Breathing exercises Flashcards
Clinical indications for breathing strategies
- Reduce dyspnea
- Increase ventilation/ventilation/prevent atelectasis
- Pain control
- Airway secretion clearance
Maintain chest wall mobility
Strategies that reduce dyspnea and WOB
pursed lip breathing
Breathing control
Strategies to increase ventilation/lung volume and prevent atelectasis
Diaphragmatic breathing
Lateral costal breathing
Segmental breathing
Breath stacking
Strategies to optimize pain control
breath stacking
Diaphragmatic breathing
Pursed lip breathing mechanism
Elongated expiration (more time to empty)
Reduced RR
Creates PEEP to splint airway open during expiration
Reduces dyspnea by reducing dynamic hyperinflation
Breathing control mechanism
Promotes relaxation
Creates conscious awareness of ventilation
Strategy involves using the diaphragm to breathe using minimal effort
Promotes conscious awareness of ventilation to reduce dyspnea
Important when patient feels respiratory efforts go unrewarded
Diaphragmatic breathing Mx
Provide opportunity for use of collateral channels to open closed alveoli
Deep slower breaths allow alveoli longer time constraints to open & fill
End inspiratory hold Mx
Improves the distribution of air in the lungs
Opens poorly ventilated areas of the lungs through collateral channel ventilation in atelectatic regions
Lateral costal expansion Mx
Raises the lateral aspect of the ribs to increase the transverse diameter of the thorax
Results in deeper breaths
Segmental breathing Mx
Increase lung volume in targeted under-ventilated areas
Tactile and verbal cues enhance localized expansion of lung segments activating the intercostals in the target area
Useful when localized pathology is affecting a specific segment
Breath stacking Mx
Gradual build up of pressure increase air entry to under-ventilated areas of the lungs
Facilitates incremental lung expansion to TLC
Useful when muscle weakness, fatigue or pain inhibits taking a single full breath
Rib springing Mx
Neurophysiological facilitation of deeper breaths
Uses external proprioceptive and tactile stimuli to produce reflex inspiratory movement responses that increase the depth of breathing
Breathing exercise prescription
Common parameters for deep breathing strategies (diaphragmatic, lateral costal, segmental, breath stacking)
- 10x every waking hour after surgery
- 5 breaths (reps) x 2 with 1 min rest
Pursed lip breathing
- Continue till cessation of dyspnea or end of dyspnea triggering activity
Breathing control
Continue till cessation of dyspnea
Breathing exercises precaution
- Hemodynamic instability: breathing exercises in general
- Deep breathing exercises in patients with COPD or hyperinflation
- Can combine with PLB to prevent worse hyperinflation
Rib springing - osteopenia, surgical incision, pain & obstructing medical lines
- Deep breathing exercises in patients with COPD or hyperinflation
Breathing exercises contraindications
- No end inspiratory hold in patients with COPD and hemodynamic instability
- Rib springing - fracture, osteoporosis, cancer of ribs, burns (thorax), coagulation disorders
