Skills, Techniques and Theory Flashcards
1
Q
What does ACBT stand for?
A
Active Cycle of Breathing Techniques
2
Q
What are the three components of ACBT?
A
- Breathing Control (BC); 2. Lower Thoracic Expansion Exercises (LTEE/TEE); 3. Forced Expiratory Technique (FET)
3
Q
What does a typical ACBT cycle consist of?
A
- BC
- 3–4 LTEE
- BC
- FET
- BC
4
Q
What is the maximum number of LTEEs to be performed in an ACBT cycle?
Why?
A
3-4
Minimises hyperventilation and fatigue in breathless patients
5
Q
What is breathing control?
A
Normal tidal breathing, relaxed shoulders and arms
6
Q
LTEE involves what?
A
Deep breathing exercises
7
Q
What can be added to an LTEE?
A
3 second end-inspiratory hold
Sniff
8
Q
What is the purpose of a breath hold in LTEE?
A
compensate for asynchronous ventilation
during inspiration - healthy lung units fill rapidly and obstructed/diseased lung units fill slowly
slower filling units partially receive inspired volume from rapid filling units via collateral channels - ‘Pendelluft flow’
9
Q
What is the purpose of a ‘sniff’ in LTEE?
A
achieve an additional increase in lung volume
aid greater expanding forces between alveoli
10
Q
In what patients should an inspiratory hold or ‘sniff’ not be used?
A
Hyperinflated
11
Q
In what patients may LTEE be used?
A
Post-surgical patients
12
Q
How does LTEE facilitate collateral channel ventilation?
A
increased inspired volumes = reduced airflow resistance
air can now flow in inter-bronchiolar channels of Martin, bronchiolar-alveolar channels of Lambert and inter alveolar pores of Kohn
airflow behind secretions
13
Q
Where are channels of Martin between?
A
Bronchiole and bronchiole
14
Q
Where are channels of Lambert between?
A
Bronchiole and alveoli
15
Q
Where are pores of Kohn between?
A
Alveolus and alveolus
16
Q
How does LTEE increase alveolar interdependence?
A
Higher lung volumes = greater expanding forces between alveoli –> assists with re-expansion of lung tissue
If one alveolus collapses, adjacent alveoli stretched/pulled inwards towards it –> walls of adjacent alveoli recoil –> collapsed alveolus pulled open
17
Q
What are the cautions of LTEE?
A
Light-headed, dizzy, hyperventilation
18
Q
How can proprioception be provided during LTEE?
A
Physiotherapists hands placed on chest wall
19
Q
FET is also known as?
A
Huffing
20
Q
Why may an FET be more useful than a cough?
A
less effort and pain than a cough
21
Q
Is the glottis open or closed during a ‘huff’?
A
open
22
Q
Low lung volume, long huff moves secretions from where?
A
Peripheral, smaller airways
23
Q
High lung volume, short huff moves secretions from where?
A
Upper, larger airways
24
Q
How many ‘huffs’ are performed in FET
A
1-2, followed by BC
25
Is a low or high volume 'huff' usually performed first?
Low
26
FET is based upon the principle of what?
Equal pressure point (EPP)
27
Define equal pressure point
Point at which the pressure in the bronchi equals the pressure outside the airway
28
Where is the location of EPP during normal tidal breathing?
In the trachea
29
What is position of EPP during FET
EPP's move distally into smaller peripheral airways
30
At lung volumes above functional residual capacity (FRC) where is the EPP located?
Lobar or segmental bronchi
31
EPP position is dependent on what 2 factors?
Lung volume and pressure outside airway
32
EPP is towards alveoli when...
lung volume decreases and/or pressure outside the airway increases
33
EPP is towards mouth when...
lung volume increases and/or the pressure outside the airway decreases
34
Airways should be cleared from...
peripheral airways up
35
During expiration airway pressure falls...
Falls along airway from alveolus to mouth
36
Proximal to EPP towards the mouth airway pressure falls below what? Resulting in…?
Airway pressure falls below pleural pressure - resulting in dynamic compression and narrowing of airway
37
Lung volume .... during FET
Decreases
38
A huff that is too long can lead to...
Paroxysmal coughing
39
Percussion involves what?
