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NPTAE Cardiopulmonary > Breathing Exercises > Flashcards

Breathing Exercises Flashcards

1
Q

Diaphragmatic Breathing (DB) : definition

A

breathing predominantly with the diaphragm while minimizing the action of accessory muscles & motion of the rib cage during inspiration

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2
Q

Diaphragmatic Breathing: Indications

A

post-surg pt w/ pain in chest wall/ abdomen/ restricted mobility
pt learning active cycle of breathing/ autogenic drainage airway clearance techniques

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3
Q

Diaphragmatic Breathing: Precautions/ Contraindications

A

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

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4
Q

Diaphragmatic Breathing: Procedure

A

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”

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5
Q

Diaphragmatic Breathing: Expected Outcomes

A 
decreased respiratory rate
decreased use of accessory muscles
increased tidal volume
decreased respiratory flow rate
subjective improvement of dyspnea
improved tolerance for activity
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6
Q

Inspiratory Muscle Training (IMT): definition

A

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

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7
Q

Inspiratory Muscle Training: Indications

A

impaired inspiratory muscle strength &/or ventilatory limitation to exercise performance

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8
Q

Inspiratory Muscle Training: Precautions/ Contraindications

A

Clinical signs of inspiratory muscle fatigue
tachypnea
reduced tidal volume
increased PACO2
bradypnea & decreased minute ventilation

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9
Q

Inspiratory Muscle Training: Procedure

A

measure pt’s max inspiratory pressure (MIP) w/ manometer

use MIP to calculate an appropriate training load

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10
Q

Inspiratory Muscle Training: Expected Outcomes

A

increased inspiratory muscle strength & endurance
decreased dyspnea @ rest & during exercise
increased functional exercise capacity

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11
Q

Paced Breathing and Exhale with Effort: Definitions

A

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

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12
Q

Paced Breathing and Exhale with Effort: Indications

A

pts w/ dyspnea @ rest or w/ minimal activity
inability to perform activity due to pulmonary limitation
inefficient breathing pattern during activity

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13
Q

Paced Breathing and Exhale with Effort: Precautions/ Contraindications

A

avoid Valsalva maneuver during activity

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14
Q

Paced Breathing and Exhale with Effort: Procedure

A

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

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15
Q

Paced Breathing and Exhale with Effort: Walking

A

1) inhale through nose while walking 2 steps
2) pause
3) exhale through pursed lips while walking 4 steps

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16
Q

Paced Breathing and Exhale with Effort: Climbing Stairs

A

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

17
Q

Paced Breathing and Exhale with Effort: Lifting

A

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

18
Q

Paced Breathing and Exhale with Effort: Expected Outcomes

A

complete activity without dyspnea

decrease pt’s fear of becoming short of breath during activity

19
Q

Pursed Lip Breathing: definition

A

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

20
Q

Pursed Lip Breathing: Indications

A

tachypnea

dyspnea

21
Q

Pursed Lip Breathing: Precautions/ Contraindications

A

forcing exhalation

22
Q

Pursed Lip Breathing: Procedure

A

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”

23
Q

Pursed Lip Breathing: Expected Outcomes

A 
Decrease respiratory rates
Relieve dyspnea
reduce PaCO2
improve tidal volume
improve SaO2
prevent airway collapse in pts w/ emphysema
increase activity tolerance
24
Q

Segmental Breathing: definition

A

aka localized breathing/ thoracic expansion exercise

intended to improve regional ventilation, prevent & treat pulmonary complications post op

25
Q

Segmental Breathing: Indications

A

decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volume
ventilation:perfusion ratio mismatch

26
Q

Segmental Breathing: Precautions/ Contraindications

A

NONE 😀

27
Q

Segmental Breathing: Procedure

A

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

28
Q

Segmental Breathing: Expected Outcomes

A

increase chest wall mobility
expand collapsed alveoli via airflow through collateral ventilation channels
assist secretion removal

29
Q

Sustained Maximal Inhale w/ Incentive Spirometer: definition

A

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

30
Q

Sustained Maximal Inhale w/ Incentive Spirometer: Indications

A

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

31
Q

Sustained Maximal Inhale w/ Incentive Spirometer: Precautions/ Contraindications

A

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

32
Q

Sustained Maximal Inhale w/ Incentive Spirometer: Expected Outcomes

A

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

33
Q

Semi-Fowler’s Position

A

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

34
Q

Reverse Trendelenburg Position

A

pt in supine w/ head above trunk and LE, decreased weight of abdominal contents on diaphragm & reducing resistance to movement during breathing

NPTAE Cardiopulmonary (16 decks)

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