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CardioPulmoaryPT1 > Airway Clearance Tech's and Mobilization > Flashcards

Airway Clearance Tech's and Mobilization Flashcards

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1
Q

Airway Clearance Tech’s and Mobilization

AKA

A

Pulm Hygiene

Chest PT

Bronchial Hygiene

Pulmonary Toileting**** (get “Stuff” OUT)

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2
Q

Pulmonary Hygiene Tech’s

What are they?

A
  • Manual or mechanical procedures that facilitate mobilization or secretions from airways
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3
Q

Pulmonary Hygiene

Optimal Airway Clearance Choice based on:

A
  • pathophys and sx’s
  • stability of medical status
  • pts adherence
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4
Q

Pulmonary Hygiene

The Pt Exam BEFORE, DURING, AFTER Tx tells us what?

A

provides info to judge pt tolerance and tx effectiveness !!!

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5
Q

Pulmonary Hygiene

GOALS:

A
  1. Optimize airway patency
  2. INC ventilation and perfusion (V/Q) matching
  3. Promote alveolar expansion
  4. INC gas exchange
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6
Q

Pulmonary Hygiene

Precautions

A
  • MEALS
    • No Trendelenberg
  • Meds***
    • Bronchodilators vs. Antibiotics
      • ​we WANT bronchodilators PRIOR TO interventions to OPEN UP BRONCHIOLES
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7
Q

WHEN is Pulm Hygiene indicated?

A
  • ANY Dx that affects Ventilation in V/Q equation
    • ​V is abnormal
    • Q is OK
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8
Q

Ex. Dx’s in which Pulm Hygiene is Indicated

A
  1. CF
    1. Obstructive– change in mucus boundary
      1. fluid in lungs, mucus EVERYWHERE
  2. Bronchiectasis
    1. Obstructive–permanent dilation of bronchia
      1. lung tissue dilates/loses integrity
  3. Atelectasis
    1. alveolar collapse
  4. Trunk + Access. mm weakness
  5. Life support: mech. vent or post-op
  6. Neonate resp distress syndrome and bronchopulm dysplasia
  7. ASTHMA
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9
Q

Pulm Hygiene

The List

A

see below

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10
Q

Diaphragm Innervation

A

Phrenic C3, C4, C5

Keeps the Diaphragm Alive!!!

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11
Q

Coughing

2 Types :

A
  1. Splinted
  2. Assisted Cough (forceful thrust of T/S bc cannot use abs)
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12
Q

Coughing

Splinted Cough

Everything you know about it…

A
  • Hug pillow/squeeze and cough
  • Trying to match pressure in vs. pressure out
  • Recommended post-op bc PAIN when they cough normally—–Pillow is like a crutch
    • ​prevent rib cage pressure on mm’s
    • pillow is for external pressure to match internal pressure
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13
Q

Coughing

Assisted Cough

A
  • SCI pts!!!!
  • BIG thoracic flexion for cough
    • ​literally extend spine, inhale, THROW BODY FORWARD and forceful cough !!!
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14
Q

Coughing

What do we WANT?

A

PRODUCTIVE, EFFECTIVE COUGH!!!

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15
Q

Postural Drainage Pos’s

Tips and tricks to remember

A
  • If it is ANTERIOR (on FRONT side of body)
    • ​they must start SUPINE
  • If it is POSTERIOR (on BACK side of body)
    • ​they must start PRONE
  • If it is MIDDLE LOBES
    • ​Raise feet up 12 in.
  • If it is BASAL/LOWER LOBES
    • ​Raise feet up 18 in.
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16
Q

Postural Drainage

A

One or more body pos’s that allow gravity to assist w/ draining secretions from ea. lung segment

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17
Q

Postural Drainage

The pos’s can be modified to address what?

A

Precautions and/or relative contraindications

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18
Q

Postural Drainage

Where does our priority lie?

A

given to most affected lung segment FIRST

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19
Q

Postural Drainage

Duration?

