Pulmonary Interventions Flashcards
(39 cards)
What are the primary muscles of Inspiration? (2)
What are the secondary/accessory muscles of Inspiration? (5)
Primary: diaphragm, external intercostals
Accessory: SCM, scalenes, Pec major, Pec minor, SA
Normal breathing rhythm is a 1:2 ratio with __ being half as long as __.
Breathing rhythm for COPD is a __ ratio d/t trapped air, incr. RV, & incr. work.
Normal RR = ___ breaths/min
COPD RR will be (more/less) than normal RR.
Normal breath character is quiet & effortless, abnormal is labored breathing
1&2) I:E ratio –> inspiration being half as long as expiration
2) 1:3-4 ratio
3) 12-20 breaths/min
4) more! (tachypnea (fast rate) + hypoventilation (shallow depth))
The diaphragm expands vertically & horizontally and is innervated by C___. It is made of Type __ muscle fibers (fatigue resistant). Diaphragmatic positioning & ROM are affected by stomach contents (distention), obesity, and what other 2 things?
1) C3-C5
2) Type 1 muscle fibers
3) body position/posture, obesity, size of organs, abd muscles
What are the muscles of expiration for quiet breathing? (2)
What are the muscles of expiration for FORCEFUL breathing? (4)
Muscles for forceful breathing __ the lower ribs & __ abd contents which pushes to diaphragm __.
1) Passive recoil of lungs & rib cage
2) Rectus abdominus, EO, TA, internal intercostals
3) depress
4) compress
5) up
Diaphragmatic breathing utilizes the diaphragm while limiting the ___ muscles during inspiration.
Indications for this tx are post-surgical pts, pts w/ __ at rest, and inefficiency w/ breathing/__ during ADLs.
1) accessory
2) dyspnea
3) SOB
Precautions/CI for diaphragmatic breathing include:
1) mod/severe __ w/ __inflation of lungs
2) pts w/ ___ breathing patterns
3) pts w/ increased dyspnea during diaphragmatic breathing
1&2) COPD w/ hyperinflation
3) paradoxical
Expected outcomes of diaphragmatic breathing are __ RR, decr. reliance on accessory muscles of inspiration, __ TV, improvement of dyspnea (subjective), & improved activity tolerance.
1) decreased RR
2) increased TV
Pursed-lip breathing is used to __ RR & __ dysnpea by maintain __ pressure in the bronchioles. This can help prevent airway collapse in pts with __ & help trapped air escape in pts w/ __. Indications include tachypnea & dyspnea. What is the only precaution/CI for pursed-lip breathing?
1) decr. RR
2) decr. dyspnea
3) positive pressure
4) emphysema
5) COPD
6) forcing exhalation
Expected outcomes of pursed-lip breathing include decr. RR & dyspnea, incr. TV & activity tolerance, & prevention of airway collapse in emphysema pts. What are 2 more expected outcomes?
1) Reduce PaCO2
2) Increase SaO2
Segmental breathing is intended to improve __ ventilation & tx pulmonary complications after surgery. The goal is to __ or __ chest wall movement through proper __ placements, verbal cues, or __ of breathing.
1) regional
2&3) facilitate or inhibit
4) hand
5) coordination
Segmental breathing is indicated for __ lung volumes, __ chest wall compliance, & ___ mismatch. What are the precautions/CIs associated with segmental breathing?
1) decreased
2) decreased
3) V/Q
4) NONE but be careful w/ pain/tenderness
Expected outcomes of segmental breathing are increased chest wall __, expand __ alveoli, & ___ loosening+clearance
1) mobility
2) collapsing
3) secretion
What is a very important to aid in airway clearance to help reduce risk of pneumonia?
Hint: Indicated for post-surgical pain, SCI (forced exp. muscles not innervated = T1-T12), & progressive weakness.
Coughing
Compensatory techniques available if pt can’t cough effectively
__/__ stimuli to the __, __, carina, or __ bronchi can cause a cough to be stimulated reflexively.
1&2) mechanical/chemical
3) larynx
4) trachea
5) lower
What are the 5 stages/components of a cough?
1) Deep inhalation
2) Glottis closes
3) Incr. pressure gradient
4) Glottis opens
5) Forceful movement of air
Post-surgical pts may need to splint chest/abdomen by applying pressure over incision w/ pillow or soft blanket roll
If pts cannot perform a directed cough, they can perform a __ cough. This cough is used to force expiration with the glottis open. It does not produce to airflow __ of a directed cough, but it helps decr. risk of __ __.
1) huff
2) velocity
3) airway collapse
Precautions/CIs for coughing are __ precautions w/ inability to control __, __ intracranial pressure, acute __ __, unstable head or neck injury, potential __, untreated pneumothorax, OP, & __ chest.
1&2) droplet precautions w/ inability to control secretions
3) elevated
4) acute MI
5) aspiration
6) flail chest
__/__ consists of positioning the pt properly so gravity aids in drainage of bronchial secretions f/b mechanical assistance to loosen secretion. Afterwards, pt is encouraged to __ to clear airway.
1) Percussion (cupped hands)/Vibration
2) cough (or huff)
If performing percussion/vibration here are some good tips to remember:
Anterior segment = __ positioning
Posterior segment = __ positioning
1) supine
2) prone
Name the segment we are working on with this positioning:
Bilateral Posterior Superior Segments
(Specifically Bilateral Superior Segmetns of the Lower Lobes)
Opposite of Bilateral Anterior Segments
flat/neutral
Name the segment we are working on with this positioning:
Bilateral Anterior Segments (lower lobes)
Opposite of bilateral Posterior Segments
lower lobes so 18 in. elevation
Name the segment we are working on with this positioning:
Bilateral Posterior Apical Segments (upper lobe)
Opposite positioning of bilateral anterior apical segments
apical = sitting up
Name the segment we are working on with this positioning:
Left Lingular
Remember: this is the left version of the Right Middle Lobe
Elevated 12 inches only!!!
Name the segment we are working on with this positioning:
Left Lateral Segment (lower lobe)
Opposite of Right lateral
Lower segment so raise 18 inches
