Interventions for patients wth pulmonary dysfunction Flashcards
Analysis of chest
Symmetry
Mobility
Chest deformities
Posture
Indications for airway clearance
Cystic fibrosis Bronchiectasis Atelectasis Resp mm weakness Mechanical ventilation Neonatal resp distres syndrome Asthma
Tracheal bronchial tree divides at what level
6th thoracic vertebra
Tracheal bronchial tree - right mainstem bronchus divides into
upper, middle, lower lobes
Tracheal bronchial tree - left mainstem bronchus divides into
upper and lower lobes
Tracheal bronchial tree - each lobe of the lung has a specific number of segments
R lung has 10 segments
L lung has 8 segments
Tracheal bronchial tree - In order to ensure max benefits of gravity with postural drainage the patient has to be
placed so that the bronchus of the segment to be drained is oriented in a vertical position
Postural Drainage indications - formal postural drainage positions are indicated for
1) Patients with localized lung problems (LLL bronchiectasis, RML pneumonia, lung abscess)
2) Pts who cant clear their own secretions
3) Comatose or semi
4) pts on respirators
5) trached pts with copious secretions
Postural drainage - precautions and/or contraindications
1) Those who should not be placed in head down
Head injuries, post neuro surgery, inc intracranial pressure, hx of cardiac conditions
2) Post abdominal surgery
3) SVC syndrome
4) Orthopnea
5) hemodynamically unstable
6) Immed after eating
Postural drainage - modified position
Less drastic positions used to mobilize secretions
Pt should be repositioned routinely
Percussion - mechanics
Brief reflexed flexion and extension of the wrists with hands in cupped position
Motion from wrist and elbow
Rhythmical motion
Percussion - performed when
throughout the breathing pattern
Percussion is applied over the
posterior and lateral parts of the lungs but only in areas protected by the rib cage
What structures should you not perform percussion over?
Stomach Neck Fx rib Breast tissue Tumor PE Incision
Contraindications to percussion
1 Hemorrhage - prone patients (with or wo hemoptysis) 2 Tuberculosis conditions 3 Recent hemorrhage bronchiectasis 4 Lung metastasis 5 Chest wound 6 Acute inflammatory condition 7 Aged or nervous pt 8 Osteoporosis 9 Fx ribs 10 PE 11 sutured bronchial stump 12 if would cause inc in pain
Vibration - mechanics
Hands held firmly on either side of chest wall, parallel to ribs to give up and down, shaking motions
Vibration - done when
only during expiratory phase of respiration
VIbration - done in what direction
A progressively downward direction
Humidification
further assists the mobility of secretions
Secretions have to be moisturized to be mobilized
Cough techniques - the patient should be asked to cough in what position
in an upright position if possible, after each of the lungs has been treated
Tracheal stimulation - cough
Breathe in, hold 3 sec
Push down and in at trachea as exhale and will produce a cough
HUFF - cough
Deep Ha ha ha
Active cycle of breathing consists of
a series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion
Active cycle of breathing - forced expiratory maneuver -
the patient performs 1 to 2 HUFFs at mid to low lung volume
Pt to concentrate on abdominal contraction to help force air out
Active cycle of beathing - what is the series
Controlled diaphragm technique for 5 to 10 sec Thoracic expansion ex Controlled dia breath 5 to 10 sec Thoracic exp ex 3 to 4 x Breathing control 5 to 10 sec Fored expiratory maneuver Diaphragmatic breathing 5 to 10 sec
Endotracheal suctioning - used only when
the above airway clearance techniques fail to adequately remove secretions
Complications associated with endotracheal suctioning
Hypoexima, bradycardia or taachy, hypotension, inc intracranial pressure, atelectasis, tracheal damage, infections
Thoracic mobility exercises - breathing exercises
Diaphragmatic breathing
Segmental breathing
Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - indications?
More typically restrictive pulm disease to help with inspiration
Can be done with obstructive too though to focus on prolonged exhale
Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - instructions
Breathe with your belly
Breathe into my hand
Your belly should come up as you breathe in
Thoracic mobility exercises - breathing exercises - Segmental breathing - indications
Works well for those that have had atelectasis or surgery if they are not airating certain areas very well
Thoracic mobility exercises - breathing exercises - segmental breathing - contraindications
low oxygen saturation
rib fractures
new incision
chest tube
Respiratory muscle training - Sustained maximal inspiration is used to
increase inhaled volume, sustain or improve alveolar inflation, maintan or restore functional residual capacity
Respiratory muscle training - Sustained maximal inspiration - used when
in acute situations for patients with post trauma pain, posperative pain, or acute lobar collapse
Inhalation - what type of contraction
always concentric contraction
Exhalation - what type of contraction
can be many types
Endurance training for breathing
Paced breathing
Pursed lip breathing
Education
energy conservation
establish a routine
avoid strenuous activities
Pulmonary rehab - ____ approach
multidisciplinary
Goals of pulmonary rehab
1 inc exercise tolerance with compliance of HEP 2 Proper breathing techniques 3 inc inspiratory mm strength and coord 4 inc compliance with meds 5 weight management 6 energy saving techniques 7 self management
Patient selection criteria for pulmonary rehab
anyone with a stable symptomatic lung disease
Referral and eval - Mild, moderate, severe lung disease based on GXT
Mild: FEV 70-85%
Moderate: FEV 55-70%
Severe: FEV less than 55%
Pulmonary rehab program duration - inpatient =
length of stay or 2 weeks
Pulmonary rehab program - duration - outpatient
6-16 weeks depending on needs of patient and insurance coverage
Pulmonary rehab intervention - inpatient exercise start with
ambulation and 6 min walk test to develop baseline
education
breathing techniques
Pulmonary rehab intervention - inpatient exercise - work up to
30-45 min, 5-7 days/wk
Pulmonary rehab intervention - outpatient duration and frequency
RPE
45 min to 1 hour 3x wek
REP 13-14
Pulmonary rehab intervention - target what first
endurance first and then go for intensity
Pulmonary rehba intervention - intensity is based on
initial GXT eval - start at 50% and work up to 85%
Pulmonary rehab intervention - education
breathing retraining with pursed lip Inspiratory mm trainer Nutrition Lung disease and death Meds Time and energy HEP Support group
Benefits of pulm rehab
Reduction in s/s Inc ex tolerance Improved QOL Reduction in hospitilizations and health care costs Prolonged life for some
Absolute contraindications to exercise
Change in ECG Unstable angina Acute CHF Acute infection Active myocarditis or pericarditis PE 3rd AV block Recent MI Uncontrolled DM Advanced or complicated pregnancy