A

5-20 mins

  • If they can be ALONE you can leave them in it longer bc they can independently move
  • 5 mins IF coordinated w/ another technique
  • NEVER leave pt unattended UNLESS they can indep. reposition themselves
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20
Q

Postural Drainage

Some Advantages:

A

easy to learn for pt.

easy to coord. w/ diff. tx’s

No $$$

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21
Q

Postural Drainage

Disadvantages

A

Contraindicated for lg. group of pts

Adherence is diff. bc we recommend 20mins

KIDS CANNOT JUST SIT FOR 20mins

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22
Q

You KNOW the segments and postural drainage positions

Reminder for Right POST. lobe and Left POST. lobe

Remember these are BOTH on BACK of body….and UPPER lobes

A
  • Right Post. UPPER lobes
    • have to START Prone, then put them on LEFT side, ELEVATE right side
  • LEFT Post. UPPER lobes
    • SAME as Right BUT now lean them onto RIGHT, ELEVATE Left side w/ pillow and RAISE HEAD OF BED UP!!!!
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23
Q

POSTURAL DRAINAGE

Precautions

*Remember HAMP

A
  • Hemoptysis
  • Ascites
  • Morbidly obese
  • Pulmonary Embolism
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24
Q

Postural Drainage

More Precautions

From lecture vs. lab

A
  1. Pulm Edema
  2. Hemoptysis
  3. Obesity
  4. Lg. pleural effusion
  5. Ascites

Still remember HAMP !!!