Rhythmical clapping with cupped hands by flexing/extending the wrist
40
Percussion uses a .... hand
Cupped
41
The lung that needs clearing using percussion is placed...
At the top
42
How long should percussion be performed for?
20-30 seconds of continuous percussions followed with pause
| 5-15 mins total in length
43
Physiology of percussion: what does percussion alter?
Intrapleural pressure
44
Physiology of how percussion assist the clearance of secretions?
1. Intrapleural pressure change is transmitted through thoracic cage and lung tissue --> external shearing force assists dislodging secretions
2. Creates oscillation of airflow --> stimulate cilial beat and/or change sputum viscosity
45
Contraindications of percussion
```
Directly over rib fracture
Directly over surgical incision
Frank haemoptysis
Severe osteoporosis
Hypoxia
Active TB
Cancerous lung
Acute pain
```
46
Precautions of percussion
```
Profound hypoxaemia
Bronchospasm
Pain
Osteoporosis
Bony metastases
Near chest drains
```
47
Vigorous or rapid percussions may lead to...
Breath holding
48
Possible complications of percussion treatment
Pain during treatment
Fatigue during treatment
SaO2 decreases during treatment
49
What type of movement is applied to the chest during VIBRATIONS
fine, high frequency, low amplitude
50
What type of movement is applied to the chest during SHAKING
Coarse, low frequency, high amplitude
51
What phase is the vibration or shaking applied?
During expiration
52
In which direction is vibration/shaking applied?
In direction of normal movement of ribs
53
Vibrations = ... oscillations
fine
54
Shaking = ... oscillations
coarse
55
Physiology: what changes do vibrations/shaking produce?
Increases expiratory flow
Increases annular flow via two-phase gas-liquid flow mechanism --> secretions moved towards large airways
Lung recoil following maximal inspiration - correctly timed compressive and oscillatory forces applied affect lung recoil to increase expiratory flow
56
Vibrations/shaking are performed during what?
thoracic expansion exercises
57
Contraindications of vibrations/shaking
```
Directly over rib fracture
Directly over surgical incision
Severe bronchospasm
Osteoporosis
Frank Haemoptysis
Active TB
Pulmonary embolism
Cancerous lung
```
58
Precautions of vibrations/shaking
```
Long-term oral steroids
Osteoporosis
Near chest drains
Profound hypoxaemia
Bronchospasm
```
59
Define ventilation
Total volume of air the leaves the lungs each minute
60
Define perfusion
The total volume of blood reaching the pulmonary capillaries
61
What is the distribution of ventilation in the upright patient?
Why?
Bases of lungs most ventilated
There is a lesser transmural pressure, with many smaller, more compliant alveoli
62
What is the distribution of perfusion in the upright lung?
Why?
Bases of lungs most perfused
Low pressure pulmonary circulation affected by gravity
63
Perfusion ... down the upright lung
increases
64
V/Q ratio is disproportionately ... in the apices than bases
higher
65
V/Q matching is optimal in which region of the lung?
mid-lung
66
V/Q mismatch occurs in which regions of the lungs?
the least and most dependent - apices and bases
67
What is the value of V/Q ratio in "alveolar dead space"
V/Q > 1
68
Define alveolar dead space mismatch
Where there is good ventilation but reduced perfusion
69
What is the value of V/Q ratio in "shunt"
V/Q = 0
70
Define shunt mismatch
Where there is good perfusion but reduced ventilation
71
Give an example of what may cause "shunt" V/Q mismatch
sputum plug
72
Give an example of what may cause "alveolar dead space" V/Q mismatch
Pulmonary embolus disrupting blood flow
73
Why do we place "good lung down"
Best ventilated lung placed in region of best perfusion
74
Which lung is slightly better ventilated?
Right
75
Why does V/Q matching need to be maintained?
To achieve adequate gas exchange
76
In which position would you place a patient with bilateral lung disease?
Why?
Right lung down
R lung larger than L
Arterial oxygen tension increased secondary to improved ventilation of right lung
77
In which position would you place a patient with unilateral lung disease?
Why?
Good lung down
Arterial oxygen tension increased secondary to improved ventilation of unaffected dependent lung
Best ventilated lung placed in region of best perfusion
78
How does an upright position contribute to V/Q matching?
