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cardiopulmonary > Pulmonary Treatment > Flashcards

Pulmonary Treatment Flashcards

1
Q

Drainage for Anterior Upper Segments of Upper Lobes

A

Position: Angled 30-45 degrees backward in reclined seating

Percussion/Auscultation: Over trapezius between the clavicle anteriorly and the scapula posteriorly

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2
Q

Drainage for Posterior Apical Segment of the Upper Lobes

A

Position: Sit upright in bed/chair while learning forward

Percussion/Auscultation: Over trapezius muscle on top of shoulder

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3
Q

Drainage for Anterior Segments of Upper Lobes

A

Position: Supine (flat)

Percussion/Auscultation: Over pectoralis major muscle

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4
Q

Drainage for Right Posterior Segment of Upper Lobe

A

Position: Prone with pillow under Right shoulder creating a 1/4 turn upward

Percussion/Auscultation: Over scapula

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5
Q

Drainage for Left Posterior Segment of Upper Lobe

A

Position: HOB elevated (30-45 deg) & prone with pillow under left shoulder creating a 1/4 turn upward

Percussion/Auscultation: Over scapula

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6
Q

How should percussion be given?

A

Lightly with cupped hand(s)

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7
Q

What position is the best for providing vibration?

A

Extended elbows over patient

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8
Q

Auscultation vs Percussion/Vibration layers

A

Auscultation needs to be directly over the skin
Percussion/Vibration is typically over a shirt/layer

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9
Q

What kind of pressure is associated with vibration

A

Slight weight bearing pressure to assist in movement of secretions

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10
Q

How long do you percuss?

A

3-5 minutes

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11
Q

How long should the patient stay in the drainage position?

A

5-10 minutes MINIMUM - As long as the can to aid in secretion movement (ideally 20-30 mins)

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12
Q

Drainage for Right Middle Lobe

A

Position: Raise feet 12 inches so the head is downward. Left side lying with right shoulder rotated back towards bed. Place pillow under right shoulder. (Armpit for women)

Percussion/Auscultation: On the thoracic wall over the anterior portion from nipple to mid-axillary line (armpit-to-nipple)

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13
Q

Drainage for Left Lingula

A

Position: Raise feet 12 inches so the head is downward. Right side lying with left shoulder rotated back towards bed. Place pillow under left shoulder. (Armpit for women)

Percussion/Auscultation: On the thoracic wall over the anterior portion from nipple to mid-axillary line (armpit-to-nipple)

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14
Q

How long do you vibrate?

A

1-10 breaths - ONLY during exhalation

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15
Q

Drainage for Bilateral Anterior Segments of Lower Lobes

A

Position: Raise feet 18 inches so head is downward. Lie supine

Percussion/Vibration: Over thoracic wall on the anterior surface just above the inferior border of the rib cage

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16
Q

Drainage for Right Lateral Segment of Lower Lobes

A

Position: Left side lying with foot of bed raised 18 inches (Trendelenburg) with head downward

Percussion/Vibration: Over right thoracic wall in the mid-axillary line at the inferior border of the thorax

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17
Q

Drainage of Left Lateral Segment of Lower Lobes

A

Position: Right side lying with foot of bed raised 18 inches (Trendelenberg) with head downward

Percussion/Vibration: Over left thoracic wall in the mid-axillary line at the inferior border of the thorax

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18
Q

Drainage for Posterior Segments of Lower Lobes

A

Position: Prone with foot of bed raised 18 inches (Trendelenburg) with head downward

Percussion/Vibration: Over posterior thoracic wall just above the inferior border of the ribcage

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19
Q

Drainage for Superior Segments of Lower Lobes

A

Position: Prone with foot of bed flat

Percussion/Vibration: Over posterior thoracic wall just at the inferior angle of scapula

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20
Q

How many postural drainage positions are there?

A

Upper = 5
Middle = 2
Lower = 5
Total = 12

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21
Q

Order of Pulmonary Treatment

A

Airway Clearance
Breathing Techniques
Assisted Cough
Flexibility & Postural Reeducation
Strengthening
Energy Conservation
Patient/Family Education

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22
Q

Airway Clearance Techniques

A

Refer to manual or mechanical procedures that facilitate mobilization of secretions from airways. Includes: Percussion, vibration, postural drainage, active cycle of breathing, deep breathing, coughing & positive expiratory pressure

23
Q

Indications for Airway Clearance

A

Impaired mucociliary transport, excessive pulmonary secretions, ineffective or absent cough

24
Q

Guidelines to remember for Airway Clearance

A

Perform at least 30 minutes - 1 hour after a meal/tube feeding OR prior to eating
Monitor vitals due to thoracic pressure changes due to coughing
Inhaled bronchodilator meds should be given PRIOR to airway clearance and to enhance outcome
Repeat every 4-6 hours as needed

25
Q

Airway Clearance Precautions

A

Uncontrolled bronchospasm
Osteoporosis
Rib fx
Metastatic cancer to ribs
Tumor obstructions
Anxiety
Coagulopathy
Convulsive/Seizure disorder
Recent pacemaker placement

