Compression/Oscillation Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Flutter Valve Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Intrapulmonary Percussive Ventilation Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Airway Clearance Methods (cont.) Mobilization & exercise Immobility is major factor contributing to retention of secretions Early mobilization & exercise are standard care for surgical patients Exercise improves overall gas exchange & lung function Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Selecting Airway Clearance Techniques Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Selecting Airway Clearance Techniques (cont.) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

Which of the following is the most appropriate airway clearance method for an infant with cystic fibrosis? PDPV MIE PEP Exercise Answer: A Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.