Week 7 and 8

Question 1

Goals of airway clearance techniques:

Answer 1

optimize airway patency, increase ventilation and perfusion matching, promote alveolar expansion, increase gas exchange

Question 2

Postural drainage

Answer 2

♣ Assumption of one or more body positions that allow gravity to assist with draining secretions from each lung segment
♣ Priority given to treating most affected lung segment first

Question 3

Percussion

Answer 3

♣ Chest percussion aimed at loosening retained secretions (manually or mechanically)

Question 4

Rate of percussion

Answer 4

100-140 times per min.

Question 5

Vibration rate:

Answer 5

12-20 Hz per min

Question 6

Idea behind percussion:

Answer 6

♣ the pressure exerted on thorax during vibration causes a volume of air to be expired that is greater than what is expired during normal tidal breathing

Question 7

Position during percussion:

Answer 7

♣ Performed manually or mechanically and utilized in postural drainage positions to clear secretions

Question 8

Four stages of cough:

Answer 8

• Inspiration greater than tidal volume – adequate = 60% of pt’s predicted vital capacity
• Closure of the glottis
• Abdominal and intercostal muscles contract, producing positive intrathoracic pressure
• Sudden opening of the glottis and the forceful expulsion of inspired air

Question 9

Effective cough:

Answer 9

deep inspiration combined with trunk extension, a momentary hold, and then a series of sharp expirations while the trunk moves into flexion

Question 10

Expiratory aid

Answer 10

negative pressure (vacuum) to the airway via the nose and mouth during the patient’s attempt to cough, along with a manual thrust to the abdomen to further increase cough flows

Question 11

Who are breathing strategies, positioning and facilitation indicated for?

Answer 11

weakness of the diaphragm, unable to correctly use the diaphragm for efficient inspiration, or who have inhibition of the diaphragm muscle due to pain

Question 12

To facilitate inspiration

Answer 12

o and ventilator movement strategies
♣ To facilitate inspiration – instruct pt to breathe in during shoulder flexion, abduction, and external rotation along with an upward gaze

Question 13

To facilitate expiration

Answer 13

♣ shoulder extension, adduction, and internal rotation with downward gaze

Question 14

Posterior pelvic tilt encourages:

Answer 14

diaphragmatic breathing pattern

Question 15

What can sidelying position do?

Answer 15

reduce pressure as well as assist in lung expansion and secretion removal

Question 16

Trendelenberg Position

Answer 16

legs elevated higher than head while supine

Question 17

Benefits of Trendelenberg Position:

Answer 17

• Optimal for facilitating secretion drainage from the lower lobes
• Can also be used to increase BP of a hypotensive pt

Question 18

Who is trendelenberg position contraindicated in?

Answer 18

pts with CHF or cardiomyopathy

Question 19

Reverse trendelenberg

Answer 19

helps reduce hypertension and facilitate movement of the diaphragm by using gravity to decrease the weight of the abdominal contents

Question 20

Positioning for Dyspnea Relief

Answer 20

♣ Lean forward on supported hands – intraabdominal pressure rises and thus pushes the diaphragm up in a lengthened position

Question 21

Rationale behind positioning for dyspnea relief:

Answer 21

With arms supported, accessory breathing muscles can act on the rib case and the thorax, allowing more expansion for inspiration

Question 22

What is pursed lip breathing used for?

Answer 22

decrease symptoms of dyspnea

slows respiratory rate

Question 23

Pursed lip breathing:

Answer 23

♣ decreasing the resistive pressure drop across the airways

decreasing airway collapse during expiration (advanced stages of COPD

Question 24

Paced Breathing

Answer 24

volitional coordination of breathing during activity

Question 25

Inspiratory Hold Technique

Answer 25

o Involves prolonged holding of breath at max inspiration

Question 26

Stacked Breathing

Answer 26

series of deep breaths that build on top of previous breath without expiration

Question 27

What is Diaphragmatic Controlled Breathing used for?

Answer 27

to manage dyspnea, reduce atelectasis, increase oxygenation

Question 28

What does Diaphragmatic Controlled Breathing facilitate?

Answer 28

outward motion of abdominal wall while reducing upper rib cage motion during inspiration

Question 29

Positioning of Diaphragmatic Controlled Breathing:

Answer 29

t to achieve in supine, progressing to sitting, standing and during activity

Question 30

Scoop technique

Answer 30

o pt sidelying with posterior pelvic tilt ♣ PT places hand on pt’s abdomen and allows 2-3 breathing cycles ♣ After exhalation, PT scoops the hand up and under the anterior thorax, giving a slow stretch and instructs the pt to breathe into my hand

Question 31

Lateral Costal Breathing:

Answer 31

o Addresses rib cage mobility and intercostal muscles

Question 32

Unilateral costal breathing:

Answer 32

♣ Most effective in side lying with uninvolved side against bed ♣ Pt brings arm on involved side into abducted position to the level of the head ♣ PT gives a stretch before inspiration and continues giving resistance through the inspiratory phase

Question 33

Bilateral costal breathing:

Answer 33

♣ Semireclined or sitting position ♣ PT places both hands on the lateral aspects of the rib case and gently applies pressure against the ribs during inspiration

Question 34

What can upper chest inhibiting technique to?

Answer 34

help a pt recruit the diaphragm during inhalation

Question 35

When is upper chest inhibiting breathing used?

Answer 35

Used only after implementation of other techniques

Question 36

Upper Chest Inhibiting Technique

Answer 36

o A diaphragm scoop is used to facilitate the diaphragm while the therapists other hand rests on the upper chest and moves with inhalation and exhalation o After assessing the pt’s chest movement through a respiratory cycle, the PT’s arm follows the upper chest to the resing position on exhalation o When the pt inhales, the PT’s arm position does not move, thus applying pressure to the upper chest and resisting expansion

Question 37

Counterotation:

Answer 37

Rotating the upper trunk to one side wihile the lower trunk is rotated in the opposite direction

Question 38

What does counterotation do?

Answer 38

o Increases tidal volume and decreases respiratory rate by reducing neuromuscular tone and increasing thoracic mobility

Question 39

Who is counterrotation effective for?

Answer 39

♣ Pts with impaired cognitive functioning after neurological insult ♣ Young children who are unable to follow verbal cues ♣ Pts with high neuromuscular tone

Question 40

Who is inspiratory muscle training indicated for?

Answer 40

pts with s/s of decreased strength or endurance of diaphragm and intercostal muscles

Question 41

Goal of inspiratory muscle training?

Answer 41

increase ventilator capacity and decrease dyspnea

Question 42

Primary consideration of weaning:

Answer 42

resolution or relative resolution of the initial event or disease that led to acute respiratory failure

Question 43

Precautions for postural drainage:

Answer 43

``` pulomonary edema hemoptysis massive obesity large pleural effusion massive ascites ```

Question 44

Relative contraindications for postural drainage:

Answer 44

``` increased ICP hemodynamically unstable recent esophageal anastomosis recent spinal fusion recent head trauma diaphragmatic hernia recent eye surgery ```

Question 45

Precautions for Vibration

Answer 45

``` uncontrol bronchospasm osteoporosis rib fractures metastsatic cancer to ribs tumor or airway obstruction anxiety recent pacemaker ```

Question 46

Relative contraindications for vibration

Answer 46

``` hemoptysis untreated tension pneumothorax unstable open wounds grafts ```