Interventions for patients wth pulmonary dysfunction

Question 1

Analysis of chest

Answer 1

Symmetry
Mobility
Chest deformities
Posture

Question 2

Indications for airway clearance

Answer 2

Cystic fibrosis
Bronchiectasis
Atelectasis
Resp mm weakness
Mechanical ventilation
Neonatal resp distres syndrome
Asthma

Question 3

Tracheal bronchial tree divides at what level

Answer 3

6th thoracic vertebra

Question 4

Tracheal bronchial tree - right mainstem bronchus divides into

Answer 4

upper, middle, lower lobes

Question 5

Tracheal bronchial tree - left mainstem bronchus divides into

Answer 5

upper and lower lobes

Question 6

Tracheal bronchial tree - each lobe of the lung has a specific number of segments

Answer 6

R lung has 10 segments

L lung has 8 segments

Question 7

Tracheal bronchial tree - In order to ensure max benefits of gravity with postural drainage the patient has to be

Answer 7

placed so that the bronchus of the segment to be drained is oriented in a vertical position

Question 8

Postural Drainage indications - formal postural drainage positions are indicated for

Answer 8

1) Patients with localized lung problems (LLL bronchiectasis, RML pneumonia, lung abscess)
2) Pts who cant clear their own secretions
3) Comatose or semi
4) pts on respirators
5) trached pts with copious secretions

Question 9

Postural drainage - precautions and/or contraindications

Answer 9

1) Those who should not be placed in head down
Head injuries, post neuro surgery, inc intracranial pressure, hx of cardiac conditions
2) Post abdominal surgery
3) SVC syndrome
4) Orthopnea
5) hemodynamically unstable
6) Immed after eating

Question 10

Postural drainage - modified position

Answer 10

Less drastic positions used to mobilize secretions

Pt should be repositioned routinely

Question 11

Percussion - mechanics

Answer 11

Brief reflexed flexion and extension of the wrists with hands in cupped position
Motion from wrist and elbow
Rhythmical motion

Question 12

Percussion - performed when

Answer 12

throughout the breathing pattern

Question 13

Percussion is applied over the

Answer 13

posterior and lateral parts of the lungs but only in areas protected by the rib cage

Question 14

What structures should you not perform percussion over?

Answer 14

Stomach
Neck
Fx rib
Breast tissue
Tumor
PE
Incision

Question 15

Contraindications to percussion

Answer 15

1 Hemorrhage - prone patients (with or wo hemoptysis) 
2 Tuberculosis conditions
3 Recent hemorrhage bronchiectasis
4 Lung metastasis 
5 Chest wound
6 Acute inflammatory condition
7 Aged or nervous pt
8 Osteoporosis
9 Fx ribs
10 PE
11 sutured bronchial stump
12 if would cause inc in pain

Question 16

Vibration - mechanics

Answer 16

Hands held firmly on either side of chest wall, parallel to ribs to give up and down, shaking motions

