SCI Tx Consideration: Part 2 Flashcards

1
Q

Wheel Chair pressure relief schedule freq/duration

A

Freq: Every 15-20 mins
Duration: 2-4 mins holding pressure relief position
For pushup method, only hold for 30-90 secs

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2
Q

Bed Rolling pressure relief schedule

A

Rolling every 2 hours

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3
Q

T/F: Skin checks should be done daily and may require adaptive equipment like a long-handled mirror.

A

True

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4
Q

What’s a very common problem in acute stages with upright tolerance? What are the S&S of this problem?

A

Orthostatic Hypotension
S&S: hypotension + tachycardia, dizzy, pale, diaphoresis, slurred speech, foggy, blurred vision, N/V
check BP every 2 mins

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5
Q

3 Strategies to manage/progress upright tolerance

A

1 Slow transitions
2 Compression garments (stockings, abd binders, ACE wrap)
3 Equipment (tilt n’space, tilt table, ERIGO, standing frame)

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6
Q

Assisted standing has many benefits for these pts. What are some assisted standing devices and frequency of standing for this pt population?

A

1) Tilt table, stand-in table, BWS, standing frames, ERIGO
2) 2-3x/week in acute care, 1x/week in OP

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7
Q

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

A

E

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7
Q

Goals for standing are typically ___-based, but can incorporate ___ LE goals as well.

A

1 tolerance based
2 LE strengthening

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8
Q

Respiratory examination should be done throughout care. Exam includes: (5)

A

1 RR, breathing pattern, chest excursion
2 cough
3 posture
4 breath support w/ speech
5 may need Pulmonary Function Testing

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9
Q

A Functional cough is loud and forceful, and consists of ___ or more coughs per exhalation. What is the functional significance?

A

1) 2 or more
2) Ind. w/ resp. secretion clearance

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10
Q

A weak functional cough is soft and less forceful, and consists of __ cough(s) per exhalation. What is the functional significance?

A

1) 1 cough
2) Ind. for clearing throat & small amts of secretions. Assistance needed for clearing large amts of secretions

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11
Q

A nonfunctional cough is a sigh or throat clearing, and consists of ___ cough(s) per exhalation. What is the functional significance?

A

1) NO TRUE COUGHS
2) Assistance needed for airway clearance

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12
Q

T/F: Pneumonia is the most common sequelae cause of death for pts with SCI.

A

True

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13
Q

___ 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.

A

1 Diaphragmatic breathing
2 belly breathing
3 sniff
add resistance to abdomen to progress exercise

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14
Q

T/F: The diaphragm is innervated by the thoracic spine.

A

False, C3-C5 keeps the patient alive!
below T10 = normal ventilatory & resp. fxn

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15
Q

Upper chest strengthening increases ___ air to enhance coughing, improve breath support for speech, or during increased activity.

A

inspired air

16
Q

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.

A

1) SCM, Pec major, Scalenes
2) before

17
Q

________ 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.

A

1) Resistive Inspiratory Muscle Trainers
2) accessory muscles
Can make these more functional by placing pt in diff positions (prone, supine, etc)

18
Q

Practice eccentric ctrl of exhalation by having pt inhale and say __ or __ for ____ before taking another breath. The goal is ____ seconds.

A

1) “ah” or “oh”
2) as long as possible
3) 10-12 seconds
can progress w/ vibration or resistance

19
Q

What are some interventions you can do to improve the patient’s chest wall mobility? (4)

A

1 deep breathing exercises
2 passive stretching
3 joint mobs
4 intermittent positive-pressure breathing
glossopharyngeal breathing can help w/ this too

20
Q

What is the ideal posture for enhance respiration?

A

APT, erect trunk, scapulae ADD, neutral head and neck alignment

21
Q

Glossopharyngeal breathing is the use of ___ and ___ to force air into lungs via a series of ___.

A

1) tongue and pharyngeal muscles
2) “gulps”
esp. used for patients if other resp. muscles are not intact

22
Q

____ __ 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.

A

1) Abdominal Binders
2) VC (vital capacity), TV (tidal vol), MEP (max expiratory pressure)

23
Q

______ techniques are crucial in preventing complications like ___. The technique consists of __ coughs per 1 exhalation.

A

1) Assisted coughing
2) pneumonia
3) 2 coughs

24
Q

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

A

1 trunk and neck extension
2 flexion
3 adduction
4 trunk and neck flexion
5 extension
6 abduction
7 folded

25
Q

At what SCI levels can patients usually regain capacity to breathe independently? What are some factors that reduce this potential?

A

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

26
Q

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.

A

FALSE, can still make goals for ind. breathing for brief periods of time

27
Q

What are the benefits of developing a goal toward developing capacity to breathe independently for patients unable to wean from the vent?

A

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