Cardioresp Treatment

Question 1

When would you prescribe a cough vs. a huff?

Answer 1

Use huffing if cough is too painful, pt lacks expiratory muscles or post op.

Question 2

What is the FITT for prescribing coughing or huffing?

Answer 2

2-3x/hour or after each secretion clearance technique

Question 3

What is important to do after teaching coughing/huffing?

Answer 3

2-3 deep breaths

Question 4

What are the 8 options for secretion clearance techniques?

Answer 4

Coughing
Huffing
Percussions
Vibrations
Postural drainage
PEP device
Active cycle of breathing
Autogenic drainage

Question 5

What baseline should you get prior to treatment? What else should you assess?

Answer 5

SOB, auscultate, RPE

Assess cough and deep breathing

Question 6

What is the FITT for percussions and vibrations?

Answer 6

2-3x/day, mod frequency, 3-5min per segment

Question 7

What is the rationale for vibrations?

Answer 7

Mobilizes secretions due to changes in mucus viscosity
Improves intrapulmonary gas exchange
Improves cilia function
Stimulates chest wall

Question 8

What is the difference in the actions of coarse and fine vibrations?

Answer 8

Coarse = loosens secretions off of airway walls
Fine = helps facilitate cilia sweeping secretions more centrally

Question 9

What is the function of a PEP device? (5)

Answer 9

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

Question 10

What is the FITT for PEP device?

Answer 10

10x followed by huff/cough with 2-3 deep breaths. Perform cycles 15-20min

Question 11

How does active cycle of breathing work?

Answer 11

Thoracic Expansion Exercise (TEE) - 2-3 diaphragmatic breaths
Breathing Control (BC) - normal tidal volume breathing
Huff/Cough
In upright or PD position

Question 12

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?

Answer 12

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

Question 13

What is the FITT for active cycle of breathing?

Answer 13

3-4 reps of TEE -> BC -> 2 huffs/cough per session. 1-3x/day

Question 14

What is the function of pursed lip breathing?

Answer 14

Reduces resp rate, reduces hyperinflation, creates positive end expiratory pressure splinting airways for improved gas exchange, facilitates mucus mobilization towards proximal airways

Question 15

What is the FITT for PLB?

Answer 15

3-5 reps, 3-5 sets

Question 16

What is the function of inspiratory muscle training?

Answer 16

Decreases SOB, increases strength/endurance of respiratory muscles, improves QOL, improves functional capacity

Question 17

How is maximal inspiration pressure/max expiration pressure tested?

Answer 17

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

Question 18

What is the FITT for inspiratory muscle training for strength vs. endurance?

Answer 18

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)

Question 19

What are positions to reduce SOB?

Answer 19

• 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

Question 20

What is the function of summed breathing? What is the FITT?

Answer 20

Improve inspiration if patient has weak diaphragm

10 reps x1 set every hour

Question 21

What is the function of incentive spirometry? What is the FITT

Answer 21

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)

Question 22

What are strategies to alleviate SOB? (5 Ps)

Answer 22

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

Question 23

What is the FITT for assisted cough with breath stacking?

Answer 23

5 reps, 4x/day, every day