VIVA

Question 1

WHat is the evidence for Breathing exercises

Answer 1

Holland et al (2012)

WIth COPD patients - increased 6MWT

Question 2

List the evidence for IMT

Answer 2

Shoemaker et al 2009 - chronic COPD increases Dyspnoea
Hill et al 2010 - chronic COPD - was a guide line for prescription
Bissett 2012 - Guide line for acute COPD patients

Question 3

Name the evidence for pursed lip breathing

Answer 3

Bhatt 2012

COPD patients - increased exercise capacity

Question 4

Name the evidence for PEP

Answer 4

Johnson and James 2013
For excessive respiratory secretions
need more research, they viewed articles showing the Bubble PEP is well used

Question 5

Name the evidence for Mobilisation

Answer 5

Mackay et al 2003 - Addition of DB - not worth it. Mobilisation is king. Open abdominal surgery

Question 6

Name the Evidence for mobilisation for PPC’s

Answer 6

Haines et al 2013
Showed relationship between delay in Mobilising and increase in PPC’s. Every day we don’t mobilises increase risk by 3 fold

Question 7

What does Brasher et al 2013 say

Answer 7

There is no evidence that the addition of DB to normal chest physio including mobilisation actually prevents PPC’s

Question 8

Describe what Stiller and Phillips 2003 say?

Answer 8

Mobilisation aims to increase avleolar ventilation and VQ mismatch but need to take lots of things into consideration when aiming to mobilise

Question 9

What body systems should be take into consideration when mobilising a patient?

Answer 9

Cardiovascular: HR, BP, Cardiac status ( Recent AMI, Unstable ANging, arrythmia, aortic stenosis), more than the ocassional VEB, runs of VT, AF, new STEMI
Respiratory considerations: RR, PaO2/FiO2 ration >300, SpO2
Heamatological and MEtabolic - <20 000 platelet count (Increase in BP, avoid mobiisation)
SUbjective consideration - consciousness, muscle strength
Orthopaedic conditions
COntraindicated in Split skin grafts, burns, pressure wounds
Attachments
Environment

Question 10

What do you do when the patient has Increase of WOB issues acutely

Answer 10

Lean forward
Pursed lip breathing
Breathing control

Question 11

WHat can you do when a patient has WOB issues chronically

Answer 11

IMT

or Pulmonary rehab - especially for COPD patients

Question 12

List the contraindications to IMT

Answer 12

Recent undrained pneumothorax
Large bullae
Marked Osteoporisis - spontaneous rib fractures
Lung surgery with the last 12 months

Question 13

Prescribe IMT to an acute patient

Answer 13

Frequency 5-7 days a week
Intensity: 50% of MIP or greater
Duration: 6 breaths, 5 sets with rests inbetween

Question 14

Prescribe IMT to chronic COPD patient

Answer 14

Frequency 3-4 days a week for 8 weeks
Intensity <30% of MIP
Duration 2 minutes on and 1 minute rest. Repeat 7 times

Question 15

How many coughs should you prescribe at once?

Answer 15

No more than 2 at onces

Question 16

How would you prescribe Bubble PEP to a patients

Answer 16

Blow bubbles for 4-6 seconds. Repate 10 times. At lest 3 times a day. Bernie says once every hours they are awake if possible

Question 17

List some precautions to Postural drainage.

Answer 17

Hypertension, Unstable CV system, After Osophageal surgery, after a meal, Hiatus hernia, GORD, Osteoporosis, Recent head injury, orthopnoea, distressed or is distressed in the potion, PO, Abdominal distension, Recent head/ neck surgery, Cerebral aneurysm

Question 18

List the precautions to Percussion, Vibrations, shaking

Answer 18

Fractured ribs, Frank Haemoptysis, Rab cancer, osteoporosis or long term steroid use, burns, surgical incisions, ICC drain, Severe bronchospasm, severe pleuritic pain, very low platelet levels

Question 19

List the contraindications to Bubble PEP

Answer 19

Recent Pneumonectomy
Frank Haemoptysis
Extensive Bullae and Cysts
Undrained Pneumothorax

Question 20

List the precautions for Bubble PEP

Answer 20

ALtered consciousness - confusion - risk of drinking water
Paediatric patients
Patients needing high levels of oxygen or continuous oxygen therapy

Question 21

What are the risk associated with Oxygen therapy

Answer 21

Oxygen toxicity/ Carbon dioxide nercrosis
Fire
Absorption atelectasis
Retrolental fibroplasis
Mucosal damage

Question 22

Explain Carbon Dioxide Nercrosis

Answer 22

Cehmoreceptors become insensitive to CO2 as the stimulus for ventilation and relies on low PaO2. If given too much O2 therapy, causing PaO2 to rise they loose their stimulus to breath - hypoventilate and have a respiratory arrest

Question 23

Reeve et al, 2010 performed a couple studies on the same group of patients. What did the study, that was stopped early say

Answer 23

This study found that there was no statistical dfference between their two groups of patients receiving the two types of physio therapy. Aka mobilisation and Mobilisation and DB. Mobilisation is awesom

Question 24

What was the purpose of Reeve et al 2012’s study

Answer 24

This was to show that shoulder exercises for post thoracotomy patients was of benefit to them in terms of less shoulder pain, and less total pain at D/C and function at 3 months post op compared to those of the non exercise group

Question 25

What was the Surgery the patients in Reeve et al 2010 underwent?

Answer 25

Pulmonary resection via a Thoracotomy

Question 26

What does the evidence say about mobilising acutely ill patients

Answer 26

Stiller and Phillips 2003. They showed that the you have to weigh up the risks and benefits of mobilizing the patient.