Flashcards in 3) Therapeutic Body Positioning Deck (36):
Why is therapeutic body positioning done?
To incr arterial oxygenation
Why does TBP work?
It has a direct effect on the O2 transport system
What is the single most important objective of CPPT?
What are the goals of TBP?
*Decr work of breathing
*Optimize lung vol
*Improve VQ matching
*Improve gas exchange
*Assist w/AW clearance
What needs to be considered for TBP?
What needs to be done after a TB position is determined to be good?
Monitor the pt & re-position if necessary
What determines time course for TBP?
True or False: TBP duration should be response-dependent, not time-dependent
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
What is the most physiologically important position?
Upright w/dependent legs
What did MJ say about supine positioning?
It is the "god awfulest position you can put a pt in"
Considerations for TBP?
*Prone positioning will require multiple PT's
*Use modified positions when extremes aren't feasible
*Encourage movement & DB/C
What is bed rest deconditioning
Separate process that occurs along w/the course of the disease
How long does it take for fluid shifts to start after a pt is on bedrest?
Negative effects of bed rest
What does bed rest equal besides death?
Sx's of adverse rxn to exercise
*HR>THR or >20BAR
*SBP or DBP drop >10mmHg
*No rise in SBP
*DBP rise >10mmHg
*Pain in teeth, jaw, arms, or ears
If a pt is hemodynamically unstable, should you tx them?
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
What should upright positioning be coupled w/?
Exercise to optimize O2 transport
True or False: Upright positioning slightly incr main airway diameter.
What position decr myocardial work & urinary stasis?
If a pt has unilateral lung disease, how should they be positioned & why?
Sidelying w/healthy lung down-->incr PaO2
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
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
What does trendelenburg position favor?
Gas exchange in the upper lung fields & alveolar distension at the bases
Benefits of Trendelenburg position
*Augments O2 transport in pt's w/chronic air flow limitations & patho in the base
*Decr risk of reflux
True or False: The diaphragm still has a decent mechanical advantage in trendelenburg.
True or False: Side-lying accentuates AP expansion of the chest wall
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
True or False: In prone, the abdomen can be restricted or free
What does prone positioning w/free abdomen enhance?
True or False: Semiprone positioning can provide many of the same benefits as prone w/less risks for ventilated pt's.
What part of the lung do ventilated pt's have preferential ventilation?
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