PT Interventions for the Pulmonary System Flashcards
(299 cards)
1
Q
generally a person’s SpO2 goal will be bw ______%
A
90-92%
2
Q
for someone with COPD, what might their SpO2 goal be?
A
88%
3
Q
if the appropriate prescription is written, can the PT titrate O2 up/down?
A
yup
4
Q
t/f: in the event of an energy that warrants administration of supplemental O2, the PT may provide supplemental O2, but the physician should be notified and an order should be written following the event
A
true
5
Q
at the end of a PT session, what needs to be checked on the O2 before leaving?
A
we need to return supplemental O2 to their prior level and flow rate if changed
if the pt can’t maintain their prescribed SpO2 at previous levels, inform the provider
6
Q
if a pt’s SpO2 drops below 90% what should we do?
A
stop and do coughing techniques, pursed lip breathing, positional change, or deep breathing and recheck SpO2
7
Q
after doing breathing/coughing techniques if you reassess O2 and it is still below 90%, what should you do if they are not on O2?
A
consult the MD for revised O2
8
Q
after doing breathing/coughing techniques if you reassess O2 and it is still below 90%, what should you do if they are on O2 and you have an MD order to titrate?
A
adjust the flow as needed and/or change the delivery method
9
Q
after doing breathing/coughing techniques if you reassess O2 and it is still below 90%, what should you do if they are not on O2 and you can’t contact the MD?
A
decrease activity level
10
Q
a pt’s SpO2 drops below 90% so you stop and do breathing/ coughing techniques. You reassess and O2 is still below 90%. They are on O2 and you can’t contact the MD so you decrease activity and check their SpO2 again. Their SpO2 is still below 90%, what should you do?
A
stop activity and discuss with the MD
11
Q
your pt’s SpO2 drops below 90% so you stop and do breathing/coughing exercises and reassess their O2 and it’s above 90%, what do you do?
A
monitor and continue the POC
12
Q
your pt drops below 90% so you do coughing/breathing exercises and they are still below 90%. You decrease the activity level and reassess O2 and it is above 90%, what do you do?
A
monitor and continue the POC
13
Q
when adjusting O2, go up by ___ liters/min at a time and wait for a response
A
1
14
Q
t/f: at any point b4 turning up the O2, try breathing/coughing exercises
A
true
15
Q
what is a precaution with oxygen usage?
A
can be negative in pts w/chronically elevated CO2 levels (COPD)
16
Q
why do we have to be careful titrating O2 with someone who has chronically elevated CO2 (like COPD)?
A
bc increased O2 can decrease their RR and/or depth of respiration
17
Q
what are some signs that O2 may be too high?
A
if the pt is lethargic, disoriented, or drowsy after increasing their O2 titration
18
Q
generally, if the O2 tank is less than __%, we should refill it before activity
A
30
19
Q
what things do we need to consider with O2 before activity?
A
is the O2 delivery device appropriate?
is there adequate O2 in the tank?
can the delivery be escalated if necessary?
20
Q
what is the most common pt population for pulmonary rehab?
A
chronic lung disease w/fxnal limitations (COPD)
21
Q
other than pts with COPD, what other pts may be good candidates for pulmonary rehab?
A
pts with interstitial lung disease or pulmonary HTN
22
Q
t/f: there is a lack of research for pulmonary rehab for secondary pulmonary diseases like pulmonary fibrosis from chemo
A
true
23
Q
what is the goal of pulmonary rehab?
A
focus on fxnal capacity and health related QOL, NOT improvement of the disease processes or lung fxn measures
24
Q
t/f: the goal of pulmonary rehab is to improve PFTs for pts
A
false
25
what are the key measurement domains for pulmonary rehab?
exercise capacity
clinical symptoms
health-related behaviors
psychosocial status
26
what is the traditional setting for pulmonary rehab?
outpatient is the most common, but can also be inpatient or home care
27
what is a common barrier to pts getting pulmonary rehab?
it is often outpatient, and these pts have a hard time getting out to go to therapy
28
what is the typical timeline for pulmonary rehab?
6-12 weeks 2-3x/week
29
who may or may not be on the pulmonary rehab team?
PT, OT, behavioral health, social work, pharmacy, nutrition
30
who is always involved in pulmonary rehab?
medical director, respiratory therapist, pt and family, and program director
31
what are the components of pulmonary rehab?
pt assessment and individualized goal setting
exercise and fxnal training
self-management education
nutritional intervention
psychosocial management
32
what is the gold standard for testing exercise and fxnal level?
