Week 5 Flashcards

Question

What are the characteristics of IV anti-inflammatory: glucocorticoids?

Answer 1

Use in severe asthma attacks (status asthmaticus) or respiratory distress • Methylprendisolone (Medrol)

Answer 2

Hyperglycemia, HTN, Osteoporosis, Myopathy, Mood Swings. | • Less side effects with Inhaled Delivery

Answer 3

- Airway hyperresponsiveness - Inflammation - Smooth muscle hypertrophy - Mucous secretion - Heavily involved in asthma

Answer 4

``` • Montelukast (Singulair) • Inhibits the effects of leukotrienes - Airway hyperresponsiveness - Inflammation - Smooth muscle hypertrophy - Mucous Secretion • Great for Asthma, “OK” for COPD • Delivered in pill form • Enhance effects of glucocorticoids and allows for smaller dosages. - Often prescribed together ```

Answer 5

• Pirfenidone (Esbriet) and nintedanib (Ofev) • Anti-Fibrotic medication • Inhibit pathways that lead to fibrosis and scaring of lungs - Suppress fibroblast proliferation, reduces fibrogenic mediator production, • Prior to these medications there were no true IPF meds - Oxygen and Steroids (not ideal)

Answer 6

A endogenous chemical involved in regulating modulating several physiological functions: • CNS neural modulation, gastric secretions and hypersensitivity reactions • 4 receptor subtypes (H1-H4) • H1 are involved with the respiratory system and hypersensitivity - Nasal Congestion, sinusisitis, rhinitis, mucousal irritation,

Answer 7

Block these receptors, most are non specific

Answer 8

Sedation, fatigue, dizziness, | incoordination

Answer 9

Diphenhydramine (Benadryl)

Answer 10

Relieve nasal congestion in the upper respiratory tract

Answer 11

Alpha-1 agonist

Answer 12

``` Pseudoephedrine (Sudafed) • Causes vasoconstriction in nasal passages • Essentially “dries up” muscousal vasculature and reduces nasal congestion • Oral or Nasal Spray ```

Answer 13

* Decrease viscosity (thickness) of respiratory secretions | * Allows for easier mobilization of secretions up the “muco-cilliary elevator”

Answer 14

``` Often delivered orally • Guanefisine (Mucinex) • Guanefisine and antitussive (Robitussin) - dextromethorphan (DM) - Codeine (DAC) ```

Answer 15

Suppress coughing response/ reflex | • Due to irritation in airways and sinuses

Answer 16

• Makes it difficult to get rid of the mucus that collects in the lungs and airways. • May increase secretions • Asthma and young children

Answer 17

• Central mediated inhibition: codeine and dextromethorphan (DM) - Opiates, Act on brainstem • Local mediated inhibitors: Antihistamines and local anesthetics - Act on respiratory tissue

Answer 18

• Treatment of acute exacerbation or infection - Increased dyspnea, Increased chest congestion AND FEV1 < 50%. • Treatment of acute bronchitis or pneumonia • Prevention of acute exacerbation (prophylactic antibiotics)

Answer 19

• Bactericidal - Penicillins: Penicillin and Amoxicillin, - Cephalosporins: Ciprofloxacin (Cipro) • Bacterostatic: - Macrolides: Azithromycin (Zpack)

Answer 20

• Reduce serious illness and mortality in patients with COPD • GOLD and CDC recommends annual vaccine for: - Patients with COPD - Patients with pulmonary fibrosis - Patients with asthma >6months of age - The elderly, ages >50years of age - Young Children, ages 6months-4years of age - Health-care personnel - Morbidly Obese patients BMI>40 - Immunosuppressed patients

Answer 21

* Hypoxemia * Reduce work of breathing * Reduce work of the heart (especially RV)

Answer 22

For patients with Pulse Oximetry <88% or SpO2 <55mmHg • May also be prescribed for patients with PAH and RV HF • Patients with chronic COPD may have different guidelines

Answer 23

*Smoking* is the main risk factor in the development of COPD

Answer 24

* Improves Respiratory symptoms * Reduces Bronchial hyperresponsiveness * Prevents accelerated decline in lung function and may improve FEV1. * In all smokers

Answer 25

Within a week

Answer 26

* How much one smokes on a daily basis | * Within 30 minutes of waking up each day.

