Pulmonary: interventions

Question 1

Use towel or pillow over incisions or painful areas by applying pressure during cough exhalation

(Ex. after a heart surgery, sternotomy)

Answer 1

Splinted Cough

Question 2

Used when there is a need for a decreased potential airway collapse. Forced exhalation maneuver with glottis open. Can have patient say “ha, ha, ha” during rapid exhale

Answer 2

Huff Cough

Question 3

Breathe in, a little more, a little more (like sneezing) to facilitate a cough

Answer 3

Breath Stacking

Question 4

Developed to help clear secretions in patients with asthma. Forced expiratory technique for airway clearance performed in 3 main steps

Answer 4

Active Cycles of Breathing (ACB)

Question 5

Active Cycles of Breathing step 1

Answer 5

Breathing Control
Diaphragmatic breathing for 5-10 sec at normal tidal volume

(can be done with a pursed lip)

Question 6

Active Cycles of Breathing step 2

Answer 6

Thoracic Expansion Exercises

• Aka: Segmental Breathing
• Increase regional ventilation
• Do 3-5 reps, may include 2-4 sec breath hold

Question 7

Active Cycles of Breathing step 3

Answer 7

Forced Expiratory Technique

• Recommend using huff cough (“ha” cough into the hand or tissue)
• Quiet tidal breathing before a med-lg inhale followed by a huff cough

https://www.youtube.com/watch?v=XvorhwGZGm8

Question 8

controlled breathing to mobilize secretions by varying expiratory airflow without PD , means “self-drainage” and uses different speeds of breathing to move mucus

Answer 8

Autogenic Drainage

Question 9

Autogenic Drainage, phase 1

Answer 9

UNSTICKING
Breathes at tidal volume inhalation, go into expiratory reserve

“Unstick” mucus in smaller airways by breathing at low lung volumes

Question 10

Autogenic Drainage, phase 2

Answer 10

COLLECTION
Breathes slightly above tidal volume and into expiratory reserve

“Collect” mucus in middle airways by breathing at low to mid lung levels (increasing inspiration & exhalation). Moving breathing from lower to higher lung area and moving mucus with it

Question 11

Autogenic Drainage, phase 3

Answer 11

EVACUATION
Breaths into inspiratory reserve and just to end of tidal volume
“Evacuate” secretions from central airways by breathing at mid to high lung levels (breathing at higher lung volumes)

(Continue for 3-4 cycles and encourage patient not to cough until complete OR if they hear a “mucus rattle”)

Question 12

___________ can be particularly useful to COPD patients who have emphysema, a common scenario. People with emphysema have very collapsible airways

Answer 12

Pursed-lip breathing

If you teach them to breathe in normally but breathe out through a narrow orifice of their lips, they keep the pressure up in their airways and it tends to prevent the large airways from collapsing.