17 CARDIORESPIRATORY TREATMENTS Flashcards
INDICATIONS FOR BREATHING ACTIVITIES
Acute or chronic lung disease.
Pain in the thoracic or abdominal area.
Airway obstruction.
Deficits in the CNS cause muscle weakness.
Severe orthopedic abnormalities.
Stress reduction.
GOALS FOR BREATHING EXERCISES
Improve ventilation.
Increase the cough effectiveness.
Prevent pulmonary (lung) impairments such as atelectasis (collapsed lung).
Improve the strength, endurance and coordination of the respiratory muscles.
Maintain/improve chest and thoracic spine mobility.
Correct inefficient or abnormal breathing patterns
Promote relaxation
Help patients cope with shortness of breath attacks
Improve overall functional capacity of patients.
PRINCIPLES OF TEACHING BREATHING EXERCISES
Reassure clients
Assure safety
Let clients rest between instructions
Demonstrate exercises so that the clients can see and perhaps feel the movement that is expected
Know and respond to signs of distress
PRECAUTIONS WHEN TEACHING BREATHING EXERCISES
AVOID forced expiration (other than coughing).
AVOID prolonged expiration.
DO NOT encourage hyperventilation.
CHEST MOBILITY EXERCISES
Any exercises that combine active movements of the trunk or extremities with deep breathing: may be very specific trunk & breathing exercises, may be more general e.g. tossing a ball or balloon
Overall goal: to improve chest mobility while at the same time improving chest expansion and lung use: the goal for each patient will depend on their diagnosis and chest assessment.
AIRWAY CLEARANCE: COUGHING
Normal mechanism of removing secretions in the lungs.
COMPONENTS OF A COUGH
Phase I: deep inspiration.
Phase II: close glottis.
Phase III: abdominal muscles contract and diaphragm elevates to increase the pressure in the chest cavity.
Phase IV: glottis opens, explosive expiration of air.
DECREASED COUGH
Inability to take a deep breath.
Inability to forcibly expel air.
Decreased action of the cilia in the bronchial tree.
Increase amount or thickness of the mucus.
INTERVENTION TO IMPROVE COUGH
Teach a better cough technique.
Hydration.
Verbal Instructions and Coaching (encouragement).
Manual Assisted Coughing.
Teach an alternative cough technique: “huff” or “k”.
THERAPIST ASSISTED COUGH
Position: supine, seated.
Technique: full breath by patien, on exhalation- abdomen is manually pushed in and up.
Precaution: avoid pressure directly on Xiphoid Process.
MANAGEMENT OF SECRETIONS
Normal oral management: drool, spit, swallow.
Interventions: hydration, positioning, swallowing training (SLP), oral suctioning
AIRWAY CLEARANCE POSTURAL DRAINAGE
A method of clearing the mucous out of the lungs by tipping the person on an angle.
GOALS OF POSTURAL DRAINAGE
Assist with the removal of secretions from the lungs.
CONTRINIDCATIONS TO POSTURAL DRAINAGE
Hemorrhage or severe hemoptysis.
Severe acute lung or heart conditions.
Cardiovascular instability.
Recent neurosurgery.
POSTURAL DRAINAGE POSITIONS
Based on the position of the bronchi: some segments require that the person be sitting upright or slightly forward.
TREATMENT ADDING TO POSTURAL DRAINAGE
Percussions: manual beating on chest over desired lung segment(s).
Shaking: manual shaking during exhale.
Vibrations: manual vibration during exhale.
CONTRAINDICATIONS TO PERCUSSION, VIBRATION AND SHAKING
Over fractures or spinal fusion.
Osteoporosis.
Pulmonary Embolism (clot in the lungs) do not do it
Low platelet count.
Unstable angina.
Chest wall pain.
Recent thoracic surgery or trauma.
CONSIDERATIONS WITH POSTURAL DRAINAGE
Time of day: either one hour before or two hours after a meal.
Patient preparation: develop rapport with the clients prior to positioning the client in the “vulnerable” head down position.
Treatment sequence: usually lasts from 5 minutes to 20 minutes.
Client evaluation: should be evaluated both prior to and after treatment (observation, palpation, auscultation).
Discontinuation of treatment: any signs of respiratory distress.
AIRWAY CLEARANCE: OTHER TECHNIQUES
Active cycle of breathing: breathing control 3-4 deep breaths with hold x2, 1-2 huffs.
Autogenic drainage: self-drainage techniques combined with different speeds of breathing.
Drainage devices: combine positive expiratory pressure and oscillatory vibration of the air.
Exercise: physical activity appropriate for the individual.
IMPORTANT INFORMATION FOR CARDIORESPIRATORY TREATMENTS
Remember to take breaks during breathing exercises.
Patient can feel light-headed.
Patient should be encouraged to cough at any point during the process/activity.
Assess for sign of distress.
