Breathing Exercises

Question 1

Diaphragmatic Breathing (DB) : definition

Answer 1

breathing predominantly with the diaphragm while minimizing the action of accessory muscles & motion of the rib cage during inspiration

Question 2

Diaphragmatic Breathing: Indications

Answer 2

post-surg pt w/ pain in chest wall/ abdomen/ restricted mobility
pt learning active cycle of breathing/ autogenic drainage airway clearance techniques

Question 3

Diaphragmatic Breathing: Precautions/ Contraindications

Answer 3

moderate to severe COPD & marked hyperinflation of lungs w/o diaphragm movement

pt w/ paradoxical breathing patterns/ who demonstrates increased inspiratory muscle effort & increased dyspnea during DB

Question 4

Diaphragmatic Breathing: Procedure

Answer 4

Semi-Fowler’s position to start
sniffing can be used to facilitate contraction of diaphragm
have pt place one hand on upper chest and the other just below the rib cage
Instruct: “breath slowly through your nose so that your stomach moves out against your hand. Feel your abdomen gently rise into your hand. Exhale through pursed lips, let the hand on your abdomen descend while the hand on your chest remains still”

Question 5

Diaphragmatic Breathing: Expected Outcomes

Answer 5

decreased respiratory rate
decreased use of accessory muscles
increased tidal volume
decreased respiratory flow rate
subjective improvement of dyspnea
improved tolerance for activity

Question 6

Inspiratory Muscle Training (IMT): definition

Answer 6

attempts to strengthen diaphragm and intercostal muscles w/ 2 different devices

1) flow resistive breathing- pt inspires through mouthpiece & adapter w/ adjustable diameter. decreased diameter = increased resistance
2) threshold breathing- buildup of negative pressure before flow occurs through a valve that opens @ critical pressure. provides consistent, specific pressure for IMT regardless of pt’s breathing rate

Question 7

Inspiratory Muscle Training: Indications

Answer 7

impaired inspiratory muscle strength &/or ventilatory limitation to exercise performance

Question 8

Inspiratory Muscle Training: Precautions/ Contraindications

Answer 8

Clinical signs of inspiratory muscle fatigue
tachypnea
reduced tidal volume
increased PACO2
bradypnea & decreased minute ventilation

Question 9

Inspiratory Muscle Training: Procedure

Answer 9

measure pt’s max inspiratory pressure (MIP) w/ manometer

use MIP to calculate an appropriate training load

Question 10

Inspiratory Muscle Training: Expected Outcomes

Answer 10

increased inspiratory muscle strength & endurance
decreased dyspnea @ rest & during exercise
increased functional exercise capacity

Question 11

Paced Breathing and Exhale with Effort: Definitions

Answer 11

Paced Breathing: strategy to decrease work of breathing & prevent dyspnea during activity- allows pt w/ shortness of breath to become less fearful of activity/exercise

Exhale with Effort: breathing strategy employed during activity to prevent pt from holding their breath- breaks any activity into one/more breaths w/ inhale during resting/less active phase & exhale during movement/ more active phase

Question 12

Paced Breathing and Exhale with Effort: Indications

Answer 12

pts w/ dyspnea @ rest or w/ minimal activity
inability to perform activity due to pulmonary limitation
inefficient breathing pattern during activity

Question 13

Paced Breathing and Exhale with Effort: Precautions/ Contraindications

Answer 13

avoid Valsalva maneuver during activity

Question 14

Paced Breathing and Exhale with Effort: Procedure

Answer 14

perform activity @ temp that doesn’t exceed pt’s breathing limits
find a comfortable inspiration:expiration time to synchronize w/ exertion phase of activity
synchronize breathing with components of activity
inhale before/during easier portion
exhale during more vigorous portion
DO NOT hold breath or rush through activity

Question 15

Paced Breathing and Exhale with Effort: Walking

Answer 15

1) inhale through nose while walking 2 steps
2) pause
3) exhale through pursed lips while walking 4 steps

Question 16

Paced Breathing and Exhale with Effort: Climbing Stairs

Answer 16

1) inhale while standing
2) exhale through pursed lips while stepping up/down 1 or 2 stairs
3) remain on step until breathing control is restored

