Bronchopulmonary
Hygiene
CRT 3? = 2%
RRT 3?
• Upper Lobes
–bed flat or sitting
• RML or LLingula
–foot of bed elevated
•15°
•12-14 inches
• Lower Lobes
–Foot of bed elevated
•30°
•18 inches
Review
of
Postural
Drainage
Positions
A 34-year-old patient with
bronchiectasis wishes to continue an
appropriate pulmonary hygiene
program while maintaining full-time
employment as an accountant. Which
of the following would best assist this
patient in attaining this goal?
A. ultrasonic nebulizer
B. IPPB with bronchodilator
C. MDI with bronchodilator
D. Flutter ® mucous clearance device
While performing postural drainage on
a patient who is in a head-down
position, the patient appears dyspneic
due to severe prolonged coughing. The
respiratory therapist should
A. perform percussion.
B. turn the patient.
C. administer oxygen.
D. place the patient in Fowler's
position.
The respiratory therapist is reviewing the
most recent report from a patient's PA
chest radiograph. The right heart border
can be identified and the right diaphragm
is obscured. How should the patient be
positioned for postural drainage and
percussion over the affected area?
A. supine with pillow under the knees
B. lying on left side with head down 15
degrees and rotated 1/4 turn backward
C. in a semi-Fowler's position
D. in a prone position with head down 25
degrees
The respiratory therapist is caring for a 75year-old female who has had a cough
productive of purulent sputum for 5
years. She was diagnosed with a
Mycobacterium avium complex lower
respiratory tract infection 3 years earlier.
Her chest radiograph shows ring shadows
and dilated and thickened airways,
configured like tramlines, in the right
middle lobe. In addition to antibiotic
therapy, which of the following should the
respiratory therapist recommend?
A. transtracheal aspiration
B. postural drainage
C. diagnostic bronchoscopy
D. respiratory isolation
A patient with a history of chronic
bronchitis complains of shortness of
breath following chest surgery. The
patient is receiving 30% O 2 by mask.
Rhonchi in the right lower lobe are
heard on auscultation. Which of the
following should the therapist
recommend?
A. PEP with incentive spirometry
B. ultrasonic nebulizer therapy
C. acetylcysteine (Mucomyst) therapy
D. chest percussion
Which of the following is (are) necessary for
normal airway clearance?
I. Patent airway
II. Functional mucociliary escalator
III. Effective cough
A.
B.
C.
D.
I and II
I, II, III
II and III
II
A patient with abdominal muscle weakness is
having difficulty developing an effective
cough. Which of the following phases of the
cough reflex are primarily affected in this
patient?
I. Irritation
II. Inspiration
III. Compression
IV. Expulsion
A.
B.
C.
D.
I, II, and III
II and IV
II, III, and IV
III and IV
All of the following are goals of bronchial
hygiene therapy except which one?
A.
Reverse the underlying disease process
B.
Help mobilize retained secretion
C.
Improve pulmonary gas exchange
D. Reduce the work of breathing
Which of the following clinical signs
indicate that a patient is having a problem
with retained secretions?
I. Lack of sputum production
II. Labored breathing
III. Development of a fever
IV. Increased crackles and rhonchi
A.
B.
C.
D.
II and IV
I, II, and III
III and IV
I, II, III, and IV
The application of gravity to achieve specific
clinical objectives in respiratory care best
describes which of the following?
A.
Breathing exercises
B.
Postural drainage therapy
C.
Hyperinflation therapy
D. Directed coughing
Postural drainage should be considered in all
of the following situations except which
one?
A.In patients with pleural effusion
B.In patients who expectorate more than 25
to 30 mL sputum per day
C.In the presence of atelectasis caused by
mucous plugging
D.In patients with cystic fibrosis or
bronchiectasis
If tolerated, a specified postural drainage
position should be maintained for at least
how long?
A.
1 to 2 minutes
B.
3 to 5 minutes
C.
20 to 30 minutes
D. 3 to 15 minutes
While reviewing the chart of a patient
receiving postural drainage therapy, you
notice that the patient tends to undergo
mild desaturation during therapy. Which of
the following would you recommend to
manage this problem?
A.Increase the patient's FIO2 during therapy.
B.Discontinue the postural drainage therapy
entirely.
C.Discontinue the percussion and vibration
only.
D.Decrease the frequency of treatments.
Properly performed chest vibration is
applied at what point?
A.
Throughout inspiration
B.
At the end of expiration
C.
At the start of inspiration
D. Throughout expiration
A physician orders postural drainage for a
patient with consolidation in the right
middle lobe. Which of the following
positions would you recommend for this
patient?
