Breathing Exercise & Secretion Clearance Flashcards
Diaphragmatic Breathing
Indication:
- Dynpnea
- Apical breathing/accessory muscle use
- Low tidal volume
Points to note:
- 3-4 breaths, 10 reps/hr
- Max inhalation–>hold for 3-5 seconds
Pursed Lip breathing
Indication:
- COPD with hyperinflation
Points to note:
- Exhale 2X longer than Inhale
- Use as needed
Segmental Breathing
Indication:
- Hypoventilation at a segment of the lung
- Poor lung expansion
Points to note:
- Ask patient breathe into hands placed on lateral borders of ribcage
- Exhale: inward & downward pressure
- Light manual resistance to lower rib
Breath Stacking and Inspiratory Hold
Indication:
- Painful inhale
- Inspiration muscle weakness
Points to note:
- Stack small breath+inspiration hold
SOS
Indication:
-COPD/Asthma–>slow down breathing during exacerbation/attack
Points to note:
Positioning:
- Seated with arms on table/lap
- Standing against wall with arms on thigh
- **Breath in & out of mouth initally as fast as necessary
- blow out longer but not forceful
- purse lip breathing+long slow exhalation
- Nose breath in
Inspiratory Muscle Training
Indication:
- Patients with moderate to severe COPD who are medically stable
**Avoid hyperinflation–>perform full exhalation using PLB after each inhale with IMT
- People with weak muscles of inspiration
**Never use during exacerbation/right after exacerbation
Points to note:
- Breath in/out with nose plogged
- 30 min/day (can spread out in 2-3 sessions), 4-6 day/wk
Cough
Requires deep inhalation
→ glottis closure
→ increased abdominal pressure → glottis opens
→ explosive expiration.
Huffing or Forced Expiratory Technique (FET)
Requires inhalation
→ mouth and glottis open
→ forced air out using chest and abdominal muscles with open glottis
**remove secretions out of smaller airways
Assisted Cough
Indications:
* Ineffective cough due to loss of neurological/muscular function to expiratory muscles
e.g. SCI T5/higher
- Excessive or tenacious secretions.
Contraindication:
* Ruptured diaphragm
* Inferior vena cava filter
Precaution:
* Bowel obstruction
* Increased ICP
* Gastric reflux
* Fracture
* Abdominal aortic aneurysm (AAA)
* Trauma to chest
* Pregnancy
* Gastrotomy
* Recent abdominal surgery
* Cardiac instability
* Fragile or rigid rib cage
* Thorax/spinal trauma
Postural Drainage
Point to note:
- Maintained for ~10 min, but dependent on patient
Contraindications/Precautions to postural drainage:
Blood vessel & Circulation
* Unstable cardiovascular status
* Increased intracranial pressure
* Congestive heart failure
* Aneurism
Lung related
* Untreated pneumothorax
* Hemoptysis
* Pulmonary embolism
Others:
* Esophageal anastomosis
* Recent laminectomy
* Patient upset/agitated
Percussions, Vibrations
Percussions:
- Must expose area before beginning, check skin before and after treatment
- 30-60 seconds+2-3 huffs/cough
Vibration:
- towards larger airways
Contraindications to percussion/vibrations
MSK issue
- Fractured ribs
- Osteoporosis
CP issue
- Oxygen desaturation
- Subcutaneous emphysema of neck and thorax
- Poor/unstable cardiovascular status
- Recent bright red hemoptysis
- Pneumothorax
- Pulmonary embolism
- Recent pacemaker insertion
Neuro issue
- Unstable head injury
- Increase ICP
- Uncontrolled seizures
Other condition
- Hemorrhage tendency
- Metastatic bone cancer
- Resectable tumor
- Recent skin graft
- Pain intolerance to treatment
Precaution:
* Bronchospasm
* Bruising
* Patient upset/agitated
* Tube feed - stopped 30 minutes prior to treatment to minimize risk of aspiration
Positive Expiratory Pressure (PEP) Mask/ Oscillating PEP
Indication:
Keeps airways open
–>allowing air to get behind mucus–>push mucous forward to be expelled
Technique:
- exhales against resistance
- 10-15 breaths+2-3 huffs to clear any secretions
- As needed
Active Cycle of Breathing (ACB)
Indication:
Mobilization of secretions towards upper airway + expectoration of mucus with huff cough +/- PD
Technique:
Relax breathing 1 min–> Diaphragmatic breath x 30 sec+inspiration hold–> Huff x 2-3–>Relax breathing 1 min–> 3-4 cycles/until secretions are clear
Autogenic Drainage (AD)
Indication:
Mostly for CF, secretion removal
3 phases:
Unsticking: small lower airway
Exhale fully–> breath in at very low lung volume with nose–>Hold 3 sec–>Exhale with mouth
Collecting: moves mucus into middle airway
**feel the secretion move to middle airways
Slight deeper breath with nose–>hold 3 sec–>Exhale with mouth
Evacuating: moves mucus out of upper airways
**feel secretion–>move into upper airway
Max inhale with nose–>hold 3 sec–>Exhale through mouth–>huff/cough
!!No coughing during Step 1/2
30-45 mins 2x/day
Suction
Purpose:
removal of secretions and mucus from upper airways.
- Endotracheal: recommended time is 10-15 sec.
4 Passages:
- indwelling
- tracheostomy tube
- oropharyngeal
- nasopharyngeal (NP)
Contraindication to nasopharyngeal (NP) suctioning:
* Basal skull fracture
* Nasal bleeding or bleeding disorders
* Nasal stenosis
* Nasal infection
* Nasal pathology (e.g. epistaxis, polyps, septal deviation)
* Acute head or facial injury
* Cerebral spinal fluid leakage
* Epiglottitis or croup
* Increased restlessness and agitation
* Cardiovascular instability