Answer 27

* Help reduce the craving for tobacco; Bupropion (Zyban) * Help reduce withdrawal symptoms; Varenicline (Chantix). * Nicotine replacement therapy: most helpful for people who smoke >.75PPD

Answer 28

By measuring Maximum Inspiratory (MIP & Expiratory Pressure (MEP)

Answer 29

Posture, Chest wall excursion, Rib and Thoracic Spine | Mobility

Answer 30

Arterial Blood Gases (ABG), Pulse Oximetry (SpO2)

Answer 31

Spirometry (FVC and FEV1), Respiratory Rate (RR),

Answer 32

Fremitus, Voice Sounds, Breath Sounds

Answer 33

Independence, Sputum Assessment

Answer 34

VAS, RPE, MMRC Dyspnea Scale, St George’s Respiratory Scale, Dyspnea Index

Answer 35

6MWT, Max Test, Submax

Answer 36

BERG, POMA, DGI, BEST

Answer 37

5 or 10m Gait Speed, TUG,

Answer 38

5Ttime Sit to Stand, 30 Sec Sit to stand

Answer 39

* Disposition: Distress, Short of breath, Somnolent etc | * Skin: Edema, JVD, Cyanosis, Sweating

Answer 40

Normal, Barrel Chest, slouched, guarding, pes escavatum or Pectus carinatum

Answer 41

• Rate and Depth - Neck, Chest, Abdomen • Accessory muscle usage • Asymmetrical Paradoxical Chest Wall Movements • Nasal Flaring • Pulse Oximetry RA or with supplementation

Answer 42

• Have the patient flex neck slightly • Place your index finger in the suprasternal notch • Place the top of finger in suprasternal notch medial to left SC joint. • Push inwards toward the cervical spine • Repeat on right side • Normal test - No obstruction to the advancement of the finger. • Most Common Cause of deviation: Midline shift due to Pneuomothorax (moves away from lesion)

Answer 43

If there is chest pain, a mass seen on inspection, breast masses, or draining sinuses.

Answer 44

• Examine for tenderness and masses - Soft tissues (also assess for crepitus - Large thoracic muscles - Costal cartilages, intercostal spaces, costochondral junctions and xiphisternal • Palpate the ribs for point tenderness, swelling, crepitus, and pain on chest compression.

Answer 45

With one hand supporting the back, compression of the sternum with the other elicits pain at the untouched fracture site.

Answer 46

• Place a hand on each side of the chest wall • Extend thumbs so their tips meet in the midline. • Have the patient inspire deeply permitting your palms to move freely with the chest while your fingers are anchored on the chest wall. • Normally, the thumbs move laterally from midline in equal distances. • Asymmetric excursions suggest a lesion on the lagging side in the chest wall, the pleura, or the upper lobe of the lung.

Answer 47

Latissimus Dorsi

Answer 48

Lateral Ribs

Answer 49

Place measuring tape around chest wall • Xiphoid process is Most reliable landmark • May also use Axilla and interval between xiphoid and umbilicus • Normal excursion is 2-3inches or 4-6cm

Answer 50

• Increased transmission of sound, can be detected as fremitus over the affected area while the patient repeatedly vocalizes - “one, two, three” or “99” • The examiner moves his or her palms systematically over the two hemithoraces. • Common Causes of increased fremitus (Vibration) - Consolidation of the lung • Conversely, impairment of sound transmission, as by a pleural effusion, diminishes vocal fremitus. • A good test to start chest exam - Not very specific however due to size of hands - If differences are appreciated always follow up with auscultation

Answer 51

Evaluates regional or side-to-side differences in lung density • Normal lung density willsound resonant (table) • Areas of increased density (e.g. consolidation, atelectasis) will sound dull. (quads) • Areas of decreased density (e.g. emphysema) will sound hyperresonant. (puffed out cheeks or bloated belly)

Answer 52

• Place pad of middle finger of non dominant hand on the subject’s chest in the intercostal space. • Using the middle finger of your dominant hand, tap the knuckle of the middle finger of your non dominant hand . - Keep Percussing finger rigid, tap like woodpecker • Listen for the pitch of the sound produced and note the vibrations from the chest with your finger

Answer 53

* Inflammatory cells, enter the airways and alveoli in response to lower airway infection. * May be yellow, green, or dirty gray.

