Breathing Exercises Flashcards
Diaphragmatic breathing indicated for who?
post-surgical pts with pain in chest wall or abdomen or restricted mobility.
Pt learning ACB or AD
Dyspnea at rest or with minimal activity
inability to perform ADLs due to dyspnea or inefficient breathing pattern.
Diaphragmatic breathing precautions/contraindications
moderate to severe COPD with marked hyperinflation of the lungs without diaphragmatic movement.
Pts with paradoxical breathing patterns or who demonstrate increased inspiratory muscle effort and increased dyspnea during DB.
Inspiratory muscle training (IMT) attempts to
strengthen the diaphragm and intercostal muscles
Different modes of IMT:
flow resistive breathing and threshold breathing
Flow resistive breathing
patient inspires through a mouthpiece and adapter with an adjustable diameter.
Threshold breathing
buildup of negative pressure before flow occurs though a valve that opens at a critical pressure. Provides consistent and specific pressure for IMT, regardless of how quickly or slowly patients breath
Precautions/contraindications of IMT
clinical signs of inspiratory muscle fatigue: in order:
tachypnea
reduced tidal volume
increased PaCO2
bradypnea and decreased minute ventilation
Paced breathing
allows anyone who experiences SOB to become less fearful of activity and exercise
Exhale with effort
during activity to prevent a patient from holding their breath
Pursed lip breathing
reduces RR, dyspnea, maintains small positive pressure in bronchioles which may help prevent airway collapse in patients with emphysema. Any patient who is short of breath may use this technique.
Segmental breathing
localized breathing or thoracic expansion exercises. Intended to improve regional ventilation and prevent and treat pulmonary complications after surgery.
Indications for segmental breathing
decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volumes
ventilation:perfusion mismatch
Expected outcomes for segmental breathing
expand collapsed alveoli via airflow through collateral ventilation channels
assist with secretion removal
Indications for incentive spirometer
decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volume
ventilation:perfusion mismatch
atelectasis or risk of it due to surgery
restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm
Precautions/contraindications for incentive spirometer
less than 10 mL/kg or inspiratory capacity
patients with severe COPD with increased RR And hyperinflation
Forward leaning with arm support optimizes
length-tension relationship of the diaphragm and allows pec minor and major to assist in elevating rib cage during inspiration.
Semi-Fowler’s position
supine with HOB elevated to 45 degrees and pillows under knees
used for CHF or other cardiac conditions
Clinical contraindications for inpatient and outpatient cardiac rehab
unstable angina
resting SBP >200 mmHg or resting DBP >110 mmHg
orthostatic drop of >20 mmHg with symptoms
critical aortic stenosis
acute systemic illness or fever
uncontrolled atrial/ventricular arrhythmias
third degree heart block without pacemaker
active pericarditis or myocarditis
recent embolism
thrombophlebitis
resting ST segment depression or elevation >2mm
uncompensated HF
Inpatient cardiac rehab phase I
AROM
ambulation
self care
average time 3-5 days
Discontinue exercise in cardiac rehab phase I if..
HR >130 bpm or >30 beat above resting
DBP>110 mmHg
decrease in SBP >10 mmHg
significant ventricular or atrial dysrhythmia
2nd or 3rd degree heart block
signs or symptoms of angina, marked dsypnea, and ECG changes of suggestive ischemia
Exercise in cardiac rehab phase I
active UE and LE exercise can begin 24 hours after bypass and 2 days after infarct.
Progress from sitting to standing (1-4 METS)
progressive, supervised walking (2-3 METS) to walking up and down steps or treadmill walking (3-4 METS)
RPE and HR in cardiac rehab phase I
<13
post infarction: HR<120 or <20 above resting
post surgery: <30 above resting
Duration and frequency of cardiac rehab phase I
intermittent bouts of 3-5 minutes progressing to 10-15 minutes of continuous activity
first 3 days: 3-4 times per day
after 3 days: 2x/day with increased duration
Progression of exercise in cardiac rehab phase I
adequate increase in HR
adequate increase in SBP (10-40 mmHg)
Outcomes of inpatient cardiac rehab
walk 5-10 minutes continuously or 1,000 feet four times daily
walk up and down a flight of stairs independently
Immediate outpatient cardiac rehab (Phase II)
can begin immediately after hospitalization and last up to 12 weeks
exercise test with ECG is recommended for patients entering outpatient program and as changes in patients condition warrant
Monitoring during outpatient cardiac rehab (phase II)
low risk patients: 6-12 sessions of ECG and BP monitoring and medical supervision
moderate to high risk: continuous ECG and BP monitoring and medical supervision usually for 12 sessions.
Rating of what on the angina scale is recommended end-point to cease activity during inpatient and outpatient cardiac rehab.
1
Individuals who experience angina during activity during cardiac rehab phase II should
discontinue activity immediately and rest in sitting or recumbent position
Individuals with medication for angina should be encouraged to use it as directed. If angina is not relieved by termination of activity or by nitro what should you do?
ER
Exercise THR for aerobic training should be ___ beat/min below known ischemic or anginal threshold.
> or equal to 10
Discontinue exercise during phase II outpatient cardiac rehab if…
plateau or decrease in HR with increase in work
SBP plateaus or falls with increase in work or >250 mmHg
DBP >115 mmHg
ST segment depression >1 mm
2nd or 3rd degree heart block
ventricular dysrhythmias
angina or other symptoms of CVD insufficiency
Aerobic exercise intensity for those in cardiac rehab phase II
without entry exercise test: exercise HR equal to standing RHR +20 bpm with caution
Moderate dehydration is considered a loss of how much percent of bodyweight?
6%
How much should you drink for each pound lost of body weight?
1 pint
Disorientation, dizziness, apathy, headache, nausea, vomiting, hyperventilation, dry skin
heat stroke
LBP, elevated HR and RR, wet and pale skin, weakness, dizziness
heat exhaustion
decreased HR and RR, pale skin, weakness, vertigo, nausea
heat syncope
localized muscle spasms progressing to debilitating muscle cramps
heat cramps
Exercise in cold may lower
may lower the angina threshold and increase risk of death or injury in individuals with heart disease.
Hypothermia is characterized by
body temp <97 degrees F
Duration and frequency of exercise for outpatient cardiac rehab
15-20 minutes of continuous or intermittent exercise during first month.
25-30 minutes during next three or four months
40 min + after 6 months
Interval training for those that cannot tolerate exercise continuously
3-5x/week
Clinical indications for pulmonary rehab
dyspnea at rest or with exertion
hypoxemia
hypercapnia
reduced exercise tolerance
decline in ADLs
chronic bronchitis
emphysema
asthma
interstitial lung disease
bronchiectasis
cystic fibrosis
lung cancer
chest wall disease
neuromuscular disease
preop or post op lung
ventilator dependency
Guidelines for aerobic exercise for pulmonary rehab
> 50% peak oxygen consumption determined by exercise test
using dyspnea rating at submax level during exercise test
60-80% of peak work rate achieved determined from exercise test
RPE of 4-6 on 0-10 scale or 12-16 on 6-20 scale
maintain O2 >90%
Duration of pulmonary rehab sessions
minimum of 30 minutes accumulated exercise per session
interval training for those that cannot exercise continuously
3-5 days per week
