Respiratory Physiotherapy:CVR- Terms:Definitions Airway clearance + atelectasis PDF

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Respiratory Physiotherapy:CVR- Terms:Definitions Airway clearance + atelectasis...

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RESPIRATORY PHYSIOTHERAPY/CVR- Terms/Definitions Airway clearance + atelectasis METHODS OF SPUTUM CLEARANCE - deep breathing o thoracic expansion exercises can be used to get air behind secretions, through collateral channels and therefore improve velocity of expiration -

active cycle of breathing o a cycle of breathing control, deep breathing and huffing, tailored to the patient to assist mobilisation of secretions without causing desaturation of oxygen

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autogenic drainage o a method of altering breathing to cause the maximal velocity of airflow to occur in the region of the secretion

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postural drainage o a method that utilises gravity to remove secretions by placing the patient into a position appropriate for the airway affected, based on patient assessment and an understanding of the anatomy of the brochial tree. useful where secretions are copious and localised

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manual clearance techniques o percussion, vibrations and shaking to mechanically loosen secretions

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hydration o limits sputum clearance as viscosity of sputum increases and the cilia can no longer beat effectively

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nebulisers o can be used to administer brochiodilator drugs, saline, steroids, antibiotics and mucolytic agents

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suction o removal of secretions from lungs using a catheter attached to a vacuum pump

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exercise o movement is known to increase rate of sputum clearance but can only be utilised if the patient has sufficient energy reserves

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Positive Expiratory pressure (PEP) masks o PEP marks, Flutter, Acapella, Cornet, Bubble PEP - designed to create a resistance to expiration, resulting in a back pressure which helps to keep the airway open for longer, enabling secretions to move

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what are the 4 types of mucus

o Mucoid (clear, white, COPD, non-infected and viral infection) o Mucopurulent o Bloodstained (fresh = breakdown of capillary bed post infection or rupture of bronchial artery/branches) o Pluggy brompton visual grading of sputum -

M1 mucoid with no suspicion of pus

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M2 predominantly mucoid with suspicion of pus

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P1 1/3 purulent , 2/3 mucoid

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P2 2/3 purulent , 1/3 mucoid

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P3 more than 2/3 purulent

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FB fresh blood

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OB old blood

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R rusty

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what does infected sputum look like cream, yellow, green and grey

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what does old blood in mucus highlight rusty brown = pneumonia

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what does pink frothy mucus highlight pulmonary oedema

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what does bright red, frothy mucus highlight pulmonary oedema

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what problems/diseases lead to low lung volumes (restrictive only) o alterations in lung parenchyma = interstitial fibrosis o disease of pleura = pneumothorax o structural changes to wall = scoliosis o Abdominal distention ie pregnancy

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what is closing volume o the volume of lung inflated when small airways in the dependant part of the lung begin to collapse during expiration. I an healthy individual, closing volume is < FRC

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what happens if FRC falls below closing volume o a reduction is FRC predispose patients to atelectasis and if closing capacity > FRC the alveoli collapse during expiration (normal tidal breathing) trapping air and precipitating atelectasis

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causes of low lung volumes/altelectasis (post surgery) o abodominal or thoracic surgery, where it occurs mainly as a result of pain and inhibition of diaphragm, causing shallow breathing. (other causes include, consolidation, airway obstruction, age and respiratory muscle dysfunction)

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why is atelectasis worse in an obese patient o fat prevents adequate lung expansion by squishing the thorax. V/Q mismatch also occurs

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why is atelectasis worse in an elderly patient o inadequate lung expansion results for elderly not having the strength to generate a strong and healthy breath. History of a respiratory condition such as CF or COPD or Asthma may have damaged airway or mucus may obstruction airway. Compliance is less in an elderly patient also.

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name 1 internal (affects alveoli directly) cause of atelectasis o consolidation (most frequently caused by lobar pneumonia)

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signs of low lung volumes o poor lung expansion o decreased tidal volume o breathlessness o increased work of breathing o decreased exercise tolerance o alveolar collapse o decreased breath sounds o sputum retention

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what are the 4 types of atelectasis o obstructive - foreign body (intrinsic) or tumour (extrinsic) o passive = shallow breathing o compressive = pleural diseases o adhesive = increased surface tension = presence of pus/fluid reduces surfactant coating

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inspiratory physiotherapy techniques o sustained maximal inspirations with holds and sniffs o localisation of expansion to particular areas of lung o positioning o mobilising/exercise o incentive spirometers o adjuncts to breathing using positive pressure...