A.Head down, patient prone with a pillow
under abdomen
B.Head down, patient supine with a pillow
under knees
C.Patient supine with a pillow under knees,
bed flat
D.Head down, patient half-rotated to left,
right lung up
The End
Compared with the inside diameter of
a tracheostomy tube, the outside
diameter of the suction catheter
should be less than
A. 1/8 as large.
B. 1/5 as large.
C. 1/4 as large.
D. 1/2 as large.
A patient receiving mechanical ventilation requires
frequent suctioning. He has a history of
developing PVCs during suctioning procedures.
The respiratory therapist should
I. limit the duration of the suctioning.
II. increase the F I O 2 before, during, and after
suctioning.
III. observe the patient's ECG monitor while
suctioning.
IV. request an anti-arrhythmic medication for the
patient.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
The respiratory therapist is assessing a
patient with COPD who has been
receiving PEP therapy for 4 days.
Which of the following outcomes
indicates therapy should continue?
A. positive subjective response
B. stable vital signs
C. increased exercise tolerance
D. unchanged SpO 2 values
•
A patient with cystic fibrosis was involved in a motor vehicle crash and is
being monitored for possible increases in intracranial pressure. Airway
clearance has been ordered per protocol. Which of the following are
appropriate for this patient? I. postural drainage and percussion
II. oscillatory PEP
III. in-exsufflator
IV. high frequency chest vest A. I and II only B. I and III only C. II and IV
only D. III and IV only EXPLANATIONS: I. False. Postural drainage and
percussion in a head-down position are contraindicated in a patient with
possible increased ICP. II. True. Oscillatory PEP, administered through the
Acapella and Flutter ® valves, is an acceptable airway clearance technique
because it does not require a head-down position. III. False. An inexsufflator is primarily used for patients with neuromuscular diseases. It
may cause airway collapse in patients with obstructive disease. The inexsufflator may agitate the patient and may increase intracranial pressure.
IV. True. A high frequency chest vest is an acceptable airway clearance
technique for this patient because it does not require a head-down position.
(h) A. Incomplete and incorrect response included.
(h) B. Incorrect response.
(c) C. Correct response.
(h) D. Incomplete and incorrect response included.
• A patient with a persistent dry cough suddenly starts
producing copious amounts of pus-like, yellow, mucoid
sputum. Which of the following actions should the
respiratory therapist take? A. Request an order for
aerosolized acetylcysteine (Mucomyst). B. Notify the
physician a draining lung abscess is suspected. C. Obtain
an order for postural drainage and percussion. D. Perform
nasotracheal suctioning. EXPLANATIONS: (u) A.
Aerosolized Mucomyst may precipitate bronchospasm and
may increase secretions, possibly making it difficult for the
patient to clear all the secretions. (c) B. Sputum, secondary
to a lung abscess, is characterized by its sudden onset and
production of pus-like, yellow, mucoid sputum. (h) C. There
is no indication for postural drainage and percussion. There
is the potential for contaminating the rest of the lungs with
the infected secretions. (u) D. Nasotracheal suctioning is
traumatic and could cause vomiting. Suctioning would only
be indicated if the patient were unable to clear the
secretions.
• A patient with bronchiectasis has received postural
drainage. Based on the results of auscultation,
sputum production, and the chest radiograph, the
therapy was deemed ineffective. Which of the
following should the respiratory therapist
recommend? A. volume-oriented IPPB therapy B.
incentive spirometry C. turning and mobilization D.
PEP and increased hydration EXPLANATIONS: (u) A.
Secretion clearance would not improve directly with
hyperinflation maneuvers. (u) B. Secretion clearance
would not improve directly with hyperinflation
maneuvers. (u) C. Since postural drainage has failed,
there is no reason to anticipate turning and
mobilization, a similar procedure, would be effective.
(c) D. These are secondary methods for secretion
clearance and would be indicated when postural
drainage is ineffective.
Which of the following conditions alter normal
mucociliary clearance?
I.
Bronchospasm
II. Cystic fibrosis
III. Ciliary dyskinesia
A.
I, II, III
B.
I and II
C.
I and III
D. II and III
A physician orders postural drainage for a
patient with aspiration pneumonia in the
superior segments of the left lower lobe.
Which of the following positions would you
recommend for this patient?
A.Patient prone with a pillow under abdomen,
bed flat
B.Head down, patient prone with a pillow
under abdomen
C.Head down, patient supine with a pillow
under knees
D.Patient supine with a pillow under knees,
bed flat