BRTP03 Breathing Techniques

Question 1

Tips for patient education

Answer 1

1. Make sure learner understands reason for technique and therapy
2. Make sure they are willing and ready to learn.
3. Demonstrate and explain the procedure to patient and family.
4. Ask patient to explain and demonstrate back to you. (Teach back)
5. Provide additional direction until adequate performance.
6. Address questions and concerns
7. Provide written instructions

Question 2

Pursed lip breathing

Answer 2

Indicates chronic airway obstruction

Question 3

Purpose of Pursed Lip Breathing (PLB)

Answer 3

• To prevent the air trapping caused by bronchiolar airway collapse
• PLB increases BACK PRESSURE throughout bronchial tree
• This helps keep small airways open and less likely to trap air at the alveolar level

Question 4

Purpose of PLB continued

Answer 4

To reduce anxiety caused by dyspnea or distress particularly in those with COPD.

Question 5

More on PLB

Answer 5

• Usually the easiest breathing technique to learn and is often done instinctively.
• Relief of dyspnea is almost immediate
• Patients need to be taught to use just enough positive airway pressure

Question 6

What does pursed lip breathing do

Know most of these

Answer 6

Improves ventilation

Releases trapped air in lungs

PREVENTS AIRWAY COLLAPSE

keeps the airways open longer due to causing BACK PRESSURE and decreases work of breathing

PROLONGS EXHALATION TO SLOW BREATHING RATE

Improves breathing pattern by moving old air out and new air in

Relives shortness of breath

Causes relaxation

Question 7

Diaphragmatic/ Abdominal breathing

Answer 7

One hand on chest one on stomach

Focus on raising stomach

Question 8

Diaphragmatic/ Abdominal Breathing purpose?

Answer 8

STRENGTHEN THE DIAPHRAGM

AVOID THORACIC BREATHING (will increase oxygen use)

DIAPHRAGM USES LESS O2

Decreases oxygen demand caused by using accessory muscles.

Decrease O2 demand

Use less effort and energy to breathe

Decrease WORK OF BREATHING TO SLOW RATE

PREVENT OR CORRECT DEVELOPMENT OF ATELECTASIS

Best if done sitting up.

Question 9

Lateral Costal breathing

Answer 9

Placing hands on sides at base of ribs breathing in slowly and allow ribs to expand

Question 10

Purpose of Lateral Costal Breathing (and keywords)

Answer 10

Unilateral and bilateral costal breathing exercises INCREASE VENTILATION TO THE LOWER LOBES and augments diaphragmatic breathing

INCREASES MOBILITY of the diaphragm and may INCREASE DISTRIBUTION OF VENTILATION TO LUNG BASES

Used on patients who are PREGNANT, had abdominal surgery, or can’t tolerate hand on the abdomen.

Question 11

What technique can help relieve dyspnea in COPD patients?

Answer 11

Pursed lip breathing

Question 12

What breathing technique strengthens the diaphragm?

Answer 12

Diaphragmatic/ Abdominal Breathing

Question 13

What technique is best for pregnant patients?

Answer 13

Lateral costal breathing

Question 14

Phases of a cough

Answer 14

Irritation
Inspiration
Compression
Expulsion

Question 15

Causes of coughing

Know most of these

Answer 15

Infection 
Dust
Chemical fumes
Foreign body 
Cold air
High flow rates 
Irritants

Question 16

What can happen when you don’t cough or breathe deep?

Answer 16

Atelectasis

Question 17

What is atelectasis?

Answer 17

A complete or partial collapse of a lung, due to alveoli deflating

Question 18

2 primary types of atelectasis?

Answer 18

Compression atelectasis- typically caused by small tidal volumes (usually links to pleural effusion)

Gas absorption atelectasis- caused by interruption of ventilation or a significant change in V/Q (alveolar gas is absorbed and alveolus collapse)

Question 19

Directed cough

Answer 19

Deliberate maneuver that is taught, supervised and monitored.

Mimics the features of an effective spontaneous cough.

Question 20

Giving a directed cough order requires?

Answer 20

Good patient instruction

Proper positioning

Breathing control and exercises to strengthen the expiratory muscles

Splinting for pain

Question 21

Splinting

Answer 21

Supporting the area when taking a deep breath or coughing.

Usually used for surgical patients or anyone experiencing a painful area to support when coughing.

A pillow or teddy bear is used.

Usually always accompanied with pain meds

Question 22

What modification is made for COPD/ abnormal lungs?

Answer 22

Huff Cough/ Forced Expiratory Technique (FET)

COPD patients get fatigued and dyspneic with cough

COPD patients have trouble w high pleural pressures and bronchial collapse during a forced cough

Question 23

Types of modified coughing techniques

Answer 23

1. Forced expiratory technique (FET) or Huff Cough
2. Active cycle of breathing (ACB)
3. Autogenic breathing
4. Manually assisted cough

Question 24

How to Forced expiratory technique (FET) or Huff cough?

What stays opens with this technique?

Answer 24

Sitting position, leaned forward take 2-4 pursed lip breaths.

On mid inspiration, exhale bursts of air in a “huff” or “who” w moderate force.

Making the noise KEEPS THE GLOTTIS OPEN.

Helps prevent alveolar collapse

Question 25

Active cycle of breathing

Answer 25

Consists of repeated cycles of:
Diaphragmatic breathing
Thoracic Expansion
Forced Expiratory Technique (FET)

Question 26

Autogenic drainage

Answer 26

Associate this with cystic fibrosis

Difficult to learn

Children need to be 12 before trying to master

Diaphragmatic breathing to mobilize secretions by varying lung volumes and expiratory airflow in 3 distinct phases