Pulmonary - Pt position

Question 1

What is orthopnea

Answer 1

When someone lies flat that they have trouble breathing

Question 2

How is orthopnea defined

Answer 2

by pillows

Question 3

What population has trouble breathing when they lie flat

Answer 3

People with heart failure

Question 4

What are the advantages to being upright

Answer 4

(do not have to be standing - sitting in long sit is upright)

Ventilation is greatest in lower lung fields
least in apices –>
Beneficial because – greater concentration of alveoli at bases

Perfusion is greatest in bases 2° gravity - Will have ventilation and perfusion in the same place at the same time –> VQ matching

Also diaphragm will be assisted by gravity - will not have to work as hard to get diaphragm down

Lastly lung can expand in every direction

Question 5

What is the fancy word for the lung being able to expand in every direction

Answer 5

orthogonally

Question 6

What could be a benefit in supine

Answer 6

Better perfusion in the part that is dependent.

Question 7

What could be some disadvantages in supine

Answer 7

diaphragm level rises 2° losing assist from gravity
↓ lung volume
lungs expand more laterally because weight of habitus anteriorly and surface posteriorly block excursion

But not the best - therefore we want to minimize the amount of time out pts are in supine and maximize the amount of time out pts are in upright

Question 8

What are the advantages to having a pt side lying

Answer 8

The dependent lung will have getter perfusion and VQ matching and the top lung will have greater expansion/excursion

Question 9

If someone had a right lower lobectomy what would be the benefits of being right side lying

Answer 9

surgical drainage and greater perfusion to right side

Question 10

What considerations should you take with one chest tube

Answer 10

You never want a chest tube on the top draining down

Question 11

How should you position a patient with 2 chest tubes

Answer 11

Semi fowler position
or
Chair

Question 12

What is semi fowler

Answer 12

an inclined position where pt is on their back at a bed angle between 30 and 40 degrees

Question 13

How would you want to drain someone secretions or mucus out?

Answer 13

You would want them the opposite of how you would position someone to get rid of surgical drainage

Mucous drains from the periphery to the center

Question 14

When positioning what is more important to drain, surgical drainage or mucus

Answer 14

Surgical drainage! it is much more important that you get the post surgical fluid out of the person than that you manage the secretions effectively