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Cardiorespiratory Physiotherapy > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What are the effects of increased secretions

A

congest airways

  • decreasing cilial function
  • increase WOB - leading to fatigue
  • Decreasing ventilation - leading to V/Q mismatch and hypoxia
  • Long term damage/scarring
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2
Q

Physio techniques to improve airway clearance

A 
cough
active cycle of breathing (ACBT)
Positive expiratory pressure (PEP)
Autogenic drainage 
percussion and vibration
inhalation therapy
exercise therapy
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3
Q

How does a supported cough help

A

increases intraabdominal pressure with support

increases force = increases effectiveness of the cough

decreases tension on the wound during contraction

decrease ROM through which the muscles contracts

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4
Q

Aim of the assisted cough

A

assist in generation of explosive force

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5
Q

Why do physio’s care about airway clearance

A

airway clearance strategies are essential to your physio toolkit

aim

  • identify secretion production/retention problems or those at risk of these problems
  • select and implement most appropriate technique for that individual
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6
Q

Normal airway clearance

A

2 mechanisms

  • mucociliary clearance
  • cough
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7
Q

Mucociliary escalator

A

Propels mucous by the cilia
coordinated
unidirectional wave like motion
move foreign particles toward the trachea at a rate of 5-15mm/min

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8
Q

Factors decreasing mucociliary clearance

A 
decreased ciliary beating 
-medications - GA, narcotics 
-drying mucous - dehydration
high FiO2
Positive Pressure Ventilation
ETT
Decreased lung volumes 
Pollutants
Decreased cough effectiveness
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9
Q

Cough

A 
protective reflex 
1st 6 generations of airways cleared 
mechanism 
-increased inspiratory volume
-closure of glottis 
-increased intra-thoracic pressure (ITP)
-Abdominal muscle contractions 
-Increased intra thoracic and intra-abdominal pressures (IAP) against a closed glottis 
-Ascent of diaphragm 
-Forceful expulsion of air/secretions/foreign bodies
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10
Q

What can go wrong with a cough

A

Decreased lung volume

  • pain
  • restriction
  • obstruction
  • fear/anxiety
  • muscle weakness
  • neurological impairment

Solution : methods of increasing lung volume

Decreased expiratory force

  • pain
  • muscle weakness
  • poor elastic recoil (emphysema)
  • Inability to close glottis (bulbar palsy)

Solution: assist the expiratory phase

  • supported cough
  • assisted cough
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11
Q

techniques of assisted cough

A
  • bibasal compression if compliant chest and bibasal expansion
  • AP sternal compression if apical movement
  • Substernal angle compression can assist diaphragm ascent
  • Subcostal thrust used for SCI patients - unable to contract abdominals to generate force
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12
Q

Other techniques for cough

A

tracheal rub
stimulated cough
cough assist machines

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13
Q

adverse affects of vigorous coughing

A 
Abnormal cardiovascular response 
abnormalities of the genitourinary tract - stress in continence 
Gastrointestinal symptoms - GORD, hernia
Msk problems
Neuro features
respiratory complications
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14
Q

ACBT Active Cycle of Breathing

A

Aims

  • mobilise and clear excess secretions
  • improves lung functions

advantages :
flexible - adapt to suit individual
-use with a variety of patients/ conditions
-not comfortable
-use in any position
-combine with other treatment, no equipment required
-can be performed independently

Duration - 10 -30 mins

  • Depends on productivity of patient
  • repeat until no longer productive or patient fatigues
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15
Q

FET Forced Expiratory Technique

A

Huff with BC
Emphasis on expiration - squeeze not wheeze
Different lung volumes (low, mid, high) to mobilise then remove secretions

Use equal pressure points

BC Prevents airflow obstruction
Length of BC depends on patient

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16
Q

PEP Positive Expiratory Pressure

A

Aim
-re-inflate collapsed part of lung by increasing collateral ventilation
-splints airways open
-Air behind secretions to mobilise upwards
Increases FRC
Increases lung volumes

17
Q

Mouthpiece

A

more common
smaller more portable device
muse keep cheeks flat

18
Q

Mask

A

if unable to keep cheeks flat

if unable to keep mouth sealed around mouthpiece

19
Q

Selecting resistance

A

Consider

  • size of resistor (1-5)
    • smaller resister number = smaller hole = greater PEP
  • -larger resistor number = larger hole = less PEP
  • Patient’s expiratory flow
    • greater flow = greater PEP
  • -Less flow = less PEP

Test

  • 6-8 breaths with PEP
  • Pressure of 10-20cm H2O
  • Able to maintain I:E = 1:3 and can complete for 2 mins
  • Check no increased WOB (Accessory muscle use) for SOB
20
Q

Indications

A

Diseases

  • CF
  • COPD
  • Bronchiectasis
  • Chronic Bronchitis
  • Restrictive Lung Disease