6MWT
33
what are examples of education topics for pts in pulmonary rehab?
normal A&P
pathophys of chronic lung diseases
description and interpretation of medical tests
breathing retraining
airway clearance
meds
respiratory devices
benefits of exercise
ADLs
diet and nutrition
irritant avoidance
exacerbation and infection prevention
coping skills
advance directive planning
palliative care
leisure activity
travel
34
ideally, in a perfect world, what would be involved in a PT management eval for pulmonary rehab?
chart review
pt interview
physical exam
nutritional assessment
chest evaluation
MSK and integ exam
fxnal eval
35
what would be included in a nutritional assessment?
weight
height
BMI
recent weight changes
36
what would be included in a chest evaluation?
auscultation of heart and lungs
cough assessment
inspection of breathing pattern
37
what would be included in a MSK and integ exam?
jt ROM
gross strength of extremities and trunk
posture
gait
skin inspection
edema inspection
38
what would be included in a fxnal eval?
ADLs/IADLs
balance and gait
prior LOF
need for adaptive equipment
fall risk
leisure (social and fam activity)
39
what is the order of PT interventions for pulmonary rehab?
1) airway clearance
2) fxnal training (energy conservation, relief of dyspnea, breathing retraining)
3) physical endurance (endurance training, strength training, flexibility, respiratory muscles training)
40
what are the 3 different reasons for positioning?
1) positioning for dyspnea relief
2) positioning to maximize ventilation/perfusion matching
3) paired positioning and breathing techniques
41
what are the different positions for dyspnea relief?
w/arms supported (or in closed chain)
tripoding
leaning against a wall
42
what does positioning with arms supported (or in closed chain) do for dyspnea relief?
the accessory muscles can act on the rib cage and thorax, allowing more expansion for inspiration
43
what does tripoding do for dyspnea relief?
intraabdominal pressure rises and pushes the diaphragm up in a lengthened position
44
what does positioning changes do for dyspnea relief?
creates a better length-tension relationship by fixing the UE so the other end of the muscles can work in moving the rib cage for more efficient muscle use
45
what does the Q in VQ matching mean?
perfusion
46
what does the V in VQ matching mean?
ventilation
47
what is perfusion?
the amount of blood flow
48
what is ventilation?
air flow in and out of an area
49
t/f: perfusion and ventilation are unequal thought the lungs and changes with position
true
50
t/f: generally blood flow follows gravity with perfusion
true
51
what area of the lungs gets the most perfusion?
the lowest (dependent) parts
52
in sitting/standing, where is the most perfusion in the lungs?
at the bases of the lungs
53
in supine, where is the most perfusion in the lungs?
to the posterior lungs
54
in S/L, where is the most perfusion in the lungs?
on the side of the lungs you are lying on
55
when there is lower interpleural pressure, is there increased or decreased volume at the end of expiration?
increased
56
when there is an increased volume at the end of expiration, is there higher or lower potential to expand (compliance)?
lower
57
when there is lower potential to expand (compliance) is there higher or lower ventilation?
lower
58
t/f: dependent areas tend to have greater compliance and greater ventilation
true
59
t/f: ventilation is altered by mechanical ventilation
true
60
in sitting, where in the lungs is there more potential to open (compliance)?
at the bases of the lungs bc they are more compressed
61
bc the top of the lungs are not very compressed in sitting/standing, is there more or less potential to open (compliance)?
less
62
if the base of the lungs are compressed 50%, they can open __%
50
63
if the top of the lungs are compressed 10%, they can open __%
10
64
best oxygenation is achieved where the V/Q ratio is ...
1:1
65
if there is low V, but high Q, what happens?
there is decreased O2 to deoxy blood
there is decreased CO2 elimination
66
if there is high V, but low Q, what happens?
limited ability to increase overall PaO2 bc available hemoglobin saturates quickly
67
t/f: ventilation/perfusion goes up when you go down the lungs in sitting/standing
true
68
where is there optimal VQ in upright positioning in the lungs?
at about rib 4/5
69
when the FRV is increased, is there more or less alveolar collapse?
less
70
in upright position, VQ is highest where and decreases moving where?
highest at the bases
decreased moving cephalically
71
t/f: with larger lung volumes there is improved diaphragm excursion
true
72
what is the best position to optimize VQ most times?
in upright positions
73
in supine the FRV is ____ which leads to ___ airway collapse
decreased, increased
74
t/f: lower FRV leads to more airway collapse
true
75
t/f: dependent airway collapse leads to VQ mismatch
true
76
what happens to VQ matching in supine?
there is reduced lung volume leading to lower FRV and more airway collapse
increased resistance to the diaphragm from abdominal contents
dependent airway collapse=VQ mismatch
narrowing of airways
secretion pooling
compressed bronchioles leads to thickened mucus
77
VQ is highest where is SL?
