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PHTY3250 > L4-5: Low Lung Volumes, Atelectasis and Ventilation Strategies > Flashcards

L4-5: Low Lung Volumes, Atelectasis and Ventilation Strategies Flashcards

1
Q

Which lung segment is auscultated at the point marked X?

A

Right upper lobe anterior segment (rib 2-4, midclavicular line)

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2
Q

An extrathoracic wheeze characteristically more marked during inspiration. True or False.

A

True

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3
Q

An intrathoracic wheeze characteristically more marked during expiration. True or false.

A

True

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4
Q

An intrathoracic wheeze characteristically more marked during _____ (inspiration/expiration).

A

expiration

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5
Q

An extrathoracic wheeze characteristically more marked during ______ (inspiration/expiration).

A

inspiration

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6
Q

What is type II respiratory failure?

A

Hypoxaemia with hypercapnia

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7
Q

What is the colour of low VS high oxygen concentration?

A
  • Low: Green
  • High: White
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8
Q

Why care about Ventilation? What is the aim?

A
  1. No breath = No life
  2. Ventilation strategies are vital in Physio toolkit
  3. Ax outcome and modify Rx as needed

Aim = Identify ventilation problems / individuals at risk of these problems –> select and implement most appropriate technique/s for individual

  • Treat and identify ventilation problems
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9
Q

What does BIBA stand for?

A

BIBA: Brought in by ambulance

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10
Q

What does ICC stand for?

A

Intercostal catheter

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11
Q

What are 3 pieces of information found in the bed chart?

A
  1. Vital signs
    1. BP
    2. HR
    3. RR
      1. Normal: 12-16 breaths
    4. SpO2
      1. Normal: >96% FiO2
  2. Pain
    1. VAS
  3. Medications
    1. PCA
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12
Q

What are 7 characteristics of the patient interview?

A
  1. Main concern
    • eg. Painful rib fractures; pain-limited cough
  2. Pain
    • eg. Sharp, over injured area
  3. Cough
    • eg. Ineffective due to pain ; avoiding // non-productive
  4. SOB
  5. PMHx - Medical chart info confirmed
  6. Functional ability - Independent, No formal exercise usually performed
  7. Social Hx - Medical chart info confirmed
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13
Q

What are 2 major things to be aware of in the physical examination?

A
  1. Environment / Attachments
    1. Supine, resting in bed
    2. Hudson mask, FiO2 0.35, SpO2 91%
    3. ICC: Swinging, bubbling, draining (Module 2)
    4. PCA: Dorsum L) hand
  2. Patient general state
    1. Alert, cooperative
    2. Grimacing in discomfort
    3. Posture: Guarding R) side
    4. Colour: NAD
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14
Q

What are 4 characteristics of environment/attachments to be aware of in the physical examination?

A
  1. Supine, resting in bed
  2. Hudson mask, FiO2 0.35, SpO2 91%
  3. ICC: Swinging, bubbling, draining (Module 2)
  4. PCA: Dorsum L) hand
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15
Q

What are 4 characteristics of patient general state to be aware of in the physical examination?

A
  1. Alert, cooperative
  2. Grimacing in discomfort
  3. Posture: Guarding R) side
  4. Colour: NAD
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16
Q

What are 5 major assessments of the physical examination?

A
  1. Respiration
    1. Chest shape - NAD
    2. Breathing pattern
      • ↓ Costal expansion R) side
      • Pain on deep inspiration - avoiding
    3. ↑ Accessory muscle use
      • With not wanting to expand the thorax
  2. Palpation
    1. ↓ R) basal costal expansion
    2. ° Fremitus
      • Retained secretions
  3. Auscultation
    1. ↓BS R) base
    2. °AS
  4. Cough – not performed at this time due to 8/10 pain
  5. Circulation
    1. DVT check – calves SNT (soft, non tender)
    2. Pulses ++ tibialis anterior, dorsalis pedis, all R)= L) = N
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17
Q

What does NAD stand for?

A

NAD: No abnormality detected

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18
Q

What does AS stand for?

