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Cardio 2 > Physical Therapy Plan of Care > Flashcards

Physical Therapy Plan of Care Flashcards

1
Q

what is the PT Diagnosis

A

Primary dysfunctions to guide the therapist toward interventions that should be addressed initially
this is not the medical diagnosis

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2
Q

Plan of care includes what

A

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

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3
Q

what are Acute Cardiopulmonary Conditions

A

Disease in which O2 transport system fails to meet immediate demand

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4
Q

Acute cardiopulmonary dysfunction is often associated with

A
  • Ischemic CVD
  • COPD
  • Postoperative pulmonary complications
  • HTN
  • DM
  • Obesity
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5
Q

Cardiovascular Effects of Immobilization

A
  • Increased basal heart rate
  • Decreased max heart rate
  • Decreased max oxygen
    uptake
  • Orthostatic hypotension
  • Increased risk VTE
  • Decreased total blood volume
  • Decreased Hemoglobin concentration
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6
Q

Pulmonary Effects of Immobilization

A
  • Decreased vital capacity
  • Decreased residual volume
  • Decreased PaO2
  • Impaired ability to clear secretions
  • Increased ventilation-perfusion mismatch
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7
Q

mechanically ventilated and PT treatment

A

pt during this leads to improved outcomes

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8
Q

what is the goal of ventilated pts

A

Goal of ventilated patients is to return to spontaneous breathing

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9
Q

what is weaning

A

process of discontinuing mechanical ventilation

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10
Q

mechanical ventilation and medications

A

this combo leads to complications

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11
Q

Special Considerations for Mechanically Ventilated Patients

A
  • Airway clearance
  • Inspiratory muscle strengthening
  • Diaphragmatic facilitation
  • Breathing strategies
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12
Q

what form of exercise should be used in acute care

A

both endurance and strength training should to prevent and treat negative neuromuscular and cardiopulmonary sequelae of critical illness

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13
Q

Goal of endurance

A

maximize independence and efficiency when patient performs ADLs

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14
Q

Discharge Planning - function level

A

Assess current level of function vs prior level of function

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15
Q

how to determine next level of care

A

Report activity tolerance and rehabilitation potential

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16
Q

Airway Clearance Techniques

A

Manual or mechanical procedures that facilitate mobilization of secretions from airways

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17
Q

goals of Airway Clearance Techniques

A

optimize airway patency, increase ventilation and perfusion matching, promote alveolar expansion, increase gas exchange

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18
Q

what is High Frequency Chest Wall Oscillation Devices

A
  • Positive pressure air pulses are applied to the chest wall via inflatable chest or air pulse generator
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19
Q

High Frequency Chest Wall Oscillation Devices results

A
  • Decreased viscoelasticity of mucus
  • Helps sputum expectoration
  • Improve airflow in low lung volumes
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20
Q

Positive Expiratory Pressure Devices function

A

Allows more air to enter the peripheral airways via collateral channels

The pressurized air goes behind secretions to prevent alveoli from
collapsing

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21
Q

Positive Expiratory Pressure Devices benefits

A
  • Gives independence to patients with COPD and other pulmonary disorders
  • Improves compliance
  • Decreases hospital length of stay
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22
Q

Vibratory Positive Expiratory Pressure functions

A
  • Improves lung function and oxygenation
  • Facilitates mucus expectoration
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23
Q

two types of Vibratory Positive Expiratory Pressure

A

flutter and acapella

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24
Q

flutter and acapella gravity

A

Flutter device is gravity dependent while acapella can be used in any position

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25
Q

Mechanical Percussor

A
  • Provides gentle mechanical vibrations
    to remove secretions
  • Less frequently used in hospital setting
26
Q

Mechanical Insufflator function

A

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

27
Q

Oral high frequency oscillation device

A
  • Improves clearance of CO2
  • Used when conservative measures fail
28
Q

Intrapulmonary percussive ventilation device

A

Combines aerosol inhalation and internal thoracic percussion via mouthpiece

29
Q

Cornet device

A

Vibratory positive expiratory pressure device to improve mucus expectoration and oxygenation

30
Q

Postural Drainage

A

Assumption of one or more body positions that allow gravity to assist with draining secretions from each lung segment
* “Good lung down”