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25
Postural Drainage **Relative Contraindications** **NEVER DO if have these**
1. Recent head trauma/INC'd ICP 2. Spinal fusion or Sx 3. **Hemodynamically unstable** 4. Diaphragmatic hernia 5. Recent eye sx 6. Esophageal anastomisis
26
Percussion Technique ## Footnote **Mvmt of hand/wrist w/ CUPPED hand==pod of air**
* Chest percussion aimed @ **loosening retaining secretions** * **​**manual OR mechanical * its ALL in the wrist * lean your forearm on pt.
27
Vibration Technique
* Manual OR mechanical * **utilized IN postural drainage pos's to clear secretions** * **REMEMBER** * **​**Start the vibration **as they EXHALE!!!**
28
Percussion ## Footnote **Advantages vs. Disadvantages** **\*REMEMBER BETTER TO DO IT ON SKIN!!!**
* **Advantages** * **​**zero cost * GOOD **adherence** * can be done on infants, children, newborns * relaxing for kids * **can utilize postural drainage AND percussion same time** * **Watch O2sats AND vitals during** * **Disadvantages** * **​**CTS risk
29
Percussion ## Footnote **Duration?**
* Until secretions coughed up * 2-5 mins * or PT fatigues
30
Percussion ## Footnote **Advantages**
1. infants, young children 2. **Postural drainage + percussion==\> effective and good adherence** 3. Monitor O2 sats and vitals during 4. zero cost
31
Percussion ## Footnote **Disadvantages**
* Repetitive percussion from caregiver==\> **INC risk CTS (Carpal Tunnel Syndrome)** * **NOT tolerated well in pts w/ issues in pain mgmt or coagulation**
32
Vibration ## Footnote **HOW performed and utilized WHEN?**
Mech. OR manual & **utilized IN postural drainage pos's** ## Footnote **\*rapidly shaking or vibrating shoulders** **ONLY DURING EXHALATION!!!**
33
Vibration ## Footnote **Advantages:**
1. GOOD if you fatigue bc **2s rest break** 2. moves secretions 3. **well tolerated by pts** 4. Use on **post-sx pts** 5. **Encourages INC VT**
34
Vibration ## Footnote **Disadvantages**
1. need someone to help you if no mech. 2. **Adherence impaired** bc **caregiver avail.** 3. Cannot coordinate if **RR too high**
35
Percussion and Vibration **Precautions** **Uncontrolled bronchospasm THEN all the MSK stuff...**
1. **uncontrolled bronchospasm** 2. **osteoporosis** 3. **Rib fx** 4. **metastatic cancer to ribs** 5. tumor obstruction in airway 6. anxiety 7. coagulopathy 8. convulsive OR seizure disorder 9. **Recent pacemaker**
36
Percussion and Vibration ## Footnote **Contraindications** **DO NOT DO**
1. Hemoptysis 2. Untx'd tension pneuomothorax 3. platelet count \<20,000/mm^3 1. **likely to bleed** 4. hemodynamically unstable 1. **BP not nrml, vitals not nrml** 5. open wounds, burns in T/S 6. PE 7. subcutaneous emphysema 1. **air pocket under skin** 8. skin grafts/flaps on thorax
37
Active Cycle of Breathing Technique ## Footnote **ACBT** **Consists of what?**
series of maneuvers performed by pt to emphasize IND in **secretion clearance & thoracic expansion**
38
ACBT ## Footnote **3 Components:**
1. Breathing Control 2. Thoracic Expansion Exs 3. Forced Expiratory Exs aka **Huffing**
39
ACBT ## Footnote **Breathing control phase**
* VT breaths AND emphasis on **diaphragmatic breathing**
40
ACBT ## Footnote **Thoracic Expansion Exs**
* DEEP breaths (Vital Capacity, VC breaths) * **Can add percussion/vibration here**
41
ACBT ## Footnote **Forced Expiratory Exs** **aka Huffing** **"Fogging the mirror"**
* DEEP breath THEN cough w/out closing epiglottis * **Think of fogging up a mirror** * **Cycle:** * **​TV--\> VC--\> forced exhale (like a big siiiiighh)**
42
ACBT ## Footnote **Advantages**
1. Flexible---\> any pos. 2. Inexpensive 3. Children as young as 4yo 4. relieves caregiver 5. **Research is substantial**
43
ACBT ## Footnote **Disadvantages**
* Time consuming * 20 mins * Boring
44
Airway Clearance Tech's or **Cough assist machines** ## Footnote **What are they?**
* Mech. apply force to body or intermitt. press. changes to airway to **assist insp/exp. mm function**
45
Airway Clearance ## Footnote **Mech. Cough Machine**
