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CardioPulmoaryPT1 > Airway Clearance Tech's and Mobilization > Flashcards

Airway Clearance Tech's and Mobilization Flashcards

1
Q

Airway Clearance Tech’s and Mobilization

AKA

A

Pulm Hygiene

Chest PT

Bronchial Hygiene

Pulmonary Toileting**** (get “Stuff” OUT)

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2
Q

Pulmonary Hygiene Tech’s

What are they?

A
  • Manual or mechanical procedures that facilitate mobilization or secretions from airways
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3
Q

Pulmonary Hygiene

Optimal Airway Clearance Choice based on:

A
  • pathophys and sx’s
  • stability of medical status
  • pts adherence
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4
Q

Pulmonary Hygiene

The Pt Exam BEFORE, DURING, AFTER Tx tells us what?

A

provides info to judge pt tolerance and tx effectiveness !!!

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5
Q

Pulmonary Hygiene

GOALS:

A
  1. Optimize airway patency
  2. INC ventilation and perfusion (V/Q) matching
  3. Promote alveolar expansion
  4. INC gas exchange
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6
Q

Pulmonary Hygiene

Precautions

A
  • MEALS
    • No Trendelenberg
  • Meds***
    • Bronchodilators vs. Antibiotics
      • ​we WANT bronchodilators PRIOR TO interventions to OPEN UP BRONCHIOLES
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7
Q

WHEN is Pulm Hygiene indicated?

A
  • ANY Dx that affects Ventilation in V/Q equation
    • ​V is abnormal
    • Q is OK
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8
Q

Ex. Dx’s in which Pulm Hygiene is Indicated

A
  1. CF
    1. Obstructive– change in mucus boundary
      1. fluid in lungs, mucus EVERYWHERE
  2. Bronchiectasis
    1. Obstructive–permanent dilation of bronchia
      1. lung tissue dilates/loses integrity
  3. Atelectasis
    1. alveolar collapse
  4. Trunk + Access. mm weakness
  5. Life support: mech. vent or post-op
  6. Neonate resp distress syndrome and bronchopulm dysplasia
  7. ASTHMA
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9
Q

Pulm Hygiene

The List

A

see below

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10
Q

Diaphragm Innervation

A

Phrenic C3, C4, C5

Keeps the Diaphragm Alive!!!

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11
Q

Coughing

2 Types :

A
  1. Splinted
  2. Assisted Cough (forceful thrust of T/S bc cannot use abs)
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12
Q

Coughing

Splinted Cough

Everything you know about it…

A
  • Hug pillow/squeeze and cough
  • Trying to match pressure in vs. pressure out
  • Recommended post-op bc PAIN when they cough normally—–Pillow is like a crutch
    • ​prevent rib cage pressure on mm’s
    • pillow is for external pressure to match internal pressure
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13
Q

Coughing

Assisted Cough

A
  • SCI pts!!!!
  • BIG thoracic flexion for cough
    • ​literally extend spine, inhale, THROW BODY FORWARD and forceful cough !!!
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14
Q

Coughing

What do we WANT?

A

PRODUCTIVE, EFFECTIVE COUGH!!!

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15
Q

Postural Drainage Pos’s

Tips and tricks to remember

A
  • If it is ANTERIOR (on FRONT side of body)
    • ​they must start SUPINE
  • If it is POSTERIOR (on BACK side of body)
    • ​they must start PRONE
  • If it is MIDDLE LOBES
    • ​Raise feet up 12 in.
  • If it is BASAL/LOWER LOBES
    • ​Raise feet up 18 in.
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16
Q

Postural Drainage

A

One or more body pos’s that allow gravity to assist w/ draining secretions from ea. lung segment

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17
Q

Postural Drainage

The pos’s can be modified to address what?

A

Precautions and/or relative contraindications

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18
Q

Postural Drainage

Where does our priority lie?

A

given to most affected lung segment FIRST

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19
Q

Postural Drainage

Duration?

