CVR - COPD Flashcards
What are the key problems for pts with stable COPD
Dyspnoea
Retained secretions
Reduced exercise capacity
What physio management treatments are available for dyspnoea
- positioning
- breathing control
- pursed-lip breathing
- energy conservation and pacing
- fan therapy
What physio management treatments are available for airway clearance?
- active cycle of breathing technique (ACBT)
- positive expiratory pressure (PEP) devices
- postural drainage
- manual techniques
What physio management treatments are available for reduced exercise capacity?
- inspiratory muscle training
- tai chi
- pelvic floor muscle training
- pulmonary rehab
What are the aims of physio in the management of dyspnoea in patients with COPD?
- reduce work of breathing (WOB)
- improve the quality of life
How does positioning benefit patients with dyspnoea?
- encourages relaxation of upper chest and shoulders
- allows movement of lower chest and abdomen
- optimises length-tension relationship of the diaphragm
- overall reduces the work of breathing (WOB)
How would you perform positioning for COPD patients with dyspnoea?
Lean forwards position
Abdominal contents raise the anterior part of the diaphragm
Facilitates its contraction during inspiration
‘Loading the diaphragm’
How can pursed-lip breathing help pts with dyspnoea?
Aims to prevent airway closure on expiration and increase expiratory time
Generates a small positive pressure during expiration
May lead to decreased RR, increased TV and improved gaseous exchange
Describe the ‘blow-as-you-go’ technique and why it is used
Breathe in before the effort and breath out during the effort
- as you lift a heavy object
Helps make tasks easier and can be combined with pursed-lip breathing
Briefly describe paced breathing and how it is beneficial in day to day life
Pt paces steps with breathing
- inhalation on one step, exhalation on the next step
Useful during activities such as walking or climbing the stairs
How can fan therapy benefit those with dyspnoea?
A cool draft of air may reduce sensation of dyspnoea
Can be combined with positioning and breathing techniques
Hold fan approx 15cm away from the face
Aim draft at the center of the face
Describe the technique of pursed-lip breathing
- pt should be in a comfortable, well-supported position
- pt encouraged to relax upper chest, shoulders and arms
- inspire to normal tidal volume through the nose for approx 2 seconds
- during expiration, purse the lips and though blowing through a straw, and exhale for 4 seconds
What is tai-chi and how is it beneficial to those with dyspnoea?
Combination of exercise and meditation and consists of slow movements and deep breathing
Low-intensity exercise with benefits of lung function and exercise capacity
Beneficial in improving balance and reducing falls
Estimated to work at 50-74% max HR
Describe the active cycle of breathing technique
Comprises a cycle of:
- breathing control
- thoracic expansion exercises (deep breathing)
- forced expiration technique (one or 2 huffs combined with breathing control)
What are the aims of thoracic expansion exercises?
AKA deep breathing exercises
- get air behind retained secretions in order to aid removal using forced expiratory techniques
- re-inflate areas of lung collapse
How do you perform thoracic expansion exercises?
Pt encouraged to take 3-4 deep breaths
3-second hold after inspiration and before expiration
Facilitated by therapists hands on the lateral aspect of the chest to promote proprioceptive input
What are the aims of forced expiratory technique and what are the two types of huffs that can be performed?
Aims to mobilise retained secretions from the peripheral airways to the central airways to enable them to be expectorated
- low lung volume huffs - will move the peripherally situated secretions (exhale actively with a sigh)
- high lung volume huffs - when secretions have moved to larger, more proximal upper airways, a huff or cough from a high lung volume can be used to clear them (exhale forcefully, as though trying to steam up a mirror)
Describe how the use of an equal pressure point can help mobilise secretions
During forced expiration, the pressure outside the airway remains relatively constant, whilst the pressure inside the airway decreases from the peripheral airways to the mouth, resulting in airway compression.
With a forced expiration, a wave of EPP’s move peripherally into smaller airways as the lung volume decreases and the pressure within the airway falls. This, together with the turbulent airflow created, facilitates the movement of secretions downstream towards the mouth.
Give some examples of manual techniques and the aim of them
- percussion
- vibs and shakes
Aim to loosen secretion from the airway walls
Briefly describe what percussion is
Consists of rhythmic clapping on the chest, creating an energy wave that is transmitted to the airways, loosening the secretions
Performed throughout the respiratory cycle
Briefly describe what vibs and shakes are
Vibs are intermittent chest wall compressions consisting of fine oscillations. Performed on exhalation after a deep inhalation
Shakes are coarser movements where the chest wall is rhythmically compressed
What are the 5 signs of respiratory disease?
Cough Dyspnoea - can they speak in full sentences? Sputum Wheeze Chest pain
Briefly describe the MRC dyspnoea scale
1 = not troubled by breathlessness in ADLs 2 = short of breath when hurrying or up slight hills 3 = walks slower than others on level ground 4 = stops for breath after 100m 5 = too breathless to leave the house or when dressing
What is included in a subjective assessment?
HPC
PMH
DH
SH
What does the pitch of a wheeze tell you?
What causes a monophonic wheeze?
Pitch of the wheeze is related to the degree of narrowing.
HIgh pitch = more narrow
Monophonic (single pitch) wheeze caused by a single airway narrowing
What is included in an objective assessment of a CVR pt?
Airway Breathing Cardiac Disability Exposure
What do you look at for the airway section of a subjective assessment?
Is the patient self-ventilating
Is the airway patent (do they have a normal voice)
Palpation of the trachea
- central = normal
- deviated to one side = indicated an underlying mediastinal shift
What do you look for in the breathing section of a subjective assessment?
Look, Listen, Feel
Look:
- observation of patient and chest
- breathing pattern
- breathing rate (check their “pulse”)
- observation of bucket and pump handle motion
- cough assessment (peak flow meter, aim=270l/min)
Listen:
- breath sounds and added sounds
- percussion note (tap your finger on the lungs)
- vocal resonance (repeat “ninety-nine, normal= indistinct and unintelligible)
Feel:
- Thoracic expansion (3-5cm is normal displacement)
- Vocal fremitus (palpate over lungs and repeat “ninety-nine”)
What do you look at for the cardiac section of a subjective assessment?
- Heart rate = 60-100bpm
- Blood pressure = 95/60 to 140/90mmHg
- Temperature (ear) = 35.7-38.0 degrees
- Fluid balance (fluid intake vs output)
What do you look at for the disability section of a subjective assessment?
- Level of consciousness (AVPU scale):
- Alert
- responsive to Voice
- responsive to Pain
- Unresponsive
What do you look at for the exposure section of a subjective assessment?
- Head to toe examination
- BMI
- Any MSK or neuro problems
- Hands:
- finger clubbing
- tremor
- Ankles:
- swelling (bilateral)
What are some functional tests that could be performed?
Mobility assessment - stairs
6 min walk test
Modified incremental shuttle walk test