in the dependent lung
78
in unilateral lung disease, how do we position a pt in SL?
with the "good" lung down
79
in SL which lung do we want on the bottom to maximize VQ?
the good lung
80
why do we want the "bad" lung on top in SL?
bc gravity can drain the secretions
81
besides VQ matching, what is an advantage of SL?
it offloads a lot of boney prominences
82
why would we put someone in prone for VQ matching?
for pts on mechanical ventilators
less lung mass anteriorly means that there is less lung collapse in prone than in supine
more even VQ distribution
83
what conditions would we put someone in prone for?
mechanical ventilated pts
ARDS
COVID-19
84
why would we put a pt in Trendelenburg positioning for VQ matching?
bc it is optimal for facilitating secretion drainage from the lower lobes of the lungs
85
t/f: trendelenburg positioning may alleviate dyspnea in pts with COPD
true
86
what are some contraindications for Trendelenburg positioning?
CHF
cardiomyopathy
acute brain injury
87
why is Trendelenburg positioning good for VQ matching?
bc it allows gravity to pull the abdominals up to help the diaphragm have more room to expand for ventilation
88
t/f: most people tolerate Trendelenburg positioning well
false, most pts can't tolerate it
89
when are therapeutic positioning techniques and paired breathing strategies indicated?
for pts who have weakness or inhibition of the diaphragm
90
t/f: therapeutic positioning techniques should taught at rest and then incorporated into fxnal mobility activities
true
91
what pts may be good candidates for therapeutic positioning techniques?
SCI, phrenic nerve injuries, post-abdominal surgery, or pts on mechanical ventilation for a long time
92
at rest, ___pelvic tilt will encourage a diaphragmatic breathing pattern
posterior
93
how does posterior pelvic tilt encourage diaphragmatic breathing?
by closing the anterior chest and putting the diaphragm on stretch for better length-tension relationship
94
what is the therapeutic positioning and paired breathing for inspiration?
shoulder flexion
abduction
ER
upward eye gaze
95
what is the therapeutic positioning and paired breathing for expiration?
shoulder extension
adduction
IR
downward eye gaze
96
how do we use paired breathing in bed mobility?
exhale while rolling (flexion bias)
inhale while coming to sit w/trunk extension (ext bias)
97
how do we use paired breathing for sit to stands?
exhale during hip/trunk flexion
inhale during hip/trunk extension
98
breathing exercises are primarily used to address what?
ventilation
99
t/f: breathing exercises may also address airway clearance as a consequence of improving ventilation
true
100
pursed lip breathing is used for what?
dyspnea relief
101
what are the indications for pursed lip breathing?
increased RR, dyspnea, and wheezing
102
what are the goals of pursed lip breathing?
relief of dyspnea, reduced RR, improved activity tolerance, reduced wheezing
103
what breathing exercise helps splint airways open for expiration?
pursed lip breathing
104
t/f: pursed lip breathing helps prolong expiration
true
105
how long should expiration be compared to inspiration?
expiration should be twice as long as inspiration
106
what is the technique for pursed lip breathing?
instruct the pt to breathe in for 2 counts and breathe out as if through a straw for 4 counts
107
what is diaphragmatic breathing?
breathing technique that facilitates outward motion of the abdominal wall while reducing upper ribs cage motion during inspiration
108
what are the indications for diaphragmatic breathing?
hypoxemia, tachypnea (upper chest breathing), atelectasis, anxiety, excess secretions
109
what are the goals for diaphragmatic breathing?
eupnea, improved SpO2, reduction of atelectasis, anxiety, excess secretions
110
t/f: diaphragmatic breathing should be taught in multiple positions
true
111
why should diaphragmatic breathing be taught in multiple positions?
bc there is not necessarily carryover from one position to another
112
how should we progress positions for teaching diaphragmatic breathing?
start in supine, progress to sitting, standing, and then ambulation
113
what are the facilitation techniques for diaphragmatic breathing from least to most reliance on the therapist?
posterior pelvic tilt
tactile cues using own hands or therapist's hands on their stomach or objects like a weight
upper chest relaxation (contract-relax techniques)
sniffing technique
scoop technique
114
t/f: if you do too many breathing exercises in a row it can lead to hyperventilation
true
115
what is the sniff technique for diaphragmatic breathing?
position the pt in a gravity eliminated position (SL or semi fowlers) and in posterior pelvic tilt
instruct the pt to sniff 3x
give verbal feedback to breathe through the diaphragm
instruct the pt to sniff deeply 2x but longer this time
progress to a single sniff
continue to provide cuing to sniff more slowly, quietly, and with less effort
116
what is the scoop technique for diaphragmatic breathing?
