Cardioresp Treatment Flashcards
When would you prescribe a cough vs. a huff?
Use huffing if cough is too painful, pt lacks expiratory muscles or post op.
What is the FITT for prescribing coughing or huffing?
2-3x/hour or after each secretion clearance technique
What is important to do after teaching coughing/huffing?
2-3 deep breaths
What are the 8 options for secretion clearance techniques?
Coughing Huffing Percussions Vibrations Postural drainage PEP device Active cycle of breathing Autogenic drainage
What baseline should you get prior to treatment? What else should you assess?
SOB, auscultate, RPE
Assess cough and deep breathing
What is the FITT for percussions and vibrations?
2-3x/day, mod frequency, 3-5min per segment
What is the rationale for vibrations?
Mobilizes secretions due to changes in mucus viscosity
Improves intrapulmonary gas exchange
Improves cilia function
Stimulates chest wall
What is the difference in the actions of coarse and fine vibrations?
Coarse = loosens secretions off of airway walls Fine = helps facilitate cilia sweeping secretions more centrally
What is the function of a PEP device? (5)
Creates back pressure to splint open airways when exhaling 10-20 cmH20
Helps with secretion clearance
Performed when pt has weak expiratory muscles to produce cough
Improves FRC
Improves collateral ventilation
What is the FITT for PEP device?
10x followed by huff/cough with 2-3 deep breaths. Perform cycles 15-20min
How does active cycle of breathing work?
Thoracic Expansion Exercise (TEE) - 2-3 diaphragmatic breaths
Breathing Control (BC) - normal tidal volume breathing
Huff/Cough
In upright or PD position
What are the 3 phases of autogenic drainage? How many reps are done in each phase? How long should sessions be and how many times per day?
Unstick - exhaling to low lung volumes to mobilize mucus (ERV) 5-6 reps 3 sec hold
Collect - mucus collects when breathing in mid lung volumes 5-6 reps, 3 sec hold
Evacuate - evacuation of mucus occurs when breathing at larger lung volumes 5-6 reps 3 sec hold
30-45min sessions 1x/day
What is the FITT for active cycle of breathing?
3-4 reps of TEE -> BC -> 2 huffs/cough per session. 1-3x/day
What is the function of pursed lip breathing?
Reduces resp rate, reduces hyperinflation, creates positive end expiratory pressure splinting airways for improved gas exchange, facilitates mucus mobilization towards proximal airways
What is the FITT for PLB?
3-5 reps, 3-5 sets
What is the function of inspiratory muscle training?
Decreases SOB, increases strength/endurance of respiratory muscles, improves QOL, improves functional capacity
How is maximal inspiration pressure/max expiration pressure tested?
With nose clips on
MIP - breathe out as much as possible first then create seal around device and breathe in as much as possible. Best of 3 trials.
MEP - same as MIP but breathing out into device.
Give breaks between trials
What is the FITT for inspiratory muscle training for strength vs. endurance?
Strength: F 2-4x/wk I 60-85% PI max T 8-12 reps 1-2 sets
Endurance: F 4-6x/wk I 40-85% PI max T >15 min (as tolerated)
What are positions to reduce SOB?
- Leaning against wall with hands on thighs to unload thorax
- Leaning forward against a table with arms on table and head resting on arms, feet on floor
- Leaning forward sitting in a chair with elbows on thighs
What is the function of summed breathing? What is the FITT?
Improve inspiration if patient has weak diaphragm
10 reps x1 set every hour
What is the function of incentive spirometry? What is the FITT
Prevent atelectasis and airway closure, comply with breathing exercises, goal setting
3-4 reps 3-5 sets every hour (10x/hour, not in a row)
What are strategies to alleviate SOB? (5 Ps)
Positioning - unload thorax to make breathing efficient
Prioritizing - eliminate unnecessary tasks and look for shortcuts, ask for help
Planning - space out strenuous tasks
Proficiency - use of equipment and performing tasks with least amount of work
Pacing - take breaks, naps before taxing tasks
What is the FITT for assisted cough with breath stacking?
5 reps, 4x/day, every day
