PT Interventions 2

Question 1

What is the active cycle of breathing (ACB) technique developed for?

Answer 1

To assist secretion clearance in patients with asthma

Question 2

What are the components of ACB?

Answer 2

• Breathing control
• Thoracic expansion
• Forced expiratory technique

Question 3

ACB: breathing control

Answer 3

Gentle, relaxed breathing

Done for 5-10 seconds

Question 4

ACB: thoracic expansion exercise

Answer 4

3-4 deep, slow, relaxed inhalations to inspiratory reserve with passive exhalation

Chest percussion, vibration, or shaking may be combined with exhalation

Question 5

ACB forced expiratory technique

Answer 5

1-2 huffs at mid to low lung volumes with the glottis open into the ERV

Brisk adduction of upper arms may be added to self-compress the thorax

Question 6

ACB: precautions/contraindications

Answer 6

• Splinting postop incisions to achieve adequate expiratory force
• Bronchospasm or hyperreactive airways

Question 7

How does AD work?

Answer 7

Uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing

Question 8

Autogenic drainage is to improve airflow here

Answer 8

In small airways to facilitate movement of mucus

Question 9

What are the 3 phases of autogenic drainage (AD)?

Answer 9

1. Unsticking phase
2. Collecting phase
3. Evacuation phase

Question 10

Autogenic drainage: unsticking phase

Answer 10

• slowly breathe in through nose followed by 2-3 second breath-hold (allows collateral ventilation to get air behind the secretions)
• exhale down into ERV

Question 11

Autogenic drainage: collecting phase

Answer 11

breathe at tidal volume interspersed by 2-3 second breath holds

Question 12

Autogenic drainage: evacuating phase

Answer 12

deeper inhalation’s from low-mid IRV with breath holding followed by a huff

Question 13

Autogenic drainage: What may be used to control expiratory flow rate?

Answer 13

Exhalation through pursed lips

Question 14

Autogenic drainage: average tx time

Answer 14

30-45 mins

Question 15

Autogenic drainage: considerations

Answer 15

Requires motivation and concentration to learn

Question 16

Directed coughing attempts to compensate for:

Answer 16

The patient’s physical limitations - to elicit a max forced exhalation

Question 17

What is huffing?

Answer 17

Forced expiratory maneuver performed with glottis open (similar to fogging a pair of glasses)

Question 18

How is huffing performed?

Answer 18

Contract abdominal muscles during rapid exhalation with open glottis

Say ha, ha, ha

Question 19

Who should not perform huffing?

Answer 19

• Elevated ICP or known intracranial aneurysm
• Acute MI
• Acute head, neck, or spine injury
• Acute abdominal pathology
• Untreated pneumothorax
• Osteoporosis
• Flail chest

Question 20

Huffing: safety considerations

Answer 20

• Increased risk of droplet transmission

- Potential for regurgitation/aspiration

Question 21

High frequency airway oscillation devices

What do they do?

Answer 21

Acappella
Flutter

Combine positive expiratory pressure and high frequency airway vibrations to mobilize secretions in the airways

Question 22

What is postural drainage and how does it work?

Answer 22

• Positioning the pt so that gravity will help drain bronchial secretions from specific lung segments toward central airways
• Can be removed by cough or mechanical aspiration

Question 23

How long should a percussion tx last?

Answer 23

Several minutes

Question 24

When should chest vibrations be performed?

Answer 24

During exhalation

Question 25

How long should postural drainage positions be held?

Answer 25

2-3 minutes

Question 26

Contraindications for postural drainage: ICP

Answer 26

ICP less than 20 mm Hg

Question 27

Contraindications for postural drainage:

Answer 27

- Head and neck injury until stabilized - Active hemorrhage - Recent spinal surgery or acute spinal injury - Active HEMOPTYSIS - Empyema - Pulmonary edema associated with CHF - Large pleural effusion - PULMONARY EMBOLISM - Confusion/anxiety - Rib fx, with or without flail chest - Surgical wound or healing tissue

Question 28

Trendelenburg position is CONTRAINDICATED for:

Answer 28

- Uncontrolled HTN - Distended abdomen - Esophageal surgery - Recent hemoptysis related to lung carcinoma (treated surgical or with radiation) - Uncontrolled airway at risk for aspiration (e.g. tube feeding or RECENT MEAL)

Question 29

Which segments? Pt in a sitting position, leaning back 30-40˚ Percussion and vibration performed above clavicles

Answer 29

Apical segments R and L upper lobes

Question 30

Which segments? Pt turned ¼ from prone on the L side with bed horizontal and head/shoulders raised on pillow. Vibration and percussion performed around medial border of R scapula

Answer 30

Posterior segment of R upper lobe

Question 31

Which segments? Patient turned ¼ from prone on R side with head of bed elevated 45˚ and head/shoulders raised on pillow. Percussion and vibration performed around the medial border of L scapula

Answer 31

Posterior segment L upper lobe

Question 32

Which segments? Pt turned ¼ from supine on R side with foot of bed elevated 12 inches. Percussion and vibration are performed over the L chest between the axilla and the left nipple

Answer 32

Lingula and L upper lobe

Question 33

Which segments? Patient in supine with bed horizontal Percussion and vibration performed below clavicles

Answer 33

Anterior segments of R and L upper lobes

Question 34

Which segments? Pt turned ¼ from supine on L side with foot of bed elevated 12 inches Percussion and vibration over R chest between axilla and R nipple

Answer 34

R middle lobe

Question 35

Which segments? Prone with bed horizontal Percussion and vibration below the inferior border of scapulae

Answer 35

Superior segments L and R lower lobes

Question 36

Which segments? Pt supine with foot of bed elevated 18 inches. Percussion and vibration over lower ribs on L and R side

Answer 36

Anterior basal segments R and L lower lobes

Question 37

Which segments? Pt prone with foot of bed elevated 18 inches Percussion and vibration over lower ribs on L and R side of chest

Answer 37

Posterior basal segments R and L lower lobes

Question 38

Which segments? Pt in sidelying with foot of bed elevated 18 inches. Percussion/vibration over lower ribs

Answer 38

Lateral basal segments lower lobes