Breathing Exercises

Question 1

Indication of

Diaphragmatic Breathing

Answer 1

• Post- Surgical patient with pain in the chest wall or abdomen, or restricted mobility
• Patient learning active cycle of breathing or autogenic drainage airway clearance technique
• dyspnea at rest or with minimal activity
• Inability to perform ADLs due to dyspnea or inefficient breathing pattern

Question 2

Precaution/Contras

Diaphragmatic breathing

Answer 2

• Moderate to severe COPD and marked hyperinflation of the lungs without diaphragmatic movement
• Patients with paradoxical breathing patterns, or who demonstrate increased inspiratory muscle effort, and increased dyspnea during DB

Question 3

PRocedure for diaphragmatic breathing

Answer 3

• Semi-Fowler’s position is a good starting position
• sniffing can be used to facilitate contraction of teh diaphragm
• Have the patien place one hand on the upper chest and the other just below the rib cage

Question 4

Expected Oucomes

Diaphragmatic breathing

Answer 4

• DEcrease respiratory rate
• decrease use of accessory muscles of inspiration
• increase tidal volume
• decrease respiratory flow rate
• subjective improvement of dyspnea
• imporve tolerance for activity

Question 5

Inspiratory muscle training

definition and indication

Answer 5

• attempts to strengthen the diaphragm and intercostal muscles
• two different IMT devices provide different modes of training: flow resistive breathing and threshold breathing
• indictaion: impaired inspiratory muscle strength and/or ventilatory limitation to exercise performance

Question 6

Flow resistive breathing

Answer 6

• patient inspires through a mouthpiece and adapter with an adjustable diameter
• decreasing the diameter increases the resistance to breathing, provided that breathing rate, tidal volume and inspiratory time are kept constant

Question 7

threshold breathing/loading

Answer 7

• requires the buildup of negative pressure before flow occurs through a valve that opens at a critical pressure
• threshold breathing provides consistent and specific pressure for IMT, regardless of how quickly or slowly patients breathe

Question 8

Inspiratory muscle training precautions/ contraindictaion

Answer 8

• clinical signs of inspiratory muscle fatigue in order of appearance:
• –tachypnea
• –reduced tidal volume
• – increased PaCO2
• –Bradypnea and decreased minute ventilation

Question 9

Inspiratory muscle training procedure

Answer 9

• measure the patient’s maximum inspiratory pressure (MIP) with a manometer
• Use the measured MIP to calculate teh training load

Question 10

inspiratory muscle training expected Outcomes

Answer 10

• Increase inspiratory muscle strength and endurance
• decrease dyspnea at rest and during exercise
• increase functional exercise capacity

Question 11

Threshold inspiratory muscle trainer

Answer 11

• have the patient place the mouthpiece in his or her mouth and inhale with enough force to open the valve
• adjust teh spring tension by turning the control knob to adjust the pressure indicator to the prescribed setting
• the device is marked every 2 cm H2O. the higher the setting the greater teh effort needed
• Begin training at 30-40% of teh patient’s maximum inspiratory pressure
• the patient breathes against that resistance at resting respiratory rate and tidal volume for 5 to 15 minutes, two to three times a day
• resistance can be increased in small increments by adjusting the tension on the spring until the training load reaches 40-60% of MIP over a four to six week period

Question 12

PFLEX Inspiratory Muscle Trainer

Answer 12

• Have the patient place the PFLEX in his or her mouth and breathe at tidal volume
• turn the dial selector to regulate the resistance to breathing- setting 1 provides the least resistance
• Begin training with the setting that elicits the 30- 40% level of MIP for 10 to 15 minutes daily, gradually increasing to 20 to 30 minutes, three to 5 days per week
• once the patient can easily tolerate 30 minutes at one resistance, increasing the resistance to the next setting

Question 13

Paced breathing and exhale with effort

definition and indication

Answer 13

• Paced breathing is a strategy to decrease the work of breathing and prevent dyspnea during activity. It allows anyone who experiences SOB to become less fearful of activity and exercise
• exhale with effort is a breathing startegy employed during activity to prevent a patient from holding their breath. the technique breaks any activity into one or more breaths with inhalation during the resting or less active phase of teh activity and exhalation during the movement or more active phase of the activity
• -Indication: Patients with dyspnea at rest or with minimal activity. inability to perform activity due to pulmonary limitation. Inefficient breathing pattern during activity

