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Semester 5 PMCP Exam 4 > Interventions for patients wth pulmonary dysfunction > Flashcards

Interventions for patients wth pulmonary dysfunction Flashcards

1
Q

Analysis of chest

A

Symmetry
Mobility
Chest deformities
Posture

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2
Q

Indications for airway clearance

A 
Cystic fibrosis
Bronchiectasis
Atelectasis
Resp mm weakness
Mechanical ventilation
Neonatal resp distres syndrome
Asthma
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3
Q

Tracheal bronchial tree divides at what level

A

6th thoracic vertebra

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4
Q

Tracheal bronchial tree - right mainstem bronchus divides into

A

upper, middle, lower lobes

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5
Q

Tracheal bronchial tree - left mainstem bronchus divides into

A

upper and lower lobes

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6
Q

Tracheal bronchial tree - each lobe of the lung has a specific number of segments

A

R lung has 10 segments

L lung has 8 segments

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7
Q

Tracheal bronchial tree - In order to ensure max benefits of gravity with postural drainage the patient has to be

A

placed so that the bronchus of the segment to be drained is oriented in a vertical position

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8
Q

Postural Drainage indications - formal postural drainage positions are indicated for

A

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

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9
Q

Postural drainage - precautions and/or contraindications

A

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

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10
Q

Postural drainage - modified position

A

Less drastic positions used to mobilize secretions

Pt should be repositioned routinely

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11
Q

Percussion - mechanics

A

Brief reflexed flexion and extension of the wrists with hands in cupped position
Motion from wrist and elbow
Rhythmical motion

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12
Q

Percussion - performed when

A

throughout the breathing pattern

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13
Q

Percussion is applied over the

A

posterior and lateral parts of the lungs but only in areas protected by the rib cage

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14
Q

What structures should you not perform percussion over?

A 
Stomach
Neck
Fx rib
Breast tissue
Tumor
PE
Incision
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15
Q

Contraindications to percussion

A 
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
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16
Q

Vibration - mechanics

A

Hands held firmly on either side of chest wall, parallel to ribs to give up and down, shaking motions

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17
Q

Vibration - done when

A

only during expiratory phase of respiration

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18
Q

VIbration - done in what direction

A

A progressively downward direction

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19
Q

Humidification

A

further assists the mobility of secretions

Secretions have to be moisturized to be mobilized

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20
Q

Cough techniques - the patient should be asked to cough in what position

A

in an upright position if possible, after each of the lungs has been treated

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21
Q

Tracheal stimulation - cough

A

Breathe in, hold 3 sec

Push down and in at trachea as exhale and will produce a cough

22
Q

HUFF - cough

A

Deep Ha ha ha

23
Q

Active cycle of breathing consists of

A

a series of maneuvers performed by the patient to emphasize independence in secretion clearance and thoracic expansion

24
Q

Active cycle of breathing - forced expiratory maneuver -

A

the patient performs 1 to 2 HUFFs at mid to low lung volume

Pt to concentrate on abdominal contraction to help force air out

25
Q

Active cycle of beathing - what is the series

A 
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
26
Q

Endotracheal suctioning - used only when

A

the above airway clearance techniques fail to adequately remove secretions

27
Q

Complications associated with endotracheal suctioning

A

Hypoexima, bradycardia or taachy, hypotension, inc intracranial pressure, atelectasis, tracheal damage, infections

28
Q

Thoracic mobility exercises - breathing exercises

A

Diaphragmatic breathing

Segmental breathing

29
Q

Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - indications?

A

More typically restrictive pulm disease to help with inspiration
Can be done with obstructive too though to focus on prolonged exhale

30
Q

Thoracic mobility exercises - breathing exercises - Diaphragmatic breathing - instructions

A

Breathe with your belly
Breathe into my hand
Your belly should come up as you breathe in

31
Q

Thoracic mobility exercises - breathing exercises - Segmental breathing - indications

A

Works well for those that have had atelectasis or surgery if they are not airating certain areas very well

32
Q

Thoracic mobility exercises - breathing exercises - segmental breathing - contraindications

A

low oxygen saturation
rib fractures
new incision
chest tube

33
Q

Respiratory muscle training - Sustained maximal inspiration is used to

A

increase inhaled volume, sustain or improve alveolar inflation, maintan or restore functional residual capacity

34
Q

Respiratory muscle training - Sustained maximal inspiration - used when

A

in acute situations for patients with post trauma pain, posperative pain, or acute lobar collapse

35
Q

Inhalation - what type of contraction

A

always concentric contraction

36
Q

Exhalation - what type of contraction

A

can be many types

37
Q

Endurance training for breathing

A

Paced breathing

Pursed lip breathing

38
Q

Education

A

energy conservation
establish a routine
avoid strenuous activities

39
Q

Pulmonary rehab - ____ approach

A

multidisciplinary

40
Q

Goals of pulmonary rehab

A 
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
41
Q

Patient selection criteria for pulmonary rehab

A

anyone with a stable symptomatic lung disease

42
Q

Referral and eval - Mild, moderate, severe lung disease based on GXT

A

Mild: FEV 70-85%
Moderate: FEV 55-70%
Severe: FEV less than 55%

43
Q

Pulmonary rehab program duration - inpatient =

A

length of stay or 2 weeks

44
Q

Pulmonary rehab program - duration - outpatient

A

6-16 weeks depending on needs of patient and insurance coverage

45
Q

Pulmonary rehab intervention - inpatient exercise start with

A

ambulation and 6 min walk test to develop baseline
education
breathing techniques

46
Q

Pulmonary rehab intervention - inpatient exercise - work up to

A

30-45 min, 5-7 days/wk

47
Q

Pulmonary rehab intervention - outpatient duration and frequency
RPE

A

45 min to 1 hour 3x wek

REP 13-14

48
Q

Pulmonary rehab intervention - target what first

A

endurance first and then go for intensity

49
Q

Pulmonary rehba intervention - intensity is based on

A

initial GXT eval - start at 50% and work up to 85%

50
Q

Pulmonary rehab intervention - education

A 
breathing retraining with pursed lip
Inspiratory mm trainer
Nutrition
Lung disease and death
Meds
Time and energy
HEP
Support group
51
Q

Benefits of pulm rehab

A 
Reduction in s/s
Inc ex tolerance
Improved QOL
Reduction in hospitilizations and health care costs
Prolonged life for some
52
Q

Absolute contraindications to exercise

A 
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

Semester 5 PMCP Exam 4 (6 decks)

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