Lab 3: CVP Interventions Flashcards
What is typical chest excursion for an adult?
5-7cm
Normal respiratory rate for adults?
12-20
What position is chest wall excursion measured in?
With the pt lying in supine and flat, the examiner places both hands lightly over the anterior chest with thumbs over costal margins so that their tips almost meet at the xiphoid. The pt is instructed to take a deep insirpation while the examiners hands are allowed to move with chest expansion
CWE can also be measured with a tape measure to quantify motion in different areas of the thorax. The tape measure is wrapped around the thorax in a level position and pulled just taut (but not restricting chest wall expation) at three anatomic sites
* Where are these 3 sites
The angle of Louis on the sternum, located at the second rib, for upper chest motion, which is produced by bucket handkle motion
The xiphoid process for mid-chest expansion, which is due predominantly to bucket handle motion
The midpoint between the xiphoid process and the umbilicus for lower chest expansion, where most of the bucket handle motion occurs
What are the 900 indications for cardiac rehab?
Recent MI
Acute Coronary artery syndrome
Chronic stable angina
Congestive heart failure
After coronary artery bypass surgery
After a percutaneous coronary intervention
Valvular surgery
Cardiac transplantation
Contraidnications for cardiac rehabiliation
Unstable angina
Acute decompensated congestive heart failure
Complex ventricular arrhytmias
Severe oulmonary hypertension (right ventricular systolic pressure greater than 60 mmHg)
Intracavitary thrombus
Recent thrombophlebitits with out without pulmonary embolism
Severe obstructive cardiomyopathies
Severe or symptomatic aortic stenosis
Uncontrolled inflammatory of infectous pathology
Any musculoskeletal condition that prevents adequate participation in exercise
What is diaphragmatic breathing used for?
Used to manage a patients dyspnea, reduce atelectasis, and increase oxygenation
* Good for end stage COPD - lets you get that trapped air out
Explain how pursed lip breathing is executed and what its used for
pt instructed to inhale through the nose for 2 to 3 seconds with the mouth closed and then exhale slowly over 4 to 6 seconds through lips held in a whistling or kissing position
Helps control RR, and helps w/ airway collapse in COPD
Explain what pace breathing is
During rhythmic activities, breathing can be coordinated with the rhythm of the activity. During nonrhythmic activities, the pt can be instructed to breathe in at the beginning of the activity and out during the activity
* so essentially what you do in lifting to get that core activation w/ hard activities
This can be combined w/ pursed lip breathing or diaphragmatic breathing. Helps contorl RR and dyspnea
Explain what segmental breathing is
You’re essentially applying pressure over a specific portion of the lung that they arent filling well
Explain Inspiratory hold techniques
* when is it used?
Prolonged holding of the breath at maximum inspiration. It can be used in conjunction with vibration techniques to aid in airway clearance
* Makes sense, everything is opened up
* “Breathe all the way in and hold”
Explain what stacked breathing is
Series of inhalation
Short breath –> medium breath –> large breath
Indications for coughing techniques: Secretions, secretion, unstable airway for huffing
Desired result = clearance
Explain an effective cough
An effective cough consists of a deep inspiration followed by closure of the glottis and a momentary hold during which contration of the abdominal muscles increases intrathoracic and intraabdominal pressures
Explain what a double cough is?
After deep inspiration, the pt performs two coughs in one breath; the second is usually more forceful than the first
Explain what a controlled cough is
* What is the point in the first 2 breaths?
The pt takes three deep breaths, exhaling normally after the first two and then coughing firmly on the third; the first two breaths are believed to decrease atelectasis and increase the volume of the cough
Explain what a 3 cough is
* Whats the point in this technique
The pt takes a small breath and gives a fair cough, then takes a bigger breath and gives a harder cough, and finally takes a really deep breath and gives a forceful cough; this techniques allows for pts to work their way up to a forceful cough
smal breath –> small cough
Medium breath –> medium cough
Large breath –> Large cough
What is huffing?