Answer 54

Acute bronchitis, resolving pneumonia, small tuberculous cavities, or lung abscess

Answer 55

Bacterial Pneumonia, Lung abscess, bronchiectasis, or bronchopleural fistula communicating with an empyema.

Answer 56

Anaerobic infection (PNA) and/or lung abscess.

Answer 57

Increased mucous production and mucous plugs occur in asthma; during resolution retained mucous and mucous plugs are mobilized.

Answer 58

* Coughing up blood or bloody mucous | * Hallmark sign of Pulmonary Embolism, may also occur with trauma, pneumonia

Answer 59

* inflammation in the nose, nasopharynx, gums, larynx, or bronchi. * Sometimes it occurs after severe paroxysms of coughing and minor airway trauma

Answer 60

* Alveoli and respiratory bronchioles are flooded with fluid from the capillaries * Producing thin secretions containing air bubbles, frequently colored with hemoglobin. * Hallmark sign of pulmonary edema

Answer 61

* Patient lays supine with anterior chest exposed * Palpate anterior chest well with thumbs over costal margins so tips meet at xiphoid * Instruct patient to sniff of take deep breath, allow thumbs to move with chest wall * Normal test is equal upward movement of the costal margins • ***Can also be done in sitting using percussion and markings pre and post inspiration, • Normal should see ascent to T10 expiration, descent to T12 inspiration

Answer 62

My having the subject expire to a residual volume (RV) (ie, fully expire) and then perform a maximum inspiratory maneuver. • Opposite for Expiratory Pressures

Answer 63

As the most negative (MIP) or positive (MEP) pressure attained after the first second of effort

Answer 64

One that demonstrates a 2-s plateau of inspiratory effort. Take average of 3 trials, values should be within 10% of largest measure

Answer 65

Effort and understanding of test, age, gender, height, weight, fitness level and smoking status

Answer 66

Type of mouthpiece, presence of a small leak, number of trials and lung volume at the starting point of test performance

Answer 67

To assess the strength of the diaphragm

Answer 68

Indirectly measures the oxygen saturation of hemoglobin in arterial blood (SpO2) • SaO2 is a direct measurement of oxygensaturation, taken from ABG

Answer 69

95% – 100% | • Percent error of 90%

Answer 70

* Bright ambient light on probe * Nail thickness (including nail polish) * Skin pigmentation * Low peripheral perfusion states * Hypoxemia (<80% SaO2) * Motion artifact * Carbon monoxide poisoning

Answer 71

12-20 breaths/min

Answer 72

Respiratory rate above 20 breaths/min

Answer 73

Respiratory rate above 12 breaths/min

Answer 74

Max volume air contained in lung at end of max inspiration, 5-7L

Answer 75

* Maximum volume of air that can be expired in single breath after max inspiration, * Men: 5.0L; Women 3.8L, * FVC = maximally forced VC

Answer 76

Amount of air expired in first second of FVC; normal 80%

Answer 77

Normal breath; volume gas expired during unforced respiratory cycle (one breath), 0.4-0.7L

Answer 78

Amount of air expired per min (TV x RR), 4L/min; The Cardiac Output of Ventilation

Answer 79

Amount of air remaining in lungs after max expiration: 1L

Answer 80

Diffusion Capacity,: Normal >80%

Answer 81

Volume of additional air that can be inhaled after a normal tidal breath in

Answer 82

Volume of additional air that can be pushed out after the end expiratory level of normal breathing

Answer 83

Volume of gas that remains in lungs at end of normal tidal breath outequilibrium point (ERV + RV)

Answer 84

• Haemoptysis (of unknown origin) • Pneumothorax • Unstable cardiovascular status, recent myocardial infarction or pulmonary embolism • Thoracic, abdominal or cerebral aneurysms • Recent eye surgery • Acute disorders affecting test performance, such as nausea or vomiting • Recent thoracic or abdominal surgical procedures

Answer 85

- Age - Height - Gender - Ethnicity

Answer 86

• Patient must inhale maximally to total lung capacity, then blast the air out • There should be no cough or hesitation during the first second of the maximal exhalation • The patient must continue to exhale forcefully for at least 6 seconds and until a plateau is reached (3 seconds for children under age 10) • The largest and second largest FVC and FEV1 values should be repeatable within 150 ml (100 ml if the FVC is less than 1.00 L) • A minimum of 3 acceptable trials is required • The largest FVC and FEV1 from acceptable efforts are reported; the FEV1/FVC is calculated from these values

