CR Tx Flashcards
What is the purpose of incentive spirometry? How often should a patient be using it?
Inspiratory muscles training and regular deep breathing (especially good for atelectasis and post-surgical prophylaxis) with visual goal/input. Measures inspiratory effort.
Common parameters: 10X/hr. Adjust based on patient needs.
What are the two types of incentive spirometers?
volume (more accurate but also more expensive and less common) and flow (most common).
What are the requirements for incentive spirometry to be safe?
i) RR < 25 bpm
ii) FVC > 15ml/kg
OR
IC >12ml/kg
Pt cannot have asthma/COPD.
What are some adverse effects that can arise from incentive spirometry?
i) apical breathing pattern
ii) bronchospasm (not for asthma?COPD patients)
iii) hyperventilation
Describe the difference between deadspace, shunt and silent units.
i) deadspace: normal ventilation, no perfusion
ii) shunt: no ventilation, normal perfusion
iii) silent unit: no ventilation, no perfusion (can result from shunt secondary to hypoxic pulmonary vasoconstriction).
What positioning is best for a patient with i) bilateral lung disease ii) no lung disease iv) in respiratory distress?
i) bilateral - prone
ii) unilateral - sidelying, affected side up
iii) normal - sitting upright
iv) head up, leaning forward.
When should a patient breathe with their nose or mouth when performing deep breathing exercises?
IN through the nose, OUT through the mouth.
List some of the benefits of diaphragmatic breathing.
i) increased ventilation
ii) reduced work of breathing
iii) mobilize secretions
iv) restore/prevent alveolar collapse
v) improve chest wall mobility
Explain the process of diaphragmatic breathing including normal parameters.
Place hand over patients diaphragm for tactile cuing. Instruct patient to push hand out to breathe in deeply to the lower lung. Then have them try with their own hand. Rx: X10 breathe per hour.
Can do sustained maximal inspiration at end 3-5s.
Explain the process of lateral costal breathing.
Pt sidelying - guide rob movement lateral to improve thoracic mobility and breathing to the lateral segments off the lower lobes.
Explain the process of pursed lip breathing. Include it’s indication.
Instruct pt to purse lips (“as if blowing out a birthday cake”). Breathing out slowly. This will increase pressure at the upper airway thereby reducing closing volume and hyperinflation. It also keeps the small airways open for longer. This is indicated for COPD or any other obstructive lung disease. Often combined with other exercises.
Describe the process of segmental breathing.
Deep breathing using tactile cues to improve ventilation to a specific lung segment (research does not support this!).
Describe breath stacking as a treatment technique as well as the indication. Name a contraindication.
Useful when breathing is painful. Pt take repeated inhalations to “stack” breaths to reach capacity.
Contraindication: COPD.
List the SOS for SOB.
i) stop and rest in comfortable position
ii) get head and shoulders down
iii) breath in AND out through mouth
iv) breath in and out as fast as you can
v) Blow OUT longer, use PLB if it helps
vi) Begin to slow breathing
vii) Begin to use nose
viii) use diaphragmatic breathing
ix) Wait 10min.
List six ways to assist with coughing.
i) position in sitting
ii) vibrations on expiration
iii) tracheal tickle above sternal notch(noxious stim for cough)
iv) summed breathing (stacking then a large cough/huff)
v) Huffing (repeated expiration, may use tissue for visual).
NOTE: double-barreled cough is best! May splint with a pillow if painful.
Describe the process of a manual cough assist.
One forearm on chest and other on abdomen below xiphoid. Apply pressure and vibration at the end of the cough. Tell pt three big inspirations and on the fourth, you will cough.
