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Acute Care Module 3 > Pulm PT > Flashcards

Pulm PT Flashcards

1
Q

what is the optimal position for cardiopulm function

A

upright and moving

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2
Q

what is Dean’s Hierarchy rankings (9)

A
  1. mobilization and exercise
  2. body positioning
  3. breathing control maneuvers
  4. coughing maneuvers
  5. relaxation/energy conservation
  6. ROM exercise
  7. postural drainage
  8. manual techniques
  9. suctioning
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3
Q

PTs should assess/reassess patients ________ the administration of pulmonary interventions

A

before, during, and after

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4
Q

what are the four most common education interventions for pulm patietns

A
  1. impact of environmental factors on disease
  2. pharm
  3. O2 delivery systems
  4. signs of disease exacerbation
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5
Q

what are the 7 components of chest PT

A
  1. postural drainage
  2. percussion
  3. vibration
  4. coughing
  5. breathing techniques
  6. suctioning
  7. mobilization
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6
Q

when do you stop providing airway clearance techniques

A

when the secretions reach the upper airway or the patient stops producing secretions

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7
Q

how do we know that chest PT is effective

A

reduction in rate of pulm infections

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8
Q

what are three important precautions regarding postural drainage

A
  1. may inc metabolic demand or worsen V/Q resulting in dec oxygenation
  2. trendelenburg in CHF/HTN/PE/obese/etc may increase cardiac pressure
  3. sidelying may hurt patients with orthopedic pathologies
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9
Q

what are the four contraindications to postural drainage

A
  1. hemorrhage/hemoptysis
  2. untreated acute conditions
  3. CV instability
  4. recent neurosurgery (increased ICP)
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10
Q

what is the most important way to determine which lob of the lung needs chest PT/postural drainage?

A

auscultation

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11
Q

how long should each postural position be maintained?

A

5-20 min per position and 30-40 min per session

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12
Q

what do you do after a postural drainage session?

A

encourage deep breathing and coughing

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13
Q

what are the five precautions/contraindications for percussion

A
  1. platelets <50,000 or hemoptysis
  2. orthopedic sites
  3. PE or unstable CV status
  4. chest wall pain
  5. open wounds
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14
Q

T/F: percussion should be performed with a thin layer covering the site to be percussed

A

true, place a thin cloth or hospital gown over the patient prior to tx

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15
Q

how long should percussion last

A

3-5 min per area

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16
Q

what should follow a percussion session

A

vibration, coughing, and/or suctioning

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17
Q

what are the five precautions and contraindications for vibration

A

same as percussion

  1. platelets <50,000 and hemoptysis
  2. orthopedic sites
  3. PE or unstable CV status
  4. chest wall pain
  5. open wounds
18
Q

how do you direct a vibration session

what comes after vibration

A

ask the patient to deep breathe for 3-5 cycles

apply vibrations during exhalation

coughing and/or suctioning should follow treatment

19
Q

how many generations of airways does coughing clear?

A

up to 7

20
Q

when making a cough as active as possible for a patient, how do you position them for success?

A

inhale with trunk extension and trunk flex during expiration

21
Q

how do you teach an effective cough? (3)

A
  1. have the pt place hand on abdomen
  2. take two deep huffs and make the “k” sound
  3. take a deep relaxing inhale followed by a sharp double cough
22
Q

coughing is not appropriate for emphysema patients, how would you instruct them to cough?

A

have them take small or medium breaths followed by huffs or a small series of coughs

23
Q

post op patients fatigue quickly if they max cough each time, how do you fix this problem?

A

have them use a series of coughs starting with a small breath/cough, then a medium breath/cough, and finally a large breath and cough

24
Q

what are three things you should avoid during coughing instruction

A
  1. avoid letting the pt gasp for air
  2. avoid uncontrolled coughing
  3. avoid forceful coughs with recent CVA/aneurysm (huff instead)
25
Q

how do you instruct a pt to huff?

A

have the pt take a deep breath then rapidly contract the abdomen while forcefully saying “ha ha ha”

26
Q

what are two manually assisted coughing techniques

A

Heimlich and anterior chest compression

27
Q

how do you encourage the Heimlich in supine?

A

heel of hand just above the navel and force up during a cough

28
Q

what are the three self-assisted techniques for coughing

A
  1. prone on elbows head flexion
  2. long sitting head throwing
  3. short sit Heimlich
29
Q

how does a cough-assist work

A

insufflator-exsufflator device gradually applies PAP followed by a rapid negative pressure that stimulates a natural cough

30
Q

how do HFCWC and HFCWO work

A

vest devices that inflate and deflate as the pt sits upright progressing from low-med-high spending 5-10 min at each frequency for a total of up to 30 min

31
Q

how does a therepep work

in what patient populations is this used

A

mask/mouthpiece provides resistance to (and a slightly active) expiration to prevent airway collapse

pneumonia and CF

32
Q

how does the active cycle of breathing technique work

A

breathing control > 3-4 deep breaths > breathing control > 3-4 deep breaths > breathing control > huffing followed by cough prn > repeat

33
Q

what is the ventilatory movement strategy for inspiration

A

trunk ext
shoulder flxn, abd, ER
upward gaze

34
Q

what is the ventilatory movement strategy for exhalation

A

trunk flxn
shoulder ext, add, IR
downward gaze

35
Q

why do we wanna do diaphragmatic breathing

A

to manage dyspnea, reduce atelectasis, and increase oxygenation, but it cant be used in COPD populations

36
Q

what are techniques to optimize diaphragmatic breathing

A
  1. use hand for stimulus

2. semi fowler > sitting > standing > walking

37
Q

when would we want to use sniffing and how do you teach it

A

in patients who are having difficulty with diaphragmatic breathing

place hands on stomach, sniff 2 times, and let is out slowly

38
Q

when do you use pursed lip breathing

A

copd patients and those who are short of breath

39
Q

what does pursed lip breathing do

A

slows expiration rate and increases inspired air volume

40
Q

T/F: patients should engage their abdomen when performing pursed lip breathing

A

false

41
Q

where are the three locations for segmental breathing

A
  1. posterior basal - pt leans forward on pillow and hands placed over post lower ribs
  2. right middle/lingula - pt sitting and hands just below axilla
  3. apical - pt sitting finger tips unilaterally below clavicle

Acute Care Module 3 (11 decks)

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