Positioning for VQ and breathing exercises Flashcards
What is the rationale behind using this treatment (Pain/Increase ROM/strengthen)? (positioning for VQ)
we want the most optimal VQ (1:1)
by positioning a patient correctly you can optimise their VQ ratio or help treat problems leading to mismatch, often used alongside other treatment techniques such as postural drainage and manual techniques
What are the physiological effects of the treatment/how does it achieve the aim? (positioning for VQ)
improved ventilation, enhanced perfusion, reduced work for breathing by eliminating respiratory muscle fatigue, improved oxygenation of blood and tissues
What structures are affected by the technique? (positioning for VQ)
alveoli
pulmonary vessels
IPP
position and function of the diaphragm
airways, by promoting the drainage of secretions
What principles are used in carrying out the technique? (positioning for VQ)
in a self ventilating adult in the upright position, the dependant lung (just above the bases) has the best VQ matching
Why is the IPP more negative at basal level?
weight of fluid in the pleural cavity
What level has larger alveoli but why is this a negative?
apical because of the weight of the basal region expanding them
but the smaller underinflated alveoli in the lung bases have greater potential to expand on inspiration
What is the analogy used for the difference between apical and basal lungs?
slinky spring
Why is there less perfusion in the apical region of the lungs?
volume and pressure of alveoli is high so it encroaches on the surrounding vessels, and gravity causes hydrostatic pressure in the blood vessels to be less above the heart, so less blood flow is directed to the apices
What are the 3 zones of the lungs, what are the characteristics of each and what has the best VQ?
Zone 1: apices, low blood flow and expanded alveoli leads to low blood flow and therefore high V/Q at 5:0
Zone 2: middle, potential to expand and good hydrostatic pressure, V/Q ration is about equal at 1:0
Zone 3: bases, alveoli aren’t very expanded, high blood flow, low V/Q at 0:5
What is the definition of ventilation and perfusion, then shunting and dead space?
V=rate at which gas enters or leaves the lungs
Q=process of delivery of blood to capillary bed
shunting=area with no ventilation
dead space=area with no perfusion
Precautions and Contraindications?
Precautions:
nausea, vomiting, dizziness
cv instability
raised ICP
recent thoracic, abdominal or spinal surgery
burns or wounds
Contraindications:
head and neck injury until stabilise
active haemoptysis (coughing up blood)
undrained pneumothorax (gas in air space) (chest pain, dry cough, bluish skin)
bronchopleural fistula-hole in the lung or bronchus
rib fracture
recent epidural or spinal infusion
pulmonary embolism
How does body positioning have an effect on VQ?
ventilation and perfusion will increase towards the dependant area of the lung (lung most affected by gravity)
for example, if someone is placed on their right side, the right lung is the dependant lung
What effect does mechanical ventilation have on VQ positioning?
normally inspiration occurs due to negative pressure within the IPS and alveoli, but with mechanical the air flow will take the path of least resistance so the non dependant lung is better ventilated.
What is the treatment procedure for positioning for VQ?
introduce yourself
explain purpose of treatment and check contraindications
gain informed consent to carry out treatment
ensure environment is suitable
position patient
observe effects of patient in this position
monitor patient carefully throughout the treatment for any adverse reactions and check they are comfortable and consent throughout.
after reassess the patient and check for any adverse effects
consider position to leave the patient in following treatment and ay advice you would give to other health professionals.
What is the rationale behind using this treatment (Pain/Increase ROM/Strengthen etc)? (breathing exercises)
target respiratory problems
breathe with minimal effort and encourage airflow in individuals with respiratory problems
What are the physiological effects of the treatment? (breathing exercises)
explained below
What structures are affected by the technique? (breathing exercises)
alveoli
diaphragm
respiratory muscles
abdomen
bronchioles
What principles are used in carrying out the technique? (breathing exercises)
pt modesty and safety considered
communicate regularly
Precautions and contraindications? (breathing exercises)
precautions:
acute medically unwell
acute unstable head, neck, or spinal injury
acute bronchospasm (muscles that line the bronchi tighten and lead to wheezing and coughing)
inadequate pain control
contraindications:
patients unable to participate as breathing exercises require an element of patient participation and understanding
What are 6 positions you can tell the patient to do when they are short of breath?
standing leaning forward with your elbows resting on something
standing leaning back against a wall, arms relaxed, feet one foot from the wall slightly spread apart
sitting leaning forward with elbows rested on knees, wrists and hands limp
sitting upright, wrists and hands limp, back against chair
sitting leaning forward with elbows resting on table, can use pillows to rest head on
high side lying, few pillows under head and shoulder, pillow between waist and armpit to stop sliding down the bed, knees and hips slightly bent
What should documentation look like for breathing techniques? (breathing exercises)
date, pt name and DOB
date pt VCG, contraindications checked
treated in upright sitting with pillow to support (Ex.)
taught and practiced breathing control
pt had good technique and able to practice independently
no adverse effects following treatment
print my name, signature
student physiotherapist
What is the treatment procedure for breathing exercises?
introduce yourself, gain informed consent to carry out treatment
ensure environment is suitable and position patient appropriately using pillow and a towel/blanket for comfort as required
carry out the breathing techniques, communicate regularly and provide feedback on their technique
ensure to monitor the patient carefully throughout for any adverse reactions, e.g. light headedness/dizziness and check they are comfortable with the technique and consent for you to continue
reassess patient and check for any adverse effect
What does ACBT consist of?
breathing control, thoracic expansion and forced expiratory technique/huff (FET)
(only cover BC and TE in level 4)
What is breathing control and what is it used for?
means normal gentle breathing at tidal volume, low effort, arms supported with upper chest, shoulders and hands relaxed.
breathing gently to be more calm and relaxed, to gain control of breathing, prevent increase in airflow obstruction and allow patients to feel more rested between the active and forced techniques of the cycle
How is the breathing control technique applied?
physio places hand over the abdomen
pt gently breathes in and concentrates on allowing the abdominal wall to rise gently under the physios hands, with the abdomen slowly sinking back to rest position when breathing out
upper chest and shoulders should maintain relaxed throughout
emphasis needs to be placed on the importance of regular practice which the pt can do by resting both hands over to abdomen to feel the mvmt caused by diaphragmatic movement not abdominal muscle contraction.
What is thoracic expansion and why is it useful?
deep breathing exercises that emphasis deep inspiration with quiet unforced expiration
emphasis is on increasing the lateral movement of the chest particularly towards the lower lobes of the lung
upper chest and shoulders relaxed
air can enter the lungs through pores of kohn (alveoli and neighbour) canals of lambert (alveoli and respiratory bronchiole) channels of martin (between 2 respiratory bronchioles)
the slow deep breaths allow the channels to be accessed more effectively which can allow air to move secretions and reflate collapsed alveoli
How to apply the forced expiration technique?
pt positioned appropriately
place palm of hand in midaxillary line over 7th and 8th ribs, fingers relaxed covering the posterior aspect of thorax
instruct pt to relax and breathe out, allowing ribs to sink down and in-not forced.
then apply mild pressure to the chest wall and instruct pt on the next inspiration to expand the lower ribs against your hand.
pressure released at the end of inspiration, but hands kept on chest wall and re-applied when the pt is ready to breathe again