A

5-20 mins

  • If they can be ALONE you can leave them in it longer bc they can independently move
  • 5 mins IF coordinated w/ another technique
  • NEVER leave pt unattended UNLESS they can indep. reposition themselves
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20
Q

Postural Drainage

Some Advantages:

A

easy to learn for pt.

easy to coord. w/ diff. tx’s

No $$$

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21
Q

Postural Drainage

Disadvantages

A

Contraindicated for lg. group of pts

Adherence is diff. bc we recommend 20mins

KIDS CANNOT JUST SIT FOR 20mins

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22
Q

You KNOW the segments and postural drainage positions

Reminder for Right POST. lobe and Left POST. lobe

Remember these are BOTH on BACK of body….and UPPER lobes

A
  • Right Post. UPPER lobes
    • have to START Prone, then put them on LEFT side, ELEVATE right side
  • LEFT Post. UPPER lobes
    • SAME as Right BUT now lean them onto RIGHT, ELEVATE Left side w/ pillow and RAISE HEAD OF BED UP!!!!
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23
Q

POSTURAL DRAINAGE

Precautions

*Remember HAMP

A
  • Hemoptysis
  • Ascites
  • Morbidly obese
  • Pulmonary Embolism
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24
Q

Postural Drainage

More Precautions

From lecture vs. lab

A
  1. Pulm Edema
  2. Hemoptysis
  3. Obesity
  4. Lg. pleural effusion
  5. Ascites

Still remember HAMP !!!

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25
Q

Postural Drainage

Relative Contraindications

NEVER DO if have these

A
  1. Recent head trauma/INC’d ICP
  2. Spinal fusion or Sx
  3. Hemodynamically unstable
  4. Diaphragmatic hernia
  5. Recent eye sx
  6. Esophageal anastomisis
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26
Q

Percussion Technique

Mvmt of hand/wrist w/ CUPPED hand==pod of air

A
  • Chest percussion aimed @ loosening retaining secretions
    • ​manual OR mechanical
    • its ALL in the wrist
    • lean your forearm on pt.
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27
Q

Vibration Technique

A
  • Manual OR mechanical
  • utilized IN postural drainage pos’s to clear secretions
  • REMEMBER
    • ​Start the vibration as they EXHALE!!!
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28
Q

Percussion

Advantages vs. Disadvantages

*REMEMBER BETTER TO DO IT ON SKIN!!!

A
  • Advantages
    • ​zero cost
    • GOOD adherence
    • can be done on infants, children, newborns
    • relaxing for kids
    • can utilize postural drainage AND percussion same time
    • Watch O2sats AND vitals during
  • Disadvantages
    • ​CTS risk
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29
Q

Percussion

Duration?

A
  • Until secretions coughed up
  • 2-5 mins
  • or PT fatigues
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30
Q

Percussion

Advantages

A
  1. infants, young children
  2. Postural drainage + percussion==> effective and good adherence
  3. Monitor O2 sats and vitals during
  4. zero cost
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31
Q

Percussion

Disadvantages

A
  • Repetitive percussion from caregiver==> INC risk CTS (Carpal Tunnel Syndrome)
  • NOT tolerated well in pts w/ issues in pain mgmt or coagulation
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32
Q

Vibration

HOW performed and utilized WHEN?

A

Mech. OR manual & utilized IN postural drainage pos’s

*rapidly shaking or vibrating shoulders

ONLY DURING EXHALATION!!!

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33
Q

Vibration

Advantages:

A
  1. GOOD if you fatigue bc 2s rest break
  2. moves secretions
  3. well tolerated by pts
  4. Use on post-sx pts
  5. Encourages INC VT
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34
Q

Vibration

Disadvantages

A
  1. need someone to help you if no mech.
  2. Adherence impaired bc caregiver avail.
  3. Cannot coordinate if RR too high
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35
Q

Percussion and Vibration

Precautions

Uncontrolled bronchospasm THEN all the MSK stuff…

A
  1. uncontrolled bronchospasm
  2. osteoporosis
  3. Rib fx
  4. metastatic cancer to ribs
  5. tumor obstruction in airway
  6. anxiety
  7. coagulopathy
  8. convulsive OR seizure disorder
  9. Recent pacemaker
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36
Q

Percussion and Vibration

Contraindications

DO NOT DO

A
  1. Hemoptysis
  2. Untx’d tension pneuomothorax
  3. platelet count <20,000/mm^3
    1. likely to bleed
  4. hemodynamically unstable
    1. BP not nrml, vitals not nrml
  5. open wounds, burns in T/S
  6. PE
  7. subcutaneous emphysema
    1. air pocket under skin
  8. skin grafts/flaps on thorax
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37
Q

Active Cycle of Breathing Technique

ACBT

Consists of what?

