Cardio Treatments

Question 1

ACBT

Answer 1

breathing control rep 4
thoracic expansions rep 4
breathing control rep 4
FET huff 
breathing control rep 4

Question 2

Breathing control

Answer 2

relaxed breathing
one hand on abdomen, shoulder relaxed, arms relaxed, feel tummy move in and out
slow breaths in through nose out through mouth
reduces bronchospasms and airway closure

Question 3

Thoracic expansion exercises

Answer 3

deep breathing
put hands on pt upper thorax
tell them to breathe slowly in through the nose so makes no noise, to max inspiration, encourage more breath in
hold 3 secs slow expiration out nose
rep x 4 = 1 cycle
increases speed of air flow out and driving force of elastic recoil

Question 4

Forced Expiration technique

Answer 4

Huff
slow breath in and hold 3 secs
breath out forcefully like steaming up a mirror, less forceful than a cough
helps move sputum through equal pressure point, airways below this narrow and cause increased airflow speed and secretion movement
prevents closure and compression of airways as with a cough, reduced SOB and fatigue

Question 5

Huff

Answer 5

may take a few cycles to move sputum
can get to do an effective cough if pt can
small - medium lung volumes = peripheral secretions
large volumes = proximal secretions

Question 6

Percussions

Answer 6

use of towel for comfort
rhythmical clapping motion to lung area with a cupped hand to loosen secretions
cupped hand floppy wrists
can be done in sitting, side lying, supine depends on consciousness, function
move hand to cover all areas of the lung
any part of the respiratory cycle, doesn’t disrupt it

Question 7

Vibs/ Shaking

Answer 7

can be done in sitting with hands either side or supine with both hands
rapid vibration with pressure to the chest
done on full expiration
squeezes air out of chest - fatiguing
loosens mucus
shaking = slower deeper vibs

Question 8

Incentive Spirometry (volume orientated)

Answer 8

slow deep inspiration through the device
encourage pt to continue inhaling to max
hold at full inspiration for 2 secs
helps expand the lungs and open collapsed areas
focus on getting as much air as possible - focus on volume first
then work on speed and keeping it in the happy face
normal = 3000 ish
2000 post op = good functional
rep 10-15x every 2 hours

Question 9

Devices for sputum clearance

Answer 9

PEP
flutter
acapella
Mask
OPEP

Question 10

PEP

Answer 10

positive expiratory pressure
hold open airways that want to collapse on expiration
blow through devices creates back pressure in the lung and keeps pressure above 0 so never collapse
opens alveoli
allows increased expiratory flow and secretion movement
creates oscillations to help loosen mucus
helps splint open airways and collateral channels to move secretions upwards

Question 11

Flutter

Answer 11

gravity dependent, must be used in upright position
Slow breath in and firm breath out through device
small white device with ball
cannot adjust resistance
can get lightheaded after 4, use deep breathing in between to prevent dizziness
can be quite hard
have to keep drying the ball or it doesn’t work properly

Question 12

Acapella

Answer 12

long green one
can adjust resistance 1-5
start with middle resistance then adjust upwards
easier to do long expiration
slow breath in then firm breath out through the device
can be used in any position
rep 5-10

Question 13

PEP Mask

Answer 13

used for children
cf pts
one way inspiratory and one way expiratory valves
helps decrease airway collapse
has resister on expiration - hole which can be adjusted size wise to provide different peps and resistances
smaller hole = more pep = more resistance
elbows on a surface, hold mask, lower face into mask and use gravity to create a seal
pushes air through collateral circulation for secretions in tiny airways
followed by huffs and coughs to unclog airways
10 breaths then breathing control / ACBT
wash with soapy water and air dry
can alter viscosity and dislodge secretions

Question 14

Pursed Lip breathing

Answer 14

lips open slightly
count in and out and focus on longer breaths out
slows flow of air, opens distal airways by created PEP
releases trapped air
for sudden breathlessness
can fix arms for added pec movement of rib cage

