Pulmonary Treatment

Question 1

Airway clearance techniques include:

Answer 1

Percussion
Vibration
Postural drainage
Active Cycle of Breathing
Coughing
Positive Expiratory Pressure

*Optimize airway patency, promote alveolar expansion/ventiliation, INC gas exchange

Question 2

Indications for airway clearance include:

Answer 2

Impaired mucociliary transport
Excessive pulmonary secretions
Ineffective/absent cough

Question 3

What should pts be given before performing airway clearnace techniques?

Answer 3

Bronchodilator meds to enhance overall outcome of intervention

Question 4

PRECAUTIONS for Percussion/Vibration include:

Answer 4

Uncontrolled bronchospasm
Osteoporosis
Rib fx
Cancer to ribs
Tumor
Anxiety
Seizures
Pacemaker

Question 5

CONTRAINDICATIONS for Percussion/Vibrations include:

Answer 5

Hemoptysis (coughing up blood)
Pneumothorax
Platelets below 20,000
Unstable hemodynamic wound
Open wounds
Pulmonary Embolism
Emphysema
Skin graft

Question 6

Postural Drainage =

Answer 6

Gravity assisted positions to mobilize secretions from lobes of lungs –> large airways –> expelled

Question 7

Postural drainage PRECAUTIONS

Answer 7

Pulmonary edema
Hemoptysis
Obesity
Pleural effusion
Massive ascites

Question 8

Postural drainage CONTRAINDICATIONS

Answer 8

INC ICP
Hemodynamically unstable
Spinal fusion
Head trauma
Diaphragm hernia
Eye surgery

Question 9

How do you know if chest PT was effective?

Answer 9

Changes in:
- Sputum production
- Lung sounds
- Subjective responses to PT (“I can take a deeper breath”)
- Vital signs
- Chest x-ray
- ABG or O2 sat levels
- Ventilator variables

Question 10

Active cycle of breathing

Answer 10

Repetition of
1. Breathing control (relaxed breathing/w/ diaphragm, put hands on belly)

2. 3-4 Thoracic expansion (hands on ribs)
3. Breathing control
4. 3-4 TE
5. Breathing control
6. Forced expiratory technique (breathing control + huffing, cough)
7. Breathing control

Question 11

What’s a major pro to teaching a pt active cycle of breathing?

Answer 11

Just as effective as percussion, but they can do it on their own!

Question 12

Coughing using UE and LE

Answer 12

*Airway clearance

PNF

Inhale combo with trunk extension & elevate UE

Exhale combo w/trunk flexion & lower UE

Maximizes intrathoracic & intra-abdominal pressures with contractions & trunk movement

Question 13

Facilitate inspiratory effect =

Answer 13

Breathe in

Shoulder FLEX + ABD + ER + look UP

Question 14

Facilitate exhalation =

Answer 14

Breathe out

Shoulder EXT + ADD + IR + look DOWN

Question 15

How could you instruct your pt to position their pelvis to help engage diaphragm?

Answer 15

POST tilt

Question 16

Whats another way you could teach someone how to engage their diaphragm?

Answer 16

Sniff!

Question 17

What are some positions you could teach that would relieve dyspnea??

Answer 17

1. Standing - lean forward on supported hands
2. Sitting - lean forward, elbows supported on knees
3. Sitting - Lean forward while laying upper body/head on pillow

Question 18

Why do the dypsnea relief positions work?

Answer 18

Leaning on UE =

INC intraabdominal pressure rises & pushes the diaphragm up = relief

Enables the accessory muscles to be able to act on the rib cage & thorax for greater expansion & inspiration

Question 19

Describe what the dyspnea scale is:

Answer 19

1. Mild - Noticeable to pt, but NOT observer
2. Some difficulty - Noticeable to observer
3. Moderate difficulty, but can continue
4. SEVERE difficulty - pt can NOT continue

Question 20

Where do you want your pt to be on dyspnea scale while exercising?