Answer 87

* Sit upright: there should be no difference in the amount of air the patient can exhale from a sitting position compared to a standing position as long as they are sitting up straight and there are no restrictions. * Feet flat on floor with legs uncrossed: no use of abdominal muscles for leg position. * Loosen tight-fitting clothing: if clothing is too tight, this can give restrictive pictures on spirometry (give lower volumes than are true). * Dentures normally left in: it is best to have some structure to the mouth area unless dentures are very loose. * Use a chair with arms: when exhaling maximally, patients can become light-headed and possibly sway or faint

Answer 88

• Different techniques for performing spirometry. • Before performing the forced expiration, tidal (normal) breaths can be taken first, then a deep breath taken in while still using the mouthpiece, followed by a further quick, full inspiration. • Or; Alternatively, a deep breath can be taken in then the mouth placed tightly around the mouthpiece before a full expiration is performed. • Or; The patient can be asked to completely empty their lungs then take in a quick full inspiration, followed by a full expiration. • The patient takes a deep breath in, as large as possible (using whichever technique most effective), and blows out as hard and as fast as possible and keeps going until there is no air left. • Nose clips are essential for as air can leak out

Answer 89

• 24 item, Interviewer-administered rating of severity of dyspnea at a single state across 3 domains • TDI measures changes in dyspnea severity from the baseline as established by the BDI. • Provides a multidimensional measurement of dyspnea based on 3 components that evoke dyspnea in activities of daily living, in symptomatic individuals.

Answer 90

A concise measure of health related quality of life

Answer 91

MMRC dyspnea scale. May detect changes in QoL faster | than GOLD classifications

Answer 92

- Grade of dyspnea 0: Not troubled by breathlessness except on strenuous exercise - Grade of dyspnea 1: Shortness of breath when hurrying on the level or walking up a slight hill - Grade of dyspnea 2: Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level - Grade of dyspnea 3: Stops for breath after walking about 100, or after a few minutes on the level - Grade of dyspnea 4: Too breathless to leave the house when dressing or undressing

Answer 93

• 50 question, Disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease. • Scores range from 0 to 100, with higher scores indicating more limitations. • MCID: a mean change score of 4 units is associated with slightly efficacious treatment, 8 units for moderately efficacious change and 12 units for very efficacious treatment

Answer 94

Find the clavicle and go right above it. In the middle of the belly of the upper trap

Answer 95

Find the clavicle and move straight down, right below the angle of louie

Answer 96

Find the xiphoid, and move superior lateral to it. AN inch over and up

Answer 97

Start at the xiphoid, and go all the way after the clavicular line almost to the mid axillary line

Answer 98

Right above the spine of the scapula, over the posterior belly of the trap

Answer 99

Find the spine of the scapula, come lateral to almost mid spine of the scapula. Have the patient give themselves a hug to move the bone out of the area. Right around T3

Answer 100

Find the border of the scapula, then come up. Right between the spine of the scapula and the inferior angle. More para-sternally. Between T4 and 7

Answer 101

Go to the inferior angle of the scapula, and go straight down. In rib spaces 7, 8, 9, and 10, before the mid line of the scapula

Answer 102

- Have patient take deep breaths through the mouth while you listen through one complete respiratory cycle (inspiration and expiration) in each locations, segment by segment. - Listen from side to side, comparing the sounds and noting any differences. - Breath sounds in the same area of the lung should sound the same of the right and left side.

