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Practical Practice Flashcards

(71 cards)

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1
Q

Assessing Jugular Distention

A

-Elevate head of bed at least 45 degrees
-Vein is considered distended if it is distended above the levels of the clavicle

**indicates an early sign for R sided HF

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2
Q

Tracheal Shift

A

Evaluate the mediastinum to assess for tracheal shift
-trachea shifts to affected side when intrathoracic pressure on that sided is decreased = lobectomy or atelectasis
-trachea shifts to unaffected side when there is an increased pressure on that side = pleural effusion, pneumothorax or tumor
**moves toward the least amount of pressure

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3
Q

Upper Lobe Chest Wall Motion

A

Palm of hands anterior over chest wall from 4th rib up- fingers are stretched up and over the traps, thumbs are over the middle of the chest

**checking timing of movement and symmetry of movement while patient breathes quietly and during deep breaths

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4
Q

Right middle lobe and left lingula chest wall motion

A

Place fingers laterally over posterior axillary folds and place thumbs firmly over chest wall (under breast tissue)

**checking timing of movement and symmetry of movement while patient breathes quietly and during deep breaths

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5
Q

Lower Chest Wall Motion

A

With the patient’s back to you, wrap fingers around anterior axillary folds and place your thumbs around the base of the scapulae

**checking timing of movement and symmetry of movement while patient breathes quietly and during deep breaths

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6
Q

Palpation Fremitus

A

Palms are placed lightly on the chest wall while the patient repeats the words “99”

-Normal: there should be a uniform vibration throughout the entire chest
-Presence of secretions in the airway: fremitus is increased and there is a decreases presence of air

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7
Q

Assessing Diaphragmatic Breathing

A

Place thumbs over the costal margins with thumb tips meeting at xiphoid process. Have patient take a deep inhale- thumbs should travel equally apart (at least 2-3 inches)

**assess the involvement of diaphragm during breathing while also the use of accessory muscles

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8
Q

Mediate Percussion

A

Place the middle finger of one hand over the area being evaluated then tap on that middle finger with the other hand- to assess any changes in lung density and to assess diaphragmatic excursion

-Normal: normal resonance is produced= normal lung tissue
-Dull: “thud” sounds when percussion is over solid organs
-Tympanic: loud, long and hollow sound= hyper-inflated chest

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9
Q

Normal Lung Auscultation

A
  1. Vesicular sounds: In the peripheral lung fields- soft, low pitched sounds heard during inspiration
  2. Bronchial sounds: Over the anterior chest wall and anterior tracheal area- tutbular sounds, loud, high pitched sounds during both inspiratory and expiratory
  3. Bronchiovesicular sounds: Anteriorly over 1st and 2nd intercostal space near sternum and posteriorly over the bronchi (between scapulae)- soft version of bronchial sounds
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10
Q

Abnormal Lung Auscultations

A
  1. Continuous Sounds: Wheezes
    -constant pitch with varying duration
    -associated with airway obstruction
    -usually heard on exhale- heard on inhale can indicate severe obstruction
  2. Discontinuous Sounds: Crackles
    -brief bursts of popping bubbles
    -more common during inspiration
    -could be associated with restrictive or obstructive disorders
    -could be a result from the sudden opening of closed airways or of the movement of secretion during inspiration/exhalation (fluid in airway)

**weaker and softer sounds are heard in presence of hyperinflation
**stronger and louder sounds are heard in the presence of consolidation (secretions)

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11
Q

Ecophany

A

Using a stethoscope across the lung tissue, have patient say “EE”- should be a soft and muffled sound

Abnormal: sounds like “AY”- indicates consolidation (secretions)

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12
Q

Tripod Positioning

A

Leaning forward on support hands to provide DYSPNEA relief
-provides the diaphragm with an increased strength of contraction

Positions:
1. sitting while leaning forward on forearms
2. standing while leaning forward with hands out on counter top
3. sitting while leaning forward with head on desk under pillows

