Increased work of breathing

Question 1

list some problems that cardio-respiratory physiotherapists typically address

Answer 1

dyspnoea
chest pain
coughing - inability to clear secretions
weakness of respiratory muscles
reduced cardiac output
cardiovascular and respiratory deconditioning
increased load on respiratory system

Question 2

what are some of the objective signs which indicate increased work of breathing

Answer 2

signs of accessory muscles usage
audible sounds e.g. wheezing, cough

Question 3

what are some subjective signs Pt may be struggling with increased work of breathing

Answer 3

Pt might complain of breathlessness
pt may complain of chest pain
may struggle to do everyday tasks without fatiguing

Question 4

what outcome measures might indicate that a treatment has been successful in reducing work of breathing

Answer 4

retake respiration rate
do they look generally better than before treatment
auscultate again, see if it sounds better
use borg scale of exertion

Question 5

describe the physiological rationale of positions of ease

Answer 5

• positions encourage relaxation of upper chest and shoulders, allowing movement of lower chest and abdomen
• positions encourage respiratory muscles to work optimally
• reduces excess muscle work, reducing demand on the respiratory system
• by leaning forwards, abdominal contents raise anterior part of diaphragm, doming it which will facilitate its contraction during inspiration

Question 6

describe the physiological rationale of breathing control

Answer 6

normal tidal volume using the lower chest with relaxation of upper chest and shoulders
- normalises breathing pattern
- getting patient to use diaphragm more than accessory muscles as diaphragm is strongest
- can reduce the work of breathing, relieve breathlessness, improves ventilation of lung bases increasing gaseous exchange

Question 7

describe the physiological rationale of breathing pattern retraining

Answer 7

• best for patients who have a stable, long term conditions
• aim is to minimise over-breathing and normalise the breathing pattern
  -involves slow, rhythmical breathing timed to an external stimulus

Question 8

describe the physiological rationale of relaxation

Answer 8

• reduces sensation of breathlessness
• reduces heart rate, respiratory rate and blood pressure
• reduces anxiety

Question 9

describe the physiological rationale of pacing

Answer 9

• patient can break up tasks into smaller tasks to allow time for rests to catch their breath

Question 10

describe the physiological rationale of pursed lip breathing

Answer 10

• breathing out through pursed lips creates a small back pressure, which can help to keep the airways