position the pt in gravity eliminated position and posterior pelvic tilt
place your hand on the pt's abdomen and feel their normal breathing
during expiration, follow the diaphragm up and under the ribs
during the next inspiration, instruct the pt to breathe into your hand
117
what is the technique for upper chest inhibition for diaphragmatic breathing?
perform diaphragmatic scoop technique
place your other forearm gently over their upper chest at the level of the sternal angle
for the first few breaths allow the forearm to move w/the chest while performing diaphragm scoop
during the next inspiration, have the forearm stable, applying gentle pressure to prohibit upper chest mov't
118
when is upper chest inhibition used for diaphragmatic breathing?
after all other diaphragmatic activation techniques have been tried and failed
119
t/f: upper chest inhibition may help a pt recruit the diaphragm during inhalation
true
120
what are the indications for upper chest inhibition?
excessive accessory muscles use in inspiration
121
what is the goal of upper chest inhibition?
to reduce accessory muscle use
122
what are the indications for lateral costal expansion?
asymmetric chest wall expansion, localized lung consolidation/secretions, asymmetric posture
123
what are the goals of lateral costal expansion?
symmetric chest wall expansion, mobilization of secretions, corrected posture
124
t/f: lateral costal expansion can be unilateral or bilateral technique
true
125
what is the unilateral technique for lateral costal expansion?
have the pt in SL on the unaffected side
abduct the pt's arm over the head
at the end of expiration, the therapist provides a quick stretch to initiate inspiration (shouldn't be resistance to wall expansion)
therapist provides firm pressure throughout inspiration
126
what is the BL technique for lateral costal expansion?
pt in semi-fowlers or sitting
therapist on either side of the rib cage and breathe into the hands
at the end of expiration give sharp brief stretch
127
what are the indications for segmental breathing?
localized chest wall expansion, localized lung consolidation/secretions, asymmetric posture
128
what are the goals of segmental breathing?
symmetric wall expansion, mobilization of secretions, corrected posture
129
what is the technique for segmental breathing?
place your hand over the area of the lungs that demonstrates less mov't or has decreased ventilation and instruct the pt to breathe into the hand
130
when is segmental breathing used?
when there is pathology in a particular lung segment
131
what are the indications for inspiratory/breath hold technique?
hypoventilation, ineffective cough, atelectasis
132
what are the goals for inspiratory/breath hold techniques?
improved VQ matching, resolution of atelectasis, improved cough effectiveness
133
what is the technique for inspiratory/breath hold techniques?
pt is instructed to take as deep a breath as possible and then hold at max inspiration for 2-3 seconds followed by passive expiration
134
what are the indications for stacked breathing?
hypoventilation, atelectasis, ineffective cough, pain, uncoordinated breathing pattern
135
what are the goals of stacked breathing?
improved VQ matching, resolution of atelectasis, reduced pain, improved cough effectiveness
136
what is the technique for stacked breathing?
pt is instructed to take a deep breath and briefly hold
pt is then instructed to take another breathe in and briefly hold
pt continues taking breaths in until they can no longer inspire any more
end with passive expiration
breathe in until you can see that they can't breathe in anymore and then let it all go
137
what are the indications for incentive spirometry?
hypoventilation, atelectasis, ineffective cough
138
what are the goals for incentive spirometry?
improve ventilation, reverse atelectasis, stimulate cough, diaphragmatic breathing
139
what is a typical population that will use incentive spirometry?
post-op pts
140
what is the technique for incentive spirometry?
instruct pt to take a long, slow breath in through the mouthpiece
breathe in as deeply as they can while maintaining the bead in the middle position
therapist can set a desired lung volume or can instruct the pt to attempt to beat their own last breath
141
typical instructions for incentive spirometry are to complete __ breaths in one hour
10
142
what is the definition of paced breathing?
volitional coordination of breathing during activity
143
what are the indications for paced breathing?
low endurance for household mobility or ADLs, dyspnea on exertion, fatigue, anxiety, tachypnea
144
what are the goals of paced breathing?
increased activity tolerance, reduce dyspnea, reduce fatigue, lower anxiety, eupnea
145
t/f: paced breathing is for diaphragmatic weakness
false, that is paired breathing
146
what is the technique for paced breathing for rhythmic activities like ambulation and stairs?
use rhythm of the activity to time breathing
breathe in for 2 steps breathe out for 4 steps
147
what is the technique paced breathing for non-rhythmic activities like STSs and bed mobility?
breathe in to prep for the activity, breathe out during the movt
147
t/f: paced breathing can be helpful for painful trunk incisions
true
148
t/f: paced breathing can be combined with diaphragmatic breathing or pursed lip breathing
true
149
what are airway clearance techniques?