A

AS: added sounds (eg. crackles)

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19
Q

What are 5 stages of respiration?

A
  1. Respiratory controller
  2. Respiratory muscles
    1. Rib Cage + pleura
    2. Abdomen
  4. Movement of air
  5. Alveolar ventilation
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20
Q

What are 2 characteristics of the respiratory controller as the 1st stage of respiration?

A
  1. Respiratory center – involuntary
  2. Cortical control – voluntary
  • Eg:
    • Breathing more due to CO2 (involuntary)
    • vs
    • Voluntarily breathing deeper
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21
Q

What are 4 conditions that may affect the respiratory controller as the 1st stage of respiration?

A
  1. Pharmacological eg post-op, over-dose
  2. Head injury
  3. Tumour
  4. CVA/ stroke
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22
Q

What is respiration like a normal patient VS a COPD patient?

A
  • Normal drive to breath: built up of CO2
  • COPD drive to breath: decrease of CO2
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23
Q

What is the pathway to respiratory muscles into the 2nd stage of respiration?

A

Nerve conduction, synapses- Neurological injuries

That affect the respiratory controller

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24
Q

What are 3 conditions that may affect the pathway to respiratory muscles as the 2nd stage of respiration?

A
  1. Guillian Barre syndrome
  2. Spinal cord injury
  3. Poliomyelitis
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25
Q

What are respiratory muscles in the 2nd stage of respiration?

A

Diaphragm, intercostals, SCM, scalenes

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26
Q

What are 4 conditions that may respiratory muscles in the 2nd stage of respiration?

A

Can be less effective

  1. Myopathies
  2. Muscular dystrophy
  3. Fatigue
  4. Surgery
    • Eg. midline surgery (inhibited diaphragm)
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27
Q

What are 3 characteristics of rib cage + pleura in the 3rd stage of respiration?

A
  1. Bone
    1. Rib #s
    2. Post cardiac surgery
    3. Kyphoscoliosis
      • Physically limiting the bucket handle mechanism
  2. Pleura
    1. Pneumothorax
      • Fluid or blood caught around the thorax (Pressure/squash on lung –> lung can’t move properly)
    2. Haemothorax
    3. Pleural effusion
  3. Abnormal chest wall compliance
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28
Q

What are 3 pressure changes of the abdomen in the 3rd stage of respiration?

A
  1. Distention (Limits amount of space the lung has to expand/move)
    • Eg
      1. Obesity
      2. Pregnancy
      3. Peritoneal fluid (ascites)
      4. Pancreatitis
      5. Constipation
      6. Abdominal surgery
  2. Abnormal mechanics (muscle flaccidity)
    • Eg
      1. Spinal injury
      2. Guillian Barre
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29
Q

What are 2 characteristics of the movement of air in the 4th stage of respiration?

A
  1. Inhibition; Pain
    1. Eg: (Not wanting to expand the lungs)
      1. Surgery
      2. Chest trauma
  2. Compression
    1. Eg:
      1. Tumour
      2. Pneumothorax
      3. Haemothorax
      4. Cardiomegaly
        • Physically compressing lung (unable to get air in easily)
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30
Q

What are 3 characteristics of the alveoli ventilation in the 5th stage of respiration?

A
  1. Bronchi to alveolus
    1. Secretions within bronchi
    2. Tumour within bronchi
    3. Bronchitis; Asthma
    4. More narrow bronchi –> harder to get air through
  2. Within alveolus
    1. Decreased surfactant
    2. Pulmonary oedema
    3. Inflammation of tissue
  3. Pneumonia
    1. Emphysema
      1. Larger, floppy airways, that has less SA = less effective
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31
Q

What is the impact on ventilation for a patient who has abdominal surgery?

A
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32
Q

What are 3 characteristics of the respiratory system?

A
  1. Complex system
  2. Interdependent components
  3. Conditions affecting one part of system will affect overall process
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33
Q

What are 9 important concepts of ventilation?