The pt takes a deep inspiration and then air is forcefully exhaled as in coughing except that the mouth is kept open (less stressful on the pt and more effective than constant forced coughing, especially in pts who tend to prolong the expiratory phase of a cough almost into a wheeze, such as asthmatics and others w/ COPD)
* the pt makes a sound similar to a huff
* You breathe out prettttty hard
Explain what a pump cough is
The pt takes a deep breath and then gives three short easy coughs followed by 3 huffs
* facilitates secretion clearance in pts w/ air trapping
Explain what the forced expiratory technique is
Refers to the combination of huffing with controlled breathing. The pt performs one or two huffs from middle to low lung volumes followed by a period of relaxed, controlled, deep diaphragmatic or lower chest breathing. This process is then repeated
* huff huff breath
Explain what a directed cough is
Refers to a standard cough that is assisted by a care provider coaching the patient to take some deep slow breaths before the cough and assisting the cough effort with abdominal or thoracic compression during exhalation.
* so the PT is actually pushing on them to make them breathe
Precautions for postural drainage
- pulmonary edema
- Hemoptysis
- Massive obesity - cant get in position
- Large pleural effusion
- Massive ascites
Relative contraindications for postural drainage
- Increased intracranial pressure
- Hemodynamically unstable
- Recent esophageal anastomosis
- Recent spinal fusion or injury
- Recent head trauma
- Diaphragmatic hernia
- Recent eye surgery
so notice there are no absolute contraindications
What does this position drain?
Drains anterior superior portion of lung
* because it will flow posterior and down which will lead to the bronchial tree
What are does this position drain?
Drain Posterior apical segment (superior)
* because its going toward anterior and towards inferor (kind of the opposite direction its coming from)
What portion of the lung does this drain
Drains the anterior poertion of the lung (because its going the opposite direction of where it is)
What does this position drain?
Posterior Right
What direction does this position drain?
Posterior, apical L
What does this position drain?
R, inferior, anterior
What is this draining
L, inferior, anterior
What is this draining
Anterior, inferior/middle, L/R
What is this draining
R, inferior, middle, lateral
What is this draining?
L, latearl, inferior, middle
What does this drain?
* NoTE: that left side is propped up
Posterior and inferior segments
What does this drain?
Says superior dont fully understand unless the head was more propped up
Superior, posterior
For percussion/cupping - do it on areas you’re having trouble w/
Cup hands - move your wrists not elbows
Explain how you would do the vibration technique?
Its specifically on the exhale
gentle, high frequency oscillations combined w/ chest wall compression produced by tensing all muscles in the upper extremitites in co-contraction
Explain shaking
Exhale only. More proncouced bouncing chest compression
* good for neurologic issues
* clears up congestion in lungs
* so you shake when they exhale
* wanna do more than just moving the fashia
Explain rib spring
Exhale only - ribs are “pumped” in a springing fashion three or four times during exhalation
* so when they’re breathing out you push 3-4 times
* good for people w/ poor rib articulation mechanics - so bad mechancis in breathing due to poor articulation - typically younger adult population due to previous injury
* so its done when they are fully exhaled
Segmental breathing
After identifying the area of treatment, the therapists hands are palced on the appropriate part of the pts chest, applying firm pressure at the end of expiration
* so you’re essnetially targeting which lobe you want the to exhale into –> might be because they struggle to get air into that lobe
* Maximal insiration is sustained for 2-3 seconds and then the pt exhales, which is sometimes assisted by the PT’s manual pressure
* Could be done in combination w/ shaking and vibration
Percaustions for percussion and vibration
- Unctronolled bronchospasm
- Osteoporosis
- Rib fractures
- Metastatic cancer to ribs
- Tumor obstruction of airway
- Anxiety
- Coagulopathy
- Convulsive or seizure disorder
- Recent pacemaker placement
Relative Contraindications
Hemoptysis
Untreated tension Pnumothorax
Platelet count below 20,000 per
Unstable hemodynamic status
Open wounds, burns in the thoracic area
Pulmonary embolism
Subcutaneous emphysema
Recent skin grafts or flaps on thorax