Answer 103

Over the trachea - They are a bit higher pitched, and we hear more expiration than inspiration, because the bore of the airway is wider, so more air flow because it is more turbulent

Answer 104

Where we appreciate the 1st divisions of the bronchiole tree, which is around the angle of louie. At the manubrium and upper interscapular region. - Where they are a bit more harsher. moderately loud, medium pitch, rustling 1: 1 ratio exp:insp

Answer 105

Primarily over the lungs fields, at the Peripheral lung fields - Hear air going through the small airways of the alveoli in the respiratory bronchioles. Only hear inspiratory sound, may not hear expiratory sound, because there is not a lot of air flow there due to the smaller airway, there is not as much flow here compared to the proximal segments

Answer 106

- Loud, high pitch, tubular | - 1:2 ratio exp:insp

Answer 107

- Soft, low pitched, and with a gentle rustling quality | - May not appreciate expiration phase

Answer 108

- Air or fluid in or around the lungs (pneumonia, heart failure, and pleural effusion) - Over-inflation (emphysema) - Reduced airflow to part of the lungs (rib fracture, pneumorthorax) - Increased chest wall thickness

Answer 109

• Normally breath sounds in peripheral fields are vesicular • Bronchiovesicular in peripheral fields indicate - Partial pulmonary consolidation or compression transmitting airway sounds with increased efficiency. - Usually heard on periphery of consolidation or compression • If Compression or consolidation increases breath sounds become bronchial in nature.

Answer 110

Faint and the syllables indistinct, except over the main bronchi.

Answer 111

Consolidation, atelectasis, or fibrosis, which improve sound transmission

Answer 112

Detecting pulmonary consolidation, and atelectasis. Whispered tend to be better than spoken for detecting subtle differences

Answer 113

A form of bronchophony in which the spoken “Eee” is changed to “Ay,”

Answer 114

When spoken syllables are normally heard indistinctly, with lung consolidation syllables are distinct and sound close to the ear.

Answer 115

When consolidations transmit whispered syllables distinctly, even when too small to produce bronchial breathing

Answer 116

The “popping”; opening and closing of alveoli compressed by fluid (atelectasis)

Answer 117

During (inspiration). Sounds like Velcro

Answer 118

- Atelectasis and Pneumonia - Typically present in one lung field - Resolves with coughing or deep breaths

Answer 119

- Pulmonary Edema from HF - Present in bilateral lungs fields (especially bases) - Does not resolve with coughing or deep breaths - Resolves with sidelying positioning

Answer 120

Obstruction to airway flow, Asthma, mucous in airway, airway inflammation, tumor, or obstructing foreign bodies

Answer 121

Typically considered an expiratory sound due to forcing airflow through abnormally narrow or collapsed airways. May occur during both inspiration and expiration in asthma - Non-cardiogenic should decrease with cough

Answer 122

Foreign body in the upper airway or esophagus, an acquired lesion of the airway (e.g., carcinoma in adults)

Answer 123

- Wheeze-like sound - Usually due to a blockage/obstruction of airflow in trachea, upper airway or in the back of the throat. - Predominantly inspiratory and best heard over the neck.

Answer 124

- Coarse, grating, or leathery sound | - Usually heard late in inspiration and early in expiration

Answer 125

Posterior lung bases or lower axilla

Answer 126

Increased friction due to Inflammation of the pleural linings, multiple causes

Answer 127

Bronchial breath sounds in periphery

Answer 128

Coarse crackles, expiratory wheezing

Answer 129

Inspiratory and expiratory wheezes

Answer 130

Coarse crackles, wheezes that clear with cough

Answer 131

Decreased sounds over consolidation, Bronchial sounds in periphery.