A
  1. Functional residual capacity (FRC)
  2. Closing capacity (CC)
  3. Hypoxaemic pulmonary vasoconstriction
  4. Atelectasis
  5. Critical opening pressure
  6. Newtonian Law of Viscosity
  7. Collateral ventilation
  8. Alveolar interdependence
  9. Time constants
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34
Q

What is functional residual capacity (FRC) as the 1st important concept of ventilation?

A
  • Volume of gas in the lung after a normal expiration
    • Participates in gas exchange during insp. AND exp.
  • Balance between inward recoil of lungs and outward recoil of chest wall
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35
Q

What is static lung volumes?

A
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36
Q

What is closing capacity (CC) as the 2nd important concept of ventilation?

A
  • Volume of air in lung when small airways in dependent lung start to collapse during expiration (trapping air inside)
  • Healthy, young individual (approximately):
    • CC = RV (residual volume)
    • CC < FRC
  • If CC ≥ FRC during normal expiration there may be collapse of airways in dependent lung areas, resulting in reduced ventilation to these areas
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37
Q

What is the change of FCR with position? What position should you aim for and why?

A

Upright: Gravity helps to keep abdominal content down –> lung isn’t squashed (optimal space)

Supine: No effect of gravity of abdominal content –> lung squashes (less space)

Aim for upright positions = improve FRU

  • Air in lungs that participate in ventilation during inspiration and expiration
38
Q

What is the change of FCR with age?

39
Q

What is the impact fo FCR and CC on treatment?

A
  1. FRC lowest in supine vs sitting vs standing –> aim for upright positions to increase FRC
  2. Be aware of changes with age:
    1. CC > FRC in supine by ~45y
    2. CC > FRC in standing by ~65y
    3. (& weaker respiratory muscles)
    4. Risk of early closure of airways –> risk of hypoventilation/collapse
  3. Decreased FRC with obesity (Adipose tissue is squashing the lungs –> less space for lungs to expand):
    1. Identify those at risk –> aim for positions to increased FRC
40
Q

What is hypoxaemic pulmonary vasoconstriction as the 3rd important concept of ventilation?

A
  1. Protective response
  2. V/Q mismatch (Ventilation and perfusion mismatch) –> decreased PaO2
    1. Constriction of pulmonary vessels
      1. This is hypoxaemic pulmonary vasoconstriction (Low O2)
      2. This will divert blood to areas with greater ventilation (increased perfusion to areas of increased ventilation)
  3. • This will increased PaO2 (protection)

Blood flow to area of more O2 instead of from area with no O2. Constricts blood flow to no O2 area.

41
Q

What is atelectasis as the 4th important concept of ventilation?

A
  • Atel” = imperfect, “ectasis” = expansion
  • “Collapse” = collapsed alveoli
  • If alveoli are not ventilated, or are unstable –> collapse
  • May involve:
    • Small groups of alveoli
    • Lung segment / lobe
    • Whole lung
42
Q

What are 4 types of atelectasis as the 4th important concept of ventilation?

A
  1. Micro , Plate
  2. Compression
  3. Absorption
  4. Surfactant impairment
43
Q

What are 3 characteristics of microatelectasis as the 4th important concept of ventilation?

A
  1. Patchy areas of atelectasis not resulting in shift of structures
  2. If not adequately treated may become major atelectasis
  3. All post-surgical patients will have microatelectasis
44
Q

What are 3 characteristics of plate atelectasis as the 4th important concept of ventilation?

A
  1. Small areas of collapse
  2. Thin white lines on CXR
  3. Pulmonary oedema, pneumonia
45
Q

What are 6 examples of compression atelectasis as the 4th important concept of ventilation?

A
  1. Tumour external to bronchi- Compression (physically unable to expand –> unstable –> collapses)
  2. Pneumothorax
  3. Pleural effusion
  4. Cardiomegaly
    • Large heart –> physically compressing the lung –> unable to expand
  5. ↑ pleural pressure (or less negative)
  6. Relaxed diaphragm eg surgery, anaesthesia
46
Q

What are 5 characteristics of absorption atelectasis as the 4th important concept of ventilation?

