Interventions Flashcards
Aerobic Exercise: S&Sx for stopping
contraindications: unstable angina or MI in last month, SBP>200, DBP>110
S&SX for stopping exercise:
dyspnea
angina
marked fatigue
ataxic gait
drop in O2 >3-5%
rise in BP >20
abnormal ECG
Aerobic Exercise supine, seated, walking, standing
check all vitals before exercise
neck circles
shoulder shrugs
bent elbows
raise arms
arm abduction
bend ankles
ankle pump/circles
leg abd
reassess vitals
walking - 3x/day at home for tolerated time
increase 1-2 minutes by end of week
RPE of 11-13
lightheaded, dizzy, chest pain, SOB stop
Accessory Muscle Breathing: Facilitate and Inhibit
Facilitate - when diaphragm alone is inadequate
- supine
- put pt hand on chest and focus on it rising and falling while breathing
- place hands vertical (scalenes) then in a V (pecs)
Inhibit - to encourage diaphragmatic breathing
- supine
- place forearm over upper chest with pressure place other hand on diaphragm to rise
Active Cycle Breathing
to improve breathing control and secretion removal
- seated
- normal breathing 5-10 seconds
- deep inspiration and relaxed expiration 3-4 times
- continue cycle
- instruct pt to turn their head and hugg on exhale
Breathing Control Positioning
- regain control of breathing when SOB
- seated
- ask pt to place hands on table in front and lean forward
Chest wall expansion…deep breathing with UE movement in supine, sitting, butterfly, spirometer
to encourage lung and chest wall expansion through UE movement with deep breathing
sitting - breathe in both arms go up and look up, bring down with exhale
butterfly - both hands behind head, elbows open on in and head up, exhale bring down
spirometer - to increase lung capacity and volume, supine
- slowly take a full breath in through mouthpiece while keeping ball b/w markers
- rest for a few seconds
- repeat 10x every hour
Cough Assisted… butterfly, forced exhale, lateral costal
to improve secretion removal from lungs
- butterfly 3x then on forth one forcefully cough on exhale
- forced expiratory during butterfly: instruct to huff on exhale
- (neurologic dysfunction) lateral costal: supine, place hands on lateral rib cage, instruct to take a few slow deep breaths, on 4th breath cough on exhale and apply pressure
Splinted Cough
squeeze a pillow against your chest while coughing to make it stronger and less painful
Huff
a forced exhale breath to help clear secretions
Deep Breathing…
butterfly - hands behind head
UE mvmt sitting or standing- arms up and down during breathing
Diaphragmatic Breathing: Facilitate
for poor diaphragm breathing or increased accessory muscles
- place hand on stomach
- breath in and rise and fall as exhale
- sniff to show where diaphragm is
Paced Breathing
to regain control when SOB
- breathe in through nose, exhale longer
- try for 1:2 ratio
Pursed Lip Breathing
to regain control when SOB
- breathe in through nose, exhale through pursed lips
- perform as long as needed
Postural Drainage…
to faciliate secretion removal
percussion - 5 mins cup hands over lobe , breathing comfortably
vibration - after 5 min, deep breathing vibrate on exhale 3 times then huss on exhale
chest wall expansion - lateral costal stretch with facilitation
- to faciliate unilateral chest wall expansion
- supine
- use one hand to block lateral surface of chest wall closet to you
- place other hand under pts opposite scapula
- side bend pt towards you
- instruct deep breathings while in this position
- maintain for 5 minutes or as long as tolerated
chest wall expansion - trunk rotation stretch
- to increase unilateral expansion
- supine
- ask pt to cross arms, while blocking one side of chest wall
- rotate pt toward you, asking them to take a deep breath in
- return to starting position as they exhale
chest wall expansion - towel roll vertical and horizontal
to increase chest mobility/expansion
vertical
- supine
- place a towel roll vertically down pts spine starting at base of their neck
- sustain this position for several mins or as tolerated
- incorporate UE exercises to further increase breath in bring arms up, exhale down
horizontal
- supine
- place a towel horizontally at apex of pts thoracic spine
- encourage pt to stretch over the towel
- sustain as tolerate
- incorporate UE exercise
cough assisted - long sit with trunk control
reach arms up on inhale, down on exhale
4th time cough on out
cough assisted - long sit without trunk control
supported with their arms
stabilize back
take 3 breaths in looking up on inhale, down on exhale
4th cough
cough assisted - unilateral with trunk stabilization
hook left arm behind wheelchair
reach right arm up on inhale and down on exhale
cough on 4th exhale
postural drainage - anterior upper segment upper lobe
position 45 dg reclines
location - clavicle, upper ribs
postural drainage - posterior apical
position - forward leaning 30 dg
location - upper back, traps
postural drainage - anterior segment upper lobe
position - supine, flat HOB, pillow under knees
location - upper ribs to nipple line
postural drainage - right posterior segment upper
position - prone, 1/4 turn toward right, scapula protracted
location - medial border of scap to midline
postural drainage - left posterior upper lobe
position - prone 1/4 turn to left, HOB 45 dg by head
location - medial border of scap to midline
postural drainage - right middle lobe
position - supine, 1/4 turn to left, HOB 15 dg by feet or 12 inches
location - nipple line to bottom of ribs (in armpit area)
postural drainage - left lingular
position - supine 1/4 turn to right, HOB raised 15 dg by feet or 12 in
location - nipple line to bottom of ribs
postural drainage - anterior segment lower lobe
position - supine, Trendelenburg 18 in or 30dg by feet, pillow under knees
location - lower ribs
postural drainage - right lateral segment lower
position - left sidelying, trendelenburg 18 in or 30dg
location - lower ribs
postural drainage - left lateral segment lower lobe
position - right sidelying, trendelenburg 18 in or 30dg
location - lower ribs
postural drainage - posterior inferior lower lobe
position - prone, pillow under abdomen, trendelenburg 18 in or 30 dg by feet
location - lower ribs, 1 hand up from posterior bottom of ribs
postural drainage - superior segment of lower lobe
position - prone, pillow under abdomen
location - one + hand width superior to lower ribs
