Reduced Lung Volume Treatment Flashcards
what is atelectasis?
Collapsed lung
what 3 positions are appropriate from reduced lung volume?
sitting upright
standing
side lying - inclined towards prone
why are supine or semirecumbant positions inappropriate with reduced lung volume?
reduces lung volume - therefore reducing the FRC –> closure of the airways during respiration
what position is appropriate for patients with unilateral pathology?
side lying towards prone - on the unaffected side
what is the progression of thoracic expanision exercises?
End inspiratory hold –> sniff –> resistance –> overpressure
what is the purpose of end inspiratory hold in TTE?
utilises collateral ventilation to open adjecent alveoli
how to explain end inspiratory hold?
breathe in as deeply as possible, then hold for 3 seconds on full inspiration
what is the purpose of the sniff?
further increases expansion to augment the collateral ventilation
how to explain the sniff?
breathe in deeply, hold for 3 seconds then sniff before exhaling
what is the purpose of resistance?
offers proprioceptive incentive to increase expansion
how to do resistance in TTE?
application of hands around the chest throughout all of inspiration - shoulde be propriceptive but not restrict movement
what is overpressure in TTE?
apply pressure at the beginning of inspiration to act as a stimulus to increase inspiration - release during mid-inspiration to allow full breath
what is the purpose of an incentive spirometer?
mechanical device - used mainly in surgical patients - visual feedback on the volume and flow rate they have achieved - encourages patients to breathe in slow & deep to improve lung volume
how to explain incentive spirometry to a patient?
sit upright - seal lips around mouthpiece and take a deep slow breath in - ‘as if you are sucking through a straw’ - try to keep the ball floating for as long as possible (or try to reach specific mark)
repeat 5-10 times
What is the purpose of inspiratory muscle training?
Improves inspiratory muscle strength in patients who are severely deconditioned (e.g. after a prolonged time on a ventilator)
How does inspiratory muscle training work?
IMT provides resistance to inspiration - increasing the load on the inspiratory muscles
Inspiratory resistance can be increased over time to cause overload and hypertrophy of the inspiratory muscles
(stronger the muscles, the more able to breathe deeply)
How to set the resistance of IMT?
Identify 1RM
Train at 60% of 1RM - 5-10 deep inspirations, then rest
What is CPAP?
Continuous Positive Airway Pressure
how does CPAP work?
applys positive pressure throughout the entire breathing cycle
what is the effect of CPAP?
increases FRC, reduces atelectasis & improves alveolar ventilation - tidal volume remains the same
pressure splints the airways open - preventing collapse
–> since the airways have not collapsed, there is increased surface area for gas exchange –> improved oxygenation
what is the effect of the Bird Respirator
maintains positive pressure during inspiration, returns pressure to normal during expiration - providing additional inspiration support to ventilate the lungs (FRC remains the same, TV improved)
What is non-invasive ventilation?
Combines increased pressure during inspiration and expiration - meaning airways remain splinted and increased inspiratory depth (improves FRC and TV)
What advice should be given to a patient with reduced lung volume?
Appropriate positioning - avoiding prolongued positions of lying down (ex. try to sit out for dinner times, when your family come etc)
Thoracic expansion - at least 10 times per waking hour
Why is exercise important in reduced lung volume?
Combines upright posture (for ventilation) with naural deep breathing
SHOULD BE FIRST LINE TREATMENT FOR REDUCED LUNG VOLUMES
Name 3 exercises appropriate for early mobilisation of patients with reduced lung volume?
Sit to stand (with support)
High knee marching in seated - with arms above head
Walking around the bed
