Hi guys,
Today at the PCR practice session we got to discussing one of the cardio case studies and it was brought up that one of the problems for the problem list that the pt has is impaired airway clearance based upon the fact that he has increased mucous production. I know that this is what we are generally taught to use as a sign for IAC. I got to thinking though... if someone is producing sputum doesn't that mean that they are clearing their airway fine by themselves? I don't understand why that would mean that they have impaired airway clearance... unless they only produced it due to physio Rx. It makes sense to me that say if they have an innefective cough that they would have IAC but I just can't link the other situation. Can somebody make it fit together please or let me know if I'm wrong in any way.
Cheers
Brent
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Hi Brent. In that case impaired airway clearance needs to be included on the problem list, but not only because of the increased mucus production. The evidence for this problem is that he has productive cough, but it is difficult to clear. Objectively the cough is weak (which is an important evidence for IAC) and the wheeze in auscultation can be due to secretion. Basically if the patient has moist cough and has difficulty clearing, that is the problem that need to be addressed. He also has pain on coughing, shallow breathing and decreased CE. Those factors probably will make more difficult to generate enough expiratory flow to cough out the secretion. The fact that the patient hasn’t been out of bed and hasn’t been doing breathing exercises also doesn’t help with shearing the secretion. That can be some facts that you can consider. The main problem for him will be his pain. If has pain, he won’t take deep breaths and won’t cough effectively. In his case education on pain management will be a primary intervention and once his pan is less and he starts mobilizing, hopefully he will be able to clear his secretion independently, therefore won’t be a problem anymore. That is the way I analysed this case. I hope it helps!
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