Pulmonary Interventions Flashcards
What are the primary muscles of Inspiration? (2)
What are the secondary/accessory muscles of Inspiration? (5)
Primary: diaphragm, external intercostals
Accessory: SCM, scalenes, Pec major, Pec minor, SA
Normal breathing rhythm is a 1:2 ratio with __ being half as long as __.
Breathing rhythm for COPD is a __ ratio d/t trapped air, incr. RV, & incr. work.
Normal RR = ___ breaths/min
COPD RR will be (more/less) than normal RR.
Normal breath character is quiet & effortless, abnormal is labored breathing
1&2) I:E ratio –> inspiration being half as long as expiration
2) 1:3-4 ratio
3) 12-20 breaths/min
4) more! (tachypnea (fast rate) + hypoventilation (shallow depth))
The diaphragm expands vertically & horizontally and is innervated by C___. It is made of Type __ muscle fibers (fatigue resistant). Diaphragmatic positioning & ROM are affected by stomach contents (distention), obesity, and what other 2 things?
1) C3-C5
2) Type 1 muscle fibers
3) body position/posture, obesity, size of organs, abd muscles
What are the muscles of expiration for quiet breathing? (2)
What are the muscles of expiration for FORCEFUL breathing? (4)
Muscles for forceful breathing __ the lower ribs & __ abd contents which pushes to diaphragm __.
1) Passive recoil of lungs & rib cage
2) Rectus abdominus, EO, TA, internal intercostals
3) depress
4) compress
5) up
Diaphragmatic breathing utilizes the diaphragm while limiting the ___ muscles during inspiration.
Indications for this tx are post-surgical pts, pts w/ __ at rest, and inefficiency w/ breathing/__ during ADLs.
1) accessory
2) dyspnea
3) SOB
Precautions/CI for diaphragmatic breathing include:
1) mod/severe __ w/ __inflation of lungs
2) pts w/ ___ breathing patterns
3) pts w/ increased dyspnea during diaphragmatic breathing
1&2) COPD w/ hyperinflation
3) paradoxical
Expected outcomes of diaphragmatic breathing are __ RR, decr. reliance on accessory muscles of inspiration, __ TV, improvement of dyspnea (subjective), & improved activity tolerance.
1) decreased RR
2) increased TV
Pursed-lip breathing is used to __ RR & __ dysnpea by maintain __ pressure in the bronchioles. This can help prevent airway collapse in pts with __ & help trapped air escape in pts w/ __. Indications include tachypnea & dyspnea. What is the only precaution/CI for pursed-lip breathing?
1) decr. RR
2) decr. dyspnea
3) positive pressure
4) emphysema
5) COPD
6) forcing exhalation
Expected outcomes of pursed-lip breathing include decr. RR & dyspnea, incr. TV & activity tolerance, & prevention of airway collapse in emphysema pts. What are 2 more expected outcomes?
1) Reduce PaCO2
2) Increase SaO2
Segmental breathing is intended to improve __ ventilation & tx pulmonary complications after surgery. The goal is to __ or __ chest wall movement through proper __ placements, verbal cues, or __ of breathing.
1) regional
2&3) facilitate or inhibit
4) hand
5) coordination
Segmental breathing is indicated for __ lung volumes, __ chest wall compliance, & ___ mismatch. What are the precautions/CIs associated with segmental breathing?
1) decreased
2) decreased
3) V/Q
4) NONE but be careful w/ pain/tenderness
Expected outcomes of segmental breathing are increased chest wall __, expand __ alveoli, & ___ loosening+clearance
1) mobility
2) collapsing
3) secretion
What is a very important to aid in airway clearance to help reduce risk of pneumonia?
Hint: Indicated for post-surgical pain, SCI (forced exp. muscles not innervated = T1-T12), & progressive weakness.
Coughing
Compensatory techniques available if pt can’t cough effectively
__/__ stimuli to the __, __, carina, or __ bronchi can cause a cough to be stimulated reflexively.
1&2) mechanical/chemical
3) larynx
4) trachea
5) lower
What are the 5 stages/components of a cough?
1) Deep inhalation
2) Glottis closes
3) Incr. pressure gradient
4) Glottis opens
5) Forceful movement of air
Post-surgical pts may need to splint chest/abdomen by applying pressure over incision w/ pillow or soft blanket roll
If pts cannot perform a directed cough, they can perform a __ cough. This cough is used to force expiration with the glottis open. It does not produce to airflow __ of a directed cough, but it helps decr. risk of __ __.
1) huff
2) velocity
3) airway collapse
Precautions/CIs for coughing are __ precautions w/ inability to control __, __ intracranial pressure, acute __ __, unstable head or neck injury, potential __, untreated pneumothorax, OP, & __ chest.
1&2) droplet precautions w/ inability to control secretions
3) elevated
4) acute MI
5) aspiration
6) flail chest
__/__ consists of positioning the pt properly so gravity aids in drainage of bronchial secretions f/b mechanical assistance to loosen secretion. Afterwards, pt is encouraged to __ to clear airway.
