Airway Clearance Techniques and Cough Reflex
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Questions and Answers

What is the recommended maintenance frequency for preventing further accumulation of secretions?

  • 3 to 5 times per week
  • 1 to 2 times per day (correct)
  • Once a week
  • 2 to 4 times per day

How long should each position be held during PD if used exclusively?

  • 2 to 3 minutes
  • 5 to 10 minutes (correct)
  • 15 to 20 minutes
  • 30 minutes

Which of the following is NOT a contraindication for performing PD?

  • Severe hemoptysis
  • Large pleural effusion
  • Severe hypertension
  • Chronic respiratory conditions (correct)

What might indicate the effectiveness of the treatment post-session?

<p>Change in the type and amount of secretions (B)</p> Signup and view all the answers

When combining PD with other techniques, how does this affect the duration of treatment?

<p>It may be decreased (B)</p> Signup and view all the answers

What is the recommended rotation rate for the handle of the Quake during use?

<p>1 to 2 rotations per second (D)</p> Signup and view all the answers

What is the primary function of the Flutter device during expiration?

<p>Produce oscillatory positive expiratory pressure (B)</p> Signup and view all the answers

Which frequency range does the Quake oscillate within to facilitate effective secretion clearance?

<p>6-24 Hz (D)</p> Signup and view all the answers

What technology does The Vest System utilize for airway management?

<p>High Frequency Chest Wall Oscillation (HFCWO) (A)</p> Signup and view all the answers

How does the Quake device enhance mucous transport in the lungs?

<p>Through stimulation of ciliated epithelial cells (D)</p> Signup and view all the answers

What material is the Flutter device primarily made from?

<p>Hardened plastic (D)</p> Signup and view all the answers

What is a unique feature of the Quake compared to other devices like Flutter?

<p>It has an integrated mouthpiece and crank. (B)</p> Signup and view all the answers

What is the optimal frequency for the ciliary beat in the lungs?

<p>11 to 15 Hz (C)</p> Signup and view all the answers

In which position should the apical segment of the right upper lobe be percussed?

<p>An upright position (D)</p> Signup and view all the answers

What is the appropriate site of percussion for the medial segment of the right lung's middle lobe?

<p>Under the right breast (B)</p> Signup and view all the answers

What is the position for percussion of the inferior segment of the lingula?

<p>Lying on the right side leaning backward 45° (C)</p> Signup and view all the answers

What is the purpose of applying external pressure on the mid rectus abdominis area after inspiration?

<p>To increase the effectiveness of the cough (B)</p> Signup and view all the answers

Which technique is recommended for patients with a history of cerebrovascular accident?

<p>Huffing multiple times (C)</p> Signup and view all the answers

Which site is targeted for percussion in the anterior segment of the lower lobes?

<p>Over the lower portion of the ribs (B)</p> Signup and view all the answers

What is the purpose of having the patient make a 'K' sound during the coughing technique?

<p>To tighten the vocal cords and contract the abdominals (A)</p> Signup and view all the answers

What precaution should be taken with hypertensive patients during coughing procedures?

<p>They must be monitored closely for increased blood pressure (B)</p> Signup and view all the answers

In patients with abdominal weakness, which technique assists in developing greater intra-abdominal pressure for a more forceful cough?

<p>Manual assistive cough with abdominal compression (B)</p> Signup and view all the answers

What is the correct angle to lean when performing percussion for the lateral segment of the lower lobe?

<p>45° forward (B)</p> Signup and view all the answers

What should be avoided during the manual assistive cough maneuver?

<p>Direct pressure on the xiphoid process (A)</p> Signup and view all the answers

Which technique is recommended to help clear sputum from the chest?

<p>Active Cycle of Breathing Technique (ACBT) (C)</p> Signup and view all the answers

What is the significance of avoiding a gasping action during coughing?

<p>It prevents mucus from entering deeper air passages (D)</p> Signup and view all the answers

For which segment do you need to be in a prone position with pillows under the abdomen?

<p>Apical segment of the right lung (D)</p> Signup and view all the answers

What is the benefit of instructing a patient to take a deep but relaxed inspiration before coughing?

<p>It enhances the effectiveness of the cough (A)</p> Signup and view all the answers

How does intermittent ice application affect the cough mechanism?

<p>It enhances the strength of the cough reflex (A)</p> Signup and view all the answers

What is the primary reason for advising patients to cough while in an erect or side-lying posture?