26
Q

Airway Clearance CONTRAINDICATIONS

A

Hemoptysis
Untreated tension pneumothorax
Platelet count < 20,000
Unstable hemodynamic status
Open wounds/burns in thoracic area
PE
Subcutaneous emphysema
Recent skin graft to thorax

27
Q

Postural Drainage Precautions

A

Pulmonary edema
Hemoptysis
Massive obesity
Large pleural effusion
Massive ascites

28
Q

Postural Drainage CONTRAINDICATIONS

A

Increased ICP
Hemodynamically unstable
Recent spinal fusion/injury
Recent head trauma
Diaphragmatic hernia
Recent eye surgery

29
Q

CONTRAINDICATIONS for Trendelenburg position

A

ICP > 20 mmHg
Uncontrolled HTN
Patients with ICP that should be avoided (neurosurgery, aneurysm, eye surgery)
Esophageal surgery
Distended abdomen
Recent gross hemoptysis related to lung carcinoma/radiation
Uncontrolled airway at risk for aspiration (tube feeding stopped 1 hour prior and started 1 hour after)
CHF
Cardiomegaly

30
Q

Components of Pulmonary/Chest PT

A

Postural drainage, percussion, vibration

31
Q

Active Cycle of Breathing

A

Breathing Control –> Thoracic Expansion –> Forced Expiration

32
Q

Active Breathing Protocol

A
  1. Breathing control
  2. 3-4 Thoracic Expansion
  3. Breathing control
  4. 3-4 Thoracic Expansion
  5. Breathing control
  6. Forced Expiratory Technique
  7. Breathing control
33
Q

What is the purpose of Active Cycle of Breathing?

A

Assist them with airway clearance!

34
Q

Purpose of Diaphragmatic Breathing

A

Manage dyspnea and improve oxygenation

35
Q

Purpose of Inspiratory Hold Technique

A

Gets air to poorly ventilated areas of lungs and aids in airway clearance

36
Q

Purpose of Paced Breathing

A

Controls dyspnea, especially during activty

37
Q

Purpose of Pursed Lip Breathing

A

Aids in dyspnea, especially with activity and emphysema

38
Q

What are the 3 normal breath sounds?

A

Vesicular, Bronchial & Bronchovesicular

39
Q

Vesicular Breath Sound

A

Soft, low pitched sound heard during inspiration. Only minimal during expiration.

Auscultated over peripheral lung fields

40
Q

Bronchial Breath Sound

A

Tubular sound - Low, high pitched sound heard equally upon inspiration and expiration

Auscultated over anterior chest and tracheal area

41
Q

Bronciovesicular Breath Sound

A

Softer version of bronchial sounds

Auscultated over junction of mainstem bronchi - Anterior 1st-2nd intercostal space near sternum & between scapulae posteriorly

42
Q

What are the two classifications for abnormal (adventitious) breath sounds?

A

Continuous (Wheezes) & Discontinuous (Crackles)

43
Q

What are Wheezes?

A

Continuous sounds with constant pitch & varying duration. Heard more on EXHALATION & associated with airway obstruction

44
Q

What are Crackles?

A

Discontinuous adventitious sounds that are brief bursts of popping bubbles or fire crackling. Either fine or course crackles. More common during inspiration & associated with restrictive or obstructive respiratory disorders

45
Q

What kind of effect will emphysema have on lung tissue density and sound transmission?

A

Both decrease - Lung tissue density decreases in emphysema, which makes it more difficult for sound transmission (resulting in decreased transmission)

46
Q

What kind of breath sounds are heard with Hyperinflation?

A

Weaker, softer sounds

47
Q

What kind of breath sounds are heard in the presence of consolidative pathologies like pneumonia?

A

Stronger, louder sounds

48
Q

What is Egophany?

A

Patient is asked to say “EE” while having their lung tissue auscultated. Normal results will sound soft and muffled - sounding like “EE”.

If it sounds like “AY” then there is consolidation present

49
Q

Why is the Tripod position used by patients?

A

Increases intra-abdominal pressure and lengthens the diaphragm, which increases the strength/tension relationship of the diaphragm for contraction during breathing – Relieving dyspnea

50
Q

Pursed Lip Breathing

A

Sign of COPD
Alleviates trapped air within the lungs & improves gas exchange. Decreases dyspnea & slows RR

51
Q

Paradoxical Breathing

A

Indicator of advanced COPD
Chest moves inward during inhalation rather than outward. Abnormal movement impairs effectiveness of inhale and limits oxygen intake

52
Q

What are the 5 steps of coughing?

A
  1. Deep inspiration (60% VC)
  2. Closure of Glottis
  3. Contraction of Chest Wall
  4. Opening of Glottis
  5. Forceful Expulsion of Air
53
Q

Name 4 standardized assessments that are appropriate for pulmonary patients

A

BORG, VRI, 6MWT, Gait Velocity

cardiopulmonary (8 decks)

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