Role of PT in Respiratory Diseases

Question 1

Monitoring

Answer 1

> O2 sat levels (pulse oximeter)
BP and HR: before, during, and after.
Peak flow or Incentive Spirometry measurements: taken to evaluate response to treatment.
Dyspnea scale: American Thoracic Society Dyspnea Scale, Borg scale, and simple VAS.
Breathing exercises and postural drainage and percussion with vibration tq.
General pulmonary hygiene tq and teach bed mobility exercises, mobility programs, and use of O2 therapy.

Question 2

Postural Drainage and Airway Clearance techniques

Answer 2

Place patient into a position such that the bronchial segment will drain, with the aid of gravity, into the larger bronchi.
Direction of the bronchi of the segment to be drained facing up into the air against gravity.

Question 3

Contraindications of Postural Drainage (PD)

Answer 3

All postural drainage:
> Pulmonary edema with congestive heart failure.
> High IC pressure.
> Pulmonary embolism.
> Rib fractures.
> Empyema/hemoptysis/extensive pleural effusions.
> Recent head and neck trauma or spinal surgery or injury.
> Bronchopleural fistula after pneumonectomy.
> Patients con confusion (no contraindication, precaution needed).

Trendelenburg PD (head down):
> Post-esophageal surgery.
> Lung carcinoma with hemoptysis.
> Any patient at risk for aspiration.
> Post-thoracotomy surgery.

Percussions/shaking:
> OP/Osteomyelitis of ribs or rib fx.
> In presence of chest burns or skin grafts on chest.
> Surgical emphysema.
> Chest wall pain/lung contusions.
> Bronchospasms.
> In recent spinal anesthesia or pacemaker placement.
> In the very old or anxious (no contraindication, precaution needed).

Vibrations:
> May be performed in many of the above situations.

Question 4

Coughing and Huffing techniques

Answer 4

Effective cough: take a deep breath and then tighten the abdominals before attempting to cough.

Huffing (aka Forced Expiration Technique FET or Active Cycle of Breathing Technique ACBT): performed by inhaling deeply and then exhaling forcefully either once or twice in a row, keeping the mouth open, without actually trying to cough.

Question 5

Breathing Exercises (general considerations)

Answer 5

> Relaxation plays an important part in effective breathing control.
Watch out for continuous use of accessory inspiratory muscles.
Apical breathing is typical and is ineffective for ventilation of lung bases.
Watch out for reversed abdominal breathing.

Question 6

Breathing Exercises (diaphragmatic breathing)

Answer 6

> Place pt in relaxed position (supine, pillow under knees and head).
Instruct to allow abdomen to relax during inspiration and flatten during expiration.
Gentle, relaxed breathing pattern is encouraged.
Gradually teach pt to use this pattern in ADL and specific exercise routines.

Question 7

Breathing Exercises (lateral costal breathing)

Answer 7

> Used to expand the basal segments of lungs.
PT places hands on lower lateral aspect of thorax and allows pt to breathe, concentrating on using the lower part of the chest.
Encourage to breathe in through the nose and out through the mouth. Encourage to push ribs against hands.
Overpressure at maximal exhalation.
Not more than 3 max breaths at one time to avoid dizziness.
TQ can be performed by the pt, placing their own hands crossed over the chest or with elbows flexed and hands against the chest.
TQ can be performed with both uni and bilateral expansion.

Question 8

Ventilators, Life Support Systems, and Intermittent Positive Pressure Breathing

Answer 8

Used for pt unable to breathe independently or who breathe insufficiently to provide adequate oxygenation.

> Controlled Mechanical Ventilation (CMV): when pt are paralyzed and unable to participate in breathing.
Assist Control (AC): completely controls breathing with the machine programmed at specific settings.
Assisted Mechanical Ventilation: delivery of O2, but pt can trigger the machine to work.
Intermittent Mandatory Ventilation (IMV): delivers preset amounts of O2 at intervals to supplement breathing, and allows pt to exhale. Pt have no control over it.
Pressure Support Ventilation (PSV): ensures a min level of inspiration and pt have more control over breathing.
Volume-Assured Pressure Support (VAPS): type of PSV, monitors tidal volume and assists maintaining an adequate TV.
Intermittent Positive Pressure Breathing (IPPB): no longer used.