[DDRN4me]

Good , agressive pulmonary toilet often helps a crumping patient

[kukukajoo]

So glad to see the humor on here! It is most welcome today!

Thanks for making me smile!!

Oh and thanks for 'splainin toilet!! Up here in NH we still use it some- we go buy toiletries and stuff. Glad I haven't had a crumping patient today!

[TazziRN]

Originally Posted by WolfpackRed

a.k.a "crumping"

I have heard that term tossed around instead of "circling the drain"

Around here nurses say "crumping" or "crashing" and the private docs say "circling the drain".

[ZASHAGALKA]

One of my favorite old time medical cartoons had a picture of three doors. The first door had a universal male sign, and the words, "Men's toilet". The second door had a universal female sign and the words, "Women's toilet". The third door had a picture of a pair of lungs and the words, "Pulmonary toilet".

~faith,
Timothy.

[NRSKarenRN]

Great answer here:

Yahoo! Answers - What is a pulmonary toilet?

Best Answer - Chosen by Asker


Roughly, it involves removing excess fluids and mucus from your lungs or otherwise trying to make your airways more open. You can pound on the chest (yes they really do this in the hospital) which loosens mucus or you can do something called "incentive spirometry" which is kind of a lung exercise. You breathe into a device with a ball that bounces up when you blow. The object is to blow hard enough that the ball bounces higher. This is supposed to keep your airways open (by making you breathe forcefully), thus preventing something called atelectasis (a collapsed lung). Pulmonary toilet is indicated for patients who are receiving artificial respiration (on a ventilator) or for surgery or other bedridden patients who may have breathing complications from lying in bed for prolonged periods. I have heard that incentive spirometry will prevent pneumonia but since that is caused by bacteria, I'm not sure that is true.

Pulmonary toilet involves several means to "empty" or "flush" lungs that are filled with mucous or fluids.

a. Nebulizer treaments: to dilate airways and stimulate cough reflex

b. Incentive Spirometer use

c.Chest Physical Therapy (Chest PT) involving vibration and
percussion/clapping --mannually or using percusser device
I always performed manual Chest PT to oldie tune of "Tea for Two" ---
just seemed to have the right cadence

d. Turning, Deep breathing then coughing, especially staged coughing
Staged coughing = series of deep breaths, then one little cough,
next cough bigger, then BIG cough

e. Mucolytic oral meds: Guiafenissen, Humbid, Mucinex

f. IV Diuretics used in patients with CHF/Pulmonary Edema
also includes minimal IV fluid rates in these patients often 50-80 cc/hr
if standard is 125/hr

g. Possibly steroids--decrease inflamation lung tissue

h. Oral or nasal tracheal suctioning

i. Postural drainage if tolerated (often used w/ Cystic Fibrosis pts )

j. Worse cases rarely done: bronchoscopy

[NRSKarenRN]

From: Thoracic Surgery Service Manual

Aggressive pulmonary toilet: Incentive spirometry q1hour, cough/deep breathe q4 ... Call a code and help will arrive if patient is crumping ...
viper.med.unc.edu/surgery/CT/PDFs/Thoracic%20Surgery%20Manual%20.pdf



PULMONARY DISORDERS - 3 Nursing CEs


Chest Trauma: Nursing Care and Management

[NRSKarenRN]

Originally Posted by ZASHAGALKA

One of my favorite old time medical cartoons had a picture of three doors. The first door had a universal male sign, and the words, "Men's toilet". The second door had a universal female sign and the words, "Women's toilet". The third door had a picture of a pair of lungs and the words, "Pulmonary toilet".

~faith,
Timothy.

I remember that cartoon...

[zacarias]

Also, some of the RTs use a vest for the patient. It wraps around them and shakes and vibrates their chest while they do nebulizer treatments.

[kukukajoo]

Funny thing is we are covering 2 sections this week- musculoskeletal and respiratory. Two different professors covered the topics. This NEVER came up in the respiratory portion of the lecture but did in the musculoskeletal lecture and we are being tested on both Monday.

Thanks for infor everyone and the giggles, which is important in school for sure!

Zacarias- A classmate had a best friend growing up with CF and said the vest you mention was a lifesaver for her and greatly improved her quality of life.

[jill48]

OMG! I have never heard of pulmonary toilet. It sounds so funny! But there is one phrase that I use quite often in my own charting that others think is funny: rectal vault. As in, "Upon digital examination of the rectal vault, this nurse found large, hard stool".