<p>To maximize airflow and lung expansion (A)</p> Signup and view all the answers

What is the purpose of using an abdominal binder in selected patients?

<p>To assist with inspiratory or abdominal muscle weakness (D)</p> Signup and view all the answers

What is the primary support needed when performing percussion on the lateral segment of the lower lobe?

<p>Pillows leaning forward 45° on the opposite side (C)</p> Signup and view all the answers

How can a patient self-assist during a cough in a sitting position?

<p>By crossing arms or interlocking hands on the abdomen (D)</p> Signup and view all the answers

Which statement best describes the Huff technique?

<p>It helps speed airflow without closing the glottis (C)</p> Signup and view all the answers

Why might a cough be more productive during a second attempt in a single expiration?

<p>The first cough fails to remove secretions leading to buildup (A)</p> Signup and view all the answers

What role do humidification therapies play in treatment for thick secretions?

<p>They enhance mucociliary transport to facilitate a productive cough (B)</p> Signup and view all the answers

What is the technique known as 'splinted cough' primarily used for?

<p>To reduce pain from an incision (D)</p> Signup and view all the answers

What is the primary purpose of autogenic drainage (AD)?

<p>To adapt breathing and improve ventilation (B)</p> Signup and view all the answers

What is the recommended breathing technique during the 'unsticking' phase of autogenic drainage?

<p>Breathe out the chest fully before inhaling with the abdomen (D)</p> Signup and view all the answers

Which type of device is commonly used to aid in airway clearance by vibrating and loosening mucus?

<p>Hand-held percussive airway devices (C)</p> Signup and view all the answers

What position should a patient ideally maintain while performing autogenic drainage?

<p>Relaxed position without any breathing restrictions (C)</p> Signup and view all the answers

What type of breathing should be performed during the 'collecting' phase of autogenic drainage?

<p>Medium-sized breaths with awareness of the chest (C)</p> Signup and view all the answers

Which condition is NOT commonly treated with vibratory positive expiratory pressure devices?

<p>Asthma (B)</p> Signup and view all the answers

What can occur if the exhalation during the AD technique is too forceful?

<p>Wheezing due to airway tightness (A)</p> Signup and view all the answers

What is a key characteristic of oscillating airway clearance devices?

<p>They deliver oscillating positive expiratory pressure and are effort dependent (D)</p> Signup and view all the answers

Flashcards

Postural Drainage (PD)

A chest physiotherapy technique that involves positioning the patient to drain secretions from specific lung segments.

Duration of PD Positions

In PD, each position should be maintained for 5 to 10 minutes to allow for effective drainage. If the position is held for longer, ensure nursing care for skin pressure relief is provided.

PD with Other Techniques

PD can be combined with other techniques like percussion, vibration, and shaking to further loosen secretions.

Contraindications of PD

Large amounts of blood in sputum, untreated acute conditions like heart failure, pulmonary edema, pleural effusion, pneumothorax, cardiovascular instability, and recent neurosurgery.

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Evaluating PD Effectiveness

The effectiveness of PD is assessed by observing the type, color, consistency, and quantity of secretions produced. Listen to the lung sounds for improvement and check for symmetrical chest expansion.

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Apical Segment of the Upper Lobe

A lung segment located at the top of the lung.

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Anterior Segment of the Upper Lobe

A lung segment located in the front of the lung.

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Posterior Segment of the Upper Lobe

A lung segment located in the back of the lung.

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Medial Segment of the Middle Lobe

A lung segment located in the middle of the lung.

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Lateral Segment of the Middle Lobe

A lung segment located on the side of the lung.

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Superior Segment of the Lingula

A lung segment located in the front of the lung.

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Inferior Segment of the Lingula

A lung segment located in the back of the lung.

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Active Cycle of Breathing Technique (ACBT)

A technique used to clear sputum from the airways.

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Tracheal Stimulation

A technique used to stimulate a cough reflex in infants or disoriented patients who can't cooperate.

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Pressure on Rectus Abdominis

Applying pressure on the mid-rectus abdominis area after taking a breath can help with coughing effectively.

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Pressure on Lower Costal Border

Applying pressure along the lower ribs during exhaling can also improve coughing efficiency.

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Intermittent Ice Application

Short bursts of ice application on the back muscles can help strengthen coughing.