Question 17

Paced Breathing and Exhale with Effort: Lifting

Answer 17

1) inhale through nose while standing/ sitting
2) exhale through pursed lips while bending to reach object
3) pause
4) inhale through nose while grabbing object
5) exhale through pursed lips while standing up

Question 18

Paced Breathing and Exhale with Effort: Expected Outcomes

Answer 18

complete activity without dyspnea

decrease pt’s fear of becoming short of breath during activity

Question 19

Pursed Lip Breathing: definition

Answer 19

simple technique to reduce respiratory rate, reduce dyspnea & maintain small positive pressure in bronchioles (may prevent airway collapse in pts w/ emphysema)
any pt short of breath may use this technique

Question 20

Pursed Lip Breathing: Indications

Answer 20

tachypnea

dyspnea

Question 21

Pursed Lip Breathing: Precautions/ Contraindications

Answer 21

forcing exhalation

Question 22

Pursed Lip Breathing: Procedure

Answer 22

semi-fowler’s = good starting position
instruct: “breathe in slowly through nose with mouth closed for two counts. purse your lips like you are going to whistle, then gently breath out through your mouth like you were going to blow out a candle for four counts. do not blow with force”

Question 23

Pursed Lip Breathing: Expected Outcomes

Answer 23

Decrease respiratory rates
Relieve dyspnea
reduce PaCO2
improve tidal volume
improve SaO2
prevent airway collapse in pts w/ emphysema
increase activity tolerance

Question 24

Segmental Breathing: definition

Answer 24

aka localized breathing/ thoracic expansion exercise

intended to improve regional ventilation, prevent & treat pulmonary complications post op

Question 25

Segmental Breathing: Indications

Answer 25

decreased intrathoracic lung volume decreased chest wall lung compliance increased flow resistance from decreased lung volume ventilation:perfusion ratio mismatch

Question 26

Segmental Breathing: Precautions/ Contraindications

Answer 26

NONE 😀

Question 27

Segmental Breathing: Procedure

Answer 27

Positioning: sitting for basal atelectasis sidelying w/ affected lung on top postural drainage positions w/ affected lung on top to assist secretion removal Therapist applies firm pressure @ end of exhale to pt's chest wall overlying area to be expanded pt inhales deeply & slowly expanding ribcage under therapists's hands Therapist reduces hand-pressure during pt's inhale

Question 28

Segmental Breathing: Expected Outcomes

Answer 28

increase chest wall mobility expand collapsed alveoli via airflow through collateral ventilation channels assist secretion removal

Question 29

Sustained Maximal Inhale w/ Incentive Spirometer: definition

Answer 29

max inspiratory effort is held for 3+ seconds @ point before exhale included in many airway clearance techniques to compensate for asynchronous ventilation, to promote air passage past mucus obstruction in airways, & maximize alveolar expansion aka incentive spirometry- encourage pt to take long, slow, deep inhales

Question 30

Sustained Maximal Inhale w/ Incentive Spirometer: Indications

Answer 30

decreased intrathoracic lung volume decreased chest wall lung compliance increased flow resistance from decreased lung volume atelectasis/ risk of due to thoracic/ upper abdominal surgery restrictive lung defect associated w/ quadriplegia &/or dysfunctional diaphragm

Question 31

Sustained Maximal Inhale w/ Incentive Spirometer: Precautions/ Contraindications

Answer 31

pt is not cooperative/ unable to understand/demonstrate proper use of incentive spirometer pt is unable to deep-breathe effectively pt w/ moderate-severe COPD w/ increased respiratory rate & hyperinflation

Question 32

Sustained Maximal Inhale w/ Incentive Spirometer: Expected Outcomes

Answer 32

absence/ improvement of in signs of atelectasis decreased respiratory rate resolution of fever normal pulse rate normal chest x-ray improved PaO2 increased forced vital capacity & peak expiratory flows

Question 33

Semi-Fowler's Position

Answer 33

pt in supine w/ head of bed elevated to 45˚ & pillows under knees for support/ maintenance of proper lumbar curvature often used for pts w/ congestive heart failure

Question 34

Reverse Trendelenburg Position

Answer 34

pt in supine w/ head above trunk and LE, decreased weight of abdominal contents on diaphragm & reducing resistance to movement during breathing