Increased FRC
Sympathetic NS stimulated
Lung volumes and flow rates maximised
Circulating blood volume and volume regulating mechanisms maintained
79
How does supine position have a negative impact on V/Q matching?
Decreases FRC
Closure of dependent airways
Reduced arterial oxygenation
Vascular congestion
80
What is the effect of prone position on V/Q matching?
Decreased gravitational pressure of heart/mediastinum on lungs
Decreased compression of abdominal organs on lungs
More chest wall compliance
81
Define alveolar dead space
The volume of air that never reaches the alveoli and never participates in respiration
82
What is the value of V/Q optimal matching?
V/Q = 1
83
What are the 4 recovery positions for chronic breathlessness?
1. Forward lean - sitting
2. Forward lean - standing
3. Lean over - pillows and plinth
4. High side lying
84
What instructions should be given to the patient during recovery positions for breathlessness?
Bend from hips not 'tummy'
Breathe as normal as possible
and from diaphragm
85
How is the diaphragm affected during leaning recovery positions for breathlessness?
Abdominal contents raise anterior part of diaphragm, facilitating its contraction during inspiration
86
How is the diaphragm affected during high side lying recovery position for breathlessness?
Curvature of dependent part of diaphragm is increased - fibres can contract more effectively
87
How is the diaphragm affected during recovery positions for breathlessness?
Optimises length tension status - improving mechanical advantage
88
Why is support given to the arms/shoulder girdle in recovery positions for breathlessness?
Optimises accessory muscle function without active fixing
Muscle tension and O2 uptake is reduced
89
What other techniques can be used for breathlessness?
'Blow as you go'
Pursed lip breathing
Pacing
90
What is 'blow as you go' technique?
Breath out on effort when doing activities (eg. sit-to-stand, bending to tie laces, reaching for something)
91
What is pursed lip breathing?
Breath out gently through pursed lips
No more effort than normal breathing
Expiratory phase longer than normal
92
What does pursed lip breathing produce?
A small amount of positive end-expiratory pressure (PEEP)
93
What is pacing for breathlessness?
Inspiration : expiration 1:2 or 2:3
In for 2 steps out for 3 steps
Avoid rushing to complete task/breath holding
94
Name for breathlessness
Dyspnoea
95
What is the taught inhaler technique?
1. Cap off
2. Shake inhaler
3. Fully exhale
4. Make tight seal with lips around inhaler
5. Simultaneously squeeze inhaler and breath in deeply and slowly
6. Hold for 10 secs
96
What are the 3 types of bronchodilators?
Relievers, preventers, anticholinergic/antimuscarinic
97
What are 'reliever' bronchodilators?
What type of drug are they?
Provide short-term symptomatic relief
Give immediate response
Short-acting beta-agonists (SABA)
98
What are 'preventer' bronchodilators?
What type of drugs are they?
Provide long-term symptomatic relief
Management of condition
Slower, less pronounced response
Inhaled corticosteroids, long-acting beta-agonists (LABA) or combined steroid and LABA
99
2 examples of SABAs
Salbutamol (Ventolin) and Terbutaline (Bricanyl)
100
Which conditions may use SABAs?
Asthma and COPD
101
2 examples of inhaled corticosteroids
Beclamethasone (Qvar) and Fluticasone (Flixotide)
102
What are the side effects of using inhaled corticosteroids?
Oral thrush, fluid retention, osteoporosis
103
2 examples of LABAs
Salmeterol (Serevent) and Eformoterol (Oxis, Foradile)
104
2 examples of combined LABA and steroid
Seretide (Fluticasone and Salmeterol)
| Foster (Beclamethosone and Formoterol)
105
Which conditions may use combined LABA and steroid?
COPD and moderate/sever asthma
106
What do anticholinergic/antimuscarinic drugs do?
Block binding of acetylcholine to muscarinic receptors in smooth muscle
Prevent bronchoconstriction and reduce mucous production
107
2 examples of anticholinergic/antimuscarinic drugs
```
Ipratropium Bromide (Atrovent)
Tiotropium (Spiriva)
```
108
What are the side effects of anticholinergic/antimuscarinic drugs?
