Treatments Flashcards
(18 cards)
Why does positive pressure ventilation reverse ventilation away from the dependent lung?
- The diaphragm is pushed down passively
- Airflow takes the path of least resistance
- Increased perfusion in dependent regions compresses lung and accentuates the perfusion gradient
- Dependent regions are prone to collapse
- Absorption atelectasis at higher oxygen concentrations
What is the purpose of postural drainage?
- The drainage of secretions , by the effect of gravity , from one or more lung segments to central airways.
- Each position places the target lung segment superior to the carina
- Held for 3-15 mins
Clinical application of postural drainage is limited by?
- More active clearance techniques being promoted
- Precautions/unhelpful side effects e.gWOB
- Patients unable to tolerate due to co-pathologies , surgery etc.
What clinical adjuncts could you use with Postural drainage?
- Clearance techniques ( Manual techniques ( percussion), ACBT)
- Often used in modified PD
- Pre-PD= Bronchodilation/Humidification
What equipment could be used in Postural drainage?
- Plinth
- Pillows
- Wedges
- Triangular specialised bean bag
What positioning would you prescribe for this patient scenario?
- 2/7 post Cholecystectomy ( removal of the ball bladder) - on the right
- Nasogastric tube in situ
- Mobility limited due to pain
- Crackles @right base
Tilted Left side lying supported by pillows( Head , back and knees) , with arm over the head for percussion access. Upper leg is flexed for support.
Due to mobility limited by post op pain i would not ask the patient to lie in prone at this stage as well as the nasogastric tube being in situ.
Give 5 simple yet effective positions of ease for Dyspnea-
- Fixing - on the knees
- Side lying
- Fixing on the back of the chair
- Slouched stance
- Pillows on the table and leaning over
What are the benefits of Abdominal breathing-
- Decrease airway turbulence
- Decrease dead space
- Favour dependent regions
- Relaxes shoulder girdle
What are the benefits of deep breathing or TEEs? ( Thoracic expansion exercises)
- Increase lung volume
- Increase ventilation
- Decrease airway resistance
- Increase surfactant secretion
- Aid V/Q matching
- Decrease dead space increase diffusion
- Increase 02 saturation
What instructions would be given for deep breathing exercises?
- Deep breath via nose
- Breath out of the mouth - relaxed
- Therapists hand over thorax to evaluate/facilitate
- 3-4 breaths and rest
- Use breath hold at full inspiration and possibly add sniff
How does humidification impact mucocililary clearance?
- impacts the function of the cilia as well as the quality and quantity of the mucous
- Prevents secretion thickening
How may humidification techniques be administered?
- Systemic hydration or intravenous fluids
- Inhalation of a vapour
- Nebulisation by inhalation of an aerosol
How is percussion carried out?
- Rhythmic clapping on the chest
- Loose wrist and cupped hand
- usually in modified postural drainage positions
- Skin covered
- Single or double handed depending on the size of the patient
- 30-1 min
How are vibrations carried out?
- Vibrations are fine oscillations of the hands
- Shaking is a coarser movement
- Directed inwards against the chest
- performed on exhalation after deep inhalation
- Patient on a firm surface
What do vibration techniques actually do to aid respiratory patients in recovery?
1) increasing absolute peak expiratory flow rates (PEFR) to move secretions towards the oropharynx
2) improving the expiratory bias of airflow to increase the annular flow of mucus towards the oropharynx
3) increasing mucus transport by decreasing the viscosity of mucus and improving expiratory flow due to the effects of oscillation of airflow 4) eliciting spontaneous coughs via the mechanical stimulation of the airways
Give some precautions for percussion and vibration techniques in respiratory patients-
- Frank Haemoptysis
- Clotting
- Uncontrolled thoracic pain
- Rib fractures
- Active TB
- Pneumothorax
Give a brief explanation of the clinical relevance of vibration vest-
The vibration of the vest against the chest wall helps to loosen mucus. The vest creates an airflow that helps to move mucus from the airway walls. For therapy to be effective, Huff Cough and regular coughing must be done during and after the treatments. Put the vest on over a thin layer of clothing.
Give a brief overview of ‘Huffing’ in respiratory care
- A huff is a forced exhalation through an open mouth and glottis instead of coughing.
- FET - Forced expiratory technique
- Helps mobilise sputum up the airways toward the mouth in a controlled way
- Uses the abdominal muscles and chest wall to facilitate expiratory airflow
- Huffing should be followed by breathing control
- Huffing usually starts from low lung volume but once secretions start to move proximally huffs can be taken from a higher lung volume