A

series of maneuvers performed by pt to emphasize IND in secretion clearance & thoracic expansion

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38
Q

ACBT

3 Components:

A
  1. Breathing Control
  2. Thoracic Expansion Exs
  3. Forced Expiratory Exs aka Huffing
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39
Q

ACBT

Breathing control phase

A
  • VT breaths AND emphasis on diaphragmatic breathing
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40
Q

ACBT

Thoracic Expansion Exs

A
  • DEEP breaths (Vital Capacity, VC breaths)
    • Can add percussion/vibration here
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41
Q

ACBT

Forced Expiratory Exs

aka Huffing

“Fogging the mirror”

A
  • DEEP breath THEN cough w/out closing epiglottis
    • Think of fogging up a mirror
  • Cycle:
    • ​TV–> VC–> forced exhale (like a big siiiiighh)
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42
Q

ACBT

Advantages

A
  1. Flexible—> any pos.
  2. Inexpensive
  3. Children as young as 4yo
  4. relieves caregiver
  5. Research is substantial
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43
Q

ACBT

Disadvantages

A
  • Time consuming
    • 20 mins
  • Boring
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44
Q

Airway Clearance Tech’s or Cough assist machines

What are they?

A
  • Mech. apply force to body or intermitt. press. changes to airway to assist insp/exp. mm function
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45
Q

Airway Clearance

Mech. Cough Machine

A
  • Delivers deep insufflations IMMED. followed by deep exsufflations
    • ​MAY add in abd. thrust, min. coughs
  • Forceful insp/exp. excursions
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46
Q

Suctioning is performed routinely for what patients?

A
  • Routinely for intubated pts (mech. vents) to facilitate removal of secretions & stim. cough reflex
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47
Q

Suctioning

Pts w/ artifical airways can be instructed in 2 things:

A
  1. Huffing
  2. Cough assist. tech’s
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48
Q

Suction cath’s can only reach how far?

A

To the lvl of mainstream bronchi

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49
Q

Suctioning should be LAST RESORT

Why?

A

Invasive!!!

Every suction is minor trauma to bronchi

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50
Q

Suctioning is a ______ technique

A

Sterile

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51
Q

Therapeutic Breathing

Consists of 2 components

A
  1. Therapeutic pos. techniques
    1. like in what pos. is best for V/Q and to open airways?
  2. Ventilatory mvmt strategies
    1. again we want to improve V/Q
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52
Q

Therapeutic Breathing

This will asisst w/ progression from _____ to ______

A

from DEP. to INDEP. in mobility and breathing

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53
Q

Therapeutic Breathing

Indicated for pts w/:

A

Weakness of the Diaphragm!!!

54
Q

Therapeutic Breathing

We want to emphasize 2 components of breathing with UE mvmt

A
  • Emphasize inspiratory effort breathing w/ UE mvmt
  • Emphasize expiratory effort breathing w/ UE mvmt
55
Q

W/ Therapeutic Breathing

Breathing tech’s must be PROGRESSED to……

A

Functional Activities

*see if they can coordinate their breathing pattern DURING functional acts

56
Q

W/ Therapeutic Breathing

Pos. of the body GREATLY influences what?

A

Influences ventilation and respiration

57
Q

W/ Therapeutic Exs

What body position is beneficial?

58
Q

Therapeutic Breathing

Positioning basically…..

A

Put human in a pos. that helps facilitate breathing or some component of pulm system

59
Q

Therapeutic Breathing

Positioning for Dyspnea Relief

Tripod or Professional Position

A

Tripod breathing—-YOU KNOW AND HAVE USED THIS!!!

