airway clearance therapy check off

phases of a cough

1. irritation (abnormal stimulus sends message to medulla to cough)

2. inspiration (respiratory muscles initiate a deep breath)

3. compression (glottis closes and expiratory muscles contract as lung pressure rises)

4. expulsion (glottis opens, a violet expulsive flow of air from lungs results- 500mph)

directed cough

upright with one shoulder rotated, instruct pt. to take deep slow breath through the nose and watch for their belly going out (diaphagramic), have them hold their breath, instruct pt. to cough in 2-3 short bursts

huff cough

glottis stays open; have pt. take a moderately deep breath, then perform 3 short exhalations saying "huff, huff, huff"

manually assisted cough

coordinating with pt. forced exhalation, the practitioner puts pressure on the thoracic cage. used on pt. with neuromuscular disease or spinal cord dysfunction

CPT

uses percussion & positions to loosen secretions.

- always keep side rails up when moving pt.

- move bed to correct height

- avoid bony areas or injured areas

- do NOT percuss over bare skin

- have suction on standby

- ask for consent

apical

by shoulders

upper anterior & posterior

right below clavicle

obstruction in both upper lobes

pt. sits upright, easier in chair

left and right posterior upper lobes

pt. leans forward over a pillow

left and right upper lobes

pt. flat in bed or semi-fowlers, percuss just below clavicles

right middle lobe or left upper lobe lingula

head of bed down 12" laying on proper side, arm behind back

right and left lower lobes

head of bed down 18", arm in front

medical insufflation (cough assist)

used to clear secretions from pt. with neuromuscular disorders to help them generate sufficient expiratory flows. most commonly delivered via mask but can also be done through a trach, mouthpiece, and ETT

indications of medical insufflation

1. Patient unable to clear secretions effectively due to muscle weakness

2. can be used in preventing respiratory complications due to secretion retention and poor tidal volumes

-have suction ready

conditions treated with cough assist

1. muscular dystrophy

2. SMA

3. spinal cord lesions

hazards and complications of cough assist

1. raised ICP

2. pain

3. abdominal distention (air)

4. fatigue

how long do you do cough assist?

3-5 sets of 5 breaths

vest airway clearance system

easy for kids and adults, helps loosen mucus

- can perform SVN while doing vest

how long do you do the vest?

2-6x a day for 30 min between 5-25Hz

indications of the vest

1. airway clearance

2. cystic fibrosis

3. bronchiectasis

4. chronic neuromuscular disorder that affects the ability to cough or clear the airway

contraindications to the vest

1. head or neck injury that is not stabilized

2. active hemorrhage

3. hemodynamic instability

indications for postural draining and percussion

1. difficulty clearing secretions

2. atelectasis due to mucus plugging

3. cystic fibrosis

4. failure of cough reflex (artificial airway, anesthesia, kyphoscoliosis)

side effects of postural draining and percussion

1. increased ICP

2. increased WOB

3. vomiting/aspiraiton

4. tachypnea

5. tachycardia

6. pain

7. injury moving pt.

contradictions of postural draining and percussion

1. increased ICP

2. unstable head or neck injury

3. active hemorrhage and hemodynamic instability

4. active hemoptysis (coughing blood)

5. large pleural effusion

6. PE

7. rib fractures

8. osteoporosis