Clinical positioning for optimizing dyspnea, ventilation & perfusion

Question 1

clinical indications

Answer 1

reduce dyspnea
decrease work of breathing and stress on the cardiac and respiratory stress
optimize lung volumes
aid ventilation/perfusion matching

Question 2

factors to consider

Answer 2

MD treatment parameters
pain
lines (associated precautions and contraindications)

Question 3

general guidelines to reduce dyspnea

Answer 3

lean forward positions
in supine/upright position
anterior fixation of the arms/upper extremities
use pillows for orthopnea
teach PLB/diaphragmatic breathing or SOS/SOB

Question 4

what do we need to monitor in patients with dyspnea

Answer 4

RR, SPO2, breathing pattern, accessory muscle use, BORG scale of dyspnea, RPE

Question 5

what are some rest positions for dyspnea

Answer 5

sitting (feet flat, chest slightly forward, elbows on knees, relaxation of neck and shoulder muscles)
sitted with desk, elbows on desk, head on pillow
leaning on wall, chest slightly forward
relax shoulders
laying down with bed elevated
side lying

Question 6

what is the rationale for leaning forward for people with COPD

Answer 6

curvature of the diaphragm increases because of the increase of intra-abdominal pressure
optimizes mechanics
stabilizing the upper extremities allows the accessory muscles to aid in ventilation
** Combo of these= decrease of WOB and increased ventilation capacity

Question 7

how is negative pressure established?

Answer 7

natural tendency of the lungs to recoil
surface tension of the alveolar fluid
elasticity of the chest wall

Question 8

where is regional ventilation greater in?

Answer 8

the dependent part of the lung

Question 9

regional ventilation in a normal population greater in:
standing :
supine:
side lying :

Answer 9

inferior/diaphragmatic areas 
posterior areas (apical and base) 
lung down

Question 10

the dependent lung is usually in:

the non-dependent lung:

Answer 10

the lowest gravitational field

in the highest gravitational field

Question 11

in restrictive diseases how is ventilation affected?

Answer 11

compliance is reduced which leads to decreased lung volumes, RR may increase to compensate

Question 12

in obstructive diseases how is ventilation affected?

Answer 12

increased resistance to airflow, high (very negative) intra pleural pressures are generated to overcome elevated airway resistance due to loss of elastic recoil and alveoli destruction

Question 13

how does ventilation switch in an abnormal pop?
standing:
supine:
side lying :

Answer 13

non dependent zones are better ventilated
apices
anterior areas
lung up

Question 14

treatment principles for ventilation

Answer 14

sitting upright for patients with low bilateral low lung volumes
side lying bad lung up

Question 15

the higher the area away from the heart the….

Answer 15

lesser the BP

Question 16

in the apex what happens to the capillaries in normal perfusion

Answer 16

capillaries collapse because of the super inflated alveoli

Question 17

what can cause alterations to perfusion

Answer 17

CO 
pressure in alveoli 
intra pleural pressure 
blockage 
hypoxia

Question 18

treatment principles for perfusion?

Answer 18

edematous limbs elevated
bed exercises to combat edema
generic compression stockings
com

Question 19

treatment principles for perfusion?

Answer 19

edematous limbs elevated 
bed exercises to combat edema 
generic compression stockings 
combine breathing exercises with exercises that target fluid retention 
mobilization

Question 20

most important thing to remember for ventilation/ perfusion

Answer 20

remember your clinical reasoning skills Meag
patient 
disease 
goals of treatment 
response to treatment 
frequent position changes