Answer 132

Inspiratory crackles

Answer 133

Decreased to absent

Answer 134

* A-airway * B-bone * C-cardiac * D-diaphragm * E&F-equal (lung) fields * G-gastric bubble * H-hilum (and mediastinum)

Answer 135

A PA (posterioranterior) and lateral chest x-ray. • The PA exam is viewed as if the patient is standing in front of you with their right side on your left. • The patient is facing towards the left on the lateral view

Answer 136

• Look at the trachea and its branches: check the 4’s - Site, size, shape, and shadow (4 S’s). • Is it patent, or narrowed indicating stenosis or Edema? • Is it central? (in children it should be straight but in adults it can deviate to the right due the aortic arch)

Answer 137

• Look at and compare the bony structures paying attention to site, size, shape, shadows and borders: - (clavicles, ribs, scapulae, thoracic vertebrae, and humeri). • Fractures? Using a pointer follow along the smooth edges of each bone looking for an interruption of the smooth line. • Lytic lesions? Look for discrete darker areas or a change in bone density. • Deformity? Extra or missing bones?

Answer 138

• Site: is it located on the right or left? • Size: is it less than half the transthoracic diameter? (i.e. is the largest diameter of the heart less than half the largest diameter of the thorax) • Shape: is it ovoid with the apex pointing to the left? • Shadows: any change in density? • Borders: is it clear or well defined? - unclear right border suggest middle lobe consolidation. - unclear left border suggest lingular lobe consolidation.

Answer 139

• The outline of the diaphragm should be clear and smooth. • Right hemidiaphragm should be higher (2-3cm) than the left • Are the costophrenic angles well defined? - whiteness immediately above the diaphragm indicates pleural effusion or consolidation. - the presence of fluid will produce a meniscus (Meniscus Sign) or a concave upper border • Is there air below each hemidiaphragm indicating bowel perforation? • Is the diaphragm below the anterior end of the 6th rib on the right? - Indicates hyperinflation

Answer 140

• Divide lung fields into zones: upper, middle, and lower zones - upper: from the apex to 2nd costal cartilage - middle: between 2nd and 4th costal cartilage - lower: between 4th and 6th costal cartilage • Look for equal radiolucency (or blackness due to air filling) between the left and the right lungs zones. • Look for any discrete or generalized grey/white shadows (described as opacity/patchy shadows) • Look for vascular markings: - indicating pulmonary hypertension pruning • Bat’s wing distribution: bilateral opacification spreading from the hilar regions into the lungs - pulmonary edema in heart failure, fluid overload, hypoproteinemia, blood transfusion reaction, and others

Answer 141

• GASTRIC FUNDUS - Look for an air bubble under the left hemidiaphragm. • Look for diaphragmatic hernia on the right or left. • Look at the hilum (which consists of main bronchus and pulmonary arteries) -the left should be higher than the right. • Compare the convex shapes and densities on both sides. • The paratracheal lines are thin lines of the right and left tracheal margins which are thickened in lymphadenopathy

Answer 142

They are both fluid in the lungs, however pleural effusion is restricted to one side, while pulmonary edema is bilateral

Answer 143

An airway clearing technique, where you breathe in slowly through the nose, hold the breath for 3 secs, and then exhale with an open mouth

Answer 144

If moves mucus from the small airways up into the larger airways, then a deeper breath followed by a forceful exhale moves the mucus from the larger airways, out of the lungs, then you cough to clear the mucus out of the airways

Answer 145

It is designed to get air behind the mucus, making it easier to cough up

Answer 146

- Breathing control: gently breathe in through your nose, to relax the airways. - Chest expansion exercise: inhale deeply and hold the breath for 3 secs, which will get air behind the mucus, and loosen it, making it move up into the larger airways more easily - Forced expiratory technique: huff-cough to move the mucus from the larger airways and out of the body

Answer 147

A technique that uses controlled breathing in 3 phases

Answer 148

- Phase 1: take in shallow breaths, to unstick mucus from the sides of the small airways - Phase 2: collect mucus by holding breath for 3 secs - Phase 3: move mucus out of the airway with a hard huff- cough

