positioning and mobilisation

Question 1

what is the evidence behind lean forward sitting for SOB?

Answer 1

-effective in alleviating SOB and increasing maximal inspiratory pressure in COPD pts w/ hoover sign
-length tension relationship between the diaphragm and the ribcage are improved

Question 2

what are positions of ease?

Answer 2

a position to ease breathlessness
eg forward lead sitting, high side lying, relaxed supported sitting
NB make sure pt docent hold breath

Question 3

what is postural drainage?

Answer 3

this is when we position our patients so that gravity can assist the draining of secretions
-area that needs to be drained should be in the uppermost position

Question 4

what are examples of contraindications / cautions for postural drainage?

Answer 4

-head and neck pathology - ENT surgery, high ICP, C spine fracture precautions
-CV pathology - hypertension, cardiac failure, pulmonary oedema
-general - before or after meal, recent vomiting, drips/ drains
-pregnancy late stages

Question 5

is there much evidence behind postural drainage?

Answer 5

no there is little supporting evidence that postural drainage positions mobilise secretions

Question 6

what position causes optimal ventilation in the mid and lower lobes?

Answer 6

upright position

Question 7

if an adult is in side lying position, where is the best ventilation happening?

Answer 7

the dependent lung is preferably ventilated due to the dependent hemidiaphragm being stretched

Question 8

how does mobilisation increase ventilation?

Answer 8

• a change in body position alters regional ventilation
  -by increasing the mobility of a patient, oxygen demand increases, resulting in a corresponding increase in minute ventilation and lung volumes

Question 9

what are the consequences of immobilisation?

Answer 9

-loss of muscle
-loss of aerobic capacity
-increased risk of clots
-reduced ROM
-general functional decline

Question 10

what is the CV and resp response to mobilisation?

Answer 10

-increased oxygen requirements - increased BP and HR
-increased minute ventilation
-improved V/Q matching

Question 11

how do we go about prescribing mobilisation?

Answer 11

-safety NB - ensure pt has no temperature or chest pain /tightness
-warm up, steady state and cool down
-avoid isometrics
-duration based on patient response
-acute cardiorespiratory dysfunction
-timed with medication eg parkinsons

Question 12

what number on the BORG breathlessness scale do we want our pts on while mobilising?

Answer 12

-3 - moderate breathlessness

Question 13

what are important considerations for mobilising?

Answer 13

-patients power
-balance
-CVS stability- BP, HR
-their oxygen sats levels (maintain sats above 90%)

Question 14

what is Portsmouth sign?

Answer 14

this is when the systolic BP is lower than the HR
-could indicate hypovolemic shock or sepsis etc

Question 15

how do we manage acute breathlessness?

Answer 15

-pursed lip breathing
-medications
-pacing

Question 16

what is pursed lip breathing?

Answer 16

-breathing in through nose
-keep lips together except at centre
-breathe out twice as long as you breathe in
-ie breath in for 1-2, breath out for 1-2-3-4

Question 17

what are the benefits for pursed lip breathing?

Answer 17

• decreased frequency of respiration rate
  -increased tidal volume
  -improved oxygenation

Question 18

why does pursed lip breathing work?

Answer 18

-it creates a small back pressure
-helps to support breathing by opening the airways during exhalation and increasing the removal of CO2

Question 19

what are precautions of PLB?

Answer 19

-ensure the pt has correct technique
-may cause fatigue of respiratory muscles
-may lower levels of CO2 too much

Question 20

what is blow as you go?

Answer 20

you get the patient to breathe in as they are making the effort
and blow out whilst they are doing it

eg when standing up - breathe in before you stand upon and then blow out as you stand up
note can be done with pursed lips

Question 21

is anxiety and SOB linked?

Answer 21

yes it is linked
can be a vicious cycle

Question 22

what is the STALL technique?

Answer 22

-stop what you are doing
-try and remain calm and turn up oxygen if necessary
-assume a position of comfort eg sitting leaning forward
-let yourself daydream and imagine yourself in a safe space
-let your breathing return to normal

Question 23

what do you do if a patient can’t talk because of breathlessness?

Answer 23

-you need to stop and slow down the activity or introduce breaks in activity
-NB education on pacing and management

Question 24

what are examples of medications for management of episodes of acute breathlessness?

Answer 24

-increasing supplemental oxygen for short period of time
-short acting bronchodilator eg inhaler