1) Percussion (cupped hands)/Vibration
2) cough (or huff)
If performing percussion/vibration here are some good tips to remember:
Anterior segment = __ positioning
Posterior segment = __ positioning
1) supine
2) prone
Name the segment we are working on with this positioning:
Bilateral Posterior Superior Segments
(Specifically Bilateral Superior Segmetns of the Lower Lobes)
Opposite of Bilateral Anterior Segments
flat/neutral
Name the segment we are working on with this positioning:
Bilateral Anterior Segments (lower lobes)
Opposite of bilateral Posterior Segments
lower lobes so 18 in. elevation
Name the segment we are working on with this positioning:
Bilateral Posterior Apical Segments (upper lobe)
Opposite positioning of bilateral anterior apical segments
apical = sitting up
Name the segment we are working on with this positioning:
Left Lingular
Remember: this is the left version of the Right Middle Lobe
Elevated 12 inches only!!!
Name the segment we are working on with this positioning:
Left Lateral Segment (lower lobe)
Opposite of Right lateral
Lower segment so raise 18 inches
Name the segment we are working on with this positioning:
Bilateral Posterior Segments (lower lobes)
Opposite of Bilateral Anterior segments (lower lobes)
elevated 18 inches
Name the segment we are working on with this positioning:
Right Lateral Segment (lower lobe)
Opposite of Left lateral
elevated 18 inches
Name the segment we are working on with this positioning:
Right Middle Lobe
Opposite of left lingular
Elevated 12 in
Name the segment we are working on with this positioning:
Left Posterior Segment (upper lobe)
Elevated for LEFT posterior segment
Always remember NONE of the positioning for the Left Lung is neutral
Name the segment we are working on with this positioning:
Bilat Anterior Apical Segments (upper lobe)
Opposite of Bilat Posterior Apical Segments (upper lobe)
inclined for upper segments
Name the segment we are working on with this positioning:
Bilateral Anterior Segments of Upper Lobe
Opposite of Bilateral Posterior Superior Segments
flat/neutral
Name the segment we are working on with this positioning:
Right Posterior Segment of Upper Lobe
Rememer R side is NOT elevated like L Posterior Segment
T/F: Percussion & Vibration are only done with exhalation.
False; PERCUSSION done during the whole resp. cycle
Precautions/CIs for percussion/vibration are similar to the ones for a cough. Six distinct precautions/CIs specific to percussion/vibration are acute __ injury, pulmonary __ associated with CHF (No positioning laying down), pulmonary __, rib fx, prolonged use of __, suspected __, & broncho__.
1) spinal
2) edema
3) embolism (PE)
4) corticosteroids
5) TB
6) bronchospasms
___ cycle of breathing technique starts w/ diaphragmatic breathing, then adds thoracic expansion for deep breathing, then a relaxed exhale, then huffs/cough, then ctrlled breathing. Expected outcomes are __ loosening/clearance, improved __, and improved effectiveness of __.
1) Active
2) secretion
3) ventilation
4) cough
main idea is practicing breath ctrl, deep breathing, & huffing/coughing in a cycle to clear chest
__ __ is staged breathing at different lung __ f/b huff/coughs to expectorate sputum. Expected outcomes of the technique include mobilizing secretions by creating __ forces induced by airflow: __ of expiratory flow helps shear secretions from bronchial walls.
1) Autogenic Drainage
2) lung volumes
3) shear forces
4) speed
An incentive spirometer is use to prevent __ by maximizing __ expansion w/ sustain max __. It gives visual feedback to encourage pt to take long, slow, deep inhalations. This intervention is VERY important for __-__ pts or those on prolonged __. When pt is awake, __ breaths should be done per hour.
1) actelectasis
2) alveolar
3) inhalation/inspiration
4&5) post-surgical pts or those on prolonged bedrest
6) 4-5 breaths/hour
As opposed to an incentive spirometer, the inspiratory/expiratory muscle trainer works to improve muscle strength of __ muscles. It creates positive pressure when __ to decrease air trapping. The strength of the instrument can also be adjusted!
1) inspiratory
2) exhaling
Acapella Flutter Device is a positive EXPIRATORY pressure device with mechanical oscillation. It creates circuit w/ lungs to allow for __ __. Most allow for __ & __ without the need to remove the device.
end with a cough
used for COPD, mucus break up
opens airways and vibrates
1) secretion mobilization
2&3) inhalation & exhalation
The Vest is great for ___ and more chronic pts in need for more regular airway clearance (CF, COPD, exacerbation, etc). It provides (intermittent/constant) (vibration/percussion) over all bronchopulmonary segments throughout the day. Secretions are removed AS SOON AS they loosen. What does this vest decr. the need for?
1) CHILDREN
2&3) CONSTANT PERCUSSION
4) decrease the need for a professional to do percussion
