Interventions Promoting Airway Clearance & Breathing

Interventions Promoting Airway Clearance & BreathingBY: KENNETH MILANGCO, RN

1. Breathing TechniquesA. Abdominal/diaphragmatic Breathing B. Pursed Lip Breathing C. Deep Breathing, Coughing, Splinting D. Incentive Spirometry

2. Chest Physiotherapy & Postural Drainage 3. Chest Tubes & Chest Drainage System 4. Mechanical Ventilation 5. Oxygen Therapy 6. Hydration

y Breathing exercises are indicated for clients with

restricted chest expansion to remove secretions from the airways. y Abdominal breathing permits deep full breaths with little effort. y Pursed-Lip creates a resistance to the air flowing out of the lungs, thereby prolonging exhalation and preventing airway collapse by maintaining positive airway pressure.

y Incentive spirometry is a method of

deep breathing that provides visual feedback to help the patient inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis.

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Chest Physiotherapy & Postural Drainagey Chest physiotherapy (CPT) includes postural

drainage, chest percussion and vibration. The goals of chest physiotherapy are: y to remove bronchial secretions, y improve ventilation, y and increase the efficiency of the respiratory muscles.

PERCUSSION / CLAPPINGy a forceful striking of the skin with cupped hands.

Percussion can mechanically dislodge tenacious secretions from the bronchial walls.

VIBRATIONy a series of vigorous quivering produced by hands

that are placed flat against the chest wall. Vibration is done after percussion to increase the turbulence of the exhaled air thus loosen thick secretions.

POSTURAL DRAINAGEy Is the drainage by gravity of secretions from various

lung segments.y Techniques intended to promote the drainage of

secretions from the lungs.

y The sequence of PVD are as follows:

a. positioning b. percussion c. vibration d. removal of secretions by coughing or suctioning. Remember: y PVD are scheduled 2 / 3 times daily depending on the lung congestion. y Done before meals and late in the afternoon(?) y Each position is assumed for 30 mins. y Auscultate after to monitor progress.

CHEST TUBES AND CHEST DRAINAGE SYSTEMSy Chest drainage systems (chest tubes) improve breathing

patterns by removing accumulations of air and/or fluid from the pleural space, permitting the lungs to return to normal expansion. y The tubes are inserted through the chest wall via a stab wound; multiple holes in the tip of the tube collect drainage from the pleural space. y This drainage is then collected into a drainage system by either suction control or gravity. y A special feature called a water seal prevents the reintroduction of air into the pleural space through the chest tube.

y Chest drainage systems come with either wet (water

seal) or dry suction control. y Wet systems use a water seal to prevent air from moving back into the chest on inspiration. y Dry systems use a one-way valve and a suction control dial in place of the water needed with wet or water seal system.

CHEST DRAINAGE SYSTEMS

Mechanical Ventilationy To control the patients respirations during surgery or

during treatment of severe head injury y To oxygenate the blood when the patients ventilatory efforts are inadequate y and To rest the respiratory muscles

INDICATIONS FOR MECHANICAL VENTILATIONy y y y

If a patient has a continuous decrease in oxygenation (PaO2) an increase in arterial carbon dioxide levels (PaCO2) and a persistent acidosis (decreased pH). Eg conditions: a. thoracic or abdominal surgery b. drug overdose LEADS TO c. neuromuscular disorders RESP FAILURE d. inhalation injury e. COPD f. multiple trauma g. shock h.multisystem failure i. coma

OXYGEN THERAPYy Indications for oxygen supplementation include: a PaO2 of 55 mm Hg or less evidence of tissue hypoxia organ damage such as cor pulmonale, secondary polycythemia, edema from right heart failure, or impaired mental status In patients with exercise-induced hypoxemia, oxygen supplementation during exercise can improve performance

HYDRATIONy Provision of adequate fluid intake, is important in

thinning the pulmonary secretions so that they may be more easily expectorated.y Beneficial in cases of pneumonia, bronchitis, and

asthma.

Pharmacology

Complementary & Alternative Therapies

Prevention of Infectiony The risk of respiratory infection can be decreased

by:

avoiding contact with people with symptoms of respiratory infection performing coughing and deep-breathing exercises to prevent pooling of respiratory secretions receiving yearly influenza vaccines and giving up smoking. A high-protein diet is important in maintaining an adequate immune system, as is avoiding factors that may reduce immune system function (eg, excessive stress, drug abuse, excessive alcohol intake)

EVALUATIONy Expected patient outcomes may include: 1. Demonstrates improved gas exchange, as reflected in arterial

blood gas measurements, breathing exercises, and use of incentive spirometry 2. Shows improved airway clearance, as evidenced by deep, controlled coughing and clear breath sounds or decreased presence of adventitious sounds 3. Has decreased pain and discomfort by splinting incision during coughing and increasing activity level 4. Maintains adequate fluid intake and maintains nutrition for healing 5. Exhibits less anxiety by using appropriate coping skills, and demonstrates a basic understanding of technology used in care 6. Adheres to therapeutic program and home care 7. Is free of complications, as evidenced by normal vital signs and temperature, improved arterial blood gas measurements, clear lung sounds, and adequate respiratory function