Pulm PT Flashcards
what is the optimal position for cardiopulm function
upright and moving
what is Dean’s Hierarchy rankings (9)
- mobilization and exercise
- body positioning
- breathing control maneuvers
- coughing maneuvers
- relaxation/energy conservation
- ROM exercise
- postural drainage
- manual techniques
- suctioning
PTs should assess/reassess patients ________ the administration of pulmonary interventions
before, during, and after
what are the four most common education interventions for pulm patietns
- impact of environmental factors on disease
- pharm
- O2 delivery systems
- signs of disease exacerbation
what are the 7 components of chest PT
- postural drainage
- percussion
- vibration
- coughing
- breathing techniques
- suctioning
- mobilization
when do you stop providing airway clearance techniques
when the secretions reach the upper airway or the patient stops producing secretions
how do we know that chest PT is effective
reduction in rate of pulm infections
what are three important precautions regarding postural drainage
- may inc metabolic demand or worsen V/Q resulting in dec oxygenation
- trendelenburg in CHF/HTN/PE/obese/etc may increase cardiac pressure
- sidelying may hurt patients with orthopedic pathologies
what are the four contraindications to postural drainage
- hemorrhage/hemoptysis
- untreated acute conditions
- CV instability
- recent neurosurgery (increased ICP)
what is the most important way to determine which lob of the lung needs chest PT/postural drainage?
auscultation
how long should each postural position be maintained?
5-20 min per position and 30-40 min per session
what do you do after a postural drainage session?
encourage deep breathing and coughing
what are the five precautions/contraindications for percussion
- platelets <50,000 or hemoptysis
- orthopedic sites
- PE or unstable CV status
- chest wall pain
- open wounds
T/F: percussion should be performed with a thin layer covering the site to be percussed
true, place a thin cloth or hospital gown over the patient prior to tx
how long should percussion last
3-5 min per area
what should follow a percussion session
vibration, coughing, and/or suctioning
what are the five precautions and contraindications for vibration
same as percussion
- platelets <50,000 and hemoptysis
- orthopedic sites
- PE or unstable CV status
- chest wall pain
- open wounds
how do you direct a vibration session
what comes after vibration
ask the patient to deep breathe for 3-5 cycles
apply vibrations during exhalation
coughing and/or suctioning should follow treatment
how many generations of airways does coughing clear?
up to 7
when making a cough as active as possible for a patient, how do you position them for success?
inhale with trunk extension and trunk flex during expiration
how do you teach an effective cough? (3)
- have the pt place hand on abdomen
- take two deep huffs and make the “k” sound
- take a deep relaxing inhale followed by a sharp double cough
coughing is not appropriate for emphysema patients, how would you instruct them to cough?
have them take small or medium breaths followed by huffs or a small series of coughs
post op patients fatigue quickly if they max cough each time, how do you fix this problem?
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
what are three things you should avoid during coughing instruction
- avoid letting the pt gasp for air
- avoid uncontrolled coughing
- avoid forceful coughs with recent CVA/aneurysm (huff instead)
how do you instruct a pt to huff?
have the pt take a deep breath then rapidly contract the abdomen while forcefully saying “ha ha ha”
what are two manually assisted coughing techniques
Heimlich and anterior chest compression
how do you encourage the Heimlich in supine?
heel of hand just above the navel and force up during a cough
what are the three self-assisted techniques for coughing
- prone on elbows head flexion
- long sitting head throwing
- short sit Heimlich
how does a cough-assist work
insufflator-exsufflator device gradually applies PAP followed by a rapid negative pressure that stimulates a natural cough
how do HFCWC and HFCWO work
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
how does a therepep work
in what patient populations is this used
mask/mouthpiece provides resistance to (and a slightly active) expiration to prevent airway collapse
pneumonia and CF
how does the active cycle of breathing technique work
breathing control > 3-4 deep breaths > breathing control > 3-4 deep breaths > breathing control > huffing followed by cough prn > repeat
what is the ventilatory movement strategy for inspiration
trunk ext
shoulder flxn, abd, ER
upward gaze
what is the ventilatory movement strategy for exhalation
trunk flxn
shoulder ext, add, IR
downward gaze
why do we wanna do diaphragmatic breathing
to manage dyspnea, reduce atelectasis, and increase oxygenation, but it cant be used in COPD populations
what are techniques to optimize diaphragmatic breathing
- use hand for stimulus
2. semi fowler > sitting > standing > walking
when would we want to use sniffing and how do you teach it
in patients who are having difficulty with diaphragmatic breathing
place hands on stomach, sniff 2 times, and let is out slowly
when do you use pursed lip breathing
copd patients and those who are short of breath
what does pursed lip breathing do
slows expiration rate and increases inspired air volume
T/F: patients should engage their abdomen when performing pursed lip breathing
false
where are the three locations for segmental breathing
- posterior basal - pt leans forward on pillow and hands placed over post lower ribs
- right middle/lingula - pt sitting and hands just below axilla
- apical - pt sitting finger tips unilaterally below clavicle
