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Cardio Pulmonary > Pulmonary Interventions > Flashcards

Pulmonary Interventions Flashcards

1
Q

list primary and secondary muscles of inspiration

A
  1. Primary
    1. diaphragm
    2. external intercostals
  2. Secondary
    1. SCM
    2. scalenes
    3. pec major/minor
    4. serratus anterior
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2
Q

list muscles of expiration

A
  1. quiet breathing → passive recoil of lungs and rib cage
  2. forceful breathing
    1. Rectus abdominus
    2. external oblique
    3. transverse abdomnius
    4. internal intercostals
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3
Q

describe the rhythm, rate, depth and character that make up the normal breathing pattern

A
  1. Rate → 12-20 bpm
  2. Rhythm → I:E ration is 1:2
  3. Depth → deeper or shallower than normal tidal volume
  4. Character → quiet and effortless
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4
Q

how is rhythm different in disorders like COPD?

A

I:E ratio is 1:3 or 1:4 due to trapped air, increased residual volume, and increased work

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5
Q

describe an abnormal breathing pattern’s character

A
  1. labored breathing
  2. use of accessory muscles
  3. audible wheezes and crackles
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6
Q

describe the diaphragm

A
  1. aids in inspiration (C3-5)
  2. expands vertically and horizontally
  3. type 1 muscle fiber
  4. dome shaped
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7
Q

diaphragm position and ROM are affected by ____________

A
  1. body position and posture
  2. stomach contents (distension)
  3. size of intestines
  4. size of liver
  5. ascites
  6. abdominal muscles
  7. obesity
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8
Q

when is diaphragmatic breathing training indicated?

A
  1. post-surgical patients
  2. dyspnea at rest
  3. inefficiency with breathing/SOB during ADLs
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9
Q

precautions/contraindications for diaphragmatic breathing training

A
  1. moderate/severe COPD w/related hyperinflation of the lungs
  2. pts with paradoxical breathing patterns
  3. pts with increased dyspnea during diaphragmatic breathing
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10
Q

describe the procedure for diaphragmatic breathing training

A
  1. start in supine or with HOB elevated 30-45
  2. pts places one hand on the upper chest and the other just below the rib cage
  3. PT then instructs:
    1. “breath in slowly through your nose so that your stomach moves out against your hand.
    2. The hand on the chest should remain relatively still.
    3. Fell your abdomen gently rise into your hand
    4. exhale through pursed lips, let the hand on your abdomen descend, while the hand on your upper chest remains still”
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11
Q

list the expected outcomes for diaphragmatic breathing training

A
  1. decreased respiratory rate
  2. decreased reliance on accessory muscles of inspiration
  3. increased tidal volume
  4. subjective improvement of dyspnea
  5. improved activity tolerance
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12
Q

what is pursed-lip breathing

A

a technique utilized to reduce respiratory rate and decrease dyspnea by maintaining positive pressure in the bronchioles.

this can help prevent airway collapse in pts with emphysema and helps trapped air escape in pts with COPD

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13
Q

indications for pursed lip breathing

A
  1. tachypnea
  2. dyspnea
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14
Q

precautions/contraindications for pursed lip breathing

A

forcing exhalation

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15
Q

describe the procedure for pursed lip breathing

A
  1. start in supine or seated position
  2. PT then instructs
    1. breath in slowly through your nose with the mouth closed for 2 seconds
    2. pucker or purse your lips as if you were blowing out a candle, then gently breathe out through pursed lips, as if trying to make the candle flame flicker for a four count
    3. do not blow with force
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16
Q

list expected outcomes for pursed lip breathing

A
  1. decreased RR
  2. decrease dyspnea
  3. reduce PaCO2
  4. improve tidal volume
  5. improve O2 sats
  6. prevent airway collapse in pts with emphysema
  7. increase activity tolerance
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17
Q

what is segmental breathing?

A
  1. a technique intended to improve regional ventilation and treat pulmonary complications after surgery
  2. goal is to facilitate or inhibit chest wall movement through:
    1. proper hand placements
    2. verbal cues
    3. coordination of breathing
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18
Q

list indications for segmental breathing

A
  1. decreased lung volumes
  2. decreased chest wall compliance
  3. VQ mismatch
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19
Q

precautions for segmental breathing

A

none

but be careful with pain or tenerness

20
Q

when would you use segmental breathing?

A

when you notice that a pt has one side restricted during respiration

21
Q

describe the pt position for segmental breathing

A
  1. sitting position for basal atelectasis
  2. sidelying with affected lung uppermost
  3. supine or sitting for bilateral expansion
  4. postural drainage positions
22
Q

describe the procedure for segmental breathing

A
  1. therapist applies firm pressure at the end of exhalation over the area that needs more expansion
  2. pt inhales deeply and slowly expanding the rib cage under the therapist’s hand utilizing the tactile cue
23
Q

T/F: segmental breathing is a muscle training technique

A

FALSE
you are not actively pushing against the rib cage, rather you are providing a quick stretch like PNF

24
Q

list the expected outcomes for segmental breathing

A
  1. increased chest wall mobility
  2. expand collapsed alveoli
  3. secretion loosening and clearance
25
Q

what is the purpose of a cough?

A

very important to aid in airway clearance and help reduce risk of pneumonia

26
Q

when would you need to teach compensatory techniques for a cough?