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Coughing Posture

Coughing should be done while sitting upright or lying on your side to clear airways effectively.

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Huffing

A gentle way of coughing that speeds up airflow without closing the vocal cords, minimizing pressure changes in the lungs.

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Huffing vs Coughing

Huffing is effective at clearing the outer lung areas while coughing efficiently clears the central lung areas.

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Huffing Technique

A breathing technique involving holding the breath for a short time after inhaling deeply, followed by a smooth 'huff' to help clear airways.

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Cough

The action of expelling air from the lungs forcefully, typically used to clear the airways of mucus or foreign objects.

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Huff Cough

A type of cough initiated by a sharp inhalation followed by a forceful exhalation, aiming to clear the airways.

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Manual Assistive Cough

A technique used to facilitate coughing by manually compressing the abdomen to increase intra-abdominal pressure, enhancing the force of the cough.

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Abdominal Binder

Support provided to a patient's abdomen during coughing to improve their ability to clear their airways.

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Glossopharyngeal Breathing

A type of breathing technique where you use your throat muscles to help you breathe.

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Splinted Cough

A technique that involves holding your incision with your hands to prevent pain during coughing.

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Therapist-Assisted Cough

A technique used to help a patient clear their airways by positioning the therapist’s hands on the patient’s abdomen and applying pressure during the cough.

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Self-Assisted Cough

A self-assisted technique to improve coughing by pushing inward and upward on the abdomen while leaning forward during the cough.

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Flutter device

A hand-held device that utilizes expiratory airflow to create oscillations, loosening mucus in the airways.

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Autogenic Drainage (AD)

A breathing technique to clear mucus from the lungs. It involves controlled breathing with three phases: unsticking, collecting, and evacuating the mucus.

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Quake device

A device with a mouthpiece and crank, enabling manual control of oscillation frequency for mucus clearance.

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Oscillation frequency

The range of frequencies generated by a device for airway oscillation.

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Unsticking Phase of AD

The first phase of AD where you take small breaths in to loosen up the mucus.

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Collecting Phase of AD

The second phase of AD where you take medium-sized breaths to gather the loosened mucus in the airways.

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Ciliary beat frequency

The frequency of ciliary beat in the airways that effectively moves mucus.

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Evacuating Phase of AD

The final phase of AD where you take deep breaths to move the collected mucus to the larger airways for coughing out.

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Vest System

A chest wall oscillating device that uses a vest and air pulses to create oscillations for mucus clearance.

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Rheology

A measure of a fluid's resistance to flow, relevant for how easy mucus is to move.

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Airway Clearance Oscillation Devices

Devices that deliver oscillating positive expiratory pressure (OPEP), used for airway clearance, often by individuals with cystic fibrosis and bronchiectasis.

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Resonance

The phenomenon where two oscillating systems with similar frequencies amplify each other's vibrations.

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Percussive Airway Devices

A type of airway clearance device that vibrates to loosen mucus, often used for Cystic Fibrosis and Bronchiectasis.

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Secretion clearance

The process of moving mucus from the lungs to the throat, often aided by oscillation devices.

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Vibratory Positive Expiratory Pressure (PEP) Devices

A type of airway clearance device that combines vibrations and air pressure to loosen mucus.

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Airway Clearance Devices: Prescription

These devices require a prescription and are commonly used for individuals with conditions like cystic fibrosis, bronchiectasis, and chronic obstructive pulmonary disease.

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Study Notes

Airway Clearance Techniques

  • Coughing is an essential mechanism for removing lung secretions and a major defense against retained secretions.
  • A normal cough has four phases: irritation, inspiration, compression, and expulsion.
  • Coughing can be triggered by inflammation, mechanical, chemical, or thermal stimuli.
  • Factors that impede the cough reflex include anesthesia, CNS depression, narcotic analgesics, pain, neuromuscular dysfunction, pulmonary restrictions, laryngeal damage, artificial airways, abdominal muscle weakness, or surgery.

The Cough Reflex

  • Coughing is a vital mechanism for clearing airways.
  • There are four phases in a normal cough: irritation, inspiration, compression, and expulsion.
  • The stimulus for coughing can be from inflammation, mechanical, chemical, or thermal causes.
  • Several factors can weaken the cough reflex, including anesthesia, CNS depression, narcotic pain relievers, pain, neuromuscular disorders, and restrictions in the pulmonary or abdominal areas. Damage to the larynx, the use of artificial airways, and abdominal muscle weakness can also compromise the cough.