* Delivers **deep insufflations IMMED. followed by deep exsufflations** * **​**MAY add in **abd. thrust, min. coughs** * **Forceful insp/exp. excursions**
46
**Suctioning** is performed **routinely** for what patients?
* Routinely for **intubated pts (mech. vents)** to **facilitate removal of secretions & stim. cough reflex**
47
Suctioning Pts w/ artifical airways can be instructed in 2 things:
1. Huffing 2. Cough assist. tech's
48
Suction cath's can only reach how far?
To the lvl of **mainstream bronchi**
49
Suctioning should be **LAST RESORT** ## Footnote **Why?**
Invasive!!! **Every suction is minor trauma to bronchi**
50
Suctioning is a ______ technique
**Sterile**
51
Therapeutic Breathing ## Footnote **Consists of 2 components**
1. Therapeutic pos. techniques 1. like in what pos. is best for V/Q and to open airways? 2. Ventilatory mvmt strategies 1. again we want to improve V/Q
52
Therapeutic Breathing ## Footnote **This will asisst w/ progression from _____ to \_\_\_\_\_\_**
from DEP. to INDEP. in **mobility and breathing**
53
Therapeutic Breathing ## Footnote **Indicated for pts w/:**
Weakness of the Diaphragm!!!
54
Therapeutic Breathing ## Footnote **We want to emphasize 2 components of breathing with UE mvmt**
* Emphasize **inspiratory effort breathing w/ UE mvmt** * Emphasize **expiratory effort breathing w/ UE mvmt**
55
W/ Therapeutic Breathing ## Footnote **Breathing tech's must be PROGRESSED to......**
Functional Activities \*see if they can coordinate their breathing pattern DURING **functional acts**
56
W/ Therapeutic Breathing **Pos. of the body GREATLY influences what?**
Influences **ventilation and respiration**
57
W/ Therapeutic Exs What body position is beneficial?
PRONE!!!
58
Therapeutic Breathing ## Footnote **Positioning basically.....**
Put human in a pos. that helps **facilitate breathing or some component of pulm system**
59
Therapeutic Breathing ## Footnote **Positioning for Dyspnea Relief** **Tripod or Professional Position**
Tripod breathing----YOU KNOW AND HAVE USED THIS!!! * arms supported allows **access. breathing mm's to act on rib cage allowing MORE expansion for INSPIRATION**
60
Suctioning goes down to mainstem bronchi to where?
**Bifurcation** of Bronchi
61
This type of Therapeutic Position for Breathing **switches origin and insertion and pulls OUT the ribcage for DEEPER INSP.**
Tripod OR Professional Posture
62
Autogenic Drainage **3 Phases** **\*ALL related to secretions** **\*NO VALSALVE**
* **Phase 1** * **​**collecting, TV breathing, prevent bronchospasms * **Phase 2** * **​**evacuate secretions, IR and HOLD breath---\> Huff * **Phase 3** * **​**Nasal VT * In/Out thru nose
63
Diaphragmatic Controlled Breathing **Used to** **_manage_** **3 things:**
1. Dyspnea 2. Reduce atelectasis 3. INC oxygenation
64
Diaphragmatic Breathing ## Footnote **Facilitates \_\_\_\_\_\_\_\_\_** **Reduces\_\_\_\_\_\_\_\_\_\_\_**
* **Facilitating** OUTWARD motion of abd. wall while * **Reducing** upper ribcage motion during INSP.
65
4 Other Tech's w/ **Diaphragmatic Breathing**
1. **Sniffing** 1. **​**engages diaphragm---\> **teach like diaphragm is an elevator trying to go DOWN!!!** 2. **Scoop Tech.** 1. **​**facilitates **diaphragm recoil** 3. **Obj's/Wts ON abdomen** 1. **​**BELOW xiphoid== activates abs 4. **Manual Trigger during Exhale** 1. **​**"Quick Stretch"
66
Diaphragmatic Breathing ## Footnote **Upper chest inhibiting tech.**
* Inhibiting UPPER CHEST can help pt **recruit diaphragm during INHALATION** * **​Used AFTER other tech's**
67
Lateral Costal Breathing OR
Segmental breathing **applying resistance to INSP/EXP** **"Breathe into my hand"**
68
Pursed lip breathing **prolongs and stabilizes what?**
Trachea/Bronchi **\*really a compensatory strategy to proloooooong exhale**
69
Pursed Lip Breathing does 3 things:
1. DECs **dyspnea** 2. Helps SLOW **RR** 3. **Beneficial for OLD** 1. **​**bc **retain CO2**
70
Pursed Lip Breathing Guidelines
1. **IN thru NOSE for 2s** 2. **OUT thru MOUTH (pursed lips, blowing out candles) for 4s**
71
Paced Breathing OR...
