Pulm part 2

Question 1

How is postural drainage similar in children and infants?

Answer 1

Children- Positions are similar–depending on the size of the child, may need special equipment for percussion.

Infants- Avoid “head below horizon”. Can cause a reflux of stomach contents to enter into esophagus.
- may need to do more than 1x per day for children and infants for an average of 30 mins (AM and PM)

Question 2

What are points for educating on postural drainage and percussion?

Answer 2

1. Demonstrate how Tx is done
2. Role of the pt (females vs males) (age considerations)
3. Avoid complicated language
4. Point out the benefits (Have the parent listen in [to crackles] for example)
5. Reinforce the proper procedures…point out common mistakes

Question 3

What are things to check before you begin PD and P with children?

Answer 3

1. Materials need to be gathered. Tissues, cups, pillows, bean bag chairs, towels, Ipod, H2O
2. Parent positioning (holding infants or small children)
3. Experiment on positioning

Question 4

How is positioning with infants and children different from adults?

Answer 4

for infants, it is more global

• adults is much more specific
• only positioning for posterior UL, anterior UL, sidelying, LL anterior, and LL posterior

Question 5

how does percussion with infants and children different from adults?

Answer 5

Force is much smaller; requires less force and time, but rhythm is same

• watch for pain signals
• if not getting mucus, increase force

after percussion apply vibrations; helps loosen and move mucus; pt takes large inhale then upon long exhale, apply vibrations

after vibrations huff and cough; aim to do 2-3 rounds of huff before cough

Question 6

what is the proper postural drainage position sequence?

Answer 6

sidelying –> prone –> supine

• sequencing is key to make sure mucus doesn’t go back down
• anything with head elevated should be done last

Question 7

manually assisted technique of coughing that gives tactile cuing at ribs plus support with exhalation; builds up pressure in intrathoracic cavity

Answer 7

costophrenic

- breathing into hands for diaphragmatic expansion

Question 8

manually assisted technique of coughing that applies pressure to a small area with quick movement with exhalation; use if manual assisting of inhalation is not possible

Answer 8

heimlich

- for CP, deep brain strokes, SCI, etc

Question 9

manually assisted technique of coughing where hands are on upper and lower chest; when exhaling, angle of hands is like a “V”

Answer 9

Anterior chest ("V") upper and lower
- never use if hyper mobile

Question 10

manually assisted technique of coughing in sidelying with rotation to facilitate inhalation and de0rotation to facilitate exhalation

Answer 10

counterrotation assist

Question 11

utilizes expiratory airflow to mobilize mucus from the smaller airways first and moving into central airways last for productive coughing; expiratory flow to mobilize secretions; certain advantages in how it builds up the mucus as a choice over postural drainage & percussion; can be alone and in a sitting positiona; large volumes of secretions

Answer 11

Autogenic drainage

- 12 years is appropriate to train

Question 12

What are the 3 phases of autogenic drainage?

Answer 12

1. The Unsticking Phase: Unsticking the mucus in smaller airways at low lung volumes; breathe in fully, pause 2-3s
2. The Collecting Phase: Collecting the mucus from the middle airways by breathing at low to mid lung volumes
3. Evacuating the mucus [that you’ve built up] from the central airways by breathing at mid to higher lung volumes

Question 13

Go through the steps of autogenic drainage.

Answer 13

1) Clear the upper airways (nose and throat) by huffing or blowing one’s nose.
2) Breathing in: Slow breathe in to keep airways open
3) always breathe in a normal sized breath, but it depends on where the mucus is located. - Low Volume (distal), to medium lung volume, to high lung volume (central)
4) Pause (let airways fill evenly to get some air behind the secretions…vent/perfusion ratio)
5) Breathing Out (Mouth preferred); Open glottis - Do not slow down the expiratory airflow (meaning no pursed-lip breathing, etc). In low lung volumes; “sigh”out. If you force your breath out, too much compression causing a wheeze; When breathing out, “rattling” should be heard; vibration should be felt; High frequencies (mucus is in small airways); Low frequencies (mucus is in large airways)—USE THIS FEEDBACK; Low lung volumes require abdominal muscles
6) Progress through Collecting phase: Inhale slowly is key to prevent mucus from being pulled back down. Cough/Huff when the urge is present.
7) Progress to Evacuation: Higher volume
8) 20-45 minutes for max benefit; experiment with positions for maximum benefit - Each phase is 2-3 minutes – do each level for 2-3 mins (progress through each one); Rest 1-2 minutes, Repeat AD (autogenic drainage),; Never over an hour; Minimum – 2x’s per day (morning and night)

Question 14

breathing technique that allows for greater voluntary ventilation in patients with high level SCIs; Pts learn to create a pocket of negative pressure within buccal cavity by maximizing the internal space, causing the outside are to rush in. the patient then closes off the entrance and proceeds to force the air back and down the thought with a stroking maneuver of the thought, pharynx, and larynx; this is the only means of ventilation when pt has been disconnected from a ventilator or phrenic nerve stimulator

Answer 14

glossopharyngeal breathing