Pulmonary_PT tx

  1. FRC & positioning - from greatest to least
    • Prone - GREATEST
    • Upright - 
    • Side-lying - greater in non-dependent
    • Supine -
  2. Which position to avoid for pts w/bronchopleural fistula
    Side-lying positioning w/affected lung uppermost if pt is on (+) P ventilation
  3. Positioning - Side-lying & expansion/diameter (2)
    • Anteroposterior expansion - INC
    • Lateral diameter - DEC
  4. In supine positioning what happens to diaphragm?
    Diaphragm moves toward head, resulting in INC abdominal P
  5. Pts with pathology to what segments of lower lobes may have INC oxygenation in prone as opposed to supine? - 2
    • Superior
    • Posterior
  6. What position causes greatest lateral diameter INC?
    Prone
  7. Which position is most comfortable to pts w/pulmonary complications?
    Upright/sitting
  8. Which expansion of lung is greatest in Upright/sitting positioning?
    Vertical lung height/anteroposterior expansion
  9. To INC expiratory force or cough do what?
    Train inspiratory mms w/resistance during inspiration
  10. Asthma - what technique is best?
    Straight diaphragmatic breathing
  11. Indications for use of postural drainage, percussion & shaking - 4
    • INC pulmonary secretions
    • Aspiration
    • Atelectasis
    • Collapse
  12. Forced expiratory technique - describe; w/what pts?
    • 1-2 expirations w/relatively low V
    • Glotis not closed
    • COPD
  13. How does PT assist or stimulate a cough?
    Compress trachea just above sternal notch
  14. 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
  15. Independent secretion removal techniques - 5
    • Autogenic drainage
    • Active cycle of breathing
    • FLUTTER or Acapella device
    • Low PEP
    • High PEP
  16. 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
    •  
    • 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
  17. 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
  18. FLUTTER or Acapella device - dependence; primarily used by what population (2); which 2 pathologies cannot do this & why?

    FLUTTER                          Acapella
    Image Upload 1          Image Upload 2
    • 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
  19. 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
  20. 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
  21. 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)
  22. 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%
  23. 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%
  24. FIM 5 score - dependence
    Supervision
  25. 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
  26. To DEC dyspnea & INC efficiency do what? - 3
    • Pursed lip breathing
    • Pacing of breathing w/therex
    • Diaphragmatic breathing
  27. Breathing exercises - 4
    • Diaphragmatic breathing
    • Pursed lip breathing
    • Segmental breathing
    • Sustained Maximal Inspiration
  28. 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
  29. 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
  30. 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
  31. 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
  32. To INC lung V & improve gas exchange do what? - 3
    • Diaphragmatic breathing
    • Segmental breathing
    • Maximal inspiratory effort
  33. 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
  34. When there is a CONTA for postural drainage what technique is best?
    Shaking (vibration) - done in postural drainage positions
  35. 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
  36. Postural drainage - L posterior basal segment - position
    Basal is bottom of lung

    Image Upload 3

    • Foot of bed elevated 20 in
    • Prone - head down
    • Pillow under hips
    • PT claps over lower ribs close to spine on each side
  37. Postural drainage - apical segments - anterior vs. posterior
    • Anterior apical segments - 2
    • Image Upload 4Semi-fowlers

    Image Upload 5Sitting

    • Posterior apical segments:
    • Image Upload 6Pt leans over pillow at 30 deg
    • PT claps over upper back
  38. Postural drainage - superior segments of lower lobes
    • Image Upload 7
    • Prone w/2 pillows under pelvis
  39. Postural drainage - posterior vs. anterior segments of upper lobes; PT claps where?
    • Anterior upper lobes:
    • Image Upload 8
    • Pt lies on back w/pillow under knees
    • PT claps bet clavicle & nipple 

    • Posterior upper lobes:
    • Image Upload 9
    • Pt leans over pillow at 30 deg angle
    • PT claps over upper back
  40. Postural drainage - anterior segments of lower lobes
    Supine w/pillows under knees
  41. Postural drainage - position for middle lobe L side; PT cups where?
    • Image Upload 10
    • Foot of bed elevated 16"
    • Head down w/1/4 rotation turn backward
    • Knees flexed

    PT cups R nipple area
  42. Postural drainage - position for Linguinal segment of L position - PT cups where?
    • Image Upload 11
    • Foot off bed elevated 12"
    • R side w/1/4 rotation turn backwards
    • Knees flexed

    PT cups - L nipple area
  43. Midsternotomy incision & PT
    PT should encourage full UE ROM postop
  44. Position - Trendelenburg vs. Reverse trendeleberg & their uses
    • Image Upload 12
    • Used for - hypotension & shock (INC blood flow to brain)

    • Image Upload 13
    • Used for - venous drainage; respiration facilitated
  45. Position - Fowler vs Semi-Fowler
    Image Upload 14Image Upload 15
Author
Tanuisha
ID
321284
Card Set
Pulmonary_PT tx
Description
Pulmonary_PT tx
Updated