PT Interventions 3 Flashcards
Who should not perform diaphragmatic breathing?
- Moderate to severe COPD
- marked hyperinflation of lungs without diaphragmatic movement
- Pts with paradoxical breathing patterns or who demonstrate increased inspiratory muscle effort
pts with increased dyspnea during DB
What are the expected outcomes of diaphragmatic breathing?
- Decreased respiratory rate
- Decreased use of accessory muscles of inspiration
- Decreased respiratory flow rate
- Increased tidal volume
- Improved dyspnea and tolerance for activity
IMT =
Inspiratory muscle training
IMT attempts to strengthen:
- Diaphragm
- Intercostals
2 different types of IMT devices
- Flow resistive breathing
- Threshold breathing
Flow resistive breathing
- pt inspires through mouthpiece and adapter with adjustable diameter
- decreased diameter increases resistance to breathing
Threshold breathing
Requires buildup negative pressure before flow occurs through a valve that opens at a critical pressure
Inspiratory muscle training: expected outcomes
- increased inspiratory mm strength and endurance
- increased functional exercise capacity
- decreased dyspnea at rest and during exercise
Paced breathing used for
- decrease work of breathing
- prevent dyspnea during activity
Paced breathing: walking
Inhale 2 steps, pause
Exhale 4 steps
Paced breathing: stairs
- Inhale through nose while standing
- Exhale through pursed lips while stepping up/down 1-2 stairs
- Remain on step until breathing control restored
Paced breathing: lifting
- Inhale through nose while standing or sitting
- exhale through pursed lips while bending to reach the object, pause
- Inhale through nose while grabbing object
- Exhale through pursed lips while standing up
Pursed lip breathing (PLB) used for
- Reduction in respiratory rate
- Reduction in dyspnea
- Maintain small positive pressure in bronchioles
Why is it good to maintain small positive pressure in bronchioles?
May help prevent airway collapse in pts with emphysema
Pursed lip breathing: expected outcomes
- Decreased RR
- Relieve dyspnea
- Reduce PaCO2
- Improve tidal volume
- Improve SpO2
- Prevent airway collapse in emphysema pts
- Increase activity tolerance
What is segmental breathing used for?
To improve regional ventilation and prevent/treat pulmonary complications after surgery
Segmental breathing positioning
- Sitting position for basal atelectasis
- Sidelying with affected lung uppermost
- Postural drainage positions with affected lung uppermost to assist with secretion removal
How does the therapist help with segmental breathing?
- Apply firm pressure at end of exhalation to chest wall overlying area to be expanded
- Pt inhales deeply and slowly expands ribcage under therapist’s hands
- Therapist reduces hand pressure during pt’s inhalation
Indications for incentive spirometers (Sustained maximal inhalation -SMI)
- Decreased lung volume
- Decrease chest wall lung compliance
- Increased flow resistance from decreased lung volume
- Ventilation: perfusion mismatch
- Atelectasis or risk of atelectasis due to thoracic and upper abdominal surgery
- Restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm
Who should not use incentive spirometry?
Pts with mod to severe COPD with increased respiratory rate and hyperinflation
Incentive spirometry: expected outcomes
- absence of or improvement in signs of atelectasis
- decreased respiratory rate
- resolution of fever
- normal pulse rate
- normal chest x-ray
- improved PaO2
- Increased FVC and PEF
Why does the forward leaning position often provide relief from dyspnea for pts with lung disease?
- Optimizes length-tension relationship of the diaphragm
- Allows pec minor and pec major to assist in elevating the rib cage during inspiration
What is the reverse Trendelenburg position and what is it used for?
- Supine with head above trunk and LEs
- Decreases weight of abdominal contents on diaphragm and reduces resistance to movement during breathing
What is the Semi-Fowler’s position and what is it used for?
- pt supine with head of bed elevated to 45˚, pillows under knees for support
- used for pts with CHF or other cardiac conditions