Question 17

Vibration - done when

Answer 17

only during expiratory phase of respiration

Question 18

VIbration - done in what direction

Answer 18

A progressively downward direction

Question 19

Humidification

Answer 19

further assists the mobility of secretions

Secretions have to be moisturized to be mobilized

Question 20

Cough techniques - the patient should be asked to cough in what position

Answer 20

in an upright position if possible, after each of the lungs has been treated

Question 21

Tracheal stimulation - cough

Answer 21

Breathe in, hold 3 sec

Push down and in at trachea as exhale and will produce a cough

Question 22

HUFF - cough

Answer 22

Deep Ha ha ha

Question 23

Active cycle of breathing consists of

Answer 23

a series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion

Question 24

Active cycle of breathing - forced expiratory maneuver -

Answer 24

the patient performs 1 to 2 HUFFs at mid to low lung volume

Pt to concentrate on abdominal contraction to help force air out

Question 25

Active cycle of beathing - what is the series

Answer 25

``` Controlled diaphragm technique for 5 to 10 sec Thoracic expansion ex Controlled dia breath 5 to 10 sec Thoracic exp ex 3 to 4 x Breathing control 5 to 10 sec Fored expiratory maneuver Diaphragmatic breathing 5 to 10 sec ```

Question 26

Endotracheal suctioning - used only when

Answer 26

the above airway clearance techniques fail to adequately remove secretions

Question 27

Complications associated with endotracheal suctioning

Answer 27

Hypoexima, bradycardia or taachy, hypotension, inc intracranial pressure, atelectasis, tracheal damage, infections

Question 28

Thoracic mobility exercises - breathing exercises

Answer 28

Diaphragmatic breathing | Segmental breathing

Question 29

Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - indications?

Answer 29

More typically restrictive pulm disease to help with inspiration Can be done with obstructive too though to focus on prolonged exhale

Question 30

Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - instructions

Answer 30

Breathe with your belly Breathe into my hand Your belly should come up as you breathe in

Question 31

Thoracic mobility exercises - breathing exercises - Segmental breathing - indications

Answer 31

Works well for those that have had atelectasis or surgery if they are not airating certain areas very well

Question 32

Thoracic mobility exercises - breathing exercises - segmental breathing - contraindications

Answer 32

low oxygen saturation rib fractures new incision chest tube

Question 33

Respiratory muscle training - Sustained maximal inspiration is used to

Answer 33

increase inhaled volume, sustain or improve alveolar inflation, maintan or restore functional residual capacity

Question 34

Respiratory muscle training - Sustained maximal inspiration - used when

Answer 34

in acute situations for patients with post trauma pain, posperative pain, or acute lobar collapse

Question 35

Inhalation - what type of contraction

Answer 35

always concentric contraction

Question 36

Exhalation - what type of contraction

Answer 36

can be many types

Question 37

Endurance training for breathing

Answer 37

Paced breathing | Pursed lip breathing

Question 38

Education

Answer 38

energy conservation establish a routine avoid strenuous activities

Question 39

Pulmonary rehab - ____ approach

Answer 39

multidisciplinary

Question 40

Goals of pulmonary rehab

Answer 40

``` 1 inc exercise tolerance with compliance of HEP 2 Proper breathing techniques 3 inc inspiratory mm strength and coord 4 inc compliance with meds 5 weight management 6 energy saving techniques 7 self management ```

Question 41

Patient selection criteria for pulmonary rehab

Answer 41

anyone with a stable symptomatic lung disease

Question 42

Referral and eval - Mild, moderate, severe lung disease based on GXT

Answer 42

Mild: FEV 70-85% Moderate: FEV 55-70% Severe: FEV less than 55%

Question 43

Pulmonary rehab program duration - inpatient =

Answer 43

length of stay or 2 weeks

Question 44

Pulmonary rehab program - duration - outpatient

Answer 44

6-16 weeks depending on needs of patient and insurance coverage

Question 45

Pulmonary rehab intervention - inpatient exercise start with

Answer 45

ambulation and 6 min walk test to develop baseline education breathing techniques

Question 46

Pulmonary rehab intervention - inpatient exercise - work up to

Answer 46

30-45 min, 5-7 days/wk

Question 47

Pulmonary rehab intervention - outpatient duration and frequency RPE

Answer 47

45 min to 1 hour 3x wek | REP 13-14

Question 48

Pulmonary rehab intervention - target what first

Answer 48

endurance first and then go for intensity

Question 49

Pulmonary rehba intervention - intensity is based on

Answer 49

initial GXT eval - start at 50% and work up to 85%

Question 50

Pulmonary rehab intervention - education

Answer 50

``` breathing retraining with pursed lip Inspiratory mm trainer Nutrition Lung disease and death Meds Time and energy HEP Support group ```

Question 51

Benefits of pulm rehab

Answer 51

``` Reduction in s/s Inc ex tolerance Improved QOL Reduction in hospitilizations and health care costs Prolonged life for some ```

Question 52

Absolute contraindications to exercise

Answer 52

``` Change in ECG Unstable angina Acute CHF Acute infection Active myocarditis or pericarditis PE 3rd AV block Recent MI Uncontrolled DM Advanced or complicated pregnancy ```