Airway Clearance Therapy

  • The goal is to mobilize and remove retained secretions.
  • This improves gas exchange, promotes alveolar expansion, and reduces the work of breathing.
  • A normal cough involves deep inspiration, glottis closure, vocal cord tightening, abdominal muscle contraction, diaphragm elevation, glottis opening, and explosive air expulsion.

Teaching an Effective Cough

  • Assess patient's voluntary/reflex cough.
  • Position the patient for comfortable breathing and coughing.
  • Encourage controlled diaphragmatic breathing.
  • Demonstrate proper cough mechanics.
  • Use a sharp, deep cough with abdominal muscle contraction.
  • Practice making a "K" sound to tighten vocal cords and abdominal muscles.
  • Combine deep inspiration with a sharp cough.
  • Consider using an abdominal binder for patients with muscle weakness.

Additional Techniques for Airway Clearance

  • Manual Assistive Cough: Manually applying pressure to the abdominal area to increase intra-abdominal pressure, helping with a stronger cough, is recommended for patients with abdominal weakness.
  • Self-Assisted Cough: This technique involves the patient crossing arms over the abdomen or placing hands below the xiphoid process and pushing inward and upward with wrists/forearms while leaning forward.
  • Splinted Cough: Using hands or a pillow to splint over an incision reduces pain during coughing.
  • Tracheal Stimulation: This involves using fingers to tickle the trachea to promote a cough, often used with infants or disoriented patients.
  • Pressure: External pressure on the mid-rectus abdominis or costal border after inspiration can improve cough effectiveness.
  • Neuromuscular Facilitation: Using intermittent ice along the paraspinal area to increase cough strength.
  • Humidification: Therapy or ultrasonic nebulizers enhance mucociliary clearance, promoting a productive cough.
  • Huffing: A gentle coughing technique with relaxed glottis that clears peripheral lung regions at low-to-mid lung volumes, and clears the central lung volumes at high lung volumes.

Airway Clearance Devices

  • Devices like Acapella, Flutter, RC-Cornet, and Quake, or the Vest (High-Frequency Chest Wall Oscillation) deliver oscillating positive expiratory pressure(PEP).
  • These devices are used to loosen mucous.
  • Flutter is a handheld device involving a ball and cone that creates oscillations on exhalation.
  • Acapella generates vibration through a mouth piece.
  • RC-cornets are PEP devices.
  • The Vest system vibrates chest walls to loosen mucus.

Postural Drainage (PD)

  • Gravity assists secretion flow by positioning.
  • Based on bronchial tree anatomy.
  • Drains specific lung areas.
  • Secretions move from bronchioles to trachea for cough or suctioning.

PD Preparation

  • Bronchodilators may aid in sputum mobilization.
  • Adequate fluid intake thins secretions.
  • Familiarity with patient's lines/tubes is crucial.
  • Maintain appropriate positioning and minimal patient stress during positioning.
  • Suction/equipment readily available for secretions from artificial airways.
  • Tissues/cups for patients to expectorate.
  • Loosen tight clothing.
  • Explain the procedure to the patient.

PD Maintenance

  • Copious sputum needs multiple treatments, 2-4 or 1-2 treatments per day.
  • Each position should be held for 5-10 mins, possibly longer or shorter depending
  • Percussion/vibration/shaking can be combined.
  • Patient directed breathing/coughing may be needed after treatment.
  • Monitor for expectoration type, color, consistency and amount.
  • Monitor breathing and chest symmetry.

Contraindications to PD

  • Severe haemoptysis (large amounts of blood), untreated acute conditions (e.g., congestive heart failure, severe pulmonary oedema, large pleural effusions), severe cardiovascular instability, severe hypertension/hypotension, recent myocardial infarction, or recent neurosurgery are contraindications to postural drainage due to increased intracranial pressure risks from head-down positions.

  • Methods for stimulating cough: tracheal stimulation, pressure, and neuromuscular facilitation.

  • Precautions for teaching an effective cough: never allow a patient to gasp for air.

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Airway Clearance Techniques PDF

Description

This quiz explores the roles of coughing in airway clearance, including its phases and triggers. Understand how factors like anesthesia and neuromuscular dysfunction can weaken the cough reflex, impacting lung health. Test your knowledge on essential airway management techniques.

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