  • arms supported allows access. breathing mm’s to act on rib cage allowing MORE expansion for INSPIRATION
60
Q

Suctioning goes down to mainstem bronchi to where?

A

Bifurcation of Bronchi

61
Q

This type of Therapeutic Position for Breathing switches origin and insertion and pulls OUT the ribcage for DEEPER INSP.

A

Tripod OR Professional Posture

62
Q

Autogenic Drainage

3 Phases

*ALL related to secretions

*NO VALSALVE

A
  • Phase 1
    • ​collecting, TV breathing, prevent bronchospasms
  • Phase 2
    • ​evacuate secretions, IR and HOLD breath—> Huff
  • Phase 3
    • ​Nasal VT
    • In/Out thru nose
63
Q

Diaphragmatic Controlled Breathing

Used to manage 3 things:

A
  1. Dyspnea
  2. Reduce atelectasis
  3. INC oxygenation
64
Q

Diaphragmatic Breathing

Facilitates _________

Reduces___________

A
  • Facilitating OUTWARD motion of abd. wall while
  • Reducing upper ribcage motion during INSP.
65
Q

4 Other Tech’s w/ Diaphragmatic Breathing

A
  1. Sniffing
    1. ​engages diaphragm—> teach like diaphragm is an elevator trying to go DOWN!!!
  2. Scoop Tech.
    1. ​facilitates diaphragm recoil
  3. Obj’s/Wts ON abdomen
    1. ​BELOW xiphoid== activates abs
  4. Manual Trigger during Exhale
    1. ​“Quick Stretch”
66
Q

Diaphragmatic Breathing

Upper chest inhibiting tech.

A
  • Inhibiting UPPER CHEST can help pt recruit diaphragm during INHALATION
    • ​Used AFTER other tech’s
67
Q

Lateral Costal Breathing OR

A

Segmental breathing

applying resistance to INSP/EXP

“Breathe into my hand”

68
Q

Pursed lip breathing prolongs and stabilizes what?

A

Trachea/Bronchi

*really a compensatory strategy to proloooooong exhale

69
Q

Pursed Lip Breathing does 3 things:

A
  1. DECs dyspnea
  2. Helps SLOW RR
  3. Beneficial for OLD
    1. ​bc retain CO2
70
Q

Pursed Lip Breathing Guidelines

A
  1. IN thru NOSE for 2s
  2. OUT thru MOUTH (pursed lips, blowing out candles) for 4s
71
Q

Paced Breathing OR…

A

REALLY just focusing/concentrating on breathing

*volitional control of breathing during activity

72
Q

Paced Breathing

A
  • Volitional control of breathing during act.
  • REALLY INTENTIONAL
    • ​Designated time interval for breathing
      • YOU CAN MAKE IT UP!!!
        • EX. IN for 3s, OUT for 6s
  • Anxiety, cardiac/pulm dis’s
73
Q

INSP MM Training

Indicated for pts w/ S/S of:

A
  • DECd strength or endurance of diaphragm or intercostal mm’s
74
Q

S/S of need for Inspiratory MM Training: 5

A
  1. DECd chest expansion
  2. DECd breath sounds
  3. SOB
  4. Uncoordinated breathing
  5. Bradypnea (<12 breaths/min)
  6. DECd tidal volume
75
Q

Insp MM Training (IMT)

GOALS:

A
  1. INC vent. capacity
  2. DEC dyspnea
76
Q

IMT program consists of two parts:

A
  1. Strengthening
  2. Endurance
77
Q

IMT Training devices

A
  1. Handheld devices
  2. Incentive Spirometers (GOOGLE)
78
Q

PEP or Positive Expiratory Pressure is for……

A

Consolidations

79
Q

PEP or

A

Resisted Exhale

80
Q

PEP does WHAT to secretion

A

Unsticks secretions

81
Q

Positive Expiratory Pressure or PEP

The process or HOW to do:

A
  • “Slowly inhale beyond normal breath”
  • HOLD breath for 2s
  • Keep cheeks stiff
  • EXHALE thru flutter valve

We are training exhalation!!!

