Lab 4 Abdominal Lab

Question 1

Answer 1

1. Smoking, chronic bronchitis, obese, diabetes (poor wound healing), age knee OA, sedentary, fear avoidance of moving, hypertension
   
   2. Because he is not moving and his lung volume is decreasing due to post-operative atelectasis (lung volume is decreasing because of sedentariness, supine position, and restricted breathing with abdominal incision). Pain inhibition is causing poor diaphragm function and more apical breathing. Post-op atelectasis is common for people not breathing, moving, and had abdominal surgery.
   3. Atelectasis, decreased lung volumes, sedentariness, surgical pain, breath rate, coughing, focus on knee OA to help with movement (may be stiff from being sedentary), hypertension may cause restriction of blood to lungs also
   4. Weaning off nasal prongs, ability to ambulate independently, strengthening ability to cough so its more effective, change breathing pattern to allow proper lung volume expansion, work with care team to decrease lethargy to improve energy for rehabilitation, ability to do stairs
      Foot and ankle pumps, coughing, deep breathing techniques, general mobility (transfers, ambulation, stair training

Question 2

How to perform diaphragmatic breathing

Answer 2

1) Use your hands to help with breathing
2) Then have patient place their hand on diaphragm and have them control their breathing
**No shrugging shoulder, not getting dizzy and all high quality breathing

Question 3

How to perform lateral costal breathing

Answer 3

1) Put hands on side of chest walls and have them breath moving your hands
Have patient to self cue but arm stays on ipsilateral side (no crossing arms as restricts chest wall)

Question 4

How to perform splinted coughing for secretion clearance

Answer 4

Splinted coughing:
1) Hold onto pillow (horizontally)
2) Have them cough twice
**Splint over incision (make sure pillow and arms are placed across incision)

Question 5

How to perform huffing for secretion clearance

Answer 5

1) Nice controlled Ha, Ha, Ha after a deep inspiration
**Forced expiration through open glottis
**Can hold kleenex across mouth vertically to see if they are moving kleenex

Question 6

Whats another method for breathing exercises that involves UE exercise

Answer 6

Can do flexion or abduction with deep breathing or have them breathe into their segment

Question 7

What are the indications for active cycle breathing

Answer 7

• Do when there is secretions (not for preventative like coughing, huffing or breathing above) and post-op
  
  • Need to be able to understand instructions and retain information
  • Breathe in through nose and out through mouth ideally (can have mouth breathers)
    Coughing and breathing is easiest in sitting then standing then laying down -> can use side lying if they only have secretions in one lung

Question 8

How to perform active cycle breathing

Answer 8

3 phases:
1. Breathing control (nice relaxed tidal volume breathes 3-4 times)
2. Thoracic expansion (3-4 large breaths ->can use 3s breath hold to treat atelectasis)
3. Breathing control again
4. Thoracic expansion again
5. Huffing/coughing (forced expiratory -> 1-2 times)
* Breathing exercises are at tidal volume
* With incision use splinted breathing
Can do as many cycles and should get sputum coming out