manual or mechanical procedures that facilitate mobilizations of secretions from airways
150
what are the indications for airway clearance techniques?
impaired mucociliary transport
excessive pulmonary secretions
ineffective or absent cough
(overall impaired airway clearance)
151
what things would let us know that airway clearance is impaired?
wet cough, crackles on auscultation, egophany, frematus on palpation
152
you should select optimal airway clearance techniques based on what?
pathophysiology and symptoms
stability of medical status
pt's adherence to the techniques
153
should we facilitate secretions from proximal or peripheral first?
from peripheral to move them closer
154
what are the goals of airway clearance?
optimize airway patency
increased VQ matching (clears secretions that block O2 exchange)
promote alveolar expansion
increased gas exchange
155
what are simple forms of airway clearance?
deep breathing, coughing techniques, and mobility
156
what are the 4 stages of an effective cough?
1) an inspiration greater than tidal volume (>60% VC) w/trunk ext
2) closure of the glottis
3) contraction of abdominals and intercostals muscles, producing positive intra-thoracic pressure
4) sudden opening of the glottis and forceful expiration of air w/trunk flexion
157
what is the only stage of an effective cough that we as PTs can't influence?
2) closure of the glottis
158
what are some things that tell us the pt is having problems with glottis closure?
they can't hold in a deep breath
159
what is the 1st line of intervention to promote effective cough?
positioning and teaching proper coughing technique
160
how can we maximize inspiration for proper cough?
verbal cues, position, and arm mov't (extension with arms up and out)
161
how can we maximize intrathoracic and intraabdominal pressures?
with contractions/mov't (breath hold, stacked breathing)
162
how can we orient the pt to respective timing?
using trunk mo'vt for expulsion
163
how should we teach post op pts to cough?
with a pillow to splint
164
why do we teach post op pts to splint while coughing?
bc it is painful for them
165
what is huff coughing?
forced expiration technique (FET)
alternative to coughing
166
what pts would benefit from huff coughing?
pts with pain from incision
fatigue from frequent coughing
167
what are the benefits from huff coughing?
less painful and fatiguing
helps stabilize collapsible bronchiole walls
breath hold helps separate mucus from airway walls and gets air behind the mucus
168
what is the technique for huff coughing?
sit upright and take a breath in then pause holding the breath
forcefully exhaled the breath w/mouth opened
like fogging up a mirror
start with medium depth inspiration and gradually increase size of inspiration
169
shallow to medium breaths affect ___ airways
peripheral
170
deep breaths affect ____ airways
proximal
171
what are the characteristics of effective huffing?
mouth open in an o shape
forced expiration
mid volume moves peripheral secretions
high volume moves proximal secretions
muscles of chest/abdomen contract
sounds like forced sigh
crackles heard if excessive secretions are present
172
what are the characteristics of ineffective cough?
mouth half/almost closed
always using high volume inspiration
abdominal muscles not used
sounds more like hissing/blowing
mouth in "e" shape
too vigorous/long (irritating on the airways)
too gentle
too short
"catching/grunting" at the back of the throat
173
what is manually assisted coughing?
174
who would use manually assisted coughing?
pts with neuromuscular impairments that cause muscle weakness leading to an ineffective cough (SCI, ALS, vent)
175
t/f: in manually assisted coughing, the pt plays an active role
true
176
what is manually assisted coughing technique?
instruct the pt to take deep breaths and deliver manual assistance as they cough
with hands on other side of the belly button, push into the abdomen
177
what is the goal of manually assisted coughing technique?
increased cough effectiveness
178
who do we use counter rotation for?
young children, pts with high tone, pts with cognitive impairments
179
what is counter rotation technique?
performed in SL using PNF techniques to facilitate inspiration/expiration w/rotary mov't
after facilitating a full inspiration, compression of the thorax is applied in all planes to aid the cough
180
what are mechanical aids for coughing?
devices and techniques that apply manual or mechanical forces to the body or intermittent pressure changes to the airways to assist w/coughing
mechanical cough delivers deep insufflations followed by deep exsufflations
may add abdominal thrust
181
mechanical cough delivers deep ____ followed by deep _____
insufflations, exsufflations
182
what are some considerations for airway clearance techniques?
should be performed at least 30 minutes minutes prior to or after a meal or tube feeding
optimize pain control prior
consider use of inhaled bronchodilators prior to intervention
monitor vital signs throughout
monitor pt tolerance and response
183
what is chest PT?
percussion and vibration
184
what is the goal of chest PT?
to loosen retained secretions when there is impaired mucociliary transport
185
t/f: chest PT is used in combo w/other techniques so secretions can be cleared after they're loosened
true
186
what other techniques may be used in combo with chest PT?
active cycle breathing and postural drainage
187
what is the main combo of PT treatments for pts who can't actively participate?
chest PT and postural drainage
188
t/f: chest PT may produce temporary desaturation?
true
189
what are the indications for chest PT?
