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Cardiopulmonary I > Pulmonary Interventions & ACTs > Flashcards

Pulmonary Interventions & ACTs Flashcards

1
Q

what does diaphragmatic breathing optimize?
what is it?

A

the use of diaphragm to breathe deeper than normal
conscious use of diaphragm to take deep breaths to use more lung capacity compared to resting tidal volume breathing

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2
Q

what are some benefits of diaphragmatic breathing?

A

strengthens diaphragm
improves ventilation and respiration
increases PaO2 and SpO2
activates parasympathetic and suppresses sympathetic
increases venous return, lowers BP
lowers stress and cortisol levels
facilitates relaxation

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3
Q

what position should your patient be in for proper diaphragmatic breathing?

A

lie in hooklying or with pillow under knees
- posterior pelvic tilt will encourage diaphragmatic breathing pattern

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4
Q

where should our patients put their hands on for diaphragmatic breathing?
– when should hands move?

A

place one hand on chest, one on abdomen
– hand on chest should remain still, hand on abdomen should rise

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5
Q

how should your breathing be during diaphragmatic breathing?

A

breathe in slowly –> fully inhaling and expanding abdomen
slowly let the abdomen down while breathing out

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6
Q

what is the benefit of pursed lip breathing?

A

pursed lips provide back pressure to small airways that maintain opening = improved gas exchange
by keeping airways open longer, air can be exhaled easier

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7
Q

pursed lip breathing promotes =
pursed lip breathing reduces =
pursed lip breathing facilitates =

A

RR
effort of breathing
relaxation, reduced stress response

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8
Q

what is the I:E ratio with pursed lip breathing?

A

1:2
exhale 2x longer than inhale

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9
Q

incentive spirometry can be used for:

A

assessment
intervention
education

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10
Q

incentive spirometry:
– prevents =
– practices =
– stimulates =

A

– passive atelectasis that can turn into PNA
– diaphragmatic breathing
– a cough

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11
Q

inhalation should be paired with:
– shoulder ___, ____, ____
– thoracic and cervical _____
– _____ eye gaze

A

– flexion, abduction, external rotation
– extension
– upward

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12
Q

exhalation should be paired with:
– shoulder ____, _____, ______
– thoracic and cervical ______
– _____ eye gaze

A

– extension, adduction, internal rotation
– flexion
– downward

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13
Q

what positions are useful in relieving dyspnea?

A

tripoding
trunk extension
sidelying
trunk elevation/sitting

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14
Q

why does tripoding work to relieve SOB?

A

anchoring distal muscle attachments allows proximal attachments to assist more effectively in thoracic cavity expansion

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15
Q

forward leaning tripoding can increase:

A

intraabdominal pressure and push diaphragm into a more lengthened position = stronger contraction

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16
Q

why does trunk extension work to relieve dyspnea?

A

allows for more effective thoracic cavity expansion

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17
Q

why does sidelying work to relieve dyspnea?

A

assists in superior lung expansion
not as restricting to the spine as supine may be

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18
Q

why does trunk elevation/sitting work to relieve dyspnea?

A

more upright position allows gravity to naturally pull the diaphragm down to create more space in the thoracic cavity

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19
Q

what are airway clearance techniques (ACTs)?

A

manual or mechanical procedures that facilitate mobilization of secretions from airways

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20
Q

what is our goal in performance of ACTs?

A

improved O2 transport –> critical for the patient to be able to progress towards any other functional goals

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21
Q

what things are the technique of ACTs based on?

A

pathophysiology and symptoms
medical stability
pt cooperation and adherence to techniques

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22
Q

what are the specific goals of ACTs?

A

optimize airway patency
increase V/Q matching
promote alveolar expansion and ventilation
increase or improve gas exchange

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23
Q

what are indications to use ACTs?

A

excessive pulmonary secretions
impaired mucociliary transport
ineffective or absent cough

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24
Q

when should ACTs be performed?

A

before or at least 30 minutes after the patient eats

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25
Q

what should be given before ACTs?

A

inhaled bronchodilators

26
Q

what should be given after ACTs?

A

inhaled antibiotics, steroids –> better deposition if after

27
Q

what is an ACT for increased ventilation during activity that enhances mucociliary transport?

A

exercise! - it is an ACT

28
Q

what is postural drainage (PD)?

A

assuming one or more body positions that allow gravity to assist with draining secretions from individual lung segments

29
Q

the segmental bronchus of the segment to be drained must be positioned ______ to the floor

A

perpendicular

30
Q

how long should each position be maintained during postural drainage?

A

> /= 5-10 minutes

31
Q

a child with CF has the worst consolidation of fluid in the left lateral lobe, which lobe should you treat first?

A

left lateral lobe –>
segment with worst airway clearance should be drained first

32
Q

what are precautions to postural drainage?