Answer 149

When another person uses cupped hands and percussion to loosen mucus from airways, this happens while the patient lies in position that uses gravity to drain the mucus from smaller airways, the patient then huffs or coughs the mucus out of their lungs

Answer 150

Works by compressing the chest in and out to create airflow, which loosens mucus from the airway walls

Answer 151

Uses resistance to open the airways and get air behind the mucus, loosening it and moving it from smaller airways to larger ones, where it is huffed or coughed out

Answer 152

Resistance forces airways to open, the vibrations from the device, called oscillations also shake mucus, loosening it from the airway walls, once the mucus has moved up into the larger airways, patient huff-cough it out of the airway

Answer 153

- Hemoptysis - Untreated tension pneumothorax - Platelet count < 20,000 per mm^3 - Unstable hemodynamic status - Open wounds or burns in the thoracic area - Pulmonary embolism - Subcutaneous emphysema - Recent skin grafts or flaps on thorax

Answer 154

- Uncontrolled bronchospasm - Osteoporosis - Rib fractures - Metastatic cancer to ribs - Rumor obstruction of airway - Anxiety - Coagulopathy - Convulsive or seizure disorder - Recent pacemaker

Answer 155

- Place one hand over the other, and move upper hand side to side for 2-3 mins, with gentle to high frequency force, at 12-20 Hz - Applied throughout expiration, if performed during ventilation, coordinate with the ventilator

Answer 156

Similar to vibration, but it is more aggressive, but with bouncing movement rathe r than side to side movements. Apply for 2-3 mins during expiration at a frequency of 2 Hz

Answer 157

Primarily during expiration, and its due to the fact that the inspiratory pressures and inter-pleural pressures are much higher than inter- pulmonary pressures, which results in collapse

Answer 158

Consists of exhaling through tightly pressed (pursed lips) and inhaling through nose with mouth closed.

Answer 159

• The patient inhales through their nose, keeping their mouth closed. - Trying to inhale for 2 seconds. • Exhale slowly through pursed lips, - Trying to exhale for 4 to 6 seconds. - “Make the birthday candles flicker but don’t blow them out” - “Blowing on hot soup

Answer 160

• Improves Ventilation • Reduces respiratory rate • Prevents premature airway collapse by increasing back pressure (positive pressure) in airways • Prolonging the breathing cycle, may allow for greater opportunity for diffusion at the alveolar capillary interface. • Slowing respiration may be relaxing and thus reduce anxiety • Great for patients with COPD!!!

Answer 161

* DSB, 6-8breaths/min, has been shown to improve symptoms of pain, both chronic and acute. * Autonomic responses such as increased heart rate variability and reduced skin conductance (markers of increased parasympathetic tone) have been observed following DSB, * More recent evidence suggests that the effects of DSB are likely more due to achieving a relaxed state or distraction from the noxious stimuli. * Therefore these changes in autonomic activity in following DSB are more likely a reflection of supraspinal activity due to achieving a relaxed or non-threatened state than the cause. * In short, breathing slowly and controlled may relax a patient and improve pain rating and the changes in autonomic function are reflection of that change not the mechanism.

Answer 162

• Manual contacts to the thoracic wall - Quick stretch or sustained facilitatory proprioceptive stimulus. - “Breathe Into my Hands” • Often used to facilitate breathing in the lower lateral segments in patients with impaired chest wall expansion. - Commonly referred to interchangeably as “Diaphragmatic breathing” - Not too effective for patients with COPD • Often done in semi-fowlers position to allow for better diaphragm movement • Can also be done on individual segments elsewhere on the chest well - “Segmental Breathing” • Can be done by provider or patient

Answer 163

• Volitional coordination of breathing during activity. • Expiration is primarily a passive activity. - Having a patient expire during exertion may prevent dyspnea during an activity • Example - Inhale while walking 2 steps then, Exhale while walking 4 steps, and repeat - Take a deep breath to start and exhale while climbing 2 stairs, and repeat • Often used incorporating PLB, DSB or “Diaphragmatic Breathing” into functional activities.