CF, bronchiectasis, respiratory muscles weakness, mechanical ventilation, ineffective cough, fremitus w/palpation, bronchial breath sounds, crackles on auscultation
190
what are the precautions for chest PT?
uncontrolled bronchospasms
osteoporosis
rib fx
metastatic CA to the ribs
tumor airway obstruction
PE
subcutaneous emphysema
recent skin grafts or flaps on the thorax
191
what is percussion?
manual: rhythmic clapping w/cupped hands
mechanical: electrical/pneumatically powered device used to reduce caregiver fatigue or allow self treatment
192
where should percussion be applied?
to the affected lung segments
193
how long should we do percussion on the affected area of the lungs?
3-5 minutes each segment
194
what should percussion sound like?
hollow sound under your cupped hands
195
what is involved in the preparation for percussion and vibration chest PT?
place pt in appropriate position
apply thin layer of fabric over the area
adjust the bed height for caregiver body mechanics
196
what is the technique for percussion?
cup your hands with the thumb and fingers adducted
should create a hollow thudding noise not a clapping noise
keep shoulders, arms, wrists relaxed
go at a rate of 100-480x/min
apply throughout inspiration/expiration
avoid boney prominences
avoid implanted medical devices
197
is percussion applied during inspiration or expiration?
both
198
what is vibration?
manual or mechanical
low amplitude, high frequency oscillation applied via therapists hands during expiration only to the affected lung segments
199
is vibration applied during inspiration or expiration?
expiration
200
where is vibration applied?
to the affected lung segments
201
what is the technique for vibration?
place hands on the affected area (side by side or one on top of the other)
instruct the pt to take deep inspiration and @ peak apply gentle but steady co-contraction of the UE throughout expiration
202
what is active cycle of breathing? (IMPORTANT)
specific cycles of 3 techniques used for airway clearance
203
what are the 3 techniques involved in active cycle breathing?
breathing control (diaphragm breathing)
thoracic expansion
forced expiratory technique (huff)
204
what is demonstrated to be as effective as airway clearance performed by a caregiver/therapist?
active cycle of breathing
205
what is breathing control in active cycle of breathing?
gentle tidal volume breathing with relaxed upper chest and shoulders
206
what is the purpose of breathing control in active cycle of breathing?
essential to prevent bronchospasms
207
what is thoracic expansion in active cycle of breathing?
active deep inspirations with passive expiration w/ or w/o percussion/vibration
208
what is the purpose of thoracic expansion in active cycle of breathing?
loosens secretions
209
what is the purpose of forced expiratory technique in active cycle of breathing?
progressively move secretions from peripheral to proximal airways for expectoration
210
what sized huffs should be used first and why?
medium sized huffs to move secretions from the periphery to proximal
211
what is the cycle in active cycle of breathing?
breathing control for 5-10 sec
3-4 thoracic expansion exercise
breathing control 5-10 sec
3-4 thoracic expiratory exercises
breathing control 5-10 sec
2 huffs of medium sized volume then start against until you can do 2 consecutive cycles with dry nonproductive coughs
212
what is the adaptation for hyperactive airways ion the active cycle of breathing?
prolonged breathing control times
213
what is the adaptation for tenacious (thicker) secretions?
do more cycles of thoracic expansion b4 FET
214
what is the adaptation for if we hear audible secretions moving from large airways in the active cycle of breathing?
change to deep volume huffs
215
what is postural drainage used for?
airway clearance
216
what is postural drainage?
assuming body positions that let gravity assist in draining secretions from each lung segment
217
with postural drainage, in each position the segmental bronchus of the area to be drained is arranged ___ to the floor
perpendicular
218
t/f: priority is given to treating the most affected lung segment 1st in postural drainage
true
219
with postural drainage, what should be encouraged bw positions as secretions mobilize?
deep breathing and coughing
220
when postural drainage is used in combo with percussion/vibration, how long should we work in each position?
3-5 minutes
221
when postural drainage is used alone, how long should we work in each position?
5-10 minutes
222
can postural drainage positions be modified if the optimal position is contraindicated?
yup!
223
what are the signs of intolerance in postural drainage?