A
  1. If bronchus or bronchiole is blocked (eg. secretion causing a muscus plug)
    1. Gas in unit distal to obstruction is trapped
    2. Gas uptake by blood continues
    3. Gas pocket collapses
  2. Or, if high FiO2 (oxygen therapy)
    1. Decreased Nitrogen (Nitrogen is a structural unit)
      • >21% of O = < nitrogren (stable airways –> collapse; V/Q mismatch)
    2. V/Q mismatch
47
Q

What are 2 characteristics of surfactant impairment for atelectasis as the 4th important concept of ventilation?

A

Surfactant –> maintain SA of alveoli

  1. Surfactant covers large alveolar surface
  2. Reduces alveolar surface tension
    1. Stabilizes alveoli
    2. Prevents collapse
    3. Surfactant affected (impaired) by:
      1. Anaesthesia
      2. Supplemental O2 (dry)
      3. Mechanical ventilation
      4. Infection
      5. Pre-term neonate
        • Have not developed adequate surfactant
48
Q

What are 6 effects of atelectasis as the 4th important concept of ventilation?

A
  1. Ventilation-perfusion mismatch
    1. hypoxemia ( PaO2)
    2. in some cases  hypercapnia
  2. Decreased FRC
  3. Decreased compliance
  4. very difficult to re-inflate
  5. Increased WOB
  6. Increased O2 consumption
49
Q

What are 3 clinical signs of atelectasis as the 4th important concept of ventilation?

A
  1. Palpation
    1. Decreased chest wall movement (unilaterally or bilaterally)
    2. +/-temperature
  2. Auscultation
    1. Decreased or absent breath sounds and/or fine end-inspiratory crackles
  3. Special tests
    1. Decreased SpO2, PaO2
    2. CXR

These signs may not all be present

50
Q

What are 3 CXR signs of atelectasis as the 4th important concept of ventilation?

A
  1. Shift of structures (TOWARDS collapse)
    1. Fissures
    2. Diaphragms
    3. Mediastinum
    4. Trachea
  2. Crowding of vessels
    1. Increased density (whiteness) of collapsed lobe
  3. Separation of lung markings in noninvolved area
  4. Crowding of ribs
  5. Silhouette sign – loss of border
51
Q

Look at the above example of (L) lung collapse. What are signs that suggest (L) lung collapse in the above CXR?

52
Q

What are 8 risk factors for atelectasis as the 4th important concept of ventilation?

A
  1. Surgical Incision (abdo / thoracic / cardiac)
  2. Previous respiratory condition
  3. Smoking history
  4. Obesity
  5. Age
  6. Impaired cognitive function
  7. Monotonous pattern of mechanical ventilation
  8. Body position (supine, slouched)
53
Q

What are 8 factors ↑ risk of atelectasis post surgery for post surgical atelectasis as the 4th important concept of ventilation?

A
  1. Surgery
  2. Splinting (/ Sore)
  3. Shallow breathing
  4. Supine, Slumped
  5. ↑ Secretions
  6. ↓ Surfactant
  7. Synthetic (mechanical) ventilation
  8. °Sighs
    • Smoking history
  10. Size (obesity)
54
Q

What are 3 important concetps to reverse atelectasis as the 4th important concept of ventilation?

A
  1. Critical opening pressure
  2. Slow laminar flow
    1. (Newtonian Law of Viscosity)
  3. Inspiratory hold
    1. Collateral ventilation
    2. Alveolar interdependence
    3. Surfactant release
    4. Time constants
55
Q

What are 1 important concept of slow laminar flow to reverse atelectasis as the 4th important concept of ventilation?

A

(Newtonian Law of Viscosity)

56
Q

What are 4 important concepts of inspiratory holds to reverse atelectasis as the 4th important concept of ventilation?

A
  1. Collateral ventilation
  2. Alveolar interdependence
  3. Surfactant release
  4. Time constants
57
Q

What is critical opening pressure as the 5th important concept of ventilation?

A

Pressure needed to overcome surface tension and achieve initial reinflation of collapsed regions

  • Example: Inflate a completely deflated balloon
    • It is difficult to inflate initially,
    • Then the rest is easier
  • Inflating alveoli is similar to this
58
Q

What is Newtonian Law of Viscosity as the 6th important concept of ventilation? What is the aim? What is the 3 benefits?

