Podcast
Questions and Answers
What is the recommended maintenance frequency for preventing further accumulation of secretions?
What is the recommended maintenance frequency for preventing further accumulation of secretions?
How long should each position be held during PD if used exclusively?
How long should each position be held during PD if used exclusively?
Which of the following is NOT a contraindication for performing PD?
Which of the following is NOT a contraindication for performing PD?
What might indicate the effectiveness of the treatment post-session?
What might indicate the effectiveness of the treatment post-session?
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When combining PD with other techniques, how does this affect the duration of treatment?
When combining PD with other techniques, how does this affect the duration of treatment?
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What is the recommended rotation rate for the handle of the Quake during use?
What is the recommended rotation rate for the handle of the Quake during use?
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What is the primary function of the Flutter device during expiration?
What is the primary function of the Flutter device during expiration?
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Which frequency range does the Quake oscillate within to facilitate effective secretion clearance?
Which frequency range does the Quake oscillate within to facilitate effective secretion clearance?
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What technology does The Vest System utilize for airway management?
What technology does The Vest System utilize for airway management?
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How does the Quake device enhance mucous transport in the lungs?
How does the Quake device enhance mucous transport in the lungs?
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What material is the Flutter device primarily made from?
What material is the Flutter device primarily made from?
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What is a unique feature of the Quake compared to other devices like Flutter?
What is a unique feature of the Quake compared to other devices like Flutter?
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What is the optimal frequency for the ciliary beat in the lungs?
What is the optimal frequency for the ciliary beat in the lungs?
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In which position should the apical segment of the right upper lobe be percussed?
In which position should the apical segment of the right upper lobe be percussed?
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What is the appropriate site of percussion for the medial segment of the right lung's middle lobe?
What is the appropriate site of percussion for the medial segment of the right lung's middle lobe?
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What is the position for percussion of the inferior segment of the lingula?
What is the position for percussion of the inferior segment of the lingula?
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What is the purpose of applying external pressure on the mid rectus abdominis area after inspiration?
What is the purpose of applying external pressure on the mid rectus abdominis area after inspiration?
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Which technique is recommended for patients with a history of cerebrovascular accident?
Which technique is recommended for patients with a history of cerebrovascular accident?
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Which site is targeted for percussion in the anterior segment of the lower lobes?
Which site is targeted for percussion in the anterior segment of the lower lobes?
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What is the purpose of having the patient make a 'K' sound during the coughing technique?
What is the purpose of having the patient make a 'K' sound during the coughing technique?
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What precaution should be taken with hypertensive patients during coughing procedures?
What precaution should be taken with hypertensive patients during coughing procedures?
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In patients with abdominal weakness, which technique assists in developing greater intra-abdominal pressure for a more forceful cough?
In patients with abdominal weakness, which technique assists in developing greater intra-abdominal pressure for a more forceful cough?
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What is the correct angle to lean when performing percussion for the lateral segment of the lower lobe?
What is the correct angle to lean when performing percussion for the lateral segment of the lower lobe?
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What should be avoided during the manual assistive cough maneuver?
What should be avoided during the manual assistive cough maneuver?
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Which technique is recommended to help clear sputum from the chest?
Which technique is recommended to help clear sputum from the chest?
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What is the significance of avoiding a gasping action during coughing?
What is the significance of avoiding a gasping action during coughing?
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For which segment do you need to be in a prone position with pillows under the abdomen?
For which segment do you need to be in a prone position with pillows under the abdomen?
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What is the benefit of instructing a patient to take a deep but relaxed inspiration before coughing?
What is the benefit of instructing a patient to take a deep but relaxed inspiration before coughing?
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How does intermittent ice application affect the cough mechanism?
How does intermittent ice application affect the cough mechanism?
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What is the primary reason for advising patients to cough while in an erect or side-lying posture?
What is the primary reason for advising patients to cough while in an erect or side-lying posture?
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What is the purpose of using an abdominal binder in selected patients?
What is the purpose of using an abdominal binder in selected patients?
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What is the primary support needed when performing percussion on the lateral segment of the lower lobe?
What is the primary support needed when performing percussion on the lateral segment of the lower lobe?
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How can a patient self-assist during a cough in a sitting position?
How can a patient self-assist during a cough in a sitting position?
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Which statement best describes the Huff technique?
Which statement best describes the Huff technique?
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Why might a cough be more productive during a second attempt in a single expiration?
Why might a cough be more productive during a second attempt in a single expiration?
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What role do humidification therapies play in treatment for thick secretions?
What role do humidification therapies play in treatment for thick secretions?
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What is the technique known as 'splinted cough' primarily used for?
What is the technique known as 'splinted cough' primarily used for?
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What is the primary purpose of autogenic drainage (AD)?
What is the primary purpose of autogenic drainage (AD)?
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What is the recommended breathing technique during the 'unsticking' phase of autogenic drainage?
What is the recommended breathing technique during the 'unsticking' phase of autogenic drainage?
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Which type of device is commonly used to aid in airway clearance by vibrating and loosening mucus?
Which type of device is commonly used to aid in airway clearance by vibrating and loosening mucus?
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What position should a patient ideally maintain while performing autogenic drainage?
What position should a patient ideally maintain while performing autogenic drainage?
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What type of breathing should be performed during the 'collecting' phase of autogenic drainage?
What type of breathing should be performed during the 'collecting' phase of autogenic drainage?
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Which condition is NOT commonly treated with vibratory positive expiratory pressure devices?
Which condition is NOT commonly treated with vibratory positive expiratory pressure devices?
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What can occur if the exhalation during the AD technique is too forceful?
What can occur if the exhalation during the AD technique is too forceful?
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What is a key characteristic of oscillating airway clearance devices?
What is a key characteristic of oscillating airway clearance devices?
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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
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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.
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Methods for stimulating cough: tracheal stimulation, pressure, and neuromuscular facilitation.
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Precautions for teaching an effective cough: never allow a patient to gasp for air.
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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.