Increase risk of CV effects, dry mouth, urinary retention, constipation, nausea, headaches
109
Inhaled drugs are delivered ... to the airways
Directly
110
Benefits of inhalation drugs
Rapid absorption due to large lung surface area --> rapid onset of action
Smaller dose required --> reduced side-effects
111
What are the 3 mechanisms that particles of aerosol interact with the airway?
1. Impaction
2. Sedimentation
3. Brownian diffusion
112
What is impaction during aerosol delivery?
Where in the airways does impaction occur?
Due to inertia of aerosol particles and the change in direction they have to make
Mouth cavity entering to trachea and bifurcation of trachea
113
What is sedimentation during aerosol delivery?
Where in the airways does sedimentation occur?
Due to gravity the particles settle
Small airways and alveoli
114
What is Brownian diffusion during aerosol delivery?
Where in the airway does Brownian diffusion occur?
Particles move from high to low concentrations so deposit upon contact with airway wall
Lower respiratory regions and alveoli
115
During inhalation of respiratory drugs via inhaler, what does the hold allow for?
Sedimentation of aerosol particles
116
Define pulmonary rehabilitation
An evidence-based, multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities
117
What does a pulmonary rehab programme consist of?
Exercise training, education and behaviour change
118
What does the exercise component of pulmonary rehab look like?
Circuit based, two hour session, twice-weekly with encouragement of home exercise
119
Patients of what conditions may benefit from pulmonary rehab?
COPD, asthma, bronchiectasis, interstitial lung disease
120
What types of exercise should be included in pulmonary rehab?
Aerobic/endurance and strength/resistance
| Also consider flexibility and balance work
121
Should pulmonary rehab exercises include upper limb, lower limb, or both?
Both upper and lower limb
122
During what type of exercise might a pulmonary rehab patient find themselves more breathless?
Upper limb
123
What principle is used to prescribe exercise for rehab?
FITT - frequency, intensity, time, type
124
What should be monitored during exercise component of a pulmonary rehab class?
```
Modified Borg Scale (0-10)
O2 saturations
Respiratory rate
HR
BP
```
125
What topics might be covered in an education session of pulmonary rehab?
```
What is COPD?
Breathlessness management
Anxiety management
Energy conservation
Chest clearance
Medications
Benefits of exercise
Self-management of condition
MDT input
```
126
What members of the MDT would be involved in pulmonary rehab?
```
Respiratory nurses
Dieticians
Occupational therapists
Smoking cessation services
Expert patients/recent graduates
Pharmacist
Respiratory consultant
Exercise instructors
```
127
Contraindications for pulmonary rehab
```
Recent MI
Unstable angina
Severe hypoxic lung failure
Uncompensated heart failure
Severe psychiatric impairment
Patient non-consenting
```
128
Cautions for pulmonary rehab?
```
Very severe COPD (FEV<30%)
Cardiac arrhythmias
Mental health concerns
Heart failure
Mobility issues/falls
Recent stroke
Recent thoracic surgery
Recent fracture
Ongoing lower back pain
```
129
What physical outcome measures could be used to assess the patients progress with pulmonary rehab?
Six minute shuttle walk test (6MWT)
Incremental shuttle walk test (ISWT)
Timed up and go test (TUG)
Ten metre walk test
130
What ADL/psychological outcomes could be used to assess the patients progress in pulmonary rehab?
St George's Respiratory Questionnaire (SGRQ)
Chronic Respiratory Disease Questionnaire (CRDQ)
London Chest Activities of Daily Living Scale (LCADL)
Hospital Anxiety and Depression Scale (HAD)
131
What are the benefits of pulmonary rehab?
```
Reduce symptom burden
Maximise exercise capacity
Increase muscle endurance and strength
Improve daily functioning/ADLs
Improve QoL
Promote health behaviour change
Promote self-management of condition
Increase social interaction
```
132
How does pulmonary rehab differ to cardiac rehab?
Less intense
Rest periods rather than active recovery
Encouragement for patients to set own limits - link with long-term self-management
133
What is the typical duration of a pulmonary rehab programme?
8-12 weeks
134
What are some possible exercises for pulmonary rehab circuit?