SOB, anxiety, dizziness, nausea, HTN, bronchospasms
224
what are the precautions for postural drainage?
pulmonary edema
hemoptysis
massive obesity
large pleural effusion
massive ascites
225
what are relative contraindications for postural drainage?
increased intracranial pressure
hemodynamic instability
recent esophageal anastomosis
recent spinal fusion surgery
recent head trauma
diaphragmatic hernia
recent eye surgery
226
what is generally the last choice for airway clearance after the other techniques have been tried and failed?
airways suctioning
227
what is the goal of airway suctioning?
removal of secretions that the pt is unable to clear
228
what are the 2 types of suctioning?
oropharyngeal and tracheal
229
what are the 2 types of tracheal suctioning?
deep and inline
230
if a pt is hooked up to ventilator, what kind of tracheal suctioning would be used?
inline tracheal suctioning
231
if a pt is not hooked up to a ventilator, what kind of tracheal suctioning would be used
deep tracheal suctioning
232
what is the goal of oropharyngeal suctioning?
to remove secretions from the oral cavity and pharynx
233
what are the indications for oropharyngeal suctioning?
difficulty expectorating or swallowing
decreased consciousness
visible secretions obstructing airways
vomit in the mouth
noisy breath sounds
234
what is the device used in oropharyngeal suctioning?
a hard plastic device called a Yankauer suction catheter
235
what is the technique for oropharyngeal suctioning?
pt in semi-fowlers or sitting with a towel over their chest
hand hygiene
mask, goggles, face shield
check suction is working with saline in a clean basin
insert the catheter into a pts mouth and run it along the gumline and pharynx on both sides
rinse the catheter using saline form the clean basin
clean the pts face and reposition as needed
hand hygiene
236
what is tracheal suctioning used for?
pts with artificial airways that need airway clearance
237
what is an open tracheal suctioning?
a free cathert is placed into the airway each time, no longer attached to a mechanical ventilator but has an open trach
238
what is an inline (closed) tracheal suctioning?
suction catheter is kept connected to the vent, using the attachment attached to the vent for suctioning
239
what is the general technique for tracheal suctioning?
pt in fowlers or semi fowlers position
explain the procedure to the pt
pre-oxygenate the pt (100% FiO2 or manual bagging)
adjust suction setting to lowest effective (100-150 mmHg)
quickly and gently insert the catheter into ET tube w/applying suction
stop at the level of the carina (when resistance is first felt and withdraw 1 cm
apply suction covering the cath vent
withdraw the cath slowly while rotating to expose secretions to side holes
240
what are possible complications with tracheal suctioning?
hypoxia
cardiac dysrhythmias
infection
airway trauma
241
how do we prevent hypoxia from tracheal suctioning?
by providing pre-oxygenation (100% FiO2 or manual bagging)
by providing rest breaks bw reps
242
how do we prevent cardiac dysrhythmias from tracheal suctioning?
by providing pre-oxygenation
by limiting each suction attempt to 10-15 seconds
by providing rest breaks bw reps
243
how do we prevent infection from tracheal suctioning?
by using sterile techniques for open suctioning
244
how do we prevent airway trauma from tracheal suctioning?
by using gentle insertion techniques
by withdrawing 1cm prior to applying suction
245
what are PEP devices?
positive expiratory pressure devices that can be smooth flow or oscillatory
246
what is the theory behind PEP devices?
increased back pressure pushing out mucus plugs
stents airways open during expiration
utilizes collateral ventilation
may reinflate collapsed alveoli
may help air get behind secretions to move them peripherally
247
how do PEP devices with oscillations work?
they provide varied flow rates and accelerated expiratory flows
248
how is the resistance of an EG Acapella PEP oscillation device adjusted?
with a dial
249
is the EG Acapella PEP oscillation device position dependent?
nope
250
what resistance do we want with PEP devices?
moderate difficulty for the pt
251
how do flutter valve PEP devices with oscillations work?
the device is position dependent and can be angle up to increase pressure or angled down to decrease pressure
252
what are the downsides of the flutter valve PEP devices?
they are harder to objectify resistance with
cant be used in a positions bc they resistances are position dependent
253
how many breaths is standard to do with PEP devices?
5-10 breaths
254
what are high frequency chest wall oscillation devices?
inflatable vest connected to an air-pulse generator that create different air flow rates to move secretions from the periphery to proximal and decrease mucus viscocity
255
what is the purpose of high frequency chest wall oscillations devices?
to move secretions from the periphery more proximal
to decrease mucus viscocity
256
high frequency chest wall oscillation devices can be used in conjunction with what other treatment?
nebulizer
257
how long are the high frequency chest wall oscillation devices used?
10 minutes at a time
258
high frequency chest wall oscillation devices should progress from ____ to _____ to ____ frequency
low, medium, high
259
t/f: deep breathing and coughing should be encouraged bw frequencies with high frequency chest wall oscillation devices
true
260
what is manual hyperinflation?
an old technique for re-inflation of collapsed lung areas
261
what is the goal of manual hyperinflation?
to re-inflate collapsed areas of lung and mobilize secretions
262
t/f: there are many contraindications for manual hyperinflation
true
263
how many caregivers are required for manual hyperinflation?
