Pulmonary Interventions Flashcards
PULMONARY:
in PT
- emerging practice not specialty
- PT: exercise training
PULMONARY: Breathing
relaxed - from to, purpose (3), used when (2)
DDB - other name, from to, position (2) + purpose (1=2), which rise more, reps, vital capacity what
RELAXED DIAPHRAGMATIC BREATHING
- tidal inspiration to tidal expiration (normal)
- purpose: maximize ventilation, dec accessory muscles, relaxation
- used when tired or SOB
DDB / LOWER CAGE
- from max inspire to max expire (ERV)
- position: semi-fowler or side-lying
- semi-fowler: contract abdomen = thoracic AP & medlat expansion
- abdomen rise > chest
- 3-5x
- vital capacity: includes IRV & ERV
PULMONARY: Breathing
stacking - for (4), how, prior to, done with (3)
pursed - ratio + purpose (5)
STACKING BREATHS
- for: pain, weakness, neuro (SCI), post-op
- how: small or moderate inhale then exhale 2x
- prior to huffs & coughs
- done with: ACBT, autogenic drainage, PEP
PURSED LIP BREATHING
- 1:2 (longer expiration)
- longer exhale = dec RR, dec dyspnea, delay small airway closure, more control airflow, calm anxiety
PULMONARY: Breathing
glossopharyngeal - other name, for (3), how
segmental - for (2), how, types (3)
GLOSSOPHARYNGEAL / FROG
- for: ventilatory dependent (high quadri, C3-C5 SCI)
- how: gulp air then tongue push back so pharynx can trap it
SEGMENTAL BREATHING
- for: chest asymmetry, dec mobility (pneumonia)
- how: PT apply inward downward push to target lobe
- unilateral lat costal, bilateral lat costal, posterior basal (pt lean forward then focus on lower ribs)
PULMONARY: Breathing
paced - for, how
dyspnea - for
PACED BREATHING
- for incorporating functional
- include rest periods
DYSPNEA RELIEVING POSITIONS
- semi-fowler, side-lying, sitting, upright
- for: ease breathlessness
PULMONARY: Cough
most what, effective til, effective (3), position (2), if thick secretions
phases 1 (1)
phase 2 (4=2)
phase 3 (1)
practice what
- most effective airway clearance
- effective til 7th tracheobrachial tree
- effective cough: sharp deep double
- position: sitting, lean forward
- if thick secretions = nebulizer first
PHASES
deep inhalation (maximally bring in)
hold breath 3SH
- glottis close, vocal chords tighten, abdomen contract
- inc intraabdominal & intrathoracic pressure
forceful/explosive expiration
- glottis open
- practice glottis closure by saying “K”
PULMONARY: Cough
coughing c splint - how, for (2), use
self assist - where
PT assist - where, position (2)
coughing with splint
- downward upward thrust
- for: painful, surgical wound
- use towel or pillow
self-assisted
- subcostal, fist
PT assisted
- subcostal, heel of hand
- semi-fowler or sitting
PULMONARY: Cough
tracheal stimulation - other name, for (2), how
huffing - other name, for, not for, how (2 steps) + must be what
TRACHEAL STIMULATION/TICKLE
- for: infants, disoriented
- 2 fingers pressure & circular on sternal notch = reflexive cough
HUFFING / FORCED EXPIRATORY TECHNIQUE
- for: weak diaphragm or abdominal muscles
- does not give shit about pressures
- mid to full inhalation = glottis still open –> “o” like fogging a mirror
- should be breath sound not wheezing
PULMONARY: Cough
ACBT - what (3), difficulty, reps & per day, stages (3)
- combined FET, bronchial drainage, manual
- easy to learn
- 4 cycles max, 3-4x/day
- stop if secretions out
breathing control (normal) –> thoracic expansion (DDB) –> by 3rd breathing control = huff or cough
PULMONARY: Cough
autogenic drainage - other name, what, TV what, difficulty, age
phase 1 - name, how (3), goal (2), volume
phase 2 - name, goal, volume
phase 3 - name, how, goal, volume
AUTOGENIC DRAINAGE / KETCHUP
- self drainage
- TV = relaxed breathing
- difficult to learn & need concentration so not for < 12y
phase 1 (unsticking)
- exhale maximally til you reach ERV –> inhale but not until TV –> exhale all again
- loosen mucus; focus on distal segments
- low volume
phase 2 (collecting)
- move mucus to middle airways
- low to mid volume
phase 3 (evacuating)
- inhale more than tidal inspiration
- move mucus out
- mid to high volume
PULMONARY: Cough
PEP - use (2), how (1=1=1=2), purpose
incentive spirometry - how, reps + per day, purpose (2), difficulty
respiratory resistance - purpose (2)
POSITIVE EXPIRATORY PRESSURE
- use flutter or acapella
- breathe through device = resistance = trap some air = residual for between alveoli & bronchioles
- purpose: secretion
INCENTIVE SPIROMETRY
- inhale = numbers go up = keep ball there for 3-5SH
- 10 reps, several/day
- purpose: prevent lung collapse & atelectasis in post-op (thoracic surgery)
- easy and can do alone
RESPIRATORY RESISTANCE TRAINING
- for strength & endurance
PULMONARY: Postural Drainage
stroke percussion vibration shaking - parameters, when done
position, total duration
trendelenburg what
- stroke & percussion: 3-5 mins
- vibration & shaking: 5-10 reps, during expiration
- position: 5-10 mins
- total: 45-60 mins
- trendelenburg: LE higher than head
PULMONARY: Postural Drainage
lobe positions & angles
upper lobe
- apicals: 30 deg head (sullivan)
- R&L: 18in 45 deg head (kisner), quarter prone
middle lobe
- lingula: 30 deg head (kisner) 16in LE (sullivan), quarter turn
lower lobe
- ant & pos basal: 45 deg head (kisner) 20in LE (sullivan)
- lateral basal: 45 deg head, 20in LE, quarter turn
- superior: flat, over scapula
PULMONARY: Post-Op
chest mob - if wound
thoracotomy - what + for (3), median & clamshell cut where, position, ROM
chest tube thoracostomy - for (2), use, how
CHEST MOB
- if wound/adhesion/scar = postpone Mx
THORACOTOMY
- chest access for lobectomy, pneumonectomy, segmemntal resection
- cuts: ant, pos, median (sternum), clamshell (subcostal)
- semi-fowler position, AROM except shoulder AAROM
CHEST TUBE THORACOSTOMY
- for drainage access (hemothorax/pneumo)
- use p-tube
- do functional with pt holding it & don’t stretch wound
PULMONARY: Post-Op
mechanical vent - d/t, intubation types (3) + Mx, weaning Mx
subcutaneous erythema - what, where (5), precedes, Mx
PTs IN MECHANICAL VENT
- d/t respiratory failure
- intubation: orotracheal nasotracheal tracheostomy (direct) = delay neck exercise
- weaning: do breathing exercises before surgery
SUBCUTANEOUS ERYTHEMA
- palpable crepitations in face neck chest axilla abdomen
- precedes pneumothorax
- don’t Mx