31
Q

Postural Drainage is most approciate for what

A

Most appropriate for mucus producing conditions, especially cystic fibrosis

32
Q

Precautions to postural drainage

A
  • Pulmonary edema
  • Hemoptysis
  • Massive obesity
  • Large pleural effusion
  • Massive ascites
33
Q

contraindications to postural drainage

A
  • Increased intracranial pressure
  • Hemodynamically unstable
  • Recent esophageal anastomosis
  • Recent spinal fusion or injury
  • Recent head trauma
  • Diaphragmatic hernia
  • Recent eye surgery
34
Q

Contraindications for Percussion and Vibration

A
  • 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
35
Q

Precautions for Percussion and Vibration

A
  • Uncontrolled bronchospasm
  • Osteoporosis
  • Rib fractures
  • Metastatic cancer to ribs
  • Tumor obstruction of airway
  • Anxiety
  • Coagulopathy
  • Convulsive or seizure disorder
  • Recent pacemaker placement
36
Q

Effective cough consists of four stages

A
  1. Inspiration
  2. Closure of glottis
  3. Abdominal and intercostal muscle contraction
  4. Forceful expulsion of air
37
Q

Ineffective cough can lead to

A

retained secretions, atelectasis, hypoxemia, and respiratory failure

38
Q

proning and bretahing

A

Use of prone positioning is beneficial for improved oxygenation

39
Q

how does a Arms supported position help with breathing

A

Allows the accessory breathing muscles to act on the rib cage allowing more expansion for inspiration

40
Q

indications for pursed lip breathing

A
  • Dyspnea, wheezing (rest or exertion)
  • Decreases patient’s symptoms of dyspnea
  • Slows respiratory rate and decrease airway collapse in pts with COPD
41
Q

indications for paced bretahing

A

Low endurance, DOE, fatigue, anxiety, tachypnea

Great with low endurance patients

42
Q

what is Paced Breathing

A
  • 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
43
Q

can paced bretahing be used with other ebretahing methods

A
  • Can be used with PLB or diaphragmatic techniques
44
Q

Diaphragmatic Breathing

A

Indicated for hypoxemia, tachypnea, atelectasis, anxiety, pulmonary secretions, and other conditions with diaphragmatic weakness

45
Q

what si the point of Diaphragmatic Breathing

A
  • Improve diaphragm’s involvement in inhalation
  • IE: reduce chest breathing & facilitate belly breathing
46
Q

why do we use​ sniffing

A

Ensure patient knows how to
activate the Diaphragm

47
Q

goal of Counterpressure

A

Allow for patient to feel the pressure and
biofeedback of the clinician’s pressure

48
Q

when do you use Quick Stretch/muscle energy technique

A

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

49
Q

what is Diaphragmatic Breathing Facilitation Techniques

A
  • 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

50
Q

what is the goal of segmental breathing

A

Encourages expansion of specific part of the lung that has been under ventilated

51
Q

what indicates that we should do segmental breathing

A

Indicated for asymmetrical chest wall expansion with absence of breath sounds, localized lung consolidation, asymmetrical posture, area of collapsed lung

52
Q

what is segmental breathing​ followed by

A

Followed by inspiratory training to allow for expansion and ventilation to the newly ventilated lung area

53
Q

procedure fro segmental bretahing

A
  1. Place your hand over the chest wall overlying the area of emphasis
  2. 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
  3. Gradually decrease your pressure as the patient inspires to allow for expansion of that area
  4. Instruct the patient to hold that breath for 2-3 seconds at the end of inspiration, then exhale
54
Q

the two parts of inspiratory training

A
  • Strengthening
  • Endurance
55
Q

Incentive Spirometry is often used when

A

post-op

56
Q

Incentive Spirometry helps with

A

Increased ventilation and help mobilize secretions

57
Q

how often should Incentive Spirometry be used

A

Perform up to 10x per hour as able – should assess patient’s ability prior to prescribing

58
Q

Inspiratory Holds and Stacked Breathing indications

A
  • Ventilate poorly ventilated areas
  • Improve cough capabilities for airway clearance
  • Hypoventilation, atelectasis, ineffective cough
59
Q

what are Inspiratory Holds

A

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

60
Q

what is Stacked Breathing

A
  • 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

Cardio 2 (12 decks)

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