Physical Therapy Plan of Care Flashcards
what is the PT Diagnosis
Primary dysfunctions to guide the therapist toward interventions that should be addressed initially
this is not the medical diagnosis
Plan of care includes what
Overall goals stated in measurable terms that indicate the
predicted level of improvement in functioning
A general statement of interventions to be used
Proposed duration and frequency
Anticipated discharge plans
what are Acute Cardiopulmonary Conditions
Disease in which O2 transport system fails to meet immediate demand
Acute cardiopulmonary dysfunction is often associated with
- Ischemic CVD
- COPD
- Postoperative pulmonary complications
- HTN
- DM
- Obesity
Cardiovascular Effects of Immobilization
- Increased basal heart rate
- Decreased max heart rate
- Decreased max oxygen
uptake - Orthostatic hypotension
- Increased risk VTE
- Decreased total blood volume
- Decreased Hemoglobin concentration
Pulmonary Effects of Immobilization
- Decreased vital capacity
- Decreased residual volume
- Decreased PaO2
- Impaired ability to clear secretions
- Increased ventilation-perfusion mismatch
mechanically ventilated and PT treatment
pt during this leads to improved outcomes
what is the goal of ventilated pts
Goal of ventilated patients is to return to spontaneous breathing
what is weaning
process of discontinuing mechanical ventilation
mechanical ventilation and medications
this combo leads to complications
Special Considerations for Mechanically Ventilated Patients
- Airway clearance
- Inspiratory muscle strengthening
- Diaphragmatic facilitation
- Breathing strategies
what form of exercise should be used in acute care
both endurance and strength training should to prevent and treat negative neuromuscular and cardiopulmonary sequelae of critical illness
Goal of endurance
maximize independence and efficiency when patient performs ADLs
Discharge Planning - function level
Assess current level of function vs prior level of function
how to determine next level of care
Report activity tolerance and rehabilitation potential
Airway Clearance Techniques
Manual or mechanical procedures that facilitate mobilization of secretions from airways
goals of Airway Clearance Techniques
optimize airway patency, increase ventilation and perfusion matching, promote alveolar expansion, increase gas exchange
what is High Frequency Chest Wall Oscillation Devices
- Positive pressure air pulses are applied to the chest wall via inflatable chest or air pulse generator
High Frequency Chest Wall Oscillation Devices results
- Decreased viscoelasticity of mucus
- Helps sputum expectoration
- Improve airflow in low lung volumes
Positive Expiratory Pressure Devices function
Allows more air to enter the peripheral airways via collateral channels
The pressurized air goes behind secretions to prevent alveoli from
collapsing
Positive Expiratory Pressure Devices benefits
- Gives independence to patients with COPD and other pulmonary disorders
- Improves compliance
- Decreases hospital length of stay
Vibratory Positive Expiratory Pressure functions
- Improves lung function and oxygenation
- Facilitates mucus expectoration
two types of Vibratory Positive Expiratory Pressure
flutter and acapella
flutter and acapella gravity
Flutter device is gravity dependent while acapella can be used in any position
Mechanical Percussor
- Provides gentle mechanical vibrations
to remove secretions - Less frequently used in hospital setting
Mechanical Insufflator function
Uses positive pressure to deliver maximal inhalation, followed abruptly by a switch to negative pressure in the upper airway
This aims at simulating the airflow changes that occur during a cough, thereby assisting sputum production
Oral high frequency oscillation device
- Improves clearance of CO2
- Used when conservative measures fail
Intrapulmonary percussive ventilation device
Combines aerosol inhalation and internal thoracic percussion via mouthpiece
Cornet device
Vibratory positive expiratory pressure device to improve mucus expectoration and oxygenation
Postural Drainage
Assumption of one or more body positions that allow gravity to assist with draining secretions from each lung segment
* “Good lung down”
Postural Drainage is most approciate for what
Most appropriate for mucus producing conditions, especially cystic fibrosis
Precautions to postural drainage
- Pulmonary edema
- Hemoptysis
- Massive obesity
- Large pleural effusion
- Massive ascites
contraindications to postural drainage
- Increased intracranial pressure
- Hemodynamically unstable
- Recent esophageal anastomosis