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13
Q

Pursed Lip Breathing

A

-pt breathes out against lips that are mostly closed and shaped in a circular fashion
-performed to alleviate the trapping of air in the lungs and improving gas exchange
-slows respiratory rate

**used to decrease symptoms of dyspnea

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14
Q

Paradoxical Breathing

A

Abnormal chest movement where the chest moves inward during inhalation rather than outward
-pts must contract abdominals during exhalation to decrease air trapped within the lungs
-an indicator of advanced COPD

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15
Q

Airway Clearance Techniques

A

-percussion
-vibration
-postural drainage
-active cycle of breathing
-deep breathing
-coughing
-positive expiratory pressure
-PEP devices
-aerobic exercise
-vibration vest

**should be performed at least 30 minutes after a meal or feeding tube

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16
Q

Percussion

A

Therapist uses cupped hands to apply “forceful” pressure to the affected segments of the lungs
-hands should fall on chest in an even, steady rhythm between 100-480 times per min
-duration: 3-5 mins
-NOT done on bare skin

**used to loosed secretions

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17
Q

Vibration

A

Using the palmar aspect of the therapist’s hands, they apply full contact with the patient’s chest wall with one hand overlapping the other. Keep arms extended. After a deep inhale, the therapist applies pressure to their chest wall and gently oscillates it through the end of expiration
-performed after percussions
-lasts for 1-10 breaths

**used to clear secretions from the affected segments

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18
Q

Precautions for Percussion and Vibrations

A

-uncontrolled bronchospasms
-osteoporosis
-rib fractures
-cancer of ribs
-tumor obstruction of airway
-anxiety
-coagulopathy
-convulsive or seizure disorder
-recent pacemaker placement

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19
Q

Contraindications for Percussion and Vibrations

A

-hemoptysis
-untreated tension penumothorax
-platelet count below 20,000 per mm
-unstable hemodynamic status
-open wounds, burns in thoracic area
-pulmonary embolism
-subcutaneous emphysema
-recent skin graft or flaps on thorax

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20
Q

Postural Drainage Precautions

A

-pulmonary embolism
-hemoptysis
-massive obesity
-large pleural effusion
-massive ascites

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21
Q

Postural Drainage contraindications

A

-increased ICP
-hemodynamically unstable
-recent spinal fusion or injury
-recent head trauma
-diaphragmatic hernia
-recent eye surgery

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22
Q

Contraindications for Trendelenburg positioning

A

-ICP >20 mmHg
-uncontrolled hTN
-for patients when increased ICP should be avoided
-esophageal surgery
-distended abdomen
-recent hemoptysis related to recent lung carcinoma
-uncontrolled airway at risk for aspiration
-CHF
-cardiomegaly