```
Arm cycle ergometer
Arm raises
Walking - treadmill, shuttle walks
Jogging
Cycling
Rowing
Step-ups/stepping machine/stairs at home
Side steps
Bicep curls
Squats - bodyweight (high reps for aerobic) weighted (lower reps for strength)
Banded pull downs
```
135
Define cardiac rehabilitation
Exercise prescription and non-pharmaceutical management of modifiable risk factors
136
What does a cardiac rehab programme consist of?
Physical activity and exercise, education and psychosocial support
137
What topics may be covered in the education portion of cardiac rehab?
Pathophysiology and symptoms
Benefits of physical activity, healthy eating
Smoking cessation
Self-management of risk factors (BP, lipids, glucose)
Emotional self-management
Resuming relationships/sexual dysfunction
Cardiopulmonary resuscitation
138
What psychosocial interventions may be provided in a cardiac rehab programme?
```
Relaxation techniques
Stress management
Motivational interviewing
CBT
Counselling
```
139
What types of patients are referred for cardiac rehab?
Priorities:
- Post MI/STEMI
- Heart failure
- Coronary revascularisation
- Post CABG
Once priorities addressed:
- Stable angina
- Post transplantation
- Post valve repair/replacement
- Grown-up congenital heart disease (GUCH)
- Post ICD implantation
- Other atherosclerotic diseases
140
What are the 4 stages of cardiac rehab?
Phase 1: inpatient
Phase 2: Early post-discharge
Phase 3: Supervised exercise training programme
Phase 4: Long term maintenance
141
Phase 3 of cardiac rehab, exercise programme, is typically how long post-surgery?
at least 6 weeks
142
What is the typical duration of cardiac rehab programme?
6-12 weeks
143
Goals of cardiac rehab
Decrease cardiac morbidity and relieve symptoms
Increase fitness and ability to resume normal activities
Regain full physical, psychological and social status
Improve health behaviour through education
Slow/reverse progression of disease
Promote risk modification and secondary prevention
144
What are the general benefits of exercise training?
```
Improved survival
Improved lipid profile
Lower BP
Improved glucose control
Reduced anxiety/depression
Reduced weight
reduced angina
Improved functional capacity
Increased confidence
Improved QoL
Reduced readmissions
Improved return to work and leisure
Support self-management skills
```
145
What are the cardioprotective mechanisms associated with regular exercise training?
Anti-ischaemic
Anti-atherosclerotic
Anti-thrombotic
Anti-arrhythmic
146
How does exercise training lead to an improved exercise capacity?
Training-induced increase in maximal stroke volume due to:
Increased left ventricular mass and chamber size
Increased total blood volume
Reduced total peripheral resistance at maximal exercise
147
What does an improved exercise capacity lead to in terms of O2?
Increased maximal O2 uptake
148
What physiological changes occur to skeletal muscle as a result of exercise training?
```
^ number and size of mitochondria
^ oxidative enzyme activity
^ capillarisation
^ myoglobin
all lead to increased extraction and utilisation of O2 from the blood
```
149
Why is it beneficial for the patient to have a higher VO2 max as a result of exercise training?
Can perform repeated sub maximal ADLs with less physiological stress - ADLs now constitute a smaller % of increased max capacity
150
What are the social benefits of cardiac rehab?
Increased return to work and leisure
151
What are the psychological benefits of cardiac rehab?
Reduced anxiety and depression
Supports self-efficacy
Increased confidence
Increased well-being and QoL
152
What members of the MDT may be involved in cardiac rehab?
```
Cardiologist
Physio
Nurse
Dietician
OT
Pharmacist
Psychology staff
```
GP's and practice nurse - continuation in community
153
What is the risk associated with exercise?
What increases the risk?
Ventricular fibrillation, MI, cardiac arrest
extensive cardiac damage, residual Ischaemia, ventricular arrhythmias on exercise
154
Exclusion factors for participating in cardiac rehab
```
Unstable angina
Uncontrolled arrhythmias
Uncontrolled tachycardia
Dissecting aneurism
Active pericarditis/myocarditis
Severe hypertension
Significant drop in SBP
Uncontrolled metabolic disorders - diabetes, thyroid
Mental disturbance
```
155
What are the physical activity recommendations?
