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NPTE Study: Cardiopulmonary > PT Interventions 2 > Flashcards

PT Interventions 2 Flashcards

1
Q

What is the active cycle of breathing (ACB) technique developed for?

A

To assist secretion clearance in patients with asthma

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2
Q

What are the components of ACB?

A
  • Breathing control
  • Thoracic expansion
  • Forced expiratory technique
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3
Q

ACB: breathing control

A

Gentle, relaxed breathing

Done for 5-10 seconds

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4
Q

ACB: thoracic expansion exercise

A

3-4 deep, slow, relaxed inhalations to inspiratory reserve with passive exhalation

Chest percussion, vibration, or shaking may be combined with exhalation

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5
Q

ACB forced expiratory technique

A

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

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6
Q

ACB: precautions/contraindications

A
  • Splinting postop incisions to achieve adequate expiratory force
  • Bronchospasm or hyperreactive airways
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7
Q

How does AD work?

A

Uses controlled breathing to mobilize secretions by varying expiratory airflow without using postural drainage positions or coughing

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8
Q

Autogenic drainage is to improve airflow here

A

In small airways to facilitate movement of mucus

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9
Q

What are the 3 phases of autogenic drainage (AD)?

A
  1. Unsticking phase
  2. Collecting phase
  3. Evacuation phase
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10
Q

Autogenic drainage: unsticking phase

A
  • 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
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11
Q

Autogenic drainage: collecting phase

A

breathe at tidal volume interspersed by 2-3 second breath holds

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12
Q

Autogenic drainage: evacuating phase

A

deeper inhalation’s from low-mid IRV with breath holding followed by a huff

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13
Q

Autogenic drainage: What may be used to control expiratory flow rate?

A

Exhalation through pursed lips

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14
Q

Autogenic drainage: average tx time

A

30-45 mins

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15
Q

Autogenic drainage: considerations

A

Requires motivation and concentration to learn

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16
Q

Directed coughing attempts to compensate for:

A

The patient’s physical limitations - to elicit a max forced exhalation

17
Q

What is huffing?

A

Forced expiratory maneuver performed with glottis open (similar to fogging a pair of glasses)

18
Q

How is huffing performed?

A

Contract abdominal muscles during rapid exhalation with open glottis

Say ha, ha, ha

19
Q

Who should not perform huffing?

A
  • Elevated ICP or known intracranial aneurysm
  • Acute MI
  • Acute head, neck, or spine injury
  • Acute abdominal pathology
  • Untreated pneumothorax
  • Osteoporosis
  • Flail chest
20
Q

Huffing: safety considerations

A
  • Increased risk of droplet transmission

- Potential for regurgitation/aspiration

21
Q

High frequency airway oscillation devices

What do they do?

A

Acappella
Flutter

Combine positive expiratory pressure and high frequency airway vibrations to mobilize secretions in the airways

22
Q

What is postural drainage and how does it work?

A
  • 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
23
Q

How long should a percussion tx last?

A

Several minutes

24
Q

When should chest vibrations be performed?

A

During exhalation

25
Q

How long should postural drainage positions be held?

A

2-3 minutes

26
Q

Contraindications for postural drainage: ICP

A

ICP less than 20 mm Hg

27
Q

Contraindications for postural drainage:

A
  • 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
28
Q

Trendelenburg position is CONTRAINDICATED for:

A
  • 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)
29
Q

Which segments?

Pt in a sitting position, leaning back 30-40˚
Percussion and vibration performed above clavicles

A

Apical segments R and L upper lobes

30
Q

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

A

Posterior segment of R upper lobe

31
Q

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

A

Posterior segment L upper lobe

32
Q

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

A

Lingula and L upper lobe

33
Q

Which segments?

Patient in supine with bed horizontal

Percussion and vibration performed below clavicles

A

Anterior segments of R and L upper lobes

34
Q

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

A

R middle lobe

35
Q

Which segments?

Prone with bed horizontal

Percussion and vibration below the inferior border of scapulae

A

Superior segments L and R lower lobes

36
Q

Which segments?

Pt supine with foot of bed elevated 18 inches.

Percussion and vibration over lower ribs on L and R side

A

Anterior basal segments R and L lower lobes

37
Q

Which segments?

Pt prone with foot of bed elevated 18 inches

Percussion and vibration over lower ribs on L and R side of chest

A

Posterior basal segments R and L lower lobes

38
Q

Which segments?

Pt in sidelying with foot of bed elevated 18 inches.

Percussion/vibration over lower ribs

A

Lateral basal segments lower lobes

NPTE Study: Cardiopulmonary (23 decks)

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