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Cardiorespiratory 1 > Skills, Techniques and Theory > Flashcards

Skills, Techniques and Theory Flashcards

1
Q

What does ACBT stand for?

A

Active Cycle of Breathing Techniques

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2
Q

What are the three components of ACBT?

A
  1. Breathing Control (BC); 2. Lower Thoracic Expansion Exercises (LTEE/TEE); 3. Forced Expiratory Technique (FET)
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3
Q

What does a typical ACBT cycle consist of?

A
  1. BC
  2. 3–4 LTEE
  3. BC
  4. FET
  5. BC
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4
Q

What is the maximum number of LTEEs to be performed in an ACBT cycle?

Why?

A

3-4

Minimises hyperventilation and fatigue in breathless patients

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5
Q

What is breathing control?

A

Normal tidal breathing, relaxed shoulders and arms

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6
Q

LTEE involves what?

A

Deep breathing exercises

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7
Q

What can be added to an LTEE?

A

3 second end-inspiratory hold

Sniff

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8
Q

What is the purpose of a breath hold in LTEE?

A

compensate for asynchronous ventilation

during inspiration - healthy lung units fill rapidly and obstructed/diseased lung units fill slowly

slower filling units partially receive inspired volume from rapid filling units via collateral channels - ‘Pendelluft flow’

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9
Q

What is the purpose of a ‘sniff’ in LTEE?

A

achieve an additional increase in lung volume

aid greater expanding forces between alveoli

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10
Q

In what patients should an inspiratory hold or ‘sniff’ not be used?

A

Hyperinflated

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11
Q

In what patients may LTEE be used?

A

Post-surgical patients

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12
Q

How does LTEE facilitate collateral channel ventilation?

A

increased inspired volumes = reduced airflow resistance

air can now flow in inter-bronchiolar channels of Martin, bronchiolar-alveolar channels of Lambert and inter alveolar pores of Kohn

airflow behind secretions

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13
Q

Where are channels of Martin between?

A

Bronchiole and bronchiole

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14
Q

Where are channels of Lambert between?

A

Bronchiole and alveoli

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15
Q

Where are pores of Kohn between?

A

Alveolus and alveolus

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16
Q

How does LTEE increase alveolar interdependence?

A

Higher lung volumes = greater expanding forces between alveoli –> assists with re-expansion of lung tissue

If one alveolus collapses, adjacent alveoli stretched/pulled inwards towards it –> walls of adjacent alveoli recoil –> collapsed alveolus pulled open