A

if unable to cough effectively for a variety of reasons such as:

  1. post-surgical pain
  2. SCI with lack of innervation to forced expiratory muscles
  3. progressive weakness
27
Q

list the stages and components of a cough

A
  1. deep inhalation
  2. glottis closes
  3. increased pressure gradient
  4. glottis opens
  5. forceful movement of air
28
Q

what can stimulate a cough?

A

reflexively by a mechanical/chemical stimulus to the larynx, trachea, carina, or lower bronchi

29
Q

what is the purpose of a directed cough?

A

can compensate for pt’s inability to elicit max forced exhalation

30
Q

describe the procedure for a directed cough

A
  1. inhale maximally, close glottis and hold breath for 2-3 seconds
  2. contract the expiratory muscles to produce increased intrathoracic pressure against the closed glottis
  3. cough strongly 2-3x through slightly open mouth

*post surgical pts may need to splint the chest/abdomen by applying pressure over incision with a pillow or soft blanket roll

31
Q

what is the purpose of splinting during coughing in post-surgical pts?

A

can help absorb all the vibrations which will reduce pain during coughing

32
Q

what is a huff cough?

A

utilizes forced expiratory maneuver with glottis open

although it does not produce the airflow velocity a cough, it helps decrease the risk of airway collapse

33
Q

describe the procedure of a huff cough

A
  1. inhale deeply through an open mouth
  2. contract abdominal muscles during a rapid exhalation with glottis open saying “Ha Ha Ha”
34
Q

precautions/contraindications for Huff Cough

A
  1. droplet precautions with inability to control secretions
  2. elevated ICP
  3. Acute MI
  4. unstable head/neck injury
  5. potential aspiration
  6. untreated pneumothorax
  7. osteoporosis
  8. flail chest
35
Q

describe percussion/vibration

A
  1. consist of positioning the pt properly so that gravity aids in drainage of bronchial secretions
  2. followed by mechanical assistance to loosen secretions
  3. after completion, pt is encouraged to cough/huff to clear airway
36
Q

important things to remember with percussion

A
  1. skin must be covered (towel, t-shirt, hospital gown)
  2. therapist rhythmically strikes the chest with a cupped hand for 2-3 minutes per affected lung segment.
    1. can be done mechanically as well
  3. cough!
37
Q

important things to remember with vibration

A
  1. same positions as percussion
  2. therapist places one hand over the affected area on each side of the rib cage
    1. or hand over hand over affected segment
  3. therapist vibrates the chest wall as the pt exhales rhythmically and with downward pressure
  4. vibration in direction of rib movements during expiration
  5. cough!
38
Q

list precautions/contraindications for percussion/vibration

A
  1. elevated ICP
  2. unstable head/neck injury
  3. acute spinal injury
  4. PE associated with CHF
  5. PE
  6. Rib fracture
  7. osteoporosis
  8. prolonged use of corticosteroids
  9. suspected TB
  10. bronchospasm
39
Q

describe active cycle of breathing techniques

A
  1. start with relaxed diaphragmatic breathing (20-30 seconds) in sitting
  2. perform 3-4 deep breaths with added thoracic expansion
  3. may add inspiratory hold of 1-3 seconds
  4. relaxed exhalation
  5. may follow with huffs or FET as secretions move into large airways
  6. relaxed, controlled breathing
  7. repeat cycle 2-4x
  8. cough at end of 3 cycles
40
Q

list outcomes of active cycle of breathing technique

A
  1. loosen and clear secretions from the lungs
  2. improve ventilation in the lungs
  3. improve the effectiveness of a cough
41
Q

describe autogenic drainage

A
  1. staged breathing at different lung volumes
    1. start with small tidal breaths from ERV in sitting
      1. repeated until secretions are felt gathering in the airways (10-20 breaths)
      2. the cough is suppressed
    2. a larger tidal volume is taken for another series of 10-20 breaths
    3. followed by a series of larger (approaching VC breaths)
    4. followed by several huff or coughs to expectorate sputum
42
Q

T/F: if you have to cough early in autogenic drainage do so

A

FALSE

try to hold cough to the very end if possible

43
Q

list the outcomes of autogenic drainge

A
  1. mobilize secretions by creating shearing forces induced by airflow
  2. speed of expiratory flow helps mobilize secretions by shearing them from bronchial walls
  3. once mobilized, secretions are transported from the periphery of the airways to the central airways to be cleared
44
Q

describe how to use an incentive spirometer

A
  1. maximizes alveolar expansion utilizing sustained maximal inspiration
  2. gives visual feedback to encourage the pt to take long, slow, deep inhalations
  3. very important in post surgical pts or those on prolonged bedrest (atelectasis)
  4. 5-10 breaths per hour when awake
45
Q

what is an Acapella Flutter Device?

A
  1. positive expiratory pressure device with mechanical oscillation
  2. creates circuit with lungs to allow for secretion mobilization
  3. most allow for inhalation/exhalation without need to remove device
  4. end with cough
46
Q

describe The Vest

A
  1. great for children along with those in need of more regular airway clearance (CF, COPD exacerbation, etc.)
  2. provides percussion over surface area of all bronchopulmonary segments
  3. secretions are removed as they loosen

Cardio Pulmonary (21 decks)

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