Question 15

Blow as you go

Answer 15

deep breath in whilst static
Blow out as you move/ do the activity
inspiration is passive so reserves energy to focus on breath in, passive expiration to focus on the task

Question 16

Rectangle breathing

Answer 16

Find a rectangle
breathe in for the short sides
longer breath out on the longer sides
helps pacing of breaths and focus on longer expiration
allows time for obstructive pts to help push trapped air out

Question 17

V/Q matching positioning

Answer 17

patient lying on good side, bad lung up
creates hanging due to gravity which creates expansion of upper lung, opens up collapsed areas, bigger negative pressure and more volume
ventilation happens best in lower most of good lung, perfusion better and better oxygenation
more effective contraction of lower dome of diaphragm
in bilateral disease R lung down, more lobes = more surface area = better perfusion
children = good lung uppermost for unilateral disease, o2 more efficient, ventilation mostly in uppermost areas and perfusion in dependent areas
weight compresses lung = more compliance = stretch for volume. bases better perfused due to gravity and fluid pressure = better oxygenation

Question 18

Positioning for lung volume

Answer 18

Upright, standing, sitting in a chair feet on the ground, side lying (normal lung = t10, upper lung t8 lower t12, average t10)
standing increases FRC increasing expiratory reserve volume
bigger FRC opens alveoli and gets more air into the lungs

Question 19

Positioning for WOB

Answer 19

lean forward to gain control over breathing
improved tension/ length relationship of the diaphragm
optimises contraction flattening of diaphragm
fixing arms = reverses insertion origin of pecs = more chest expansion of rib cage as an accessory muscle
upright positions, leaning forward, leaning backwards, upright side lying, high sitting leaning over pillow, sit on chair or edge
helps generate max inspiratory pressures and best relief of dyspnoea

Question 20

Positioning for postural drainage

Answer 20

modified = no tipping to reduce gastro-oesophageal reflux and micro aspiration
used in combo with manual techniques
improve secretion mobilisation to central airways
drainage of lung segments to be excreted by coughing or FET
positions maintain for several mins up to 15 then change
used with deep breathing/ ACBT
for pts unable to perform independent treatment techniques/ preferred modality

Question 21

Acute Post-op Mobility

Answer 21

from lying to sitting in bed
be aware of lines, monitoring etc
tell the pt what’s going to happen
remove monitoring things that aren’t necessary e.g. blood pressure
lift the head of the bed up to assist pt
get pt to shift legs around to the edge of the bed and get the pt to reach over to the side of the bed to help push up
then count on 3 and help the pt to sit, hand on their side, and help swing legs round
check dizziness/ comfort/ pain etc
make sure pt has shoes to put on to get them to stand
shuffle pt to the edge of the bed with feet flat on the floor - can lower bed to help
come to the side of the pt in a wide side lunge, one hand on their back one hand out ready for them to grab
get pt to push up using hands on the bed

Question 22

Chronic Outpatient Scenario mobility

Answer 22

2 simple exercises
marching in standing using a zimmer frame for support and WOB with the forward lean and accessory muscle fixation. start with 20 seconds on.
body weight squats 6-12 reps 2-4 sets, 3x a week
use bronchodilator prior to exercise to reduce bronchospasms

Question 23

Reasoning for chronic out pt exercises

Answer 23

Marching: increases aerobic exercise capacity, increase time before breathless, reduce dyspnoea
squats: reduce peripheral muscle weakness, co-morbidity contributes to fatigue, break the cycle of deconditioning, functional for stairs
promote activity to prevent deconditioning and excess lactate building up to reduce fatigue and breathlessness
needs to be high intensity to improve oxidative capacity of skeletal muscle to reduce ventilatory work at submaximal work loads

Question 24

Rationale for full slow long inspiration and hold

Answer 24

utilises collateral ventilation, obstructed airways take longer to fill, short breaths only fill open airways
slow gives time for full lung unit to fill
during the hold the areas of better ventilation can help obstructed areas fill due to high transpulmonary pressure at the end of a breath for an inflating pressure on alveoli