**REALLY just focusing/concentrating on breathing** **\*volitional control of breathing during activity**
72
Paced Breathing
* **Volitional control of breathing during act.** * **REALLY INTENTIONAL** * **​_Designated_** time interval for breathing * YOU CAN MAKE IT UP!!! * EX. IN for 3s, OUT for 6s * **Anxiety, cardiac/pulm dis's**
73
INSP MM Training ## Footnote **Indicated for pts w/ S/S of:**
* **DECd _strength_ or** **_endurance_ of** **_diaphragm_** **or** **_intercostal mm's_**
74
S/S of need for **Inspiratory MM Training:** 5
1. DECd **chest expansion** 2. DECd **breath sounds** 3. **SOB** 4. Uncoordinated breathing 5. Bradypnea (\<12 breaths/min) 6. DECd **tidal volume**
75
Insp MM Training (IMT) ## Footnote **GOALS:**
1. INC **vent. capacity** 2. DEC **dyspnea**
76
IMT program consists of **two parts:**
1. Strengthening 2. Endurance
77
IMT Training devices
1. Handheld devices 2. Incentive Spirometers (GOOGLE)
78
PEP or Positive Expiratory Pressure is for......
Consolidations
79
PEP or
Resisted Exhale
80
PEP does WHAT to secretion
Unsticks secretions
81
Positive Expiratory Pressure or PEP ## Footnote **The process or HOW to do:**
* "Slowly inhale **beyond normal breath"** * HOLD breath for 2s * Keep cheeks **stiff** * EXHALE thru **flutter valve** **We are training exhalation!!!**
82
Positive Expiratory Pressure and **Kids**
BUBBLES!!!! * Long straw== **\>PEP bc longer distance to reach liquid** * Short straw== **\*\*\*make it @ least 12in\*\*\***
83
PEP for kids ex. BUBBLES **Advantages**
Caregiver IND Good for "rewarding" cognitively impaired children \<4yo inexp.
84
PEP in KIDS Disadvantages
Adherence
85
Vest that does **high freq. chest wall oscillation @ LOW PRESSURES**
* High freq chest wall oscillation vest
86
Chestwall Oscillation ## Footnote **Advantages**
* Can be used w/ **other interventions** * **Sized as you grow** * **works LONG TERM--\> no tolerance build up**
87
Chest wall oscillation vest ## Footnote **Disadvantages**
If you don't have health insurance, you cannot afford it VERY $$$$
88
PFT tests are looking @:
V/Q matching!!!!!
89
PNF and whether or not it INCs **Pulmonary Function**
YES!!!! * **Significant Improves in:** * **​**ERV * VC * HIGHER pulm function * \*\***PNF resp. Ex IS effective @ INC pulm function of norm. adults**
90
PNF for airway clear. ## Footnote **INSP vs. EXP**
* INSP * during Thoracic EXT or ROT. * as ribcage expands * EXP * as things CLOSE BACK DOWN
91
What 2 forms of exercise should be used in **acute care setting?**
Endurance AND strength training!!!
92
BOTH endurance and strength training should be used in **acute care setting why?**
PREVENT and TREAT **negative NMSK sequelae of critical illness**
93
What is the **goal** of **endurance training** in **acute care setting?**
MAXIMIZE IND and **efficiency** when pt performs ADLs
94
Systemic Effects of Immobilization ESP affects you if....
Bed bound \>/= 3 days
95
Systemic effects of immobilization in a nutshell....
**Multiple organ impaired function**
96
Systemic Effects of Immob. ## Footnote **Cardiac**
* INCd RHR * DEC HR MAX * DEC VO2max * Orthostatic HypOtension * DECd SV * tot. volume blood leaving ea. ventricle per contraction of heart * EDV-ESV
97
Systemic Effects of Immob. ## Footnote **Vascular**
* INCd platelet coagulation * DECd Hgb conc. and DECd blood volume * **anemia, DVT, clotting** * Venous stasis * INCd venous compliance (stiffness)
98
Systemic Effects of Immob. ## Footnote **Respiratory**
* DECd VC * DECd RV * DECd Pa02 * Weak cough/non-effective * INCd V/Q **mismatch** * INCd risk infection * **in lungs---esp. part not using**
99
Systemic Effects of Immob. **MSK**
* DECd mm mass * DECd strength * DECd mm endurance * Jt contractures\*
100
Systemic Effects of Immob. ## Footnote **Integumentary**
* Decubitus Ulcers * **pressure wounds**
101
Systemic Effects of Immob. ## Footnote **CNS**
* Cognitive deficits * Delirium * Anxiety * **Altered sleep/wake cycle**
102
Systemic Effects of Immob. ## Footnote **Metabolic**