At least 150-300 minutes of moderate intensity aerobic activity OR at least 75-150 minutes of vigorous intensity aerobic activity
Muscle strengthening involving major muscle groups should be done on 2 or more days a week
156
What are the acute responses to exercise?
```
^ HR
^ SV
^ CO
Redistribution of blood to skeletal muscle and away from gut
^ systolic BP
diastolic BP stays relatively same
^ coronary blood flow
```
157
What is the purpose of risk stratification?
To evaluate the degree of risk of further cardiac events associated with exercise
158
What formula is used to set exercise intensity by heart rate for a patient?
Karvonen formula
159
What is monitored during cardiac rehab?
HR, BP, RPE, Symptoms
160
What 4 components of an exercise programme for cardiac rehab must be included?
1. warm up
2. aerobic work
3. resistance/strength work (usually as active recovery)
4. cool down
161
How long should an extended warm up be for cardiac rehab?
15 mins
162
Why is it important to warm up?
Reduces risk of arrhythmia
Incremental - gradually raises pulse
Focuses mind on activity ahead
163
What are the physiological effects of a warm up?
Increases ischaemic threshold through coronary artery dilation
Redistributes blood to active muscles
Increases core and muscle temperature
164
What is the purpose of the active recovery exercises in a cardiac rehab exercise circuit?
Prevent a sudden drop in BP by maintaining venous return
165
How long should a cool down be?
10 mins
166
Why is it important to cool down after exercise?
Reduce risk of hypotension, reduce risk of arrhythmias due to raised sympathetic activity
167
Example of a good cardiac rehab session?
```
15 min warm up
20 mins main session
- aerobic and active recovery stations
- 10 stations, 1 minute at each station
- repeat circuit twice - 20 mins working time
10 min cool down
```
168
Possible warm up exercises for cardiac rehab
March on spot
Arm circles
Dynamic stretches
169
Possible aerobic stations for cardiac rehab
```
Ball around body
Shuttle walks
Knee raises
Rowing
Cycling
Swimming
Stepping/step-ups/stepping machine
Side steps
Sit-to-stand
Quick squats
Treadmill
Lunge backs
```
170
Possible active recovery stations for cardiac rehab
```
Light bicep curls
Ball lifts
Push up against wall
TheraBand exercises
Lateral arm raises
```
171
Possible cool down exercises for cardiac rehab
Slow march
| Thoracic rotations
172
What is postural drainage also known as?
Gravity assisted drainage (GAD)
173
What is the principle of postural drainage?
Use of gravity to assist clearance of bronchial secretions from peripheral airways to more central, upper airways
174
What are the indications for postural drainage?
breath sounds - course crackles
cough
X-Ray - white out, patches of consolidation
175
Contraindications and precautions for head down tipped positions
```
Epistaxis
Frank haemoptysis
Cardiac failure
Severe hypertension
Cerebral oedema
Aortic and cerebral aneurisms
Abdominal distension
Reflux
Recent head/neck trauma or surgery
Sinus pain/headaches
Post abdominal/thoracic surgery
```
176
Drainage position for upper lobe, apical segments
Sitting upright
177
Drainage position for upper lobe anterior segments
Supine with knees flexed
178
Drainage position for LEFT upper lobe, posterior segment
Right side lying quarter turn, pillows to lift shoulders 30cm from bed
179
Drainage position for RIGHT upper lobe, posterior segment
Left side lying quarter turn, lying on pillow
180
Drainage position for RIGHT middle lobe
Supine with quarter turn to left, pillows under right side, foot of bed raised 12 inches
181
Drainage position for LEFT lung, lingula segments
Supine with quarter turn to right, pillows under left side, foot of bed raised 12 inches
182
Drainage position for lower lobe, apical segments
Prone with pillow under abdomen
183
Drainage position for lower lobe, anterior segments
Supine, knees flexed, foot of bed raised 18 inches
184
Drainage position for lower lobe, posterior segments
Prone, pillow under abdomen, foot of bed raised 18 inches
185
Drainage position for RIGHT lower lobe, lateral segment
Left side lying, foot of bed raised 18 inches
186
Drainage position for LEFT lower lobe, lateral segment
Right side lying, foot of bed raised 18 inches
187
What does CABG stand for?