- Recent spinal fusion or injury
- Recent head trauma
- Diaphragmatic hernia
- Recent eye surgery
Contraindications for Percussion and Vibration
- Hemoptysis
- Untreated tension pneumothorax
- Platelet count below 20,000 per mm3
- Unstable hemodynamic status
- Open wounds, burns in thoracic area
- Pulmonary embolism
- Subcutaneous emphysema
- Recent skin grafts or flaps on thor
Precautions for Percussion and Vibration
- Uncontrolled bronchospasm
- Osteoporosis
- Rib fractures
- Metastatic cancer to ribs
- Tumor obstruction of airway
- Anxiety
- Coagulopathy
- Convulsive or seizure disorder
- Recent pacemaker placement
Effective cough consists of four stages
- Inspiration
- Closure of glottis
- Abdominal and intercostal muscle contraction
- Forceful expulsion of air
Ineffective cough can lead to
retained secretions, atelectasis, hypoxemia, and respiratory failure
proning and bretahing
Use of prone positioning is beneficial for improved oxygenation
how does a Arms supported position help with breathing
Allows the accessory breathing muscles to act on the rib cage allowing more expansion for inspiration
indications for pursed lip breathing
- Dyspnea, wheezing (rest or exertion)
- Decreases patient’s symptoms of dyspnea
- Slows respiratory rate and decrease airway collapse in pts with COPD
indications for paced bretahing
Low endurance, DOE, fatigue, anxiety, tachypnea
Great with low endurance patients
what is Paced Breathing
- Patient controls breathing during activity
- “breath in at the beginning of activity and out at the end”
- Counting steps to coordinate inspiration and expiration “in” 1, 2 “out” 1,2,3,4
can paced bretahing be used with other ebretahing methods
- Can be used with PLB or diaphragmatic techniques
Diaphragmatic Breathing
Indicated for hypoxemia, tachypnea, atelectasis, anxiety, pulmonary secretions, and other conditions with diaphragmatic weakness
what si the point of Diaphragmatic Breathing
- Improve diaphragm’s involvement in inhalation
- IE: reduce chest breathing & facilitate belly breathing
why do we use sniffing
Ensure patient knows how to
activate the Diaphragm
goal of Counterpressure
Allow for patient to feel the pressure and
biofeedback of the clinician’s pressure
when do you use Quick Stretch/muscle energy technique
If the patient is having difficulty activating the diaphragm to full capacity or coordinating diaphragmatic activation at inspiration
Best performed in supine with patient’s knee bent
what is Diaphragmatic Breathing Facilitation Techniques
- Place your hands or the patient’s hands over the patient’s anterolateral rib cage
- Instruct the patient to breath into the hands
- This will also facilitate diaphragmatic motion
make sure that the pt shoulders are relaxed
what is the goal of segmental breathing
Encourages expansion of specific part of the lung that has been under ventilated
what indicates that we should do segmental breathing
Indicated for asymmetrical chest wall expansion with absence of breath sounds, localized lung consolidation, asymmetrical posture, area of collapsed lung
what is segmental breathing followed by
Followed by inspiratory training to allow for expansion and ventilation to the newly ventilated lung area
procedure fro segmental bretahing
- Place your hand over the chest wall overlying the area of emphasis
- Instruct the patient to breathe in deeply through the nose trying to direct airflow toward your hand while you apply a counter pressure with your hand
- Gradually decrease your pressure as the patient inspires to allow for expansion of that area
- Instruct the patient to hold that breath for 2-3 seconds at the end of inspiration, then exhale
the two parts of inspiratory training
- Strengthening
- Endurance
Incentive Spirometry is often used when
post-op
Incentive Spirometry helps with
Increased ventilation and help mobilize secretions
how often should Incentive Spirometry be used
Perform up to 10x per hour as able – should assess patient’s ability prior to prescribing
Inspiratory Holds and Stacked Breathing indications
- Ventilate poorly ventilated areas
- Improve cough capabilities for airway clearance
- Hypoventilation, atelectasis, ineffective cough
what are Inspiratory Holds
Involves prolonged holding of breath at maximum inspiration
The patient is instructed to hold his or her breath at the height of inspiration for 2 to 3 seconds, followed by relaxed exhalation
what is Stacked Breathing
- Series of deep breaths that build on
top of previous breath without expiration (i.e. stacked breaths) - Each inspiration is accompanied by a brief inspiratory hold
