Intervention skills Flashcards
• Teach diaphragmatic breathing using verbal, tactile, and auditory cues
o Purpose
♣ Breathing pattern is not efficient extra effort decreased functionality
Teach diaphragmatic breathing using verbal, tactile, and auditory cues
Indications
♣ Pulmonary dysfunction, pain, nervousness, airway clearance dysfunction, congestive heart failure, edema, msk restriction ie. Scoliosis,kyphosis, obesity, etc.
Teach diaphragmatic breathing using verbal, tactile, and auditory cues
Goals
♣ Decrease work of breathing
♣ Improve alveolar ventilation
♣ Increase strength, coordination of respiratory muscles
♣ Improve airway clearance by improving cough
♣ Relaxation
Teach diaphragmatic breathing using verbal, tactile, and auditory cues
Muscles
♣ Primary muscles are diaphragm and intercostals
• In pulmonary dysfunction, accessory muscle use should be discouraged
• In NM disorder accessory muscle use may improve vital capcity and functionality
o Diaphragmatic breathing – try simplest intervention first, then progress if necessary
- relaxation technique
- repatterining
- sniffing
- scoop
- lateral costal breathing
♣ Relxation Technique
- 3-4 deep breaths, hold each deep breath for 3 sec.
- Regular breathing
- 3-4 deep breaths, hold each for 3 sec
- regular breathing
- FET
♣ Repatterning Technique
Pursed lip
• Pursed lipped breathing: focus on relaxes slow, prolonged exhalation
o normal inhale
o Encourage a sssss sound
o Imagine a candle with a flame, make flicker but not go out
• Exhalantion, hold, and inhalation
o Hold for 1 or 2 seconds at top of inspiration, then pursed lips
♣ 3. Sniffing
♣ Sniffing
- may want to choose gravity lessened position
- place pt hand on abdomen for feedback
- “sniff 3 times’ note if more abdominal rise and less chest expansion if not draw attention
- “sniff 2 times, but deeper”
- “one long sniff”
- progress with quieter, longer sniffs
♣ Scoop Technique
- breathe into my hand
* scoop at end of exhalation
♣ Lateral Costal Breathing
- assess bucket handle
* lower chcest lateral costal expansion facilitaties diaphragmatic/intercostal breathing
• Perform a facilitated breathing technique (scope or lateral chest expansion with quick stretch)
o Lateral chest expansion quick stretch (unilateral or bilateral)
♣ Assess bucket handle
♣ As pt breathes out, apply firm downward pressure into ribs
♣ Just prior to inspiration, apply quick downward/inward stretch
• Stetches external intercostal to facilitate contraction
o Moves ribs outward and upward during inspiration
♣ Apply gentle resistance, Tell pt to expand lower ribs against hand as breathes in
• Provides feedback, sensory awareness
♣ Pt. may be taught to do independently with towel
• Instruct effective cough and provide manual cues as needed – in strict in huff if cough not working
o pts with copd/asthma should not take a deep breath before a cough, can lead to distress
o Can you show me how you have been coughing?
♣ Have pt in good posture sitting, standing fowler
• Pt should choose position that lends itself to trunk flexion
♣ 4 Stages
• adequate inspiration necessary air for forceful cough
o begin with diaphragmatic breathing
• glottal closure increases pressure distal to vocal folds
o
• build intra-abdominal pressure
• glottal opening and expulsion
• Transfer supping to sit for sternal precautions, or chest tube precautions
o Sternal Precautions for 6-8 weeks
o Sternal Precautions for 6-8 weeks
♣ No pulling, no pushing, no lifting more than 10lbs
♣ No shoulder flexion greater than 90 degrees
♣ Keep hands in visual field
♣ Hug pillow to chest when coughing
o Chest Tube precautions
♣
• Instruct pt how to coordinate breathing w/ daily activities, such as getting out of chair
o Ventilation
♣ Inspiration
• Trunk extension, shoulder flexion, abduction, external rotation, upward eye gaze
♣ Exhlation
• Trunk flexion, shoulder extension, adduction, internal rotation, downwatrd eye gaze
♣ can incorporate positions into breathing techniques
Instruct pt how to coordinate breathing w/ daily activities, such as getting out of chair
o activities
♣ Coming up to sitting from sidelying
♣ Dressing
• LE items: exhale while reaching down, inhale while pulling up
• UE items: pair shoulder flexion with inspiration
♣ Coming up to standing
• Breathe in with rear rocking, exhale out rock forward
• Do several cycles
• Inhale as coming up to standing
• Instruct stretch and breathing coordinated with upper extremity movement to increase chest expansion; instruct in static positioning to facilitate increased ventilation (i.e. Towel under spine suping) consider ventilation/perfusion ratio if indicated
o Vertical Towel Roll or Foam Roller
o Vertical Towel Roll or Foam Roller
♣ Improves anterior wall mobility by allowing gravity to pull shoulder back
♣ Stretches intercostal and pc muscles for easier chest expansion
♣ Can incorporate active stretching with arms
o Sidelying
♣ “lay on good lung”
♣ lateral chest expansion
♣ 1-3 pillows under ribs 8-10
♣ can incorporate active stretching with arms
• Demonstrate manual technique to increase intraabdominal force during coughing (towel/pillow)
o Heimlich-Type
♣ Pt supine or sidelying ♣ Aka abdominal thrust assist ♣ Pt hand at navel level, not on ribs ♣ Breathe in ♣ apply upward pressure as coughing
• Perform an airway clearance technique for lower segment (position, percussion, vibration)
• Teach Autogenic drainage or active cycle of breathing airway clearance technique
o Autogenic Drainage: uses breathe to move mucus from smaller airways to central airways
♣ 3 Phases
• Unsticking in smaller airways by breathing in base of lungs
• Collecting from middle airways by breathing at low-mid lung levels
• Evacuating the mucus from central airways by breathing at mig-high levels
•
Placement of EKG electrodes
RA=right arm
LA- left arm
RH- right hip
LH- left hip
• V1 = 4th intercostal space to the right of sternum
• V2 = 4th intercostal space to the left of sternum
• V3 = in between V2 and V4
• V4 = 5th intercostal space, mid-clavicular
• V5 = left anterior axillary line, level with V4
• V6 = left mid-axillary line, level with V4 and V5
• Teach phase 1 and phase 2 cardiac rehab
o Goals of Rehab
♣ Improve functional capacity
♣ Control cadiac symptoms
♣ Mitigate physiological and psychological affets of cardiac illnes
o Phase 1: Inpatient, Cardiac Unit, ICU
♣ For
- Post MI
- Post surgery
- Post-stent
- transplant
o Phase 1: Inpatient, Cardiac Unit, ICU
May begin if:
- MD approval
- No chest discomfort for 8 hours
- No new signs of decompensated heart failure
- No abnormal EKG for 8 hours
o Phase 1: Inpatient, Cardiac Unit, ICU
Goal:
• Normal CV response to changes in position and ADL
Reach 3-4 MET activity level by discharge
o Phase 1: Inpatient, Cardiac Unit, ICU
Activity
- Start at 2 MET, Increase 1 MET/day, starting with 3-5 minutes
- AROM for DVT prevention
- Changing positiongs
- Avoid isometrics, Valsalva (especially during bowel)
- Avoid head down position
