Pulmonary air clearance techniques Flashcards
Goals Of Chest PT
Prevent accumulation of secretions ↑ mobilization/drainage of secretions ↑ relaxation/avoid muscle splinting Maximize chest wall mobility Regain efficient breathing pattern Improve ventilation and vital capacity
Goals of Caridovascular Physical therapy
or CPT
Instruct in use of respiratory muscles Develop respiratory endurance ↑ cardiopulmonary exercise tolerance Prevent atelectases Maximize cough effectiveness
Purposes of Postural Drainage
Align segmental bronchi with gravity
Collect secretions centrally
Cough/Huff/Expectorate after each PD position to remove secretions
Can supplement with P & V
Airway Clearance Techniques think like active cycle breathing
Postural Drainage
Percussion and Vibration and Shaking
Active Cycle of Breathing
Autogenic Drainage
Coughing Techniques
How to drain the Anterior of Both Upper Lungs
Apical Segements of Both Upper Lungs
Posterior segements
Lingula
LLL
RLL
Posterior segements
Lingula from supine
Ant segs of BUL – supine or HOB 30*
Apical segs of BUL – sitting, slightly reclined
Post segs – Sitting leaning forward with pillows on lap
RML – ¼ turn from supine on Left (bathing beauty pose)
Lingula – ¼ turn from supine on Right (as above)
LLL – R sidelyling
RLL – L sidelying
Lingula – ¼ turn from supine
Review the picture on PPT to see different lobes
review pictrue slide 10 or around to see and visualize the different lobes
Regular trendelberg beg head or leg first what about the reverse
regular trendelenberg is basically an inversion table and the other “reverse” tredendberg is the head up first
Postural Drainage Contraindications just think like the various postioning and how they would cause increased pressure on various things
ICP > 20 mmHg Unstabilized head/neck injury Active hemorrhage Hemoptysis Empyema (effected plerual effusion) Bronchopleural fistula Pulmonary edema assoc with CHF (no posutral drainage with CHF)
Large pleural effusions PE Confused/anxious patients Rib fracture Surgical wound Post op where joint compression contraindicated
contraindications to using the trendelenberg
Neuro dx: Cerebral aneurysm, ICF drain, coma, recent CVA, uncontrolled sz
↑ ICP contraindicated
Uncontrolled HTN
Distended abdomen
Post esophageal procedures
GERD
Cardiovascularly unstable: Acute MI, pulmonary HTN, arrhythmia
Aneurysm, esp AAA Continuous tube feedings Unstable fluid balance: CHF, during HD, ascites Recent hemoptysis related to lung CA Uncontrolled airway, aspiration risk
Contraindications for the precussion think like contact issues like fractures, recently healed incsions things of that nature
Pneumothorax Platelets < 50,000 Cardiovascularly unstable pt Over rib fx or lesion Osteoporosis, CA mets, Prolonged steroid use Over surgery incisions/sternotomy Over recent graft, burn or wound
When blood too thin (↑ INR, etc.) Hemoptysis (common one) Undrained empyema Subcutaneous emphysema (air under skin ) PE Flail chest (rib fracture) Awaiting R/O for MI Acute TB Severe pain Recent spinal fusion
Explain vibration and shaking is it only used upon exhalation
Used in conjunction with Percussion or alone Gentler than percussion Uses flat hand Always go “down and in” Coordinate with exhale
Contradincations to vibration and shaking
Pneumothorax Platelets < 50,000 Cardiovascularly unstable pt Over rib fx or lesion, CA mets Over sx incisions/sternotomy Over recent graft, burn or wound Osteoporosis, prolonged steroid use (relative) When blood too thin (↑ INR, etc.) Hemoptysis Undrained empyema Subcutaneous emphysema PE Flail chest Awaiting R/O for MI Acute TB Severe pain Recent spinal fusion
What is the position for active cycle breathing
A secretion clearance technique which helps to mobilize and clear bronchial secretions by combining cycles of breathing control (BC), thoracic expansion exercises (TEE) and the forced expiratory technique (FET).
Position:
The ACBT can be done in sitting or in postural drainage positions. Use pillow support as needed to ensure relaxation and comfort. A minimum of 10 minutes is recommended in productive positions.
The steps to Active Cycle Breathing
Think shallow breathes. deep breathes and then cough deep
Step 1: Breathing Control (BC):
Take slow, relaxed breaths in through your nose and out through pursed lips. These breaths should not be full or a maximum effort; they should be shallow, relaxed breaths. Continue BC until you feel relaxed.
Step 2: Thoracic expansion exercises (TEE):
Take 3 – 4 deep breaths, expanding into your lung bases, place your hand on your side to feel for lower rib expansion. If coughing is triggered by deep breathing, return to BC.
Repeat Step 1 and Step 2
Continue to repeat Steps 1 & 2 until you feel you have mucus to clear.
Step 3: Forced Expiratory Technique (FET):
FET combines 1 – 2 forced expirations (huffs) and BC. To perform FET, take a medium sized breath (not full), open your mouth and slowly empty your lungs, contracting your abdominal muscles to squeeze the last of the air out of your lungs. Follow the huff with a period of BC. Or perform the summed/stacked breathing: breath in a little, pause, little more, pause, little more and convert to a huff or a cough.
Three types of coughing assitance
Splinted cough
Assisted or Quad cough
Tracheal stimulation
Phases of coughing (think of the glottis closing building pressure than opening again)
- Deep inspiration
- Glottis closes, pressure builds as expiratory muscles contract
- Glottis opens, trapped air is forcefully expelled