Answer 164

• Used often over areas of chest wall that are painful - Post-operative site, rib fracture etc • The sustained supportive pressure can stabilize or brace the segment of the chest wall - Allows for better ventilation - Reduces atelectasis • Can be done by provider or patient - Can use hands or pillows

Answer 165

• With the arms supported the accessory muscles can act on the chest wall and allow for greater ventilation. • Supporting the spine may “unload” the diaphragm from it’s postural control role

Answer 166

* Cystic Fibrosis * Asthma * COPD; especially Chronic Bronchitis * Bronchiectasis * Acute Pulmonary Diseases * Mechanical Ventilator Dependency * Status Post Surgery

Answer 167

* Improved SaO2 or SpO2 * Decreased Respiratory rate * Decreased Dyspnea * Resolution of pathological breath sounds * Improved chest radiograph * Improved Spirometry

Answer 168

Rhythmically percussing the chest wall with cupped hands.

Answer 169

• Hand should be firm with thumb adducted, wrists and elbows loose - Motion comes from shoulder - Wrist acts like a whip almost - Should hear hollow thumping or cupping noise - Slapping sounds indicate poor technique • Percussion 3-5 minutes each segment • Effective treatment to all segments can take up to 30-45minutes

Answer 170

• The palmar aspect of the clinicians hand is placed in full contact with the chest wall. - May use hand over hand technique • At the end of a deep inspiration the clinician exerts a downward pressure while performing an isometric contraction the arm through expiration. - This isometric contraction creates the vibration and helps mobilize secretions • Often done in conjunction with postural drainage. • 3-5 minutes per segment

Answer 171

• Time/duration: usually 5-10minutes 2-5times/day • Can be expensive • Foundations often offer grants or donated units • As effective as manual percussion for mobilization of secretions/mucous - Especially for patients with CF - Often applied with nebulizer treatment of bronchodilators and mucolytics

Answer 172

• Exhaling slowly through these devices creates back pressure (positive pressure) and transmits vibrations in large and small airways. • This back pressure opens airways and vibration dislodges and mobilizes mucus. • After blowing through the device 10-12 times, the person huff coughs. • Acapella™, Aerobika™, Flutter™ • Aerobika can be connected to nebulizer too

Answer 173

• ACB uses a series of maneuvers to help mobilize secretions • Cycle of normal tidal breaths to deep breaths, followed by coughing - 3 normal breaths - 3 Deep breaths - Repeat 3 times • Finish with coughing technique (usually a Huff Cough) • Easy to educate patients

Answer 174

• Holding a breath after a maximum inspiration • Patient is instructed to hold his breath without Valsalva for 2-3sec • This increases back pressure and stretch on Type 2 Alveolar Cells • Can be used in conjunction with other airway clearance techniques - Active Cycle Breathing, Oscillating Expiratory Pressure, Vibration

Answer 175

- Irritation - Inspiration - Compression - Expulsion

Answer 176

• Deep inspiration followed by a forced expiration without glottal closure. - Mouth and throat should be open • Often done after ACB or other secretion mobilization techniques • An inspiratory hold if often used • Patients can often use body movements to help generate expiratory pressure • Great for elderly patients and those who have pain with coughing

Answer 177

• Place one hand, below xiphoid, and the heel of the other hand - Upper abdomen • Patient will take a breath and cough as they exhale • The clinician pushes inward and upwards as the patient cough. • A pillow or towel can often be used for comfort • Used for patients with a high lesion or low abdominal tone

Answer 178

* Breathe out (exhale) normally. * Breathe in (inhale) SLOWLY. * Goal is to get this marker to rise as high as possible. * make sure this ball stays in the middle of the chamber while you breathe in. * Hold your breath for a 3 to 5 seconds. Then slowly exhale. * 10 to 15 breaths spirometer every 1 to 2 hours. * Good for preventing atelectasis (alveolar collapse) and mobilizing secretions * Used to maintain airways, especially in patients who are sitting around a lot

Answer 179

* Full body exercise and mobility! * Exercise facilitates increases in ventilation, airflow, chest wall movement and the mobilization of secretions. * One of the best chest physical therapy techniques is getting patients moving!

Answer 180

Posterior Basal

Answer 181

Peripheral

Answer 182

Atelectasis

Answer 183

Pneumothorax

Answer 184

Active Cycle of Breathing with Huff

Answer 185

Pursed Lip Breathing

Answer 186

Low Perfusion, High Ventilation

Answer 187

Splinted Cough