Coronary Artery Bypass Graft
188
Purpose of early mobilisation of post-surgical patients
```
Prevent post-op complications and post-op pulmonary complications (PPC's)
Decrease length of hospital stay
Prevent deconditioning
Promote independence
Return to work
Increase functional capacity
```
189
What are the physiological benefits of early mobilisation of the patient?
Increased ventilation
V/Q matching - increased gas exchange
Increase muscle strength
Increase functional capacity
190
What are some of the limitations to mobilisation?
```
Drips/drains/catheters
Pain
Decreased arousal
Anxiety
Surgical incisions
Medication
```
191
What should be monitored during treatment of post-surgical patient?
```
Respiratory rate
HR
BP
O2 and CO2 saturations
Breath sounds - auscultation
Sputum - volume/colour/viscosity
Drains
Temperature and pulse
Incision site - infection/re-opening/stitches
Central venous pressure (CVP)
Consciousness
Pain level
Urine output
```
192
When transferring post-surgical patient out of bed, what should they be instructed NOT to do?
What should they do instead?
Not push through/apply any weight through their hand
| Use their deltoid instead - push through back of upper arm 'chicken wing'
193
What should the physio consider when transferring a patient from lying to sitting?
Dizziness and fatigue
194
When transferring a patient, drips/drains should be placed where?
On the side of transfer, not in the way
195
Transfer patient out of bed - lying to sitting
1. drips/drains to side of transfer
2. far side arm over to front edge of bed - patient rolls onto side
3. push up through deltoid NOT hands
4. swing legs over side of bed
5. physio one hand on hip and one on shoulder to help to sit up
6. consider fatigue/dizziness
196
When performing sit-to-stand mobilisation transfer out of bed, what can the patient do to provide wound support?
Cross arms
197
Transfer patient out of bed - bed to chair
1. drips/drains to side of transfer
2. chair to side of bed
3. bed height so patients feet flat on floor
4. patient cross arms for wound support
5. direct to stand up - lean forward and push through feet - guide by shoulders
6. once standing relax arms and take deep breaths - consider dizziness
7. take hand for support and guide to chair - taking small steps around
8. patient feel chair on back of legs, then sit
198
What should patients be direct to do during auscultation? Why?
Cross arms at front
| Moves scapula and associated tissues out of the way - can auscultate directly onto thorax
199
In unilateral lung disease, which lung should be listened to first?
'Normal' lung first
200
How long should you listen for in each auscultation position?
A whole respiratory cycle - complete breath in and complete breath out
201
What are the risks during auscultation?
Hyperventilation, dizziness/light-headed
202
What kind of breaths should the patient take during auscultation? Why?
Deeper breaths than normal
| More turbulent airflow
203
Normal breath sounds
Noisy, turbulent airflow in trachea and large airways
204
A) Bronchial breath sounds
| B) Caused by?
A) loud and harsh, throughout inspiration and expiration, pause between the two
B) air replaced by solid tissue - eg. consolidation, areas of collapse, tumour
205
A) Diminished breath sounds
| B) Caused by
A) reduced sound
| B) obstruction or decrease in airflow - eg. atelectasis, emphysema, pneumothorax
206
Fine Crackles heard in which lung areas?
small, distal airways
207
Coarse crackles heard in which lung areas?
large, proximal airways
208
What causes 'crackles' in breath sounds?
Airways that have been closed or narrowed are suddenly forced open on inspiration
209
Early inspiratory crackles
reopening of large airways (eg. bronchiectasis and bronchitis)
210
Late inspiratory crackles
reopening of alveoli and peripheral airways (eg. atelectasis, pneumonia)
211
Early expiratory crackles
secretions in large airways
212
Late expiratory crackles
secretions in peripheral airways
213
Wheeze breath sounds can be .... or .... pitched, and ... or ...
High or low pitched, and monophonic or polyphonic
214
What causes 'wheeze'?
Air being forced through narrowed or compressed airways
215
Pleural rub breath sounds
Creaking, grating sounds
216
What causes pleural rub sounds?
pleural surfaces are inflamed or infected and rub together
