SCI Tx Consideration: Part 2 Flashcards
Wheel Chair pressure relief schedule freq/duration
Freq: Every 15-20 mins
Duration: 2-4 mins holding pressure relief position
For pushup method, only hold for 30-90 secs
Bed Rolling pressure relief schedule
Rolling every 2 hours
T/F: Skin checks should be done daily and may require adaptive equipment like a long-handled mirror.
True
What’s a very common problem in acute stages with upright tolerance? What are the S&S of this problem?
Orthostatic Hypotension
S&S: hypotension + tachycardia, dizzy, pale, diaphoresis, slurred speech, foggy, blurred vision, N/V
check BP every 2 mins
3 Strategies to manage/progress upright tolerance
1 Slow transitions
2 Compression garments (stockings, abd binders, ACE wrap)
3 Equipment (tilt n’space, tilt table, ERIGO, standing frame)
Assisted standing has many benefits for these pts. What are some assisted standing devices and frequency of standing for this pt population?
1) Tilt table, stand-in table, BWS, standing frames, ERIGO
2) 2-3x/week in acute care, 1x/week in OP
Which of the following is not a consideration for assisted standing?
A) incorporate trunk/UE strengthening (AROM, TB, DB, Ball tosses, fine motor)
B) LE isometrics/small range strengthening
C) use of FES
D) Monitor vitals closely ESP. BP
E) all of these are considerations
E
Goals for standing are typically ___-based, but can incorporate ___ LE goals as well.
1 tolerance based
2 LE strengthening
Respiratory examination should be done throughout care. Exam includes: (5)
1 RR, breathing pattern, chest excursion
2 cough
3 posture
4 breath support w/ speech
5 may need Pulmonary Function Testing
A Functional cough is loud and forceful, and consists of ___ or more coughs per exhalation. What is the functional significance?
1) 2 or more
2) Ind. w/ resp. secretion clearance
A weak functional cough is soft and less forceful, and consists of __ cough(s) per exhalation. What is the functional significance?
1) 1 cough
2) Ind. for clearing throat & small amts of secretions. Assistance needed for clearing large amts of secretions
A nonfunctional cough is a sigh or throat clearing, and consists of ___ cough(s) per exhalation. What is the functional significance?
1) NO TRUE COUGHS
2) Assistance needed for airway clearance
T/F: Pneumonia is the most common sequelae cause of death for pts with SCI.
True
___ breathing aka “__ breathing” is ideal for quiet breathing. Place the pt in supine and place a light obj (box of tissue) on abdomen and instruct pt to watch themselves breathe. Instructing the pt to ___ can encourage diaphragmatic response.
1 Diaphragmatic breathing
2 belly breathing
3 sniff
add resistance to abdomen to progress exercise
T/F: The diaphragm is innervated by the thoracic spine.
False, C3-C5 keeps the patient alive!
below T10 = normal ventilatory & resp. fxn
Upper chest strengthening increases ___ air to enhance coughing, improve breath support for speech, or during increased activity.
inspired air
Upper Chest Strengthening: Place your hands on pts upper chest and ask pt to push against them while breathing deeply. You can also apply a quick stretch to ___, __, & __ by pushing upper chest caudally just (before/after) asking the patient to inhale.
1) SCM, Pec major, Scalenes
2) before
________ is a useful alternative to diaphragmatic breathing & upper chest strengthening for resp. strength/endurance training. Its shown to improve strengthen/endurance in ventilation, encourages slower/deeper breathing, reduces use of ___ muscles, and increases activity tolerance.
1) Resistive Inspiratory Muscle Trainers
2) accessory muscles
Can make these more functional by placing pt in diff positions (prone, supine, etc)
Practice eccentric ctrl of exhalation by having pt inhale and say __ or __ for ____ before taking another breath. The goal is ____ seconds.
1) “ah” or “oh”
2) as long as possible
3) 10-12 seconds
can progress w/ vibration or resistance
What are some interventions you can do to improve the patient’s chest wall mobility? (4)
1 deep breathing exercises
2 passive stretching
3 joint mobs
4 intermittent positive-pressure breathing
glossopharyngeal breathing can help w/ this too
What is the ideal posture for enhance respiration?
APT, erect trunk, scapulae ADD, neutral head and neck alignment
Glossopharyngeal breathing is the use of ___ and ___ to force air into lungs via a series of ___.
1) tongue and pharyngeal muscles
2) “gulps”
esp. used for patients if other resp. muscles are not intact
____ __ are used for tetraplegics and higher paraplegics (more severe cases). It’s used to better contain contents in sitting and better position the diaphragm, leading to increased __, __, __, and blood oxygenation.
1) Abdominal Binders
2) VC (vital capacity), TV (tidal vol), MEP (max expiratory pressure)
______ techniques are crucial in preventing complications like ___. The technique consists of __ coughs per 1 exhalation.
1) Assisted coughing
2) pneumonia
3) 2 coughs
The self-cough technique procedures:
Have patient inhale as deep as possible in combo with _____ as well as shld ___ or scapular ___. Then have pt hold breath in briefly, then cough. If possible combine cough with ____ as well as shld ___ or scapular __. It pt can ctrl it, have them fall into a ___ position.
can self-apply Helmlich-like Maneuver to stomach if adequate UE strength & balance
1 trunk and neck extension
2 flexion
3 adduction
4 trunk and neck flexion
5 extension
6 abduction
7 folded
At what SCI levels can patients usually regain capacity to breathe independently? What are some factors that reduce this potential?
1) C3 or lower
2) Resp. or other med. complications, pre-existing resp. conditions, >50 y/o, VC <1000, max negative inspiratory pressure <30 cm H2O, smoking
tetraplegics usually are on vents
T/F: If patient is unable to completely wean from vent, there is no need to make a goal towards developing capacity to breathe independently.
FALSE, can still make goals for ind. breathing for brief periods of time
What are the benefits of developing a goal toward developing capacity to breathe independently for patients unable to wean from the vent?
1) reduces safety concerns from electronic failure
2) can help ease of transfers, bathing, or trachea care
gradual reduction of pt’s dependence on ventilator: Progressive Ventilator-Free Breathing
