BronchialHygieneTherapy：bronchial卫生疗法..ppt

Bronchial Hygiene TherapyRET 2275Respiratory Therapy Theory 2Bronchial Hygiene Bronchial hygiene therapy involves noninvasive airway clearance techniques to help mobilize secretions and improve gas exchangeReading AssignmentEgans Fundamentals of Respiratory CareNINTH EDITION(pgs.921-932)Bronchial HygienelNormal clearancelNormal airway clearance requires a(an)lPatent airwaylFunctional mucocilary escalatorlEffective coughlAn effective cough can effectively move mucus from the lower airways to the upper airway.Bronchial HygienelNormal clearanceBronchial HygienelAbnormal clearancelAbnormalities in airway patency,mucuciliary function,strength of breathing muscles,or cough reflex can lead to mucus retention.lMucus plugging can lead to atelectasis,pneumonia,and hypoxemia.Bronchial HygieneBronchial HygienelDiseases associated with abnormal clearancelInternal or external compression of an airway lumen(e.g.,asthma,lung cancer)lCystic fibrosislBronchiectasislNeuromuscular diseases can cause a weak cough.Bronchial HygienelGeneral Goals and IndicationslBronchial hygiene therapy for acute conditions1.Acutely ill patient with copious secretions2.Patient in acute respiratory failure with clinical signs of retained secretions3.Patient with acute lobar atelectasis4.Patient with hypoxemia due to lung infiltrates Bronchial HygienelGeneral Goals and Indications(cont.)lBronchial hygiene therapy to prevent retention of secretionslMay be useful in acutely ill patients when combined with patient mobilizationlCystic fibrosis patients benefit from chest physical therapy combined with exercise to maintain lung function.Bronchial HygienelDetermining Need for Bronchial Hygiene TherapylBedside findings such aslLoose,ineffective coughlLabored breathing patternlCoarse inspiratory and expiratory crackleslTachypnea/tachycardia lFeverlThe chest radiograph demonstrating atelectasis and infiltrates Bronchial HygienelBronchial Hygiene Methods1.Postural drainage therapy2.Coughing and related expulsion techniques3.Positive airway pressure(PAP)4.High-frequency compression/oscillation5.Mobilization and exerciseBronchial HygienelPostural drainage therapylInvolves the use of gravity and mechanical energy to mobilize secretionslIncludes turning,postural drainage,and percussion and vibrationBronchial HygienelPostural drainage therapylIndicationslInability or reluctance of patient to change positionlPoor oxygenation associated with position(e.g.,unilateral lung disease)lPotential for or presence of atelectasislEvidence or suggestion of difficulty with secretion clearancelDifficulty clearing secretions,with expectorated sputum production 25 30 ml/day(adult)Bronchial HygienelPostural drainage therapylIndications(cont.)lEvidence or suggestion or retained secretions in the presence of an artificial airwaylDiagnosis of diseases such a cystic fibrosis,bronchiectasis,or cavitating lung diseaselExternal Manipulation of the ThoraxSputum volume or consistency suggesting a need for additional manipulation(e.g.,percussion and/or vibration to assist movement of secretions by gravity in a patient receiving postural drainageBronchial HygienelPostural drainagelTurninglPrimarily done to promote lung expansion,improve oxygenation,and prevent retention of mucuslProning has been used in patients with acute lung injury to improve lung function.Bronchial HygienelPostural drainagelTurning and“Plumbing Problems”lVentilator disconnectionlAccidental extubationlAccidental aspiration of ventilator circuit condensatelDisconnection of vascular lines or urinary catheters ouch!Bronchial HygienelPostural drainage(cont.)lThe process placing the patient in various positions to drain specific segmental bronchilPositions are typically held for 3 to 15 minutes.lMost effective in patient with excessive mucus secretionPatient positions for Postural Drainage Postural DrainageBronchial HygienelPostural DrainagelMonitoringlSubjective response to painlPulse,arrhythmia,and ECG if availablelBreathing pattern and ratelSputum productionlMental functionlSkin colorlBreath soundslBlood pressurelSpO2lICPBronchial HygienelPostural drainagelOutcome assessmentlChange in sputum productionlChange in breath soundslChange in dyspnea levellChange in vital signslChange in chest radiograph/ABG resultslChange in ventilator variables Bronchial HygienelPostural drainagelDocumentation and follow-uplThe chart entry should includeThe positions usedTime in positionsPatient toleranceIndicators of effectivenessAny untoward effects observedBronchial HygienelPostural drainagelPercussion and vibrationlThe application of mechanical energy to the chest wall by use of the hands or various electrical or pneumatic deviceslDesigned to aid in movement of mucus toward the central airwaysBronchial HygienelPostural drainagelVibrationlPlace one hand on the patients chest over the involved area and place the other hand on top of the firstlAsk the patient to take a deep breathlExert slight to moderate pressure on the chest wall and initiate a rapid vibratory motion of the hands throughout expirationBronchial HygienelPostural DrainagelAbsolute ContraindicationslHead and neck injury until stabilizedlActive hemorrhage with hemodynamic instabilitylRelative ContraindicationslActive hemoptysislPulmonary embolismlRecent spinal surgerylAged,confused,or anxious patients who do not tolerate position changesRefer to AARC Clinical Practice Guidelines for complete listBronchial HygienelPostural DrainagelTrendelenburg position is contraindicated for:lRecent gross hemoptysislICP 20 mm HglUncontrolled hypertensionlDistended abdomenlPatient in whom increased ICP is to be avoided(neurosurgery,aneurysms,eye surgery)lUncontrolled airway at risk for aspiration(tube feeding or recent meal)lEsophageal surgeryRefer to AARC Clinical Practice Guidelines for complete listBronchial HygienelPostural DrainagelComplications/HazardslHypoxemialIncrease ICPlAcute hypotension during procedurelPulmonary hemorrhagelPain or injury to muscles,ribs,or spinelVomiting and aspirationlBronchospasmlArrhythmias