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23
Q

Contraindications for Reverse Trendelenburg Positioning

A

-hypotension
-history of orthostatic hypotension
-vasoactive medications

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24
Q

Number of Postural Drainage Positions

A

12 total
-5: upper lobes
-2: middle/lingular lobes
-5: lower lobes

**the longer they can remain in the position the better

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25
Postural Drainage: Anterior Upper Segments of Upper Lobes
Seated- Angled 30-45 degrees backwards in reclined position
26
Percussion and Auscultation Placement: Anterior Upper Segments of Upper Lobes
Over the traps between the clavicle anteriorly while angled 30-45 degrees backward in reclined seating
27
Percussion and Auscultation Placement: Posterior Apical Segment of upper lobes
Over traps muscle on top of shoulder (somewhat posteriorly on the back of the shoulder) while sitting upright in bed while leaning forward
28
Postural Drainage: Posterior Apical Segment of upper lobes
Sitting upright in bed or chair while leaning forward
29
Percussion and Auscultation Placement: Anterior segments of Upper lobes
Over pectoralis muscle in supine
30
Postural Drainage: Anterior segments of Upper lobes
Supine (flat) with head turned away from you
31
Percussion and auscultation: Right/Left posterior segment of upper lobe
Over right/left scapula- depending on the side that has secretions -right: prone with pillow under right shoulder -left: prone with pillow under left shoulder and HOB elevated
32
Postural Drainage: Right posterior segment of upper lobe
Prone with pillow under right shoulder (creating a 1/4 turn)
33
Postural Drainage: Left posterior segment of upper lobe
HOB elevated, patient is prone with pillow under left shoulder (creating a 1/4 turn)
34
Percussion and Vibration: Right/left middle lobe
On thoracic wall over the anterior portion from nipple to mid-axillary line (between armpit and nipple) -right: left side lying with right shoulder rotated back towards bed and pillow under right shoulder- feet elevated 12 inches -left: right side lying with left shoulder rotated back towards bed and pillow under left shoulder- feet elevated 12 inches
35
Postural Drainage: right middle lobe
Raise feet 12 inches, pt is lying on mostly left side with right shoulder rotated back towards bed with pillow under right shoulder
36
Postural Drainage: left middle lobe
Raises feet 12 inches, patient lying mostly on right side with left shoulder rotated back towards bed with pillow under left shoulder
37
Percussion and Auscultation: bilateral anterior segments of lower lobes
Over thoracic wall on anterior surface just above inferior border of ribcage- supine with feet of bed raised 18 inches
38
Postural Drainage: bilateral anterior segments of lower lobes
Raise feet of bed 18 inches, patient lies supine
39
Why would you take BP in a non-traditional way?
-amputee -lymphedema -dialysis port -mastectomy -fistula
40
Apical Pulse
Place subject supine, use index finger to find the 5th intercostal space near the sternum- use stethoscope to listen to heartbeat
41
Respiratory Rate
counting number of breaths for 60 seconds- normal: 12-20 **can pretend to hold their wrist against their chest and feel their radial pulse while secretly feeling number of breaths
42
Chest Expansion Measurement
Upper chest: tape measure placed circumferentially around inferior axillas - normal chest excursion is about 1 inch Lower chest: tape measure placed circumferentially around T10 - normal excursion is 2 inches **measure expansion from complete expiration to full inspiration
43
Signs of right sided heart failure
-jugular distension -pitting edema -two pillow orthopnea
44
What things to look at when walking into a patient's room
-facial characteristics: nasal flaring, sweating, paleness, enlarged pupils -skin tone: cyanosis -LOC -posture: scoliosis or kyphosis limits vital capacity, tripod positioning indicates signs of pulmonary disease -body type: obesity -appearance of extremities: cyanosis of nail beds, blue or purple calves
45
Auscultation of Heart
Using a stethoscope to listen to heartbeat S1: lub- closing of tricuspid and mitral valves -tricuspid: L sternal border at 4th intercostal space using the diaphragm -mitral valve: L midclavicular line at 5th intercostal space using the diaphragm S2: dub- closing of pulmonary and aortic valves -pulmonary: 2nd intercostal space at left sternal border using diaphragm -aortic: 2nd intercostal space at right sternal border using diaphragm S3: abnormal- indicative of CHF -midclavicular line at 5th intercostal space using bell S4: abnormal -midclavicular line at 5th intercostal space using bell
46
Chest PT consists of what?
-percussion -vibration -postural drainage
47
Paced Breathing
Used to help patients with dyspnea to control their breathing -rhythmic: coordinates breathing with rhythm of activities (running) -nonrhythmic: inspiration during relaxation and expiration during exertion of exercise
