BronchialHygieneTherapy:bronchial卫生疗法..ppt
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1、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 Hy
2、gienelNormal 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
3、 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
4、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
5、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 mobi
6、lizationlCystic 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 crackle
7、slTachypnea/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 exe
8、rciseBronchial 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
9、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 therapyl
10、Indications(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 manipulatio
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