Eric S. Coolong
July 21, 2014
Respiratory therapist will deal with multiple different types of pulmonary diseases ranging from obstructive to restrictive diseases. Over the last few months we have learned how to assess and treat these patients. Today we will discuss four acute conditions where bronchial hygiene is indicated. Compare the types of bronchial hygiene therapy for chronic lung conditions. Three types of diseases that myself as a respiratory therapist will see frequently on a regular basis. Respiratory therapy is constantly changing as doe’s most medical fields with the advancement of technology and the better understanding of pulmonary diseases. Bronchial Hygiene for Acute Conditions
Four acute conditions were bronchial hygiene is indicated are; patients with copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by unilateral lung disease. When treating acute conditions a respiratory therapist will want to use bronchodilators to open up the airways so bronchial hygiene therapy can be effective. For acute conditions with infections the use of antibiotics can be used after the bronchodilator therapy to be most effective. “The primary goal of airway clearance therapy is to help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange, promote alveolar expansion, and reduce the work of breathing (Kacmarek, 2013).” Bronchial hygiene is a way to clean out the airways so the lungs can do their job. Being able to produce a productive cough is also when bronchial hygiene will be needed. There are four factors to a productive cough. There are four distinct phases to a normal cough: irritation, inspiration, compression, and expulsion. In the irritation phase abnormal stimulus provokes sensory fibers to the airways to send impulses to the medullary cough center in the brain (Kacmarek, 2013).” Examples of impairments for the irritation phase are anesthesia, CNS depression, narcotic-analgesics. The second phase of the cough is when the cough center generates a reflex stimulation to initiate a deep inspiration. Examples of impairments for the inspiration phase are pain, neuromuscular dysfunction, pulmonary restriction, and abdominal surgery. The third phase is the compression stage which last about 0.2 seconds. Impulses are received and the glottis is closed to build up plueral and alveolar pressures. Examples of impairments for the compression phase are laryngeal nerve damage, artificial airway, abdominal muscle weakness, and abdominal surgery. The fourth phase expulsion is when the glottis is opened and a forceful expulsion occurs creating the cough. Examples of impairments for the expulsion phase are airway compression, abdominal muscle weakness, and inadequate lung recoil. There are many different types of therapies a respiratory therapist can use if a patient is unable to clear their own airways. Bronchial Hygiene Therapy for Chronic Conditions
Hygiene therapy has many different approaches that can be used alone or in conjunction with each other. Indications for bronchial hygiene therapy for acute conditions are copious secretions 25-30 ml/day, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by unilateral lung disease. Chronic conditions that indicate therapy are cystic fibrosis, bronchiectasis, ciliary dyskinetic syndromes, and chronic bronchitis. First we must assess the need for bronchial hygiene therapy. We do this by looking at the patient’s history, presence of artificial airway, CXR, results of PFT, age, and any type of surgery the patient has under gone. We also look at the patient’s appearance such as posture, breathing pattern, vital signs, general physical appearance. There are five general approaches to bronchial hygiene therapy. The first approach is...
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