82
Q

Positive Expiratory Pressure and Kids

A

BUBBLES!!!!

  • Long straw== >PEP bc longer distance to reach liquid
  • Short straw==

***make it @ least 12in***

83
Q

PEP for kids

ex. BUBBLES

Advantages

A

Caregiver IND

Good for “rewarding” cognitively impaired

children <4yo

inexp.

84
Q

PEP in KIDS
Disadvantages

85
Q

Vest that does high freq. chest wall oscillation @ LOW PRESSURES

A
  • High freq chest wall oscillation vest
86
Q

Chestwall Oscillation

Advantages

A
  • Can be used w/ other interventions
  • Sized as you grow
  • works LONG TERM–> no tolerance build up
87
Q

Chest wall oscillation vest

Disadvantages

A

If you don’t have health insurance, you cannot afford it

VERY $$$$

88
Q

PFT tests are looking @:

A

V/Q matching!!!!!

89
Q

PNF and whether or not it INCs Pulmonary Function

A

YES!!!!

  • Significant Improves in:
    • ​ERV
    • VC
  • HIGHER pulm function
  • **PNF resp. Ex IS effective @ INC pulm function of norm. adults
90
Q

PNF for airway clear.

INSP vs. EXP

A
  • INSP
    • during Thoracic EXT or ROT.
    • as ribcage expands
  • EXP
    • as things CLOSE BACK DOWN
91
Q

What 2 forms of exercise should be used in acute care setting?

A

Endurance AND strength training!!!

92
Q

BOTH endurance and strength training should be used in acute care setting why?

A

PREVENT and TREAT negative NMSK sequelae of critical illness

93
Q

What is the goal of endurance training in acute care setting?

A

MAXIMIZE IND and efficiency when pt performs ADLs

94
Q

Systemic Effects of Immobilization ESP affects you if….

A

Bed bound >/= 3 days

95
Q

Systemic effects of immobilization in a nutshell….

A

Multiple organ impaired function

96
Q

Systemic Effects of Immob.

Cardiac

A
  • INCd RHR
  • DEC HR MAX
  • DEC VO2max
  • Orthostatic HypOtension
  • DECd SV
    • tot. volume blood leaving ea. ventricle per contraction of heart
    • EDV-ESV
97
Q

Systemic Effects of Immob.

Vascular

A
  • INCd platelet coagulation
  • DECd Hgb conc. and DECd blood volume
    • anemia, DVT, clotting
  • Venous stasis
  • INCd venous compliance (stiffness)
98
Q

Systemic Effects of Immob.

Respiratory

A
  • DECd VC
  • DECd RV
  • DECd Pa02
  • Weak cough/non-effective
  • INCd V/Q mismatch
  • INCd risk infection
    • in lungs—esp. part not using
99
Q

Systemic Effects of Immob.

MSK

A
  • DECd mm mass
  • DECd strength
  • DECd mm endurance
  • Jt contractures*
100
Q

Systemic Effects of Immob.

Integumentary

A
  • Decubitus Ulcers
    • pressure wounds
101
Q

Systemic Effects of Immob.

CNS

A
  • Cognitive deficits
  • Delirium
  • Anxiety
  • Altered sleep/wake cycle
102
Q

Systemic Effects of Immob.

Metabolic

A
  • INCd insulin resistance
  • Anorexia
  • DECd ability to process/clear specific meds
103
Q

Systemic Effects of Immob.

Osteo

A
  • HYPERcalcemia
  • Osteopenia
  • Osteoporosis
104
Q

Systemic Effects of Immob.

GI

*when IMMOBILE==> SNS activated, ANS deactivated (rest/digest disrupted)

A
  • paralytic ileus
  • constipation
  • bowel obstruction
105
Q

Systemic Effects of Immob.

Renal

A

Diuresis

*Kidneys filter TOO MUCH bodily fluid== INC urine production + freq. to use bathroom

106
Q

Benefits of EARLY MOBILIZATION

What are the BIG 3?:

A
  1. Do NOT want PNA
  2. NO bedsores

3. NO clots

107
Q

Is bedrest warranted?

