Pulmonary Treatment Flashcards
Airway clearance techniques include:
Percussion
Vibration
Postural drainage
Active Cycle of Breathing
Coughing
Positive Expiratory Pressure
*Optimize airway patency, promote alveolar expansion/ventiliation, INC gas exchange
Indications for airway clearance include:
Impaired mucociliary transport
Excessive pulmonary secretions
Ineffective/absent cough
What should pts be given before performing airway clearnace techniques?
Bronchodilator meds to enhance overall outcome of intervention
PRECAUTIONS for Percussion/Vibration include:
Uncontrolled bronchospasm
Osteoporosis
Rib fx
Cancer to ribs
Tumor
Anxiety
Seizures
Pacemaker
CONTRAINDICATIONS for Percussion/Vibrations include:
Hemoptysis (coughing up blood)
Pneumothorax
Platelets below 20,000
Unstable hemodynamic wound
Open wounds
Pulmonary Embolism
Emphysema
Skin graft
Postural Drainage =
Gravity assisted positions to mobilize secretions from lobes of lungs –> large airways –> expelled
Postural drainage PRECAUTIONS
Pulmonary edema
Hemoptysis
Obesity
Pleural effusion
Massive ascites
Postural drainage CONTRAINDICATIONS
INC ICP
Hemodynamically unstable
Spinal fusion
Head trauma
Diaphragm hernia
Eye surgery
How do you know if chest PT was effective?
Changes in:
- Sputum production
- Lung sounds
- Subjective responses to PT (“I can take a deeper breath”)
- Vital signs
- Chest x-ray
- ABG or O2 sat levels
- Ventilator variables
Active cycle of breathing
Repetition of
1. Breathing control (relaxed breathing/w/ diaphragm, put hands on belly)
- 3-4 Thoracic expansion (hands on ribs)
- Breathing control
- 3-4 TE
- Breathing control
- Forced expiratory technique (breathing control + huffing, cough)
- Breathing control
What’s a major pro to teaching a pt active cycle of breathing?
Just as effective as percussion, but they can do it on their own!
Coughing using UE and LE
*Airway clearance
PNF
Inhale combo with trunk extension & elevate UE
Exhale combo w/trunk flexion & lower UE
Maximizes intrathoracic & intra-abdominal pressures with contractions & trunk movement
Facilitate inspiratory effect =
Breathe in
Shoulder FLEX + ABD + ER + look UP
Facilitate exhalation =
Breathe out
Shoulder EXT + ADD + IR + look DOWN
How could you instruct your pt to position their pelvis to help engage diaphragm?
POST tilt
Whats another way you could teach someone how to engage their diaphragm?
Sniff!
What are some positions you could teach that would relieve dyspnea??
- Standing - lean forward on supported hands
- Sitting - lean forward, elbows supported on knees
- Sitting - Lean forward while laying upper body/head on pillow
Why do the dypsnea relief positions work?
Leaning on UE =
INC intraabdominal pressure rises & pushes the diaphragm up = relief
Enables the accessory muscles to be able to act on the rib cage & thorax for greater expansion & inspiration
Describe what the dyspnea scale is:
- Mild - Noticeable to pt, but NOT observer
- Some difficulty - Noticeable to observer
- Moderate difficulty, but can continue
- SEVERE difficulty - pt can NOT continue
Where do you want your pt to be on dyspnea scale while exercising?
Want them at a 2-3
Huffing
*Cough technique/airway clearance
*If pt is unable to cough
Take a deep breath in & breath out in rapid exhalations (like fogging a mirror)
Allows you to move secretions from small airways to large airways to be coughed out
“Like fogging up a mirror”
Pursed lip breathing
*Decrease dyspnea symptoms (esp w/activity)
Slows HR, slows RR, decreases pressure and reduced airway collapse during expiration
*Clinical sign of COPD
Inhale through the nose for several seconds with the mouth closed and exhale over 4-6 seconds through lips in a whistle position
Diaphragmatic Controlled breathing
*Manage dyspnea, reduce atelectasis & inc oxygenation
Goal = DEC accessory muscle usage & inc diaphragm
-Position pt in posterior pelvic tilt
-Have pt sniff to demo diaphragm
-Pt hands on stomach, sniff 3x, & exhale
How could you progress diaphragmatic controlled breathing?
Reducing number of sniffs to eventually not sniffing just regular relaxed breathing
-transition to sitting, standing
How could you regress diaphragmatic breathing?
Semi-fowler or SL to for gravity eliminated position
- can add scoop resisted technique
Paced Breathing
*Control dyspnea/breathing (esp w/activity)
Typically timed/coordinated with activity/exercise
Inhale with rest & exhale during contraction/work
Inspiratory Hold
Airway clearance
Improves flow of air to poorly ventilated regions of the lungs (gets behind secretions)
Hold breath at peak of inspiration for 2-3 seconds & do relaxed exhale
Can be combined with vibration
Splinting
Improve pt’s ability to cough
Hold pillow & squeeze cough
Controlled cough
*For WEAK cough
Use especially if pt needs verbal cueing
Take 3 total breathes & on the 3rd breath cough firmly
Can squeeze pillow or towel on chest (like splinting)
Costophrenic Assist
*For pt who are too weak to GENERATE cough
Pt is supine with PT hands on bottom angles of the rib cage
Pt takes normal breathes until instructed to hold the air in & then cough
During cough, PT squeezes ribs together & POST pressure to enhance force of pt’s exhale (squeeze them together & push down toward table)
Heimlich Assist
*Use for FLACCID pts to generate cough
Use if not responding to other techniques
Pt supine and is instructed to take several normal breaths & then a deep breath in
As pt takes deep breath, PT quickly pushes under the diaphragm with the heel of the hand (near the base of the sternum)
ANT Chest Compressions
*Used for very weak pt to assist in generating a cough
PT has one forearm under clavicles & other under ribcage
PT supinates/diagonally pulls arms together as pt tries to cough (the V one)
**More effective than costophrenic bc it adds compression
Incentive Spirometer
*Practice diaphragmatic breathing
*Prevent or reduce atelectasis *Stimulate cough
Emphasis for pt who have weak cough & abdominals + post surgery
Sit EOB
Spirometer kept upright
Lips tight around mouthpiece
Breathe in slowly & deeply as possible Hold breath as long as possible then exhale slowly
10 reps every hour
*move indicator on the side to track progress
Inspiratory Muscle Training
*S&S of dec strength or endurance of diaphragm & intercostal muscles
Use handheld device for resistance training
2x/day for 15-30 minutes
Thoracic and Upper Bpdy Stretching using Towels
*For pt has reduced mobility
Can place a towel or foam roller down the spine for anterior chest wall mobility
Can place pt SL over a towel to inc lateral chest wall mobility
Can include elevating UE to inc stretch
Seated with bilateral UE PNF patterns
