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Physiotherapy Studies > Acute Care > Flashcards

Acute Care Flashcards

1
Q

What is tidal volume?

A

The volume of air inspired / expired with each normal breath

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2
Q

What is functional residual capacity?

A

The amount of air that remains in the lungs at the end of a normal expiration

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3
Q

What are the four indications for thoracic expansion exercises?

A
  • Reduced lung volumes
  • Atelectasis / lobar collapse
  • Secretion retention
  • Ineffective cough resulting from inadequate inspiratory volume
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4
Q

What do thoracic expansion exercises result in?

A

An increased lung volume above that moved during tidal breathing

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5
Q

What two mechanisms are thought to be involved in thoracic expansion exercises?

A
  • Collateral air flow

- Interdependence

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6
Q

What does collateral air flow refer to?

A

The passage of air between alveolar and bronchiole structures via anatomical channels

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7
Q

How do thoracic expansion exercises use the mechanism of collateral air flow?

A
  • A reduced pressure gradient may occur where there is either reduced volume (e.g. atelectasis) or obstruction (e.g. sputum)
  • With a deep breath in, air flows through the collateral channels (from areas of high pressure to areas of lower pressure) therefore inflating collapsed alveoli or getting behind very peripheral secretions
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8
Q

What type of cells secrete surfactant?

A

Alveolar type II cells

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9
Q

What does surfactant do?

A

Reduces the surface tension / elastic force of alveolar

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10
Q

What is the relationship between alveolar surface tension and the radius of the alveolar

A

Surface tension in the alveolar is inversely affected by the radius of the alveolus (smaller the alveoli, greater the tendency to collapse and then, more difficult to reinflate)

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11
Q

How do thoracic expansion exercises use the mechanism of interdependence? - with reference to surfactant

A

The primary physiological stimulus for the secretion of key surfactant components is through direct stretching of type II cells; such as occurs with deep breathing - thus TEE increases surfactant production, reducing alveolar surface tension

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12
Q

How do thoracic expansion exercises use the mechanism of interdependence? - with reference to stretch forces

A

During inspiration stretch forces are exerted from alveoli that are capable of inflating to other surrounding alveoli; in order to facilitate opening of collapsed alveoli

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13
Q

What are two contraindications/precautions of thoracic expansion exercises?

A
  • Untreated or suspected pneumothorax

- Untreatable shortness of breath patients

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14
Q

Where should the physios hands be placed during a thoracic expansion exercise?

A

Laterally over the 6th - 10th ribs

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15
Q

What is the ‘breathing pattern’ during a thoracic expansion exercise

A
  • Exhale (usually to FRC)
  • Slow deep breath in (approx. 6 seconds)
  • At the end of deep inspiration - pause for 1-2 seconds
  • Breathe out slowly
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16
Q

What is the difference between a sustained maximal inspiration and thoracic expansion exercises?

A

Sustained maximal inspiration uses the same mechanism as TEE however TEE is a deep to maximal inspiration where as SMI aims to approach TLC

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17
Q

What two mechanisms are thought to be involved in sustained maximal inspirations?

A
  • Collateral air flow

- Interdependence

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18
Q

What are three contraindications/precautions of sustained maximal inspirations?

A
  • Untreated or suspected pneumothorax
  • Extremely short of breath patients
  • Low blood pressure - especially diastolic <60mmHg
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19
Q

Where should the physios hands be placed during a sustained maximal inspiration?

A

Laterally over the 6th - 10th ribs

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20
Q

What is the ‘breathing pattern’ during a sustained maximal inspiration?

A
  • Exhale (usually to FRC)
  • Slow deep breath in (approx. 6 seconds)
  • At maximal inspiration - hold breathe for at least 3 seconds
  • Breathe out slowly
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21
Q

What are the four components covered when objectively assessing a cough?

A

1) Strong or weak
2) Dry or moist
3) Effective or in-effective
4) Productive or non-productive

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22
Q

What are the four stages of a cough?

A

1) Irritation
2) Inspiration
3) Compression
4) Expulsion

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23
Q

What are the indications for using the cough technique?

A

Central, upper or large airway secretions

24
Q

What is the mechanism of action for the cough technique?

A

Increased expiratory airflow and dynamic compression

25
Q

What are the two indications for breathing control?

A
  • Shortness of breath

- Oxygen desaturation during treatment of spontaneously ventilating patients

26
Q

What three mechanisms are thought to be involved in breathing control?

A
  • Increase in diaphragm excursion
  • Decreased respiratory rate
  • Increase tidal volume
27
Q

What is one contraindication/precaution of breathing control?

A

Patients with severe shortness of breath

28
Q

What is the procedure for breathing control?

A
  • Encourage the patient to relax their upper chest, shoulders and arms
  • Position the patient’s hand lightly on the upper abdomen (just below xiphoid process)
  • Instruct the patient to breathe normally and feel their abdomen rise and fall
29
Q

What is the one indication for pursed lip breathing?

A

Shortness of breath

30
Q

What is one contraindication/precaution of pursed lip breathing?

A

Patients with severe dyspnea

31
Q

What two other techniques may pursed lip breathing be used with?

A
  • Breathing control

- Thoracic expansion exercises

32
Q

How is pursed lip breathing performed?

A

Patient has to pucker/purse their lips and breathe out slowly but steadily (like breathing out through a straw)

33
Q

Describe the forced expiratory technique?

A

A combination of one or two forced expirations (huffs) and periods of breathing control

34
Q

What is the indications for forced expiratory technique?

A

Pulmonary secretions (either peripheral or central)

35
Q

What is the mechanism by which forced expiratory technique works? - in reference to huffing and breathing control

A
  • Huffing = increased expiratory airflow and dynamic compression
  • Breathing control = minimisation of potential complications of sequential huffing (e.g. bronchospasm)
36
Q

What is the procedure for forced expiratory technique?

A
  • Teach the patient how to do breathing control
  • Demonstrate and teach the patient how to perform either a low or high volume huff (depending on whether it’s central or peripheral secretions)
  • Ask the patient to perform 1-2 huffs
  • Get the patient to go back to breathing control
37
Q

What does the active cycle of breathing technique include?

A

Breathing control, thoracic expansion exercises and the forced expiration technique

38
Q

What are the two indications for the active cycle of breathing technique?

A
  • Secretion clearance (typically peripheral)
  • Maintain ventilation
  • OR BOTH
39
Q

What is the mechanism by which active cycle of breathing works - in reference to breathing control, FET and TEE

A
  • Breathing control = minimisation of potential complications of FET (e.g. bronchospasm)
  • FET = increased expiratory airflow and dynamic compression
  • TEE = collateral airflow and interdependence
40
Q

What is an example of the procedure for active cycle of breathing technique (will be individualised for each patient)?

A
  • Breathing control (30 secs - 1 minute)
  • TEE (3-4)
  • Breathing control (30 secs - 1 minute)
  • FET (1-2 huffs)
  • Breathing control (30 secs - 1 minute)
41
Q

What is the mechanism of action for the huffing technique?

A

Increased expiratory airflow and dynamic compression

42
Q

When would you use a high volume huff?

A

To clear secretions from the trachea and central larger airways

43
Q

When would you use a low volume huff?

A

To clear secretions from peripheral smaller airways

44
Q

How many huffs should be performed consecutively and why?

A

No more than 1-2 huffs as it may worsen bronchospasm or oxygen desaturation

45
Q

Give 4 contraindications / precautions for coughing?

A
  • Bronchospasm
  • Hypotension
  • Raised intracranial pressure
  • Stress incontinence
46
Q

How many SMIs should be performed consecutively?

A

Only 1

47
Q

How many TEEs should be performed consecutively?

A

Okay to do 2-3

48
Q

Explain how increased expiration flow and dynamic compression helps to clear secretions

A
  • During forced expiration airways become compressed due to the high intra-thoracic pressure created (dynamic compression)
  • This compression results in narrowing of the airways, which in-turn increases the velocity of gas flow
  • There is a point where pressure inside the airways matches the pressure outside the airways = equal pressure point
  • Throughout a forced expiration, these EPPs move dismally as expiratory volume decreases, resulting in increased rate of airflow through the compressed airways and secretion movement
49
Q

What does expiratory airflow relate to?

A

Narrower tube = greater airflow through tube

50
Q

What does dynamic compression relate to?

A
  • During a forced expiration, compression of airways occur where pressure outside is higher than pressure inside the airways
  • Distal to these areas, there is a point that remains open due to the pressure being equal - this is known as the EPP
51
Q

Why does the EPP enhance secretion clearance?

A

The EPP is a point of narrowing, this enhances secretion clearance as it means there is greater expiratory airflow

52
Q

What direction does the EPP move as lung volume increases and as lung volume decreases?

A
  • Increases = moves towards the mouth (centrally)

- Decreases = moves towards the alveoli (peripherally)

53
Q

What is the mechanism of action behind pursed lip breathing?

A
  • By pursing lips you are narrowing the exit point of airflow, this creates a back pressure within the peripheral airways which reduces dynamic compression; meaning airways stay open
  • This moves the EPP more centrally toward the cartilaginous airways which helps prevent collapse
54
Q

Explain the reasoning behind positioning to increase lung volume?

A
  • Pillows for comfort only

- Upright positioning facilitates passive diaphragm descent by use of gravity

55
Q

Explain the reasoning for positing in patient’s with shortness of breath?

A
  • Pillows support + relax the accessory muscles and reduce the energy cost of respiration
  • Positioning allows anterior displacement of the abdomen to facilitate diaphragm excursion

Physiotherapy Studies (2 decks)

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