Reduced Lung Volume Treatment

Question 1

what is atelectasis?

Answer 1

Collapsed lung

Question 2

what 3 positions are appropriate from reduced lung volume?

Answer 2

sitting upright
standing
side lying - inclined towards prone

Question 3

why are supine or semirecumbant positions inappropriate with reduced lung volume?

Answer 3

reduces lung volume - therefore reducing the FRC –> closure of the airways during respiration

Question 4

what position is appropriate for patients with unilateral pathology?

Answer 4

side lying towards prone - on the unaffected side

Question 5

what is the progression of thoracic expanision exercises?

Answer 5

End inspiratory hold –> sniff –> resistance –> overpressure

Question 6

what is the purpose of end inspiratory hold in TTE?

Answer 6

utilises collateral ventilation to open adjecent alveoli

Question 7

how to explain end inspiratory hold?

Answer 7

breathe in as deeply as possible, then hold for 3 seconds on full inspiration

Question 8

what is the purpose of the sniff?

Answer 8

further increases expansion to augment the collateral ventilation

Question 9

how to explain the sniff?

Answer 9

breathe in deeply, hold for 3 seconds then sniff before exhaling

Question 10

what is the purpose of resistance?

Answer 10

offers proprioceptive incentive to increase expansion

Question 11

how to do resistance in TTE?

Answer 11

application of hands around the chest throughout all of inspiration - shoulde be propriceptive but not restrict movement

Question 12

what is overpressure in TTE?

Answer 12

apply pressure at the beginning of inspiration to act as a stimulus to increase inspiration - release during mid-inspiration to allow full breath

Question 13

what is the purpose of an incentive spirometer?

Answer 13

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

Question 14

how to explain incentive spirometry to a patient?

Answer 14

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

Question 15

What is the purpose of inspiratory muscle training?

Answer 15

Improves inspiratory muscle strength in patients who are severely deconditioned (e.g. after a prolonged time on a ventilator)

Question 16

How does inspiratory muscle training work?

Answer 16

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)

Question 17

How to set the resistance of IMT?

Answer 17

Identify 1RM

Train at 60% of 1RM - 5-10 deep inspirations, then rest

Question 18

What is CPAP?

Answer 18

Continuous Positive Airway Pressure

Question 19

how does CPAP work?

Answer 19

applys positive pressure throughout the entire breathing cycle

Question 20

what is the effect of CPAP?

Answer 20

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

Question 21

what is the effect of the Bird Respirator

Answer 21

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)

Question 22

What is non-invasive ventilation?

Answer 22

Combines increased pressure during inspiration and expiration - meaning airways remain splinted and increased inspiratory depth (improves FRC and TV)

Question 23

What advice should be given to a patient with reduced lung volume?

Answer 23

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

Question 24

Why is exercise important in reduced lung volume?

Answer 24

Combines upright posture (for ventilation) with naural deep breathing

SHOULD BE FIRST LINE TREATMENT FOR REDUCED LUNG VOLUMES

Question 25

Name 3 exercises appropriate for early mobilisation of patients with reduced lung volume?

Answer 25

Sit to stand (with support)
High knee marching in seated - with arms above head
Walking around the bed