Post op secretions and atelectasis
Collapsible airways
Productive asthma - pressures

21
Q

Contra-indications

A 
lung surgery 
clamped ICC
Increased ICP 
Frank Haemoptysis 
Severe CV disease 
Surgical emphysema 
Severe bronchospasm 
Emphysematous Bullae 
Undrained pneumothorax
22
Q

PEP - Bubble

A

Fun
Cheap
Temporary

23
Q

PEP - oscillating

A

devices
-flutter
-acapella
Oscillations of expiratory flow combined with PEP
-alters physical properties of secretions -mechanically ruptures rigid mucous gel
-aims to decrease viscosity
facilitates mobilisation and clearance of secretions
-Prevents airway collapse
-Reduces expiratory effort

24
Q

Flutter

A 
small portable device
aim
-decrease sputum viscoelasticity 
-increases diameter of peripheral airway 
Endobronchial pressures = 10-25cmH2O
Tilt to optimum position - 8-16Hz = natural pulmonary resonance = cilial beat 
Vibration of bronchial wall not cheeks
cannot inspire through the device 
position - sitting
25
Q

Acapella

A

can inspire through device
dial up resistance - unable to measure through manometer
Oscillations dependant of gravity - can do in any position

26
Q

Autogenic Drainage (AD)

A 
self drainage utilising BC and breaths at various lung volumes to mobilise secretions 
-from smaller airways to central to be removed 
3 phases 
-unstick
-collect
-evacuate 
Suppress cough until end of routine 
Disadvantages
-difficult to learn 
-can be uncomfortable
-time consuming
27
Q

AD

A 
Unstick 
-low volume 
-from smaller airways 
-inspire, hold 3 seconds, expire fully through mouth, use abdominal muscles 
Collect 
-mid volume
-from middle airways 
-inhale slowly to higher (tidal) volume 
-expire only to TV
Evacuate 
-high volume 
-from central airways
-inspire to higher lung volumes 
-can use huff or cough to remove secretions 
Progress to next stage when 
-crackling through all expiration
-feel mucous moving up 
-feel urge to cough
28
Q

Postural drainage

A

Allows gravity to assist drainage from specific bronchopulmonary segments
-aim to get bronchi 90 degrees to horizontal
improves ventilation/perfusion
Can use with other ACT
Usually modified positions are used - no head down tilt

29
Q

PD contraindications

A 
dyspnoea 
desaturation 
after a meal 
hiatus hernia
severe haemoptysis 
abdominal distension
Late stage pregnancy 
congestive cardiac failure 
aortic or cerebral aneurysm
Surgery/trauma to head/neck 
GORD
Severe uncontrolled hypertension
cerebral oedema, early head injury
30
Q

Percussion and vibrations

A 
aim
-enhance mucociliary clearance by
-increasing cilial beating with vagal stimulation 
-decrease mucous cross links 
-increase peak expiratory flow 
Precautions 
-Rib #
-Osteoporosis 
-Pain
-SOB
-Lung cancer
31
Q

Percussion

A

procedure

  • rhythmic hitting of chest wall with a cupped hand
  • use towel between hand and chest wall skin
  • can perform in PD positions

cautions

  • can cause bronchospasm and decrease PaO2
  • –incorporate TEE
  • –minimise length of Rx
32
Q

Vibration

A

vibratory force during expiration along normal movement of the ribs
Can be used to augement FETs
Fine or coarse
Need to feel the compliance of the chest wall motion prior to technique
-basal excursion
-AP sternal movement

33
Q

Inhalation therapy

A 
administered 
-inhaler 
-nebuliser 
Therapy 
-bronchodilator- Ventolin 
-- decrease airway resistance 
--increases cilial beat 
--administer prior to physio Rx
-Mucolytics - saline, pulmozyme 
--decreases viscosity of secretions 
--administer prior, during or post physio Rx
-Inhaled steroids
--decreases inflammation 
--administer after physio Rx
34
Q

Exercise Therapy

A

Role in airway clearance

  • prior to ACTs to loosen secretions
  • increase mucous clearance and ventilation
  • different positions - assist with drainage

other benefits

  • increases BMD
  • improves posture, positive body image and wellbeing
  • improves CV fitness, muscle strength and endurance
  • improves core stability, mobility and flexibility
35
Q

Exercise therapy safety

A

exercise testing
monitor
hydration
heat control

36
Q

selection of strategies

A

patient related factors

  • cognitive ability
  • goals
  • ease of learning
  • age
  • preference
  • concentration

Technique related factors

  • effectiveness
  • limitation
  • equipment

Physio related factors

  • goals
  • skill
  • time
  • combination with other Rx

Cardiorespiratory Physiotherapy (7 decks)

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