PT Interventions 2 Flashcards
What is the active cycle of breathing (ACB) technique developed for?
To assist secretion clearance in patients with asthma
What are the components of ACB?
- Breathing control
- Thoracic expansion
- Forced expiratory technique
ACB: breathing control
Gentle, relaxed breathing
Done for 5-10 seconds
ACB: thoracic expansion exercise
3-4 deep, slow, relaxed inhalations to inspiratory reserve with passive exhalation
Chest percussion, vibration, or shaking may be combined with exhalation
ACB forced expiratory technique
1-2 huffs at mid to low lung volumes with the glottis open into the ERV
Brisk adduction of upper arms may be added to self-compress the thorax
ACB: precautions/contraindications
- Splinting postop incisions to achieve adequate expiratory force
- Bronchospasm or hyperreactive airways
How does AD work?
Uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing
Autogenic drainage is to improve airflow here
In small airways to facilitate movement of mucus
What are the 3 phases of autogenic drainage (AD)?
- Unsticking phase
- Collecting phase
- Evacuation phase
Autogenic drainage: unsticking phase
- slowly breathe in through nose followed by 2-3 second breath-hold (allows collateral ventilation to get air behind the secretions)
- exhale down into ERV
Autogenic drainage: collecting phase
breathe at tidal volume interspersed by 2-3 second breath holds
Autogenic drainage: evacuating phase
deeper inhalation’s from low-mid IRV with breath holding followed by a huff
Autogenic drainage: What may be used to control expiratory flow rate?
Exhalation through pursed lips
Autogenic drainage: average tx time
30-45 mins
Autogenic drainage: considerations
Requires motivation and concentration to learn
Directed coughing attempts to compensate for:
The patient’s physical limitations - to elicit a max forced exhalation
What is huffing?
Forced expiratory maneuver performed with glottis open (similar to fogging a pair of glasses)
How is huffing performed?
Contract abdominal muscles during rapid exhalation with open glottis
Say ha, ha, ha
Who should not perform huffing?
- Elevated ICP or known intracranial aneurysm
- Acute MI
- Acute head, neck, or spine injury
- Acute abdominal pathology
- Untreated pneumothorax
- Osteoporosis
- Flail chest
Huffing: safety considerations
- Increased risk of droplet transmission
- Potential for regurgitation/aspiration
High frequency airway oscillation devices
What do they do?
Acappella
Flutter
Combine positive expiratory pressure and high frequency airway vibrations to mobilize secretions in the airways
What is postural drainage and how does it work?
- Positioning the pt so that gravity will help drain bronchial secretions from specific lung segments toward central airways
- Can be removed by cough or mechanical aspiration
How long should a percussion tx last?
Several minutes
When should chest vibrations be performed?
During exhalation
How long should postural drainage positions be held?
2-3 minutes
Contraindications for postural drainage: ICP
ICP less than 20 mm Hg
Contraindications for postural drainage:
- Head and neck injury until stabilized
- Active hemorrhage
- Recent spinal surgery or acute spinal injury
- Active HEMOPTYSIS
- Empyema
- Pulmonary edema associated with CHF
- Large pleural effusion
- PULMONARY EMBOLISM
- Confusion/anxiety
- Rib fx, with or without flail chest
- Surgical wound or healing tissue
Trendelenburg position is CONTRAINDICATED for:
- Uncontrolled HTN
- Distended abdomen
- Esophageal surgery
- Recent hemoptysis related to lung carcinoma (treated surgical or with radiation)
- Uncontrolled airway at risk for aspiration (e.g. tube feeding or RECENT MEAL)
Which segments?
Pt in a sitting position, leaning back 30-40˚
Percussion and vibration performed above clavicles
Apical segments R and L upper lobes
Which segments?
Pt turned ¼ from prone on the L side with bed horizontal and head/shoulders raised on pillow.
Vibration and percussion performed around medial border of R scapula
Posterior segment of R upper lobe
Which segments?
Patient turned ¼ from prone on R side with head of bed elevated 45˚ and head/shoulders raised on pillow.
Percussion and vibration performed around the medial border of L scapula
Posterior segment L upper lobe
Which segments?
Pt turned ¼ from supine on R side with foot of bed elevated 12 inches.
Percussion and vibration are performed over the L chest between the axilla and the left nipple
Lingula and L upper lobe
Which segments?
Patient in supine with bed horizontal
Percussion and vibration performed below clavicles
Anterior segments of R and L upper lobes
Which segments?
Pt turned ¼ from supine on L side with foot of bed elevated 12 inches
Percussion and vibration over R chest between axilla and R nipple
R middle lobe
Which segments?
Prone with bed horizontal
Percussion and vibration below the inferior border of scapulae
Superior segments L and R lower lobes
Which segments?
Pt supine with foot of bed elevated 18 inches.
Percussion and vibration over lower ribs on L and R side
Anterior basal segments R and L lower lobes
Which segments?
Pt prone with foot of bed elevated 18 inches
Percussion and vibration over lower ribs on L and R side of chest
Posterior basal segments R and L lower lobes
Which segments?
Pt in sidelying with foot of bed elevated 18 inches.
Percussion/vibration over lower ribs
Lateral basal segments lower lobes
