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FRC & positioning - from greatest to least
- Prone - GREATEST
- Upright -
- Side-lying - greater in non-dependent
- Supine -
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Which position to avoid for pts w/bronchopleural fistula
Side-lying positioning w/affected lung uppermost if pt is on (+) P ventilation
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Positioning - Side-lying & expansion/diameter (2)
- Anteroposterior expansion - INC
- Lateral diameter - DEC
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In supine positioning what happens to diaphragm?
Diaphragm moves toward head, resulting in INC abdominal P
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Pts with pathology to what segments of lower lobes may have INC oxygenation in prone as opposed to supine? - 2
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What position causes greatest lateral diameter INC?
Prone
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Which position is most comfortable to pts w/pulmonary complications?
Upright/sitting
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Which expansion of lung is greatest in Upright/sitting positioning?
Vertical lung height/anteroposterior expansion
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To INC expiratory force or cough do what?
Train inspiratory mms w/resistance during inspiration
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Asthma - what technique is best?
Straight diaphragmatic breathing
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Indications for use of postural drainage, percussion & shaking - 4
- INC pulmonary secretions
- Aspiration
- Atelectasis
- Collapse
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Forced expiratory technique - describe; w/what pts?
- 1-2 expirations w/relatively low V
- Glotis not closed
- COPD
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How does PT assist or stimulate a cough?
Compress trachea just above sternal notch
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Precautions of percussions - 9
- Rib fx
- Costal chondritis
- Hemoptysis
- Blood coagulation problems
- Dysrhythmias
- Pain
- Severe dyspnea
- Pneumothorax w/ or w/o chest tube
- INC bronchospasm
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Independent secretion removal techniques - 5
- Autogenic drainage
- Active cycle of breathing
- FLUTTER or Acapella device
- Low PEP
- High PEP
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Autogenic drainage - dependence; what 2 pathalogies? 3 phases; when would you choose autogenic over active cycle of breathing (2)? not for what condition?
- IND peripheral secretion removal - key word
- Primarily for CF & Emphysema
- RAMPING UP SPEEDS TO FORCE MUCUS BREAK UP
- 3 phases - unstick phase / collect phase / evacuation phase
- Need more endurance than active cycle of breathing
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- Choose autogenic over active cycle of breathing - If condition is NOT as severe or mucus in large vessels rather than smaller ones
NOT FOR ASTHMA
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Active cycle of breathing - define? primarily used for what pathology? describe; which 2 pathologies cannot do this & why?
- IND peripheral secretion removal - key word
- Primarily for CF
- Relax airways - diaphragmatic breathing - in through nose out mouth
- Deep Inspiration (air behind mucus)
- Forceful Expiration (Huffing) - to clear mucus
COPD & Asthma - bc have trouble w/forceful expiration
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FLUTTER or Acapella device - dependence; primarily used by what population (2); which 2 pathologies cannot do this & why?
FLUTTER Acapella
- IND secretion removal - key word
- (+) expiratory P
- Primarily used for CF exclusively - if age is a key word - ex. 4 yo, or kid is having trouble understanding active cycle of breathing
Has vibration in device - breaks up mucus - followed by huffing or forceful expiration
COPD & Asthma - bc have trouble w/forceful expiration
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High PEP vs. Low PEP - describe & for what pts?