2
264
what is the technique for manual hyperinflation?
the 1st caregiver uses a manual inflation bag to deliver as low, deep, inspiratory breath as possible
pause after the inspiration then a quick release for rapid exhalation
2nd caregiver applies vibration during the expiration
265
what is manual therapy used for?
to address MSK restrictions to breathing
266
what is the goal of manual therapy?
to improve ventilation by reducing restriction in soft tissue mobility or thoracic jt mobility
267
what are the techniques to mobilize the thorax?
towel roll/pillow placement to mechanically open upon the ant/lat chest wall
use of UE patterns to facilitate the opening of individual lung segments
counterrotation of the trunk
use of ventilatory mov't strategies to facilitate the opening of the entire thorax
special rib mobs to free up individual segments
myofascial release techniques to free up restricitve connective tissue around the thorax
soft tissue release techniques to lengthen individual tight muscles
268
what manual therapy techniques can we use for anterior chest restrictions?
position the pt in supine and have the pt roll onto a towel roll vertically along their spine
encourage deep breathing, focusing on the area of restriction
to progress, add active/passive UE mov't
269
if someone is REALLY tight in the anterior chest, what adjustment can we make to our manual therapy techniques?
place another pillow under their head or use towel rolls under the arms
270
how long do we hold a prolonged stretch in manual therapy positions?
work up to 5-10 minutes
271
what manual therapy techniques can we use for lateral chest restrictions?
position the pt over a towel roll in SL with the side of restriction on top
encourage deep breathing into the area of restriction
to progress, add passive/active UE mov't
272
what technique uses the same training concepts from MSK and applies it to respiratory muscles?
ventilatory/respiratory muscle training
273
what MSK principles does ventilatory/respiratory muscle training use?
overload
specificity
reversibility
strength and endurance programs
274
t/f: we may need to use other techniques to re-teach proper breathing mechanics prior to initiating a program using a device for respiratory muscle training
true
275
what are the two types of respiratory muscles trainings?
inspiratory and expiratory muscle training
276
do PTs use inspiratory or expiratory muscle training more?
inspiratory muscle training
277
what are the indications for expiratory muscle training?
decreased strength or endurance of the diaphragm or intercostal muscles
278
how do we measure inspiratory muscle strength?
MIP (max inspiratory pressure)
279
how do we measure MIP?
using a device
from residual volume
measure peak pressure over 2 seconds
pt instructed to breathe all the ya out and then breathe in throught the device
measures in cmH2O
280
weakness of the inspiratory muscles is generally defined as MIP<___ cmH2O
60
281
what are the types of IMT devices?
threshold, resistive loading, and voluntary isocapnic hyperpnea
282
which IMT device has a ceiling effect?
threshold IMT devices
283
what IMT device allows airflow through the device after a pre-determined pressure is met?
threshold IMT device
284
what IMT device has a relatively low max pressure
threshold IMT device
285
what IMT device is the type utilized by athletes and increase the resistance applied?
resistive loading IMT device
286
which IMT device progressively increases the load on the resp muscles during inspiration?
resistive loading IMT device
287
does a threshold or resistive loading IMT device have a higher max pressure?
a resistive loading IMT device
288
which IMT device induces a person to increase their RR to increase the strength and endurance of the respiratory muscles rather than the resistance?
the voluntary isocapnic hyperpnea IMT device
289
how high does the voluntary isocapnic hyperpnea IMT device get the RR?
up 50-60 rpm
290
what is the goal of IMT (inspiratory muscle training)?
to increase inspiratory muscle strength, reduce dyspnea, and increase inspiratory capacity
291
there is evidence for use for IMT for what populations?
COPD, HF, failure to wean from ventilation, SCI, ALS, GBS, Polio, MS, muscular dystrophy, myasthenia gravis, ankylosing spondylitis
292
t/f: research shows that IMT is better than aerobic training for carryover
false, it is greater with aerobic training
293
who more frequently is involved with expiratory muscle training?
SLP
294
what are the indications for expiratory muscle training?
ineffective cough or swallow
295
what are the goals of expiratory muscle training?
to increase strength of expiratory muscles, increase cough effectiveness, and decrease aspiration risk
296
what device is used for expiratory muscle training?
a threshold device
297
what is the training protocol for expiratory muscle training?
5 sets, 5 breaths, 5 days/week, 5 weeks
298
what muscles are the focus of expiratory muscles training?
muscles of the deep throat
