Strenuous expiratory efforts in some chronic obstructive ...

[jeatrice]

Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients lim-it the effectiveness of coughing. Why is this so?
 
  a. The accessory muscles of inspiration op-pose the exhalation.
  b. All COPD patients have severe abdominal muscle weakness.
  c. High expiratory pleural pressures compress the small airways.
  d. Strenuous expiration causes the upper air-way to collapse.

Question 2

A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?
 
  1. Enhancing expiratory flow by bending forward at the waist
  2. Using short, expiratory bursts or the huffing method
  3. Using only moderate (as opposed to full) inspiration
  4. Having the patient tense the neck muscles while coughing
  a. 2 and 4 only
  b. 1, 2, and 3 only
  c. 3 and 4 only
  d. 1, 2, and 4 only

[Kingjoffery]

Answer to Question 1

ANS: C
In some patients with COPD, the high pleural pressures during a forced cough may compress the smaller airways and limit the cough's effectiveness.

Answer to Question 2

ANS: B
Instruct the patient to slowly take in a moderately deep breath through his or her nose. To help enhance expulsion, have the patient exhale with moderate force through pursed lips, while bend-ing forward. This forward flexion of the thorax enhances expiratory flow by upward displace-ment of the abdominal contents. After three or four repetitions of this maneuver, encourage the patient to bend forward and initiate short staccato-like bursts of air. This technique relieves the strain of a prolonged hard cough, and the staccato rhythm at a relatively low velocity minimizes airway collapse. This technique has a modification called huffing whereby the patient is in-structed to make the sound of huff, huff, huff rapidly with his or her mouth open.

[jeatrice]

Excellent

[bblaney]

TYSM