- High PEP - 50-120 cm H2O
- 10 breaths + huff from high lung V w/mask ON
- For unstable airways
Low PEP - 10-20 cm H2O 10 breaths + cough/huff @ tidal V w/mask OFF
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Airway clearance techniques - from least dependent to most + FIM scores - 5
- Cough - FIM 7 score (IND)
- Huffing - FIM 6 score
- Assisted cough
- Tracheal stimulation
- Endotracheal suctioning
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Huffing - describe; what does pt need to be able to do this? (3); FIM score? w/what pts? (2)
- Similar to cough w/open glotis
- Pt inhales deeply & immediately forcibly expels air, saying "Ha, ha"
- Build P in lung system allowing pt to have a more forceful cough
Pt needs - IND; good abd control; cognitive
Pts w/WEAK COUGH; COPD
FIM 6 score (may use assistive device but do not need any other help)
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Assisted cough - aka; dependence; describe; done when? done w/what pts? (2); FIM score
- AKA Abdominal thrusts or Hyemlich maneuver
- DEPENDENT - PT push inward & upward as pt is trying to cough - PT is acting as their abdominals
- Done Iif pt needs help w/cough:
- Pts w/low neuromuscular tone
- Pts w/flaccid abdominal mms (T8 SCI down)
FIM 4 score (min assist) - PT is helping 0-25%
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Tracheal stimulation - dependence; describe; used w/pt that cannot do what? FIM scores
- DEPENDENT
- External - have to stimulate basic reflexes to make pt cough
- Pt can’t cough or huff - can’t do assisted one
- FIM 3 score (mod assist) - 50%
- FIM 2 score (max assist) - 75%
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FIM 5 score - dependence
Supervision
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Endotracheal suctioning - for alert or unconscious? procedure; length of time;FIM score; CONTRA (2)
- Can be alert but best for unconscious
- Ventilator must be turned off --> suctioning that’s why time is important - pt is not breathing so HB INC
Length of time (10-15s for adult; 5s for pediatrics)
FIM 1 score - (100% dependent)
CONTRA - hypoxemia (starting at lower O2 level); tachycardiaton so look it up
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To DEC dyspnea & INC efficiency do what? - 3
- Pursed lip breathing
- Pacing of breathing w/therex
- Diaphragmatic breathing
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Breathing exercises - 4
- Diaphragmatic breathing
- Pursed lip breathing
- Segmental breathing
- Sustained Maximal Inspiration
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Diaphragmatic breathing - done for what? (2); describe; usually combined w/what other breathing exercise? done for pts that are (4)
Done for relaxation (parasympathetic response activation) or to improve oxygenation
Breathing into abdomen not chest & breathing out through mouth
Combined w/pursed lip breathing - relaxes accessory mm use
- In answer set - pt may be irritable, anxious, labored breathing, RR is extremely high
- For non-pathological reason
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Pursed lip breathing - for what pts? (4) does what? (4)
- COPD (emphysema; asthma) who have difficulty w/oxygenation
- Have low partial P of O2
- Pts who get fatigued very easily
- Pt's breathing is erratic
- DEC RR
- INC tidal volume
- DEC dyspnea
- Facilitate relaxation
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Segmental breathing - describe; done to facilitate what?
Pt normal breathing - PT places hands around lateral rib cage (typically done to lower ribs)
Facilitating abdominal breathing and not chest breathing
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Sustained Maximal Inspiration - aka; describe; time; sequence; encourages what?
- AKA Incentive spirometry
- When u inhale/exhale it moves ball - training for diaphragm & lungs
- Time - Max 10s
Proper process - Blow air out 1st —> lips —> slow deep inspirations
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To INC lung V & improve gas exchange do what? - 3
- Diaphragmatic breathing
- Segmental breathing
- Maximal inspiratory effort
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Postural drainage - facilitates drainage where? what else is needed? for what conditions? (3); CONTRA (2); Tx duration
- Facilitates drainage to level of segmental bronchus ONLY
- Cough is needed to clear secretions
- Conditions w/LOTS of secretions - emphesema, bronchitis, broncheactasis
- CONTRA:
- Mucus plug (mucus stuck)
- Systemic problems (difficulty w/BP, dyspnea, dizziness)
Time = Up to 20 min
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When there is a CONTA for postural drainage what technique is best?
Shaking (vibration) - done in postural drainage positions
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Percussion - done in what position after what? CONTRA (3)
Done in postural drainage positions to break up secretions; done after auscultation
- CONTRA:
- Long term corticosteroids
- Blood thinner
- Collapsed lung
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Postural drainage - L posterior basal segment - position
Basal is bottom of lung
- Foot of bed elevated 20 in
- Prone - head down
- Pillow under hips
- PT claps over lower ribs close to spine on each side
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Postural drainage - apical segments - anterior vs. posterior
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Postural drainage - superior segments of lower lobes
- Prone w/2 pillows under pelvis
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Postural drainage - posterior vs. anterior segments of upper lobes; PT claps where?
- Anterior upper lobes:
- PT claps bet clavicle & nipple
- Posterior upper lobes:
- Pt leans over pillow at 30 deg angle
- PT claps over upper back
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Postural drainage - anterior segments of lower lobes
Supine w/pillows under knees
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Postural drainage - position for middle lobe L side; PT cups where?
- Foot of bed elevated 16"
- Head down w/1/4 rotation turn backward
- Knees flexed
PT cups R nipple area
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Postural drainage - position for Linguinal segment of L position - PT cups where?
- Foot off bed elevated 12"
- R side w/1/4 rotation turn backwards
- Knees flexed
PT cups - L nipple area
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Midsternotomy incision & PT
PT should encourage full UE ROM postop
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Position - Trendelenburg vs. Reverse trendeleberg & their uses
- Used for - hypotension & shock (INC blood flow to brain)
- Used for - venous drainage; respiration facilitated
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Position - Fowler vs Semi-Fowler
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