6.2 - CVP Interventions Flashcards
Statins
Indications
MOA
Adverse effects
Hyperlipidemia
Decreases gluconeogenesis by the liver
Adverse effects:
- Myalgia
- Rhabdomyolysis
- Mm weakness
Describe each of the following adventitious breath sounds and their potential causes
Crackles (rales)
Wheezes
Rhonchi
Stridor
Crackles / Rales
- Fluid in lungs / alveoli
- Pulmonary edema, pulmonary fibrosis, infection
Wheezes
- High-pitched wheezing
- Asthma
Rhonchi
- “Snoring rhino”; gurgling, snoring sound
- Mucus in the airways
- Pneumonia, bronchitis, cystic fibrosis, COPD
Stridor
- High-pitched wheezing
- Upper airway blockage / obstruction
What is fremitus?
Palpable vibration from lungs full of fluid
Describe how to assess for fremitus
Place hand on area of lung or auscultate
Patients repeats a vowel sound - “a,a,a”
Goal is to find where the secretions are
Describe potential causes of increased fremitus
Decreased fremitus
Increased fremitus = increased fluid
- Pneumonia
- Pulmonary edema
Decreased fremitus = increased air space (decreased fluid)
- COPD
- Pneumothorax
Describe how to perform and the purpose of each of the following breathing techniques
Pursed-lip breathing
Huffing
Active cycle of breathing
Segmental breathing
Pursed-lip breathing
- Slow expiration (respiratory rate) & keep the airways open
Huffing
- To mobilize secretions (ex: Cystic fibrosis)
- Exhaling through open mouth (“HAA”)
Active Cycle of Breathing
- To mobilize secretions
- Relaxed breathing –> deep breathing (thoracic expansion) w/ 3s hold –> huffing maneuver
Segmental Breathing
- Tactile cueing to breathe into a certain portion of lung
Describe how to perform and the purpose of each of the following breathing techniques
Lateral costal breathing
Inspiratory hold technique
Incentive spirometry
Glossopharyngeal breathing
Lateral costal breathing
- Tactile expansion of lateral segments
Inspiratory hold technique
- Prolonged breathing hold w/o Valsalva
- Inflates poorly ventilated regions of the lung
Incentive Spirometry
- Deep breathing w/ biofeedback
Glossopharyngeal breathing
- “Frog” or “gulping” pattern to inhale air
- Emergency breathing for high cervical SCI
Assisted cough
Why would this be used?
Describe how to perform
Used when the patient cannot produce a functional cough
Can be self-assisted or therapist-assisted
Place pressure on epigastric area to create increased pressure while the patient attempts to cough
What techniques can be used for manual secretion removal?
Postural drainage
Percussion
Vibration
Assisted cough
How should percussion be performed?
With a CUPPED hand
Review the postural drainage techniques
Review the precautions & contraindications for postural drainage techniques
Precautions (patient protection):
- Pulmonary edema
- Hemoptysis
- Obesity
- Pleural effusion
- Ascites
“Poor circulation” & “Poor lung function”
Relative Contraindications (usually inadvisable):
- Increased ICP
- Hemodynamically unstable (heart failure)
- Esophageal anastomosis
- Spinal fusion / injury
- Head trauma
- Hiatal hernia
- Recent eye surgery
Cystic Fibrosis
What is it?
Clinical Presentation
An inherited disorder of sodium/chloride transport in exocrine glands
Affects MULTIPLE systems - respiratory, hepatic, digestive, & reproductive
Chronic bacterial airway infections & VISCOUS mucus –> obstructive lung disease
Mostly in white population
How often should airway clearance techniques be performed for those w/ cystic fibrosis?
What may this include?
Minimum 2x/day
Autogenic drainage - adjusted rates & depths of breaths to move secretions from smaller to upper airways
Active cycle of breathing - breathing control, deep breaths, then huffing
Positive expiratory pressure - bubble therapy! Keeps airways open
Other interventions:
- High frequency chest wall oscillation (“vibrating vests”)
- Acapella device (flutter valve)
Describe the appropriate exercise prescription those with for pulmonary conditions
40-85% HRR
Moderate intensity
20-30 min
