Week 9: Airway Clearance Therapy and Cough Physiology (Egan's Ch. 44) - Flashcards

Glossary-style flashcards covering cough physiology, airway clearance prerequisites, factors impairing clearance, therapy goals, measurement cues, preventive uses, and postural drainage considerations drawn from Week 9/Egan's Ch. 44 material.

Phases of the cough reflex

Irritation, Inspiration, Compression, and Expulsion are the four phases; irritation triggers coughing, inspiration brings air in, compression builds intrathoracic pressure with the glottis closed, and expulsion occurs when the glottis opens to clear secretions.

Patent airway

An airway free of obstruction that allows unimpeded airflow to and from the lungs.

Functional mucociliary escalator

The coordinated action of cilia and mucus that traps and moves inhaled particles out of the airways for clearance.

Effective cough

A cough with sufficient expulsive force and coordination to clear secretions from the airways.

Normal pulmonary compliance

Normal elasticity and distensibility of the lungs and chest wall allowing adequate ventilation with reasonable work of breathing.

Cough-provoking stimuli

Anesthesia, foreign bodies, infection, and irritating gases can provoke coughing.

Factors impairing mucociliary clearance in intubated patients

Tracheobronchial suctioning, inadequate humidification, and high inspired oxygen concentrations can impair clearance.

Drug categories that impair mucociliary clearance in intubated patients

General anesthetics, opiates, and narcotics can impair clearance; bronchodilators generally do not.

Conditions that affect airway patency and secretion clearance

Foreign bodies, tumors, inflammation, and bronchospasm can affect airway patency and clearance.

Conditions that alter normal mucociliary clearance

Cystic fibrosis, primary ciliary dyskinesia, and asthma can alter mucociliary clearance.

Goals of airway clearance therapy

Mobilize retained secretions, improve gas exchange, and reduce the work of breathing.

Conditions associated with chronic large-volume sputum production

Bronchiectasis, cystic fibrosis, and chronic bronchitis (large-volume sputum production) can be present.

Sputum production threshold for chest physical therapy effectiveness

Chest physical therapy is more likely to help when sputum production exceeds about 30 ml per day.

Reference quantity for copious mucus production

Approximately 1 tablespoon (about 15 ml) as a practical reference amount.

Documented preventive uses of airway clearance therapy

Preventing retained secretions in acutely ill patients; maintaining lung function in cystic fibrosis; preventing postoperative pulmonary complications.

Factors to assess postoperative need for airway clearance

Consider patient’s age/respiratory history, nature/duration of the surgery, and type of anesthesia (local vs general).

Essential data for assessing airway clearance needs

Pulmonary function tests and ABGs/oxygen saturation are essential; chest radiograph may be helpful; hematology is not typically essential.

Clinical signs of retained secretions

Copious sputum production, labored breathing, and increased crackles; fever is not a reliable sole sign.

Airway clearance therapies

Postural drainage and percussion; incentive spirometry; positive airway pressure; percussion, vibration, and oscillation.

Postural drainage and gravity in chest physiotherapy

Using gravity to direct drainage and help mobilize secretions from specific lung regions.

Indications for postural drainage

Use in patients with conditions like atelectasis from mucus plugging, cystic fibrosis, bronchiectasis, and significant sputum production.

Absolute contraindications to turning/postural drainage

Head and neck injury (until stabilized), active hemorrhage with hemodynamic instability, and uncontrolled risk of aspiration.

Objectives of patient turning

Prevent postural hypotension, promote lung expansion, and prevent retention of secretions.

Absolute contraindication to turning

Unstable spinal cord injuries.

Modifying head-down positions for postural drainage

Modify or avoid head-down positions in patients with unstable blood pressure, cerebrovascular issues, systemic hypertension, or orthopnea.

Pre-postoperative information when planning postural drainage

Obtain details such as the patient’s medication schedule, meal schedule, and location of surgical incision from the nurse.