clinical positioning for optimizing dyspnea, ventilation, perfusion Flashcards
clinical indications for changing position
reduce dyspnea
decrease work/stress of breathing
optimize lung volume
aid ventilation / perfusion (gas exchange)
clinical factors to consider in changing position
MD parameters pain lines precautions / conttras intubated
positions to reduce dyspnea general guidelines
lean forward
supine, upright
fixate arms / legs
pillows
positions
sitting sitting w pillow lean against wall lean over counter lying (head lifted) side lying (pillow legs)
Why lean forward in COPD
diaphragm curvature increases
diaphragm generates more pressure
mm stabilized to help w ventilation (reverse origin insertion)
what causes diaphragm increase in curvature
increase in intra abdominal pressure
how to increase ventilation capacity
diaphragm curvature increases
diaphragm generates more pressure
mm stabilized to help w ventilation (reverse origin insertion)
causes of impaired oxygenation
decrease in inspiration
ventilation / perfusion mismatch
ventilation
air in and out of lungs
perfusion (Q)
blood to pulmonary caps
diffusion
substance high to low concentration
lung compliance
ability for lungs to stretch
how is negative pressure in lung established
- natural tendency for lungs to recoil
- surface tennis of alveolar fluid
- elasticity of chest wall
where is regional ventilation greater
dependent or independent part of lung
dependent
in standing supine and side lying
where is greatest regional ventilation
standing: inferior diaphragm
supine: posterior areas
side lying: the lung down
why greatest ventilation in these potions
gradient of pleural pressure
gravity
dependent lung
lung in lowest gravitational field
non-dependent lung
lung in highest gravitational field
at the apex, intrapleural pressure it at its ____ leading to ___
most negative
decreases compliance
at the base intrapleural pressure it at its ____ leading to ___
least negative
increased compliance
restrictive disease
compliance reduced
decreased lung volume
increase WOB
whats WOB
work of breathing
whats abnormal ventilation
non dependent lung is better ventilated
standing supine and side lying whats abnormal ventilation
standing: apices
supine: anterior areas
side lying: lung up
treatment principles ventilation
sitting upright or
bad lung up
the higher the area away from the heart the ___ blood pressure
less
in the apex capillaries collapse because
super inflated alveoli
treatment principles perfusion
edematous limbs elevated
bed exercises
compression stockin
mobilize
breathing exercises with exercises
