Respiratory Therapy 1 - Exam 3

• Prevent accumulation of secretions
• Improve mobilization
• Improve ventilation

• Accumulated or retained secretions
• Ineffective cough
• Ciliary dysfunction
• Prophylactic care of patients

• Postural Drainage
• Percussion
• Vibration

• Unstable cardiovascular system
• Unstable pulmonary system
• Unstable post-op status
• Absolute contraindications
• ~ Head/Neck injury
• Relative contraindications
• ~ ICP > 20 mmHg
• ~ Empyema
• ~ Rib fractures

• Subcutaneous emphysema
• Recent skin graft
• Burns or open wounds
• Lung contusion
• Osteomyelitis of ribs
• Osteoporosis

• Rib cage trauma
• Soft tissue trauma

• Hypoxemia
• Cardiovascular instability
• Hemorrhage, hemoptysis
• Fracture ribs
• Increased ICP
• Dyspnea

Technique of clapping the chest wall with cupped hands

Isometric manuever performed with the arm and hand that is performed on exhalation only

• 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

• Postural Drainage and Percussion
• Positive Expiratory Pressure (PEP)
• Oscillation PEP
• Autogenic Drainage
• High Frequency Chest Wall (HFCWC)
• Intra-pulmonary Percussive Ventilation

Method used to remove pooled secretions by positioning the patient to allow gravity to assist in the movement of secretions.

• Therapep
• Resistex
• PariPEP

Exhale against a resistance to hold airways open and promote secretion movement up the airway

• Critical part of all forms of pulmonary clearance
• Goal is to maintain open airway without inhibiting secretion movement

• 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

• 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

• 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)

To move secretions from smaller airways to larger airways so they can be easily expelled

• Unsticking - Small Airways
• Collecting - Mid-Sized Airways
• Evacuation - Large Airways

• 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

• 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

• The Vest airway clearance system by Hil-Rom
• The MedPulse Respiratory Vest System
• The InCourage system by Respirtech

• Flutter
• Acapella
• Cornett

• Mimic natural sigh
• Encourage patient to take slow deep breaths
• Device provides visual clue for patient

• Intermittent Positive Pressure Breathing
• Application of positive pressure to spontaneously breathing patients

• Voluime - Oriented Devices
• Flow - Oriented Devices

• Positive Pressure Machine
• PR-2
• Bird Mark 7 or 8
• AP-5

• Presence of Pulmonary Atelectasis
• Presence of Conditions Predisposing to Atelectases
• Presence of Restrictive Lung Defect

• 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

• 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

• Tension pneumothorax
• ICP> 15 mmHg
• Hemodynamic instability
• Active Hemoptysis
• Air Swallowing
• Nausea

• Hyperventailation
• Discomfort
• Pulmonary Barotrauma
• Hypoxemia
• Exacerbation of Bronchospasm
• Fatigue

• Increased mean airway pressure
• Pulmonary Barotrauma
• Nosocomial Infection
• Hyperoxia
• Decrease venous return
• Gastric distension

• 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

• 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

• Sensitivity
• Peak Flow and Setting
• FiO₂ Ordered
• I:E Ratio
• 40-60 lpm

• RR and Expired Volume
• HR and Rhythm
• Sputum Production
• Skin Color
• Subjective Response to Therapy

• Vital Signs
• Sensorium
• Breath Sounds
• Sputum Production
• Positive and Negative Effects

• Prevent/relieve upper airway obstruction
• Protect airway from aspiration
• Facilitate suctioning
• Provide sealed, closed system for mechanical ventilation/ CPAP

• Prevent/relieve upper airway obstruction
• Poorly tolerated in alert patients
• Use in unconscious patients

• Prevent/relieve upper airway obstruction
• Facilitate suctioning
• Alternate every 24 hours between right and left nares

• Easy to insert
• Short-term intubation
• Larger tube size than nasal

• Easy to stabilize
• Easy to suction
• Well tolerated

• No complications of upper airway/ glottis
• Easy to suction
• Easy to stabilize
• Best tolerated artificial airway

• Used to maintain patency of tracheal stoma
• Patient can be suctioned in an emergency

Placed in esophagus and used to suction stomach

• Sinusitis
• Otitis Media
• Nasal Necrosis

• Poorly tolerated
• Difficult to stabilize

• Tips move
• Small tube

• Bleeding
• Pneumothorax
• Infection

• Mechanically ventilate patient
• protect airway from aspiration

• @ 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

• Cuffs of choice
• Inflates Evenly
• Produces low lateral tracheal wall pressure
• Can herniate over end of tube

• Small contact on tracheal wall
• Inflates unevenly
• Exceeds safe pressures

• Minimal Leak Technique (MLT) - Maintain seals except at max inspiratory pressure
• Minimal Occluding Volume (MOV) - Matain seal @ peak inspiratory pressure

• Invasive procedure that involves insertion of a small catheter into the airways
• Application of a vacuum to aspirate secretions of foreign material

• Gurgling expiratory sounds
• Visible secretions
• Inability to cough
• Sputum induction

• Hypoxemia
• Arrhythmias
• Hypotension
• Lung Collapse
• Cardiac Arrest
• Infection

• Sterile technique
• Preoxygenate
• Insert catheter w/out suction
• Apply suction only during removal
• No longer than 10-15 seconds
• Reoxygenate and ventilate

• Adults: 100-120 mmHg
• Children: 80-100 mmHg
• Infants: 60-80 mmHg

Should not be greater than 1/2 the internal diameter of the artificial airway

• Support Ventilation
• Respiratory Arrest
• CPR
• Suctioning
• Patient Transport

• Unrecognized equipment failure
• Gastric distension
• Aspiration
• Diminished cardiac output

Trendelenburg

Reverse Trendelenburg

Sims'

Fowler's

Prone

Supine