Cardiopulm - Pulmonary Hygeine & Airway Clearance

Front 1

What are 4 problems with excessive secretions?

Back 1

1. ↑ resistance to airflow interferes w/ ventilation
   
2. Interferes w/ gas exchange
3. ↑ WOB
   
4. ↑ risk for infection
   

Front 2

What are 3 ways excessive secretions interfere with gas exchange?

Back 2

1. Limits alveolar ventilation
2. ↓ gas flow of CO₂ and O₂
3. ↓ surface area for gas exchange
   

Front 3

• What 2 cell types secrete mucous? Where is each more prominent?
• What lines the airways from the trachea to terminal branches? What is its function?

Back 3

• Goblet cells (more numerous in medium-large airways) and epithelial cells
• Cilia; to mobilize secretions via the mucociliary escalator to eliminate pathogens
  

Front 4

• What % of normal vital capacity is required for adequare cough? What FEV₁?
  
• What is the clinical significance?
• At what bronchial levels is coughing effective?
• What moment is associated with coughing?

Back 4

• 60% for each
• Those that need to cough the most are those with OLD; They have ↓ capacity for cough → unproductive cough → ↑ mucous build-up → less productive cough, etc.
• Only down to the 6th and 7th bronchial generations
• Flexion

Front 5

• How does respiratory rate alter ventilation?
  
• What are 3 pathways of collateral ventilation?
• How does a partially obstructed airway affect airflow, then?

Back 5

• Slower breathing leads to more O₂ entering lungs, ↑ ventilation
  
• Pore of Kohn (inter-alveolar); Canals of Lambert (broncho-alveolar); Canals of Martin (inter-bronchial)
• Air takes the path of least resistance, leading to ventilation of blocked alveoli via collateral ventilation through hyperinflation of unblocked alveoli

Front 6

What are 7 determinants of mucociliary clearance?

Back 6

• Mucous quantity and viscosity
  
• Airway aperture
• Cilia beat frequency
• Cough
• External factors, such as disease state, smoking, anesthesia
• Ventilation

Front 7

• What happens to airway pressure as flow increases? What is it similar to?
  
• How does total cross-sectional area change throughout the airways?
• How does this affect air flows?

Back 7

• Airway pressures ↓ b/c moving air has ↓'ed pressures similar to wings of an airplane
  
• There is greater CSA in more peripheral airways.
• Air flow is greater when passing through areas of lesser CSA (upper airways)

Front 8

• How does lesser upper airway CSA relate to the equal pressure point?
• How does equal pressure point change with non-tidal breathing?
• What is the clinical significance of this?

Back 8

• The flow is greater at lesser CSAs, so the equal pressure point is closer to the upper airways at tidal volumes
• At lower lung volumes 2º to tapping into the ERV the EPP reaches more peripheral airways
• The ↑ flow associated with reaching EPP mobilizes sputum, thus lower lung volumes/tapping into ERV ↑'s sputum mobility

Front 9

• What are the types of issues that are indications for pulmonary hygiene?
  
• What are the four tenets of pulmonary hygiene?

Back 9

• Mucous problems, ventilation problems, elimination problems; Also, anybody at risk for secretion build-up
• Mobilization, observation, ventilation, elimination

Front 10

• What are 4 methods of mobilizing secretions?

Back 10

• Breathing exercises
• Postural drainage
• Percussion (minimum of 3' duration)
• Vibration/shaking (Max inhaltion, hold 3-5", slow exhale through mouth while PT vibrates lobe)
  

Front 11

• What are 3 methods for eliminating secretions?
  

Back 11

• Coughing
• Huffing (head up, neck extended, then cough w/ open glottis, 2-3x at a time only 2º risk of bronchospasm)
• Suctioning
  

Front 12

What are relative contraindications for pulmonary hygiene?

Back 12

• Hemoptysis

• Acute bony injury, recent spinal fusion/skin graft

• OP or chronic steroid use

• Metastatic lung CA

• Unstable CV status, decompensated CHF

• Untreated pneumothorax, bronchospasm, or PE

• Positioning contras

• GERD, tube feedings

Front 13

What are 4 types of ventilation exercises?

Back 13

Diaphragmatic breathing

Segmental breathing

Incentive spirometry

Positioning

Front 14

• What are 3 common inhaled antibiotics?
  
• When should they be taken? Why?

Back 14

• TOBI, Colistin, Cayston
  
• After airway clearance so that they don't get cleared out and so that they reach deeper lung zones

Front 15

What moments are associated with inhalation?

Back 15

• D₂ shoulder flexion pattern (flex/abd/ER)
  
• Trunk extension
• LE extension
• Upward eye gaze