A

Sticky surfaces peel apart more easily when the action is done SLOWLY

Aim for “slow laminar flow” inspiration

Slow, deep, smooth inspiration (<0.2 L/s) from FRC will:

  1. Allow regions with long time constants to fill
  2. Fill lower lung regions
  3. Encourage opening of alveoli
59
Q

What are the 3 benefits of slow laminar flow inspiration in Newtonian Law of Viscosity as the 6th important concept of ventilation?

A

Aim for “slow laminar flow” inspiration

  • Slow, deep, smooth inspiration (<0.2 L/s) from FRC will:
    1. Allow regions with long time constants to fill
    2. Fill lower lung regions
    3. Encourage opening of alveoli
60
Q

What are the 3 effects of fast, shallow, erratic inspiration in Newtonian Law of Viscosity as the 6th important concept of ventilation?

A
  1. Not allow regions with long time constants to fill
  2. Not fill lower lung regions – only upper lung regions
  3. Not encourage opening of alveoli
61
Q

What is collateral ventilation as the 7th important concept of ventilation?

A
  • Slow laminar flow
    • Air will eventually flow through different pathways collateral ventilation)
    • Slow unplug (with some pressure) (Law of viscosity)
62
Q

What is alveolar Interdependence as the 8th important concept of ventilation?

A

Recoiling the collapsing alveoli (with larger breath)

  • Neighbouring alveoli will stop the collapse
63
Q

What is the equation for time constants as the 9th important concept of ventilation?

A

Time constant = compliance x resistance of an alveolar unit

64
Q

What is time constants for a healthy lung as the 9th important concept of ventilation?

A

time constants of all alveoli are relatively uniform - ie same rate and pressure to inflate alveoli

65
Q

What is time constants for an impaired lung as the 9th important concept of ventilation? What are 6 characteristics?

A

time constants of all alveoli are different - ie different rates and pressures to inflate alveoli

  1. Alveolar units with ↑ resistance take longer to fill
  2. Alveoli with ↑ compliance (ie. floppy) take longer to fill
  3. AND, alveoli with ↓ compliance (ie. stiffer) take a greater inspiratory effort to fill
  4. Non-uniform time constants
  5. ↑ time required to fill alveoli with fresh air
  6. ↑ time required to empty alveoli of stale air
    1. ↑ respiratory rate
    2. ↓ time for inspiration and expiration
    3. ↓ ventilation!

Inspiratory hold / plateau can allow for different time constants

  • Allow for times that parts of lungs that collapsed to re-expand
66
Q

What are 6 medical management of atelectasis as the 4th important concept of ventilation?

A
  1. Pain relief
  2. Bronchoscopy
  3. Drainage of pneumothorax / pleural effusion
  4. Removal of tumour / obstruction
  5. Recruitment maneuvers (if ventilated)
  6. Surfactant therapy
67
Q

What are 10 physiotherapy techniques to improve ventilation?

EXAM QUESTION

A
  1. Pain relief
  2. Positioning
  3. Breathing exercises
  4. Demand ventilation / Mobilisation
  5. Facilitation techniques
  6. Incentive spirometry
  7. Positive expiratory pressure devices
  8. Non-invasive ventilation
  9. Manual & ventilator hyperinflation
  10. [Oxygen therapy]
    • Needs to be in conjunction with other methods. Cannot be the primary management.
68
Q

What are the 3 aims of pain relief as the 1st physiotherapy techniques to improve ventilation? What are 3 roles?

A

Aim to optimise inspiratory volume

  1. Support, positioning
  2. Modalities such as TENS
  3. Time Ax and Rx with pain medications; oral, IV, PCA, epidural

IMPORTANT: Physiotherapists do not prescribe or deliver medications to patients

But we do:

  1. Monitor patient’s pain levels prior to starting treatment as well as during treatment
  2. Time treatment with pain relief
  3. Optimise comfort throughout, eg support & positioning
69
Q

What are the 3 characteristics of positioning as the 2nd physiotherapy techniques to improve ventilation?

