Breathing Exercises Flashcards
Diaphragmatic Breathing (DB) : definition
breathing predominantly with the diaphragm while minimizing the action of accessory muscles & motion of the rib cage during inspiration
Diaphragmatic Breathing: Indications
post-surg pt w/ pain in chest wall/ abdomen/ restricted mobility
pt learning active cycle of breathing/ autogenic drainage airway clearance techniques
Diaphragmatic Breathing: Precautions/ Contraindications
moderate to severe COPD & marked hyperinflation of lungs w/o diaphragm movement
pt w/ paradoxical breathing patterns/ who demonstrates increased inspiratory muscle effort & increased dyspnea during DB
Diaphragmatic Breathing: Procedure
Semi-Fowler’s position to start
sniffing can be used to facilitate contraction of diaphragm
have pt place one hand on upper chest and the other just below the rib cage
Instruct: “breath slowly through your nose so that your stomach moves out against your hand. Feel your abdomen gently rise into your hand. Exhale through pursed lips, let the hand on your abdomen descend while the hand on your chest remains still”
Diaphragmatic Breathing: Expected Outcomes
decreased respiratory rate decreased use of accessory muscles increased tidal volume decreased respiratory flow rate subjective improvement of dyspnea improved tolerance for activity
Inspiratory Muscle Training (IMT): definition
attempts to strengthen diaphragm and intercostal muscles w/ 2 different devices
1) flow resistive breathing- pt inspires through mouthpiece & adapter w/ adjustable diameter. decreased diameter = increased resistance
2) threshold breathing- buildup of negative pressure before flow occurs through a valve that opens @ critical pressure. provides consistent, specific pressure for IMT regardless of pt’s breathing rate
Inspiratory Muscle Training: Indications
impaired inspiratory muscle strength &/or ventilatory limitation to exercise performance
Inspiratory Muscle Training: Precautions/ Contraindications
Clinical signs of inspiratory muscle fatigue
tachypnea
reduced tidal volume
increased PACO2
bradypnea & decreased minute ventilation
Inspiratory Muscle Training: Procedure
measure pt’s max inspiratory pressure (MIP) w/ manometer
use MIP to calculate an appropriate training load
Inspiratory Muscle Training: Expected Outcomes
increased inspiratory muscle strength & endurance
decreased dyspnea @ rest & during exercise
increased functional exercise capacity
Paced Breathing and Exhale with Effort: Definitions
Paced Breathing: strategy to decrease work of breathing & prevent dyspnea during activity- allows pt w/ shortness of breath to become less fearful of activity/exercise
Exhale with Effort: breathing strategy employed during activity to prevent pt from holding their breath- breaks any activity into one/more breaths w/ inhale during resting/less active phase & exhale during movement/ more active phase
Paced Breathing and Exhale with Effort: Indications
pts w/ dyspnea @ rest or w/ minimal activity
inability to perform activity due to pulmonary limitation
inefficient breathing pattern during activity
Paced Breathing and Exhale with Effort: Precautions/ Contraindications
avoid Valsalva maneuver during activity
Paced Breathing and Exhale with Effort: Procedure
perform activity @ temp that doesn’t exceed pt’s breathing limits
find a comfortable inspiration:expiration time to synchronize w/ exertion phase of activity
synchronize breathing with components of activity
inhale before/during easier portion
exhale during more vigorous portion
DO NOT hold breath or rush through activity
Paced Breathing and Exhale with Effort: Walking
1) inhale through nose while walking 2 steps
2) pause
3) exhale through pursed lips while walking 4 steps
Paced Breathing and Exhale with Effort: Climbing Stairs
1) inhale while standing
2) exhale through pursed lips while stepping up/down 1 or 2 stairs
3) remain on step until breathing control is restored
Paced Breathing and Exhale with Effort: Lifting
1) inhale through nose while standing/ sitting
2) exhale through pursed lips while bending to reach object
3) pause
4) inhale through nose while grabbing object
5) exhale through pursed lips while standing up
Paced Breathing and Exhale with Effort: Expected Outcomes
complete activity without dyspnea
decrease pt’s fear of becoming short of breath during activity
Pursed Lip Breathing: definition
simple technique to reduce respiratory rate, reduce dyspnea & maintain small positive pressure in bronchioles (may prevent airway collapse in pts w/ emphysema)
any pt short of breath may use this technique
Pursed Lip Breathing: Indications
tachypnea
dyspnea
Pursed Lip Breathing: Precautions/ Contraindications
forcing exhalation
Pursed Lip Breathing: Procedure
semi-fowler’s = good starting position
instruct: “breathe in slowly through nose with mouth closed for two counts. purse your lips like you are going to whistle, then gently breath out through your mouth like you were going to blow out a candle for four counts. do not blow with force”
Pursed Lip Breathing: Expected Outcomes
Decrease respiratory rates Relieve dyspnea reduce PaCO2 improve tidal volume improve SaO2 prevent airway collapse in pts w/ emphysema increase activity tolerance
Segmental Breathing: definition
aka localized breathing/ thoracic expansion exercise
intended to improve regional ventilation, prevent & treat pulmonary complications post op
Segmental Breathing: Indications
decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volume
ventilation:perfusion ratio mismatch
Segmental Breathing: Precautions/ Contraindications
NONE 😀
Segmental Breathing: Procedure
Positioning: sitting for basal atelectasis
sidelying w/ affected lung on top
postural drainage positions w/ affected lung on top to assist secretion removal
Therapist applies firm pressure @ end of exhale to pt’s chest wall overlying area to be expanded
pt inhales deeply & slowly expanding ribcage under therapists’s hands
Therapist reduces hand-pressure during pt’s inhale
Segmental Breathing: Expected Outcomes
increase chest wall mobility
expand collapsed alveoli via airflow through collateral ventilation channels
assist secretion removal
Sustained Maximal Inhale w/ Incentive Spirometer: definition
max inspiratory effort is held for 3+ seconds @ point before exhale
included in many airway clearance techniques to compensate for asynchronous ventilation, to promote air passage past mucus obstruction in airways, & maximize alveolar expansion
aka incentive spirometry- encourage pt to take long, slow, deep inhales
Sustained Maximal Inhale w/ Incentive Spirometer: Indications
decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volume
atelectasis/ risk of due to thoracic/ upper abdominal surgery
restrictive lung defect associated w/ quadriplegia &/or dysfunctional diaphragm
Sustained Maximal Inhale w/ Incentive Spirometer: Precautions/ Contraindications
pt is not cooperative/ unable to understand/demonstrate proper use of incentive spirometer
pt is unable to deep-breathe effectively
pt w/ moderate-severe COPD w/ increased respiratory rate & hyperinflation
Sustained Maximal Inhale w/ Incentive Spirometer: Expected Outcomes
absence/ improvement of in signs of atelectasis
decreased respiratory rate
resolution of fever
normal pulse rate
normal chest x-ray
improved PaO2
increased forced vital capacity & peak expiratory flows
Semi-Fowler’s Position
pt in supine w/ head of bed elevated to 45˚ & pillows under knees for support/ maintenance of proper lumbar curvature
often used for pts w/ congestive heart failure
Reverse Trendelenburg Position
pt in supine w/ head above trunk and LE, decreased weight of abdominal contents on diaphragm & reducing resistance to movement during breathing