A

pulmonary edema
hemoptysis
massive obesity
pleural effusion
thoracic cavity structural deficits
ascites
GERD
cognition/behavior
ability to follow instructions

33
Q

what are contraindications to postural drainage?

A

increased ICP
hemodynamically unstable
recent esophageal anastomosis or surgery
recent spinal fusion or injury
recent head trauma
diaphragmatic or hiatal hernia
recent eye surgery

34
Q

if a patient has a contraindication or precaution to postural drainage, how do you BEST proceed?
a. don’t do it
b. modify the position
c. you don’t need to change anything

A

b. modify the position

35
Q

a PT suspects involvement in the posterior basal segment of lower lobes for an obese patient. which of the following is a BEST position to consider?
a. positioned on abdomen, with head down, with 2 pillows under hips with foot of table elevated 20 inches
b. positioned on abdomen, with head down, with no pillow under hips with table flat
c. positioned on abdomen, with head down, with 1 pillow under hips with table flat
d. positioned on abdomen, with head down, with 1 pillow under hips with foot of table elevated 20 inches

A

c. – because they are obese, you have to modify their position

36
Q

what is percussion?

A

loosening retained secretions performed manually or with device via rhythmical clapping with cupped hands

37
Q

what is vibration?

A

loosening retained secretions via exertion of pressure and oscillation during exhalation

38
Q

which technique can be used as an alternative if needed due to discomfort?

A

vibration

39
Q

what is the goal of vibration/percussion?

A

loosen secretions enough that the pt can expectorate them or they can be drained via PD

40
Q

what are precautions of percussion and vibration?

A

uncontrolled bronchospasm
osteoporosis/osteomyelitis
rib fractures
spinal or rib metastases
tumor obstruction of airway
anxiety
coagulopathy
seizure disorder
cognition/behavior/cooperation
recent pacemaker
other recent invasive line placement

41
Q

what are contraindications of percussion and vibration?

A

hemoptysis
tension PNX
thrombocytopenia < 20
hemodynamically unstable
thoracic burns or wounds
pulmonary embolism
subcutaneous emphysema
skin grafts or surgical flaps to thorax

42
Q

what is the first-line intervention to promote effective cough to address positioning and teaching proper cough techniques?

A

assisted cough

43
Q

what are the 4 stages of an effective cough?

A
  1. inhalation greater than tidal volume (> 60% of VC)
  2. closure of the glottis
  3. contraction of abdominal and internal IC muscles to provide a positive intrathoracic pressure
  4. sudden opening of the glottis and forceful expulsion of the inspired air
44
Q

what is the glottis?

A

opening between the vocal cords in the larynx

45
Q

what does the glottis do?

A

open and close with talking, coughing, breathing, swallowing, etc.

46
Q

how should you position your patient during an assisted cough strategy?

A

facilitate trunk extension –> inhalation
facilitate trunk flexion –> exhalation

47
Q

how can you maximize inspiratory phase during assisted cough strategies?

A

verbal cues
upright positioning
upward eye gaze
UE AROM
thoracic extension

48
Q

for exhalation during an assisted cough, what do you want to maximize?

A

intraabdominal and intrathoracic pressure via positioning or muscle contraction

49
Q

for increased cough strength, what should you tell your patient to do?

A

brace or splint abdomen

50
Q

what is an alternative to coughing?

A

huffing technique

51
Q

what does the huffing technique help do?

A

prevent bronchoconstriction or collapse of weak airways
stabilizes bronchial walls and support structures

52
Q

what is the huffing technique?

A

mouth open throughout, O shaped
glottis doesn’t close over the trachea
chest and abdominal muscle contraction
forced exhalation that sounds like a loud forced sigh

53
Q

huffing technique:
long and slow forced exhalation moves secretions:
short and strong forced exhalation moves secretions:

A

in from the distal periphery
more proximally to cough

54
Q

what is the active cycle of breathing?

A

series of maneuvers to emphasize independent secretion clearance from distal to proximal and thoracic extension

55
Q

the active cycle of breathing incorporates what 3 things?

A

normal breathing
deep inhalation
huffing

56
Q

what does the active cycle of breathing help prevent?

A

bronchospasm

57
Q

what does huffing help stabilize?

A

bronchial walls

58
Q

what position is the active cycle of breathing performed in? why?

A

sitting
helps avoid GERD

59
Q

focused thoracic expansion increases _____ and promotes ______ but allows air behind secretions to help ______

A

volume ; ventilation ; force them more proximally

60
Q

describe the 3 steps to active cycle of breathing:

A
  1. breathing control:
    – normal tidal volume breathing (in through the nose, out through the mouth)
  2. thoracic expansion:
    – 4-5 inhalations with hands on lower ribs to feel expansion
    – percussion/vibration with exhalation
  3. forced expiratory technique:
    – 1-2 deep huff cough techniques with strong abdominal contraction

Cardiopulmonary I (25 decks)

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