Clinical positioning for optimizing dyspnea, ventilation & perfusion Flashcards
clinical indications
reduce dyspnea
decrease work of breathing and stress on the cardiac and respiratory stress
optimize lung volumes
aid ventilation/perfusion matching
factors to consider
MD treatment parameters
pain
lines (associated precautions and contraindications)
general guidelines to reduce dyspnea
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
what do we need to monitor in patients with dyspnea
RR, SPO2, breathing pattern, accessory muscle use, BORG scale of dyspnea, RPE
what are some rest positions for dyspnea
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
what is the rationale for leaning forward for people with COPD
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
how is negative pressure established?
natural tendency of the lungs to recoil
surface tension of the alveolar fluid
elasticity of the chest wall
where is regional ventilation greater in?
the dependent part of the lung
regional ventilation in a normal population greater in:
standing :
supine:
side lying :
inferior/diaphragmatic areas posterior areas (apical and base) lung down
the dependent lung is usually in:
the non-dependent lung:
the lowest gravitational field
in the highest gravitational field
in restrictive diseases how is ventilation affected?
compliance is reduced which leads to decreased lung volumes, RR may increase to compensate
in obstructive diseases how is ventilation affected?
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
how does ventilation switch in an abnormal pop?
standing:
supine:
side lying :
non dependent zones are better ventilated
apices
anterior areas
lung up
treatment principles for ventilation
sitting upright for patients with low bilateral low lung volumes
side lying bad lung up
the higher the area away from the heart the….
lesser the BP
in the apex what happens to the capillaries in normal perfusion
capillaries collapse because of the super inflated alveoli
what can cause alterations to perfusion
CO pressure in alveoli intra pleural pressure blockage hypoxia
treatment principles for perfusion?
edematous limbs elevated
bed exercises to combat edema
generic compression stockings
com
treatment principles for perfusion?
edematous limbs elevated bed exercises to combat edema generic compression stockings combine breathing exercises with exercises that target fluid retention mobilization
most important thing to remember for ventilation/ perfusion
remember your clinical reasoning skills Meag patient disease goals of treatment response to treatment frequent position changes