A
  1. High sitting
  2. Sitting out of bed (SOOB) / Standing
  3. Lateral / side lying ( / High side lying)
  4. Prone lying
70
Q

What is the benefit of upright positioning as the 2nd physiotherapy techniques to improve ventilation? What are 4 principles why this works?

A

↑ FRC

“Slinky spring” principle

  1. Apices have ↓ compliance
  2. Bases have ↑ compliance –> greater ↑ in volume with ventilation
  3. ↑ Perfusion in bases (gravity)
  4. Ventilation matches perfusion
71
Q

What are 4 characteristics of (high sitting) positioningas the2nd physiotherapy techniques to improve ventilation?

A
  1. Patients often slump in the bed / plinth
    1. Ensure hip joint at bed crease
    2. If move down bed, will slump more
  2. Use chair if possible (SOOB)
  3. Care with patients with obesity, may need to sit <60º
  4. Aim to improve position prior to Ax and Rx
72
Q

What is (lateral / side lying) positioning as the 2nd physiotherapy techniques to improve ventilation?

A

Can be high side lying

73
Q

What are 2 characteristics of positioning (in non-ventilated patient) as the 2nd physiotherapy techniques to improve ventilation?

A
  1. Perfusion goes to dependent lobe (lower side), ventilation follows
  2. But, after ~30 minutes dependent lobe becomes compressed
74
Q

What are 3 characteristics of positioning (in unilateral lung disease) as the 2nd physiotherapy techniques to improve ventilation? What is the exact positioning?

A

Position with ‘good’(unaffected) lung dependent to improve overall gas exchange

  1. Perfusion to dependent (‘good’) lung
  2. Ventilation follows perfusion to dependent (‘good’) lung
  3. Gas exchange improves

EXAMPLE, if L) lung is the ‘bad’ lung: R) side lying, thus R) lung is the ‘dependent’ lung (lower)

  1. ↑ Perfusion and ventilation to R) lung
  2. Will improve gas exchange if L) lung is affected
75
Q

What are 4 characteristics of (standing) positioning as the 2nd physiotherapy techniques to improve ventilation?

A
  1. Greatest FRC
  2. Can use FLS (forward-lean standing) to help relieve SOB
  3. Good for patients with paralytic ileus
  4. Tilt-table if appropriate
76
Q

What are 2 characteristics of (prone) positioning as the 2nd physiotherapy techniques to improve ventilation?

A
  1. ↑ Lung compliance, secondary to stabilisation of anterior chest wall
  2. Apply with caution - may be poorly tolerated, or contraindicated
77
Q

What are 6 characteristics of breathing exercises as the 3rd physiotherapy techniques to improve ventilation? What are 2 contraindications?

A
  1. Slow, laminar flow
  2. Facilitate BBE (Bi-basal expansion) to ↑ ventilation
    1. If BBE is not available, facilitate at ant abdomen
  3. Verbal, &/or tactile facilitation (eg fine vibration) to↑movt
  4. Avoid accessory muscle use
  5. +/- IH (inspiratory hold) / plateau or ‘sniff’ manoeuvre at end of deep insp (unless contraindicated)
  6. IMPORTANT: ensure ≤5 consecutive breaths, to avoid hyperventilation
  7. Contraindications:
    1. Severe ↑ WOB (eg, intercostal recession)
    2. Air trapping (severe hyperinflation)
78
Q

What are 4 characteristics of Demand Ventilation/Mobilisation as the 4th physiotherapy techniques to improve ventilation?

A

UL and LL movements

  1. ↑muscle activity
  2. ↑ minute ventilation (RR (respiratory rate) X TV (tidal volume))
  3. ↑ cardiac output
  4. ↑ O2 extraction at tissue

Care: Even low intensity activity will impact patients with acute cardiorespiratory impairments

79
Q

What are 2 facilitation techniques as the 5th physiotherapy techniques to improve ventilation?