Answer 20

Want them at a 2-3

Question 21

Huffing

Answer 21

*Cough technique/airway clearance
*If pt is unable to cough

Take a deep breath in & breath out in rapid exhalations (like fogging a mirror)

Allows you to move secretions from small airways to large airways to be coughed out

“Like fogging up a mirror”

Question 22

Pursed lip breathing

Answer 22

*Decrease dyspnea symptoms (esp w/activity)

Slows HR, slows RR, decreases pressure and reduced airway collapse during expiration

*Clinical sign of COPD

Inhale through the nose for several seconds with the mouth closed and exhale over 4-6 seconds through lips in a whistle position

Question 23

Diaphragmatic Controlled breathing

Answer 23

*Manage dyspnea, reduce atelectasis & inc oxygenation

Goal = DEC accessory muscle usage & inc diaphragm

-Position pt in posterior pelvic tilt
-Have pt sniff to demo diaphragm
-Pt hands on stomach, sniff 3x, & exhale

Question 24

How could you progress diaphragmatic controlled breathing?

Answer 24

Reducing number of sniffs to eventually not sniffing just regular relaxed breathing

-transition to sitting, standing

Question 25

How could you regress diaphragmatic breathing?

Answer 25

Semi-fowler or SL to for gravity eliminated position - can add scoop resisted technique

Question 26

Paced Breathing

Answer 26

*Control dyspnea/breathing (esp w/activity) Typically timed/coordinated with activity/exercise Inhale with rest & exhale during contraction/work

Question 27

Inspiratory Hold

Answer 27

Airway clearance Improves flow of air to poorly ventilated regions of the lungs (gets behind secretions) Hold breath at peak of inspiration for 2-3 seconds & do relaxed exhale Can be combined with vibration

Question 28

Splinting

Answer 28

Improve pt’s ability to cough Hold pillow & squeeze cough

Question 29

Controlled cough

Answer 29

*For WEAK cough Use especially if pt needs verbal cueing Take 3 total breathes & on the 3rd breath cough firmly Can squeeze pillow or towel on chest (like splinting)

Question 30

Costophrenic Assist

Answer 30

*For pt who are too weak to GENERATE cough Pt is supine with PT hands on bottom angles of the rib cage Pt takes normal breathes until instructed to hold the air in & then cough During cough, PT squeezes ribs together & POST pressure to enhance force of pt’s exhale (squeeze them together & push down toward table)

Question 31

Heimlich Assist

Answer 31

*Use for FLACCID pts to generate cough Use if not responding to other techniques Pt supine and is instructed to take several normal breaths & then a deep breath in As pt takes deep breath, PT quickly pushes under the diaphragm with the heel of the hand (near the base of the sternum)

Question 32

ANT Chest Compressions

Answer 32

*Used for very weak pt to assist in generating a cough PT has one forearm under clavicles & other under ribcage PT supinates/diagonally pulls arms together as pt tries to cough (the V one) **More effective than costophrenic bc it adds compression

Question 33

Incentive Spirometer

Answer 33

*Practice diaphragmatic breathing *Prevent or reduce atelectasis *Stimulate cough Emphasis for pt who have weak cough & abdominals + post surgery Sit EOB Spirometer kept upright Lips tight around mouthpiece Breathe in slowly & deeply as possible Hold breath as long as possible then exhale slowly 10 reps every hour *move indicator on the side to track progress

Question 34

Inspiratory Muscle Training

Answer 34

*S&S of dec strength or endurance of diaphragm & intercostal muscles Use handheld device for resistance training 2x/day for 15-30 minutes

Question 35

Thoracic and Upper Bpdy Stretching using Towels

Answer 35

*For pt has reduced mobility Can place a towel or foam roller down the spine for anterior chest wall mobility Can place pt SL over a towel to inc lateral chest wall mobility Can include elevating UE to inc stretch Seated with bilateral UE PNF patterns