PT Intervention

Question 1

Indications for postural drainage

Answer 1

Increased pulmonary secretions
Aspiration
Atelectasis or collapse

Question 2

PXNs of Trendelenburg:

Circulatory System

Answer 2

Pulmonary edema
CHF
HTN

Question 3

PXNs of Trendelenburg:

Abdominal Problems

Answer 3

Obesity
Ascites
Pregnancy
Hiatal hernia
Nausea and vom
Recent food consumption

Question 4

PXNs of Trendelenburg:

Neurological System

Answer 4

Recent neurosurgery
Increased ICP
Aneurysm pxns

Question 5

PXNs of Trendelenburg:

Pulmonary System

Answer 5

SOB

Question 6

PXN to sidelying:

Circulatory system

Answer 6

Axillo-femoral bypass graft

Question 7

PXN to sidelying:

MSK system

Answer 7

Humeral fx
Need for hip abduction brace
Other situations that make S/L uncomfortable (bursitis, arthritis)

Question 8

Duration can be up to __ min per postural drainage position

Answer 8

20

Question 9

Indications for percussion

Answer 9

• Excessive pulmonary secretions
• Aspiration
• Atelectasis or collapse due to mucus plugging obstructing airways

Question 10

Considerations prior to use of percussion and shaking:

General considerations:

Answer 10

Pain made worse by technique

Question 11

Considerations prior to use of percussion and shaking:

Circulatory system

Answer 11

Aneurysm pxns, hemoptysis

Question 12

Considerations prior to use of percussion and shaking:

Coagulation disorders

Answer 12

Increased PTT, increased PT, decreased platelets (below 50,000), meds that interfere with coagulation

Question 13

Considerations prior to use of percussion and shaking:

MSK

Answer 13

Rib fx, flail chest, degenerative bone disease, bone mets

Question 14

Procedure for percussion

Answer 14

1. Explain to pt
2. Put in position
3. *cover area with light-wet cloth to avoid erythema
4. 3-5 minutes per PD position
5. Force causes pt’s voice to quiver

Question 15

What point of breathing cycle is shaking/vibration applied?

Answer 15

Exhalation

Question 16

Indications for shaking

Answer 16

Pulmonary secretions
Aspiration
Atelectasis/collapse of airways from mucus plugging

Question 17

Procedure for shaking/vibration

Answer 17

1. Explain to pt
2. Put in position
3. Percussion first if indicated
4. Fingers parallel to ribs- as pt exhales, jarring/bouncing to rib cage at that level
5. 5-10 deep inhalation’s with shaking

Question 18

How many breaths should pt take with vibration/shaking technique? What are risks of more?

Answer 18

5-10 inhalations

>10 risk of hyperventilation, increased VE from decrease in PaCO2

Question 19

Who is huffing effective for?

Answer 19

Pts with collapsible A/W (COPD)

Question 20

Procedure for assisted cough?

Answer 20

1. Position pt against solid surface, supine w/ HOB flat or Trendelenburg or sitting in W/C against wall
2. PT’s hand below subcostal angle (similar to Heimlich placement)
3. Pt in hales deeply
4. Pt attempts to cough- PT’s hand presses up/in
5. Suction if needed

Question 21

Who is assisted cough used for?

Answer 21

When pt can’t generate effective cough (SCI)

Question 22

Who is tracheal stimulation appropriate for? Procedure?

Answer 22

pts unable to cough on command (infants, brain injury, stroke)
- PT’s finger or thumb just above suprasternal notch, quick inward/downward pressure on trachea triggers cough reflex

Question 23

When is endotracheal suctioning appropriate? What does it consist of?

Answer 23

After other ACT fail to adequately remove secretions.

• standard pxns
• suction catheter based on pt, system @120 mmHg pressure, sterile glove/clean hand
• catheter inserted, when resistance felt, rotate and withdraw (10-15 seconds intermittently)

Question 24

Complications of suction can include (7)

Answer 24

1. Hypoxemia
2. Brady/tachycardia
3. Increased ICP
4. Hypo/hypertension
5. Atelectasis
6. Trach damage
7. Infection