Interventions - Cardioresp Flashcards
What are the 5 interventions
- Positioning
- Breathing exercises
- Airway clearence technqiues
4.. Forced Expiratory techniques - Exercise
What is the positioning for V?Q matching
- Unilateral lung disease: Lie on th eunaffected side “good lung down”
- Bilateral: lie prone
- Pneumonectomy: Do not lie with affected side up
- ARDS: Proning
Positions to decrease dyspnea
1)Leaning against a wall hands onto thighs
2) Leaning over a table
3) Sitting, leaning forward with elbows resting on thigs
4) Sitting, leaning forward against a table
Whate are 5 breathing exercises
1) deep Diaphragmatic
2) Pursed Lip breathing
3) Segmental
4) Inspiratory mm training
5) Sustained max inspiration
Why use Deep Diaphragmatic breathing
- decreases the use of accessory mm
- More efficient (less energy costs) than using accessory mm for breathing
- promotes relaxtion
- may use hand son belly to guide diapragmatic breathing or may cue que it by asking patient to take “QUICK SNIFF”
What is Pursed Lip breathing
- breath in through th enose and exhaling through tightly pressed pursed lips “smell the roses, blow the candls”
- Exhalation phase should be 3x long as inspiration (2s in, 6s out) - used for people with hyperinflation “junk air out”
- Creates positive back pressure that splints small airways open longer
- HELPS CONTROL AND REDUCE RR
- more efficient emptying of the lung
- improve gas exchange
- promotes relaxation
What is inspiratory mm training
- Resistive exercise training for mm of respiration - to increase strength or endurance of resp mm
Strength
F:2-4x/week I: 60-85% (manometer), T: 8-12reps 1-2sets
Endurance: F: 4-6x/week, I:40-85%, T>15mins (as tolerated)
What i segmental breathing?
- localized breathing towards a segment of a lung that requires greater expansion or ventilation
- using tactile input
What is Sustained maximal inspiration
- performs maximal inspiration to TLC for 3-5s
- Use incentive spirometer using device to measure flow or volume
- often used post-op to prevent atelectasis or airway closure**
- provides visual feedback and provides incentive/goal for patient which in turn helps with patient compliance
What are the 6 ways to clear the airway
1) Postural drainage
2) Percussion
3) vibrations
4) PEP device
5) Independant breatjing techniques
6) Suctioning
Describe POstural Drainage
- placed in position that allows drainage of secretions from bronchiol airways via gravity
- used in conjuction with vibs and percussions
- pt face and SPO2 should be monitored
- signs of intolerance = SOB, anxiety, nasuea, diziness, hypertension and bronchospasm
Position for anterior upper segment
In tilt reclined position
Position for posteriorr apical drainage
ab crunch position - thorax towards knees
Anterior segment draiange
Supine
Right posterior segment
pillow on right and patient turned 1/4 to the right
Left lungular segement
Quarter turned to left - with trendelenburg (table tilt of 12inches)
Superior segments
Prone
Posterior segments
Prone with table trendelenburg of 18 inches
Left lateral (right lateral = vise versa)
Side lye to left with trendelenburg of 18 inches.
What is percussion
- secretion mobilization technique using rhytmical force - hands in cupped position against thorax of patient
- Aim: dislofge secretions from the airways so they may be expelled through the central airways via coughing or sucitoning
What is Vibrations
- secretion mobilization technique in which vibratory force is applied
- PERFORMED ONLY ON ECHALATION
- proposed vibrations increase mucocilliary transport from periphery to central airways
2 types
- Course (shaking): LArge amplitude, low frequency (2Hz)
2. Fine: low amplitude, high frequency force (12-20Hz)
Better tolerated+decreased risk
What is PEP device
Positive expiratory presure
- hand-held devices
- created back pressure to splint airways while exhaling through the device - Similar to PLB
- can be used with aerolized medication
>15minsx 2-3x per day
What is Low PEP vs High pressure PEP
Low pressure
- 10-20cmH2O
- Provides equal effectiveness as HIGH P, but lower presumed risk of pneumothorax
HIgh P PEP
- 50-120cmH2O
- PEP mask used
- Less commonly used due to risk of pneumothorax
What is Non-oscillating PEP, OScillating and flutter
Non-Oscillating
- smooth flow. Creates back pressure in similar way as PLB (pursed lip breathing))
OScillating (flutter)
- provides accelerated expiratory flow rates and interupts airflow through oscillation of airways which helps loosen secretions and helps move them centrally