* INCd insulin **resistance** * **Anorexia** * **DECd ability to process/clear specific meds**
103
Systemic Effects of Immob. ## Footnote **Osteo**
* HYPERcalcemia * Osteo**penia** * Osteo**porosis**
104
Systemic Effects of Immob. **GI** **\*when IMMOBILE==\>** SNS **activated,** ANS **deactivated (rest/digest disrupted)**
* paralytic ileus * constipation * bowel obstruction
105
Systemic Effects of Immob. ## Footnote **Renal**
Diuresis \***Kidneys filter TOO MUCH bodily fluid== INC urine production + freq. to use bathroom**
106
Benefits of EARLY MOBILIZATION ## Footnote **What are the BIG 3?:**
1. Do NOT want **PNA** 2. NO **bedsores** **3.** NO **clots**
107
Is bedrest warranted? **If Meds:**
* multiple **vasopressors** * **fibrolytics** * **​blood too thin w/in 24hrs** * **​ex. TPA**
108
Is bedrest warranted? ## Footnote **if Hemodynamically unstable:**
* Acute MI * unstable arrhythmias
109
Is bedrest warranted? **If certain life-support machines** **\*bc the way the lines are attached to indiv.**
* femoral IABP * femoral ECMO * ICP monitors
110
Is bedrest warranted? ## Footnote **Hospice**
Pt. dictated care \***depends on what they want\***
111
Is bedrest warranted? **Excessive Pain: "Goal being to minimize pain"**
* burns/trauma/wounds * **WB precautions!!!** * **​ONLY SW or Ax. Crutches!!!!!!!**
112
is bedrest warranted? ## Footnote **Dependent Edema: "Rest, Ice, Compression, Elevation"** **RICE**
* IF * Post-trauma * post-sx * peripheral edema control
113
Is bedrest warranted? ## Footnote **Specific MD activity orders:**
**_Bed Rest_** **OOB to chair** **BR** **ad lib**
114
Rx Mob. for Pulm Pt ## Footnote **Step 1: PT exam**
what factors are negatively affecting pts V/Q?
115
Rx Mob. for Pulm pt ## Footnote **Step 2: Parameters**
\*are there any parameters worth monitoring? \*what monitors are avail?
116
Rx Mob. for Pulm Pt ## Footnote **Step 3: Is mobility feasible and safe?**
\*check precautions and contraindications
117
Rx Mob for Pulm pt ## Footnote **Step 4: What are the pts goals for today AND future?**
!!!!!!!!!!!!
118
Rx Mob. for Pulm pt ## Footnote **Step 5: Schedule session w/ interdisciplinary team**
\*nursing \*resp. tx \*family
119
Rx Mob. for Pulm pt ## Footnote **Step 6: Match deficits in step 1, info in step 2, 3, and 4 w/ Mobilization, PD, percussion, vibration, pulm hygiene, etc.**
!!!!!!!!
120
Rx Mob. for Pulm pt **Step 7: Plan for _duration_ and** **_intensity_**
!!!!
121
Rx Mob for Pulm pt ## Footnote **Step 8: Educate and carry it out!!!**
!!!!!
122
Rx Mob for Pulm pt ## Footnote **Step 9: Assess your rx's effectiveness**
!!!!
123
Rx Mob for pulm pt **Step 10: change** **_intensity, freq, duration_** **based on response/effective. and parameters**
!!!!!!!!!
124
Rx Mob for Pulm pt ## Footnote **Step 11: Could anything be optimized?**
RE-ASSESS!!!!
125
RX MOB FOR PULM pt ## Footnote **\*\*\*\*ACSM Parameters to Elicit Long-Term Effects:** **KNOW THESE!!!!**
* **Int:** 40-85% or RHR based on **Karvonen** * **​Karvonen== %int(HRR) + RHR** * **​HRR==MHR-RHR** * **​MHR==220-age** * **Karvonen==Ex. HR==%int(HRR) + RHR** * **Duration:** 20-40 mins * **Freq:** 3-5x/week * **Mode:** sitting tol, amb, therEX * **Monitor:** HR, BP, RR, Sa02 ## Footnote **SAFETY IS _PARAMOUNT!!!!!!!!_**
126
Mob of Pulm pt ## Footnote **Functional mobility training may be initiated WHEN?**
As soon as **pt can roll B/L in bed w/ _stable vital signs_**
127
functional mobility training for pulm pt. **What does this entail?**
* Bed mobility * **Transfers and Amb.** * **​**use of AD's====TEACH THEM! * recruit personnel assist for equip. mgmt * **Progress pt to LEAST RESTRICTIVE AD!!!**
128
HOW DO YOU CHOOSE AN INTERVENTION???
* Pt Info: * age * **motivation** * Availabilty * Effectiveness * Clinical status * Lifestyle * Expense\*\*\*\*\* **Do _Functional Mobility_** **along w/ other interventions!!!**
129
LONG-TERM Effects **Mobilization**
* Getting rid of secretions * INC functional capacity * **Preventing future consolidations & PNA\*\*\*****​**
130

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