Question 14

Paced breathing and exhale with effort

-precautions and contras

Answer 14

• Avoid Valsalva maneuver during activity

Question 15

Paced breathing and exhale with effort

- Procedure

Answer 15

• Perform activity at at a tempo that does not exceed the patient’s breathing limitation
• Find a comfortable inspiration to expiration time to synchronize with the exertion phase of activity
• synchronize breathing with components of teh activity: inhale before or during the easier component of teh activity. exhale during the more vigorous component of teh activity
• Do not hold breath or rush through the activity

Question 16

Pursed-lip breathing definition indication

Answer 16

• is a simple technique to reduce RR, reduce dyspnea and maintain a small positive pressure in the bronchioles, which may help prevent airway collapse in patients with emphysema. Any patient who is SOB may use this technique
• tachypnea
• dyspnea

Question 17

Pursed-lip breathing precautions/contra

Answer 17

• forcing exhalation

Question 18

Pursed-lip breathing procedure

Answer 18

-Breathe in slowly through your nose with the mouth closed for two counts. Pucker, or purse your lips as if you were going to whistle, then gently breathe out through pursed lips, as if trying to make a candle flame flicker, for a four count. do not blow with force

Question 19

Pursed-lip breathing expected outcomes

Answer 19

• Decr RR
• Relieve dyspnea
• Reduce arterial partial pressure of carbon dioxide
• imporve tidal volume
• improve oxygen saturation
• prevent airway collapse in patients with emphysema
• incr activity tolerance

Question 20

Segmental breathing

- definition and indication

Answer 20

• intended to improve regional ventilation and prevent and treat pulmonary complications after surgery. it is based on the presumption that asymmetrical chest wall motion may coincide with underlying pathology and that inspired air can be directed to a particular area by facilitation or inhibition of chest wall movement through proper hand placements, verbal cues or coordination
• • decr intrathoracic lung volume
• • decr chest wall lung compliance
• • incr flow resistance from decr lung volume
• • ventilation: perfusion mismatch

Question 21

Segmental breathing procedure

Answer 21

Position of pt: sitting position for basal atelectasis, sidelying with affected lung uppermost, postural drainage positions with affected lung uppermost to assist with secretion removal

• therapist applies firm pressure at the end of exhalation to the patient’s chest wall overlying the area to be expanded
• Pt inhales deeply and slowly expands the rib cage under the PT’s hands
• PT reduces hand pressure during the patient’s inhalation

Question 22

segmental breathing expected outcome

Answer 22

• incr chest wall mobility
• expand collapsed alveoli via airflow through collateral ventilation channels
• assist with secretion removal

Question 23

Sustained Maximal Inhalation with Incentive Spirometer

definition

Answer 23

• a maximal inspiratory effort is held for three or more seconds at the point of max inspiration before exhalation.
• many airway clearance techniques include SMI to compensate for asynchronous ventilation, to promote air passage past mucus obstructions in airways, and to maximize alveolar expansion. SMI is also called incentive spirometry when using a device that provides visual or other feedback to encourage the patient to take long, slow deep inhalations

Question 24

Sustained Maximal Inhalation with Incentive Spirometer

Indication

Answer 24

• decr intrathoracic lung volume
• decr chest wall lung compliance
• incr flow resistance from decr lung volume
• Ventilation:perfusion (V:Q) mismatch
• Atelectasis or risk of atelectasis due to thoracic and upper abdominal surgery
• restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm

Question 25

Sustained Maximal Inhalation with Incentive Spirometer

precautions/ contras

Answer 25

• Pt is not cooperative or is unable to understand or demonstrate proper use of the incentive spirometer
• Pt is unbale to deep breathe effectively
• pt with moderate to severe COPD with incr RR and hyperinflation

Question 26

Sustained Maximal Inhalation with Incentive Spirometer

Procedure

Answer 26

• Hold the incentive spirometer in a verticla position
• have the patient exhale completely, then seal his lips around the mouthpiece
• breathe in slowly and deeply through the mouth, raising the ball or piston of the spirometer
• encourage the pt to move the diaphragm and expand the lower chest, not the upper chest
• Hold teh breath for at least three seconds and not the highest level the piston reaches
• Perform SMI independently five to ten breaths per hour when awake

Question 27

Sustained Maximal Inhalation with Incentive Spirometer expected outcome

Answer 27

• abssence of or imporvement in signs of atelectasis
• decr RR
• Resolution of fever
• normal pulse rate
• normal chest x-ray
• improved Pa O2
• Increased forced vital capacity an dpeak expiratory flows