what are 2 main reasons for breathing exercises?
1) reduce dyspnea 2) optimize lung volumes and reduce atelectasis
what is the reduced dyspnea positioning?
how to describe pursed lips breathing to a pt
how to describe diaphragmatic breathing to a pt
how to describe Lateral costal expansion/Segmental breathing breathing to a pt
Describe V/Q matching - positioning
Top = 3:1 gas exchange not great
Bottom have more of a 1:1 ventilation to profusion ratio
-Better for someone standing or sitting therefore
-Same for supine (better for back side of lungs)
-For side lying – better for lung that’s closer to the bed
-Gravity affects where blood flow goes to lungs
-Regions that are more dependant = lowermost regions of lung
-Lower parts relative to gravity will always get more blood
explain the equal pressure point
see lab handout
impaired mucocillary clearance is secondary to what?
what are 4 techniques for airway clearance?
describe how to do "huffing"
mid lung – depends on what section we are working on
what are the benefits of huffing vs coughing?
what is the mechanism behind huffing?
- Don’t want to push air out too forcefully otherwise airway collapse
describe high vs low lung volume wrt the EPP and huffing
what are indications for the use of huffing?
- Can perform in side-lying if necessary but optimal position is in “sitting up” – bc can take a bigger volume in compared to supine – depends on where in the lung you want to mobilize the secretion
describe the active cycle breathing technique (huffing)
1. Breathing control (relaxation):
1-2 minutes (relaxed diaphragm breathing) performed at normal tidal volumes and natural rate (or PLB).
2. Thoracic expansion (active secretion mobilization):
30 seconds lower thoracic expansion exercises or slow sustained deep breathing from FRC to TLC
3. FET (active secretion clearance):
2-3 huffs or coughs interspersed with breathing control
May be performed in an upright, modified gravity assisted positions or postural drainage position +/- clapping/vibs.
Minimum of 3-4 cycles recommended
1st bump = Have secreted in ___ lungs
2nd bump – secreted mid-bronchi
what is autogenic drainage (and the 3 phases)?
describe how to perform autogenic drainage
describe the phases of autogenic drainage (graph wrt FRC, RV)
-Move to stage 2 when cracking sound is heard at the end of each expiration
for autogenic drainage - how long does a session last, how long does it take to teach, can positional changes be used to benefit?
what is the PEP mask? how is it used?
Inspiration through nose/mouth - normal VT using diaphragm.
Expiration should only be slightly active – NOT forced.
10 - 15 breaths through the PEP mask
Followed by FET & spontaneous cough as needed without mask.
Cycle repeated 5-6 times or minimum 20 minutes.
–1-3 times daily depending on severity of disease.
what is the mechanisms of action for the PEP mask?
for postural drainage techniques - how should the pt be positioned wrt the lung segments recieveing the drainage?
how often and for how long should postural drainage be performed?
what are the contraindications for postural drainage?
describe the technique/aim of percussion/clapping
•should be used in conjunction with postural drainage and deep breathing
•should NOT be used on patients who have scant or no secretions.
•use a thin towel over the percussion zone in patients with sensitive skin ie. elderly patients
•useless in obese patients
what is the mechanism for percussion/clapping?
what are precautions for percussion/clapping?
what are contraindications for percussion/clapping?
manual vibration techniques - what is the aim and how should it be performed (frequency)?
what is vibratory positive epiratory pressure (and name 3 devices)?
Oscillation during the expiratory cycle of PEP breathing.
3) quake device