48
Inspiratory hold
Prolonged holding of breath for 2-3 seconds at maximum inspiration with a relaxed exhale -aides in airway clearance and used for poorly ventilated regions of the lungs
49
Diaphragmatic controlled breathing
Place patient supine with towel roll under ischial tubes for a posterior pelvic tilt, instruct patient to "sniff" to engage diaphragm -sniff 3 times with hands on abdomen, then 2 sniffs, then 1 sniff
50
Inspiratory muscle training
Apply outward force around ribcage to resist breathing in order to strengthen diaphragm -used for patients with decreased strength/endurance of diaphragm or intercostals
51
Incentive Spirometer
A tool to practice diaphragmatic breathing and stimulate cough- typically post-op -helps to strengthen weak abdominals and weak cough Steps: -sit upright at edge of bed -place lips tight around mouthpiece -breathe in slowly and as deeply as possible -exhale slowly
52
Manual cough techniques
-prone on elbows -splinting -long sitting -short sitting **looking up towards the ceiling and coughing while throwing head forward
53
Assisted cough techniques
-controlled cough -huff cough -costophrenic assist -heimlich-type assist -anterior chest compression assist
54
controlled cough
-take 3 breaths -1st and 2nd breaths are normal -on the 3rd breath cough firmly- can assist by hugging a towel roll or pillow
55
Huff breath
-take a deep breath in -do not close glottis -breathe out in rapid exhalations as if trying to fog up a mirror
56
Costophrenic assist
With patient in supine with PT's hands on costophrenic angles of rib cage. After the patient inhales, the patient is instructed to cough and the PT applies an inward and inferior force to enhance their exhaled airflow **used for patients who are too weak to generate an effective cough
57
Heimlich-type assist
With patient in supine, PT places heel of hand around the level of the navel. Patient takes several breaths, then they take a deep breath in and instruct patient to cough while the PT pushes up and in under the diaphragm with their hand **used for flaccid patients, and/or those who are very weak and other techniques have not worked
58
Anterior chest compression assist
With patient in supine, PT places one forearm on upper chest and other forearm on the abdomen. Instruct patient to start with several breaths and then have them cough while the PT applies a diagonal compression by bringing forearms together **used for patients who have very weak chest wall muscles- more effective than costophrenic assist because of the added compression to the upper anterior chest wall
59
Indications for airway clearance
-impaired mucociliary transport -excessive pulmonary secretions -absent/ineffective cough
60
Goals of airway clearance
-to mobilize secretions -optimize airway patency -promote alveolar expansion and ventilation -increase gas exchange
61
Active cycle of breathing
Used for airway clearance Steps: -breathing control: quiet breathing with hand on stomach -3-4 diaphragmatic breaths: hands on ribcage -breathing control -3-4 diaphragmatic breaths -breathing control -forced expiratory technique: several huffs, medium breaths, deep breaths, forced cough -breathing control
62
Percussion and Vibration: Right lateral segments of lower lobes
feet of bed raised 18 inches, side lying on left side- over right thoracic wall at the inferior border of the inferior thorax
63
Postural Drainage: Right lateral segments of lower lobes
feet of bed raised 18 inches, side lying on left side
64
Percussion and Vibration: Left lateral segments of lower lobes
Feet of bed raised 18 inches, side lying on right side- over left thoracic wall at the inferior border of the inferior thorax
65
Postural Drainage: Left lateral segments of lower lobes
feet of bed raised 18 inches, side lying on right side
66
Percussion and vibration: posterior segments of lower lobes
Feet of bed raised 18 inches, prone- over posterior thoracic wall at the inferior border of the ribcage
67
Postural drainage: posterior segments of lower lobes
Feet of bed raised 18 inches while patient is prone
68
Percussion and vibration: superior segments of lower lobes
Bed is flat, patient prone- at the inferior angle of the scapula
69
How do you know if Chest PT was effective?
-change in sputum production -changes in lung sounds -change in subjective response -change in vitals -change in chest x-ray
70
Breathing Techniques
-pursed lip breathing -paced breathing -inspiratory hold -diaphragmatic breathing -thoracic mobilization -inspiratory muscle training
71
Thoracic mobilization
Improves anterior chest wall mobility which will allow for improved breathing -patients lies vertically across a foam roll -can elevate UE to further stretch the affected areas

Cardiopulmonary Practical (1 decks)

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