| Knowledge |
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States Contraindications
and Relative Contraindications
of procedure.
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| Preparation |
| Clinical Standards for Procedures and Interventions. |
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| Verifies provider order or protocol; reviews chart for indications, goals, contraindications, and recent airway clearance response. |
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| Identifies and gathers required equipment: PEP or PAP device with adjustable resistance, manometer or built-in gauge. Selects mouthpiece (with nose clips if needed) or mask. |
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| Assessment |
| Assesses Vital Signs. |
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| Obtains history of recent sputum production (amount, consistency, color) and prior response to airway clearance therapy. |
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| Implementation |
| Selects interface and ensures seal: mouthpiece with nose clips or well-fitted mask; confirms comfort and absence of leaks. |
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| Instructs patient to inhale slightly larger than normal, then exhale actively (not forcefully) through the device with a prolonged exhalation (approximate I:E ratio of 1:3 to 1:4) while maintaining a stable seal. |
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| Guides cycle structure: complete 10 to 30 breaths through the device followed by Directed Cough maneuvers; repeat 4 to 8 cycles for a total session length of 10 to 20 minutes as tolerated. |
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| Monitoring & Modifications |
| Monitors vitals and patient response throughout; pauses or discontinues if adverse effects occur (e.g., dizziness, desaturation, chest pain, hemoptysis), and notifies appropriate personnel. |
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| Observes manometer or gauge during exhalation and titrates resistance and/or oscillation to generate approximately 10 to 20 cm H2O expiratory pressure or an effective audible/feelable oscillation, as clinically indicated following device guidelines. |
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| Provides coaching to optimize technique (seal, posture, exhalation time, diaphragmatic breathing) and reassesses periodically; reinstructs as needed. |
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| Post-Intervention |
| Cleans and dries device components per policy and manufacturer instructions; if single-patient use, rinses with sterile or distilled water and air-dries; stores dry in a clean container. |
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| Documents session details: device type and resistance/oscillation settings, manometer pressures, number of cycles and breaths, patient tolerance, sputum characteristics, and patient education provided. |
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| Post-Intervention Management Steps. |
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