HESI Remediation Flashcards
Types of Breathing Exercises?
- Deep breathing and Coughing
- Pursed Lip Breathing
- Sustained maximal Inspiration
+Breathing Exercises
Deep breathing and coughing exercises
AID in lung expansion and expectoration of respiratory secretions.
#TX: when pt. are immobilized or after general anesthesia. Instructions to the patient include the following:
- Sit in a semi-Fowler for max. lung expansion.
- Place one hand on the abd to feel it rise and fall with breathing.
- Inhale deeply through the nose, pause 1 to 3 seconds, and exhale slowly through the mouth.
- After 4 to 6 deep breaths, cough deeply from the lungs to aid in the expectoration of sputum.
- After thoracic or abd surg., splint the incision with a pillow to min. discomfort and support the incision.
+Breathing Exercise
Pursed Lip Breathing
TX: inhibit airway collapse and dec. dyspnea in pt. with chronic lung dz.
#What are the steps?
- Instruct pt. pucker the lips as if to whistle
- Then inhale through the nose and slowly exhale through pursed lips. (Exhalation lasts 2X as long as inhalation.)
+Breathing Exercise
Sustained maximal inspiration
TX: to ensure deep inspiration for maximal expansion and aeration of the lungs
#What instrument is used?
An incentive Spirometer is commonly used to ensure maximum inspiration.
Cholelithiasis
Incisional CholecystectomyAssessment
1. Vitals until stable.
2. Observe chest expansion and auscultate breath sounds.
3. Inspect dressing for bleeding.
#What to Assess is T-tube of NG tube present?
Incisional Cholecystectomy
POST-OP ASSESSMENT
If a T-tube or NG Tube is present
–NOTE color/ amount of drainage.
–EXAMINE passive drains to ensure that they are fxning (T-tube); Suction for NG tube
–INSPECT the skin around the incision or the drain/Nares for redness or breakdown.
?Teach for What Post Op Surg?
1. AVOID fatty foods for several weeks./ Low Fat diet for 4-6 wks
2. Remove the dressings & bathe normally next day.
3. NOTIFY the HCP if redness, drainage, or pus from the incision occurs
4. REPORT SX of peritonitis: severe abd pain, chills, fever, and vomiting.
5. AVOID heavy lifting for 4 to 6 wks. Sexual activity can be resumed when you feel well enough.
Laparoscopy Cholecystectomy
Pt. Teaching @ Discharge
-low fat diet
-bathe next day w/out dressing
-notify doc of drainage, redness, pus, or peritonitis sx occur
-avoid heavy lifting for acouple wks, sex can resume
What are the EXPECTED OUTCOMES/ PT. GOALS for a Pre-operative Respiratory Pt.?
–Pt. is prepared for surgery physically and emotionally
–Pt. can demo deep breathing, coughing, and leg exercises
–pt. teach/back understanding of procedure and expectations the post-op period
–Maintain fluid and electrolyte balance throughout the perioperative period
What is included in Pre-OP Teaching?
Info about post-op…
bandages,
tubes & drains
Medications/ Pain Control
exercises
turning/ antiembolism measures assistive devices
dietary guidelines
What breathing techniques are used by post-op patients to maintain lung expansion and prevent atelectasis and pneumonia?
–Controlled cough
–Deep breaths in through the nose and exhaled through the mouth
–Diaphragmatic breathing
–Pursed-lip exhalation
Procedural Concerns
How to TEACH a pt. how to deep breath Pre-op?
*Pt. should be in semi-fowlers or fowlers
- Rest palms of hands below the rib cage, w/ the middle fingers touching.
- Take slow, deep breaths:
+Inhale through nose.
+Feel the abd push against the hands.
+Keep chest & shoulders still. - Inhale as deeply as possible.
- Hold breath 3 - 5 sec.
- Exhale slowly through pursed lips tech., and stop exhaling when the middle fingers touch again.
- Perform each inhalation and exhalation 3-5 X before resting.
- Perform all of these steps 10Xqhr
Pre-Op
How to instruct pt. on Controlled Coughing?
- Have the pt. take 2 deep breaths in and out.
- Then inhales as deeply as possible and holds it for 3-5 sec
- Release the breath as a full cough; cough 2/3 X, but do not inhale between coughs
- Perform these steps 2-3Xq2hrs
There is a definitive fall in lung volume postoperatively, and these breathing exercises are as effective as continuous positive airway pressure in increasing lung volume
Respiratory Operative
Evidence-based practice
When and Why is Post-op Splinting Appropriate?
*Splinting= supporting site with a pillow
— to support an incision & promote comfort by decreasing pressure, discomfort, and pain related to an incision.
— used during coughing, deep breathing, or movement that may cause sutures to tear.
— used primarily for incision sites on the abdomen and the thorax.
What Post Op exercises are important to explain and demo?
–>diaphragmatic breathing
=improves lung expansion and oxygen delivery without using excess energy
–>incentive spirometry =prevents atelectasis after surgery
–>controlled coughing=removes retained mucus in the airways
–>turning &leg exercises.
What are the 3 basic Breathing exercises/ techniques to improve ventilation and oxygenation?
- deep-breathing and coughing exercises
- pursed-lip breathing: Prevent alveolar collapse (TX: COPD pt.)
- diaphragmatic breathing: decreasing air trapping and reducing the WOB (TX: pulmonary dz, postop pt, & women in labor to promote relaxation and provide pain control.)
