rt check off week 5

hypoxemic hypoxia

most treatable by bronchial hygeine, removes airway obstruction

indications of bronchial hygiene therapy

difficulty with secretion clearance, >30mL a day, atelectasis caused by mucus plugging, cystic fibrosis, presence of foreign body in airway

hazards of bronchial therapy

increased intracranial pressure, hypoxemia, acute hypotension, vomit and aspiration, bronchospasm

supine feet elevated 30 degrees

anterior lower lobes

supine head elevated

anterior upper regions

sidelaying, feet elevated 30 degrees

left lateral segment anterior sidelayinbg

side laying feet elevated 15 degrees

left lingular anterior

sidelaying head elevated

left posterior segment

chair position learned forward

posterior apical segment

perform percussion

for 2-3 minutes

exhalations

apply vibration for 3 exhalations towards center

forced expiration technique

forced expirations from low to mid volume with glottis open, huff cough, breathe in and out slowly through pursed lips then huff

autogenic drainage

breathing through low to high lung volumes to move mucus, start with small breaths then breathe out, then medium breaths, then full breaths, followed by huff coughing

PAP therapy duration

10-20 breaths

PEP devices

use 10-20cmH2O expiratory pressure

percussive devices

use 30 cmH2O and start at max frequency then work down, institute periodic 5-10 sec breath hold

incentive spirometry

provides visual cues to patient when desired inspiratory volume of flow is reached, proved to be effective in high risk patients, you inhale into it, mimics a sigh

intermittent positive airway pressure breathing

noninvasive ventilation, goal is to achieve a deep sigh through a positive pressure assisted breath, increases Palv > Ppl

PEP indications

patients with expiratory airflow limitation will best respond, mimics pursed lip breathing by giving expiratory resistance, patient takes larger than tidal breath then exhales through device

oscillating PEP

expiratory pressure of 1-20cmH2O created by patient actively exhaling against a fixed orifice flow resistor or variable orifice thershold