A
  1. Stretch facilitation
  2. Neurophysiological facilitation (NPF)
    • (perioral stimulation; intercostal stretch)

Aim to ↑ventilation in patients with ↓LOC

80
Q

What are 5 characteristics of (stretch) facilitation techniques as the 5th physiotherapy techniques to improve ventilation?

A
  1. Based on stretch reflex, PNF
  2. Quick stretch of intercostal muscles at end of expiration, before the start of inspiration
  3. Stronger contraction of intercostals (more forceful)
  4. Larger inspiration
  5. Monitor effect prior to performing next stretch
81
Q

What are 5 characteristics of incentive spirometry as the 6th physiotherapy techniques to improve ventilation?

A
  1. Visual cue to provide feedback regarding inspiration
    1. Flow device eg Triflow, Cliniflo
    2. Volume device eg Voldyne, Coach
  2. Principles of improving ventilation (slow laminar flow…)
82
Q

What are 3 characteristics of Positive Expiratory Pressure (PEP) devices as the 7th physiotherapy techniques to improve ventilation?

A
  1. Positive pressure during expiration eg like breathing out through pursed lips
  2. ↑FRC and splints airways open
  3. Less commonly used for ventilation; usually for airway clearance
83
Q

What are 2 characteristics of Non Invasive Ventilation (NIV) as the 8th physiotherapy techniques to improve ventilation?

A
  1. Positive pressure ventilation via mask / mouthpiece
  2. Eg, CPAP, BiPAP, IPPB
84
Q

What are characteristics of Manual & Ventilator Hyperinflation as the 9th physiotherapy techniques to improve ventilation?

85
Q

What are 4 summaries of physiotherapy techniques to improve ventilation?

A
  1. Variety of techniques – using the same principles to reinflate alveoli (slow laminar flow,… )
  2. Consider patient presentation
    1. Eg age, conscious vs unconscious
  3. Can use combination of techniques – eg pain relief, position into high sitting, breathing exercises (TEE), mobilisation
  4. Regular exercises needed eg each hour
    • Prescribe frequency and duration
86
Q

How will you modify your approach fro different ages and stages (eg.children)?

A
  1. Instruments
  2. Bubbles
  3. Feathers,
  4. Balloons
  5. Pin wheel
  6. Games with blowing ball
87
Q

What are 3 characteristics of increased work of breathing? What are 2 management?

A

Can occur with respiratory distress, respiratory failure, COPD, anxiety, exertion

  1. ↑ accessory muscle use
  2. ↑ RR
  3. ↓ energy available for other organs

Management of increased WOB:

  1. Positioning
  2. Breathing control (BC)
88
Q

What are 3 characteristics of positioning in increased work of breathing (WOB)?

A
  1. “Recovery positions”
  2. Supported positions
    1. Forward lean sitting / standing
    2. Relaxed sitting / standing
  3. Recruitment of axiohumeral muscles
    1. Reverse origin-insertion action
    2. Assists respiration
    3. Hands on hips, knees, head –> fixate LL –> use muscles in a reverse origin-insertion action and move the chest/ribs
89
Q

What are 6 characteristics of breathing control (BC) in increased work of breathing (WOB)?

A
  1. Gentle tidal breathing
  2. Emphasise lower chest, not upper chest –> Minimal effort expended
  3. Inspire through nose to warm, humidify and cleanse air (but through mouth if nose is blocked)
  4. Intersperse throughout other techniques for recovery & to prevent airflow obstruction
  5. Duration of BC depends on pt’s presentation
  6. 2-3 breaths, up to minutes++
90
Q

What are 6 features in the clinical problem solving framework?

A
  1. Problem (what problem/s does this patient have that I can treat?)
  2. Evidence (how do I know this problem exists? ie, Ax findings)
  3. Pathophysiological cause (what causes this problem?)
  4. Management & rationale (what can I do to help improve this problem, & why have I selected this approach?)
  5. Outcome measures (how will I know if this Mx is working?)
  6. + Special considerations (what do I need to think about before assessing / treating this patient?)
91
Q

Example clinical problem solving framework?

92
Q

What is the handover/ward round report?

PHTY3250 (20 decks)

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