3) Therapeutic Body Positioning Flashcards Preview

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Flashcards in 3) Therapeutic Body Positioning Deck (36):
1

Why is therapeutic body positioning done?

To incr arterial oxygenation

2

Why does TBP work?

It has a direct effect on the O2 transport system

3

What is the single most important objective of CPPT?

TBP

4

What are the goals of TBP?

*Decr dyspnea
*Decr work of breathing
*Optimize lung vol
*Improve VQ matching
*Improve gas exchange
*Assist w/AW clearance

5

What needs to be considered for TBP?

*Pain
*GI system
*CV response
*Neuromuscular system

6

What needs to be done after a TB position is determined to be good?

Monitor the pt & re-position if necessary

7

What determines time course for TBP?

*Pathology
*Type
*Severity
*Other factors

8

True or False: TBP duration should be response-dependent, not time-dependent

True

9

Why is sitting upright w/arms fixed on thighs effective at decreasing work of breathing?

It incr intra-abdominal pressure so the curvature of the spine incr, which optimizes the diaphragm's MA & its capacity to generate pressure

10

What is the most physiologically important position?

Upright w/dependent legs

11

What did MJ say about supine positioning?

It is the "god awfulest position you can put a pt in"

12

Considerations for TBP?

*Time constrains
*Prone positioning will require multiple PT's
*Use modified positions when extremes aren't feasible
*Encourage movement & DB/C
*Monitor vitals

13

What is bed rest deconditioning

Separate process that occurs along w/the course of the disease

14

How long does it take for fluid shifts to start after a pt is on bedrest?

24hrs

15

Negative effects of bed rest

*
*
*
*
*
*
*
*
*
*
*

16

What does bed rest equal besides death?

Sensory deprivation

17

Sx's of adverse rxn to exercise

*Unusual/severe fatigue
*Angina
*Dizziness
*Irregular pulse
*Marked SOB
*HR>THR or >20BAR
*SBP or DBP drop >10mmHg
*No rise in SBP
*DBP rise >10mmHg
*Cyanosis
*Pallor
*Pain in teeth, jaw, arms, or ears
*Severe claudication
*Nausea/vomiting
*HA
*Ataxia
*Mental confusion

18

If a pt is hemodynamically unstable, should you tx them?

No

19

If a pt has dyspnea, what position should you put them in & why?

Upright w/arms fixed on thighs

*This incr intra-abdominal pressure, which incr the curvature of the diaphragm, which optimizes its MA & ability to generate pressure

20

What should upright positioning be coupled w/?

Exercise to optimize O2 transport

21

True or False: Upright positioning slightly incr main airway diameter.

True

22

What position decr myocardial work & urinary stasis?

Upright

23

If a pt has unilateral lung disease, how should they be positioned & why?

Sidelying w/healthy lung down-->incr PaO2

24

If pt has bilateral lung pathology, how should they be positioned?

Sidelying w/R lung down-->Its larger so there will be less compression on it from the heart

25

If pt has a lung removed, how should they be positioned?

Side w/no lung down-->Don't want fluid to go into their remaining lung

26

What does trendelenburg position favor?

Gas exchange in the upper lung fields & alveolar distension at the bases

27

Benefits of Trendelenburg position

*Augments O2 transport in pt's w/chronic air flow limitations & patho in the base
*Decr dyspnea
*Decr risk of reflux

28

True or False: The diaphragm still has a decent mechanical advantage in trendelenburg.

True

29

True or False: Side-lying accentuates AP expansion of the chest wall

True

30

What are the physiologic benefits of prone positioning?

*Incr arterial oxygenation
*Incr arterial O2 tension
*Incr tidal volume
*Incr lung compliance
*Decr work of breathing

31

True or False: In prone, the abdomen can be restricted or free

True

32

What does prone positioning w/free abdomen enhance?

*Lung compliance
*Tidal volume
*FRC
*Diaphragm excursion

33

True or False: Semiprone positioning can provide many of the same benefits as prone w/less risks for ventilated pt's.

True

34

What part of the lung do ventilated pt's have preferential ventilation?

Upper lung

35

Why is prone positioning good?

The posterior aspect of the lungs has a much greater surface area than the anterior region does so it allows for incr gas exchange

36

What do frequent positional changes stimulate?

*Lymphatic drainage
*Surfactant production
*Distribution of pulmonary immune factors