If Meds:

A
  • multiple vasopressors
  • fibrolytics
    • ​blood too thin w/in 24hrs
      • ​ex. TPA
108
Q

Is bedrest warranted?

if Hemodynamically unstable:

A
  • Acute MI
  • unstable arrhythmias
109
Q

Is bedrest warranted?

If certain life-support machines

*bc the way the lines are attached to indiv.

A
  • femoral IABP
  • femoral ECMO
  • ICP monitors
110
Q

Is bedrest warranted?

Hospice

A

Pt. dictated care

*depends on what they want*

111
Q

Is bedrest warranted?

Excessive Pain: “Goal being to minimize pain”

A
  • burns/trauma/wounds
  • WB precautions!!!
    • ​ONLY SW or Ax. Crutches!!!!!!!
112
Q

is bedrest warranted?

Dependent Edema: “Rest, Ice, Compression, Elevation”

RICE

A
  • IF
    • Post-trauma
    • post-sx
    • peripheral edema control
113
Q

Is bedrest warranted?

Specific MD activity orders:

A

Bed Rest

OOB to chair

BR

ad lib

114
Q

Rx Mob. for Pulm Pt

Step 1: PT exam

A

what factors are negatively affecting pts V/Q?

115
Q

Rx Mob. for Pulm pt

Step 2: Parameters

A

*are there any parameters worth monitoring?

*what monitors are avail?

116
Q

Rx Mob. for Pulm Pt

Step 3: Is mobility feasible and safe?

A

*check precautions and contraindications

117
Q

Rx Mob for Pulm pt

Step 4: What are the pts goals for today AND future?

A

!!!!!!!!!!!!

118
Q

Rx Mob. for Pulm pt

Step 5: Schedule session w/ interdisciplinary team

A

*nursing

*resp. tx

*family

119
Q

Rx Mob. for Pulm pt

Step 6: Match deficits in step 1, info in step 2, 3, and 4 w/ Mobilization, PD, percussion, vibration, pulm hygiene, etc.

120
Q

Rx Mob. for Pulm pt

Step 7: Plan for duration and intensity

121
Q

Rx Mob for Pulm pt

Step 8: Educate and carry it out!!!

122
Q

Rx Mob for Pulm pt

Step 9: Assess your rx’s effectiveness

123
Q

Rx Mob for pulm pt

Step 10: change intensity, freq, duration based on response/effective. and parameters

124
Q

Rx Mob for Pulm pt

Step 11: Could anything be optimized?

A

RE-ASSESS!!!!

125
Q

RX MOB FOR PULM pt

****ACSM Parameters to Elicit Long-Term Effects:

KNOW THESE!!!!

A
  • Int: 40-85% or RHR based on Karvonen
    • ​Karvonen== %int(HRR) + RHR
      • ​HRR==MHR-RHR
        • ​MHR==220-age
      • Karvonen==Ex. HR==%int(HRR) + RHR
  • Duration: 20-40 mins
  • Freq: 3-5x/week
  • Mode: sitting tol, amb, therEX
  • Monitor: HR, BP, RR, Sa02

SAFETY IS PARAMOUNT!!!!!!!!

126
Q

Mob of Pulm pt

Functional mobility training may be initiated WHEN?

A

As soon as pt can roll B/L in bed w/ stable vital signs

127
Q

functional mobility training for pulm pt.

What does this entail?

A
  • Bed mobility
  • Transfers and Amb.
    • ​use of AD’s====TEACH THEM!
    • recruit personnel assist for equip. mgmt
    • Progress pt to LEAST RESTRICTIVE AD!!!
128
Q

HOW DO YOU CHOOSE AN INTERVENTION???

A
  • Pt Info:
    • age
    • motivation
  • Availabilty
  • Effectiveness
  • Clinical status
  • Lifestyle
  • Expense*****

Do Functional Mobility along w/ other interventions!!!

129
Q

LONG-TERM Effects Mobilization

A
  • Getting rid of secretions
  • INC functional capacity
  • Preventing future consolidations & PNA***​

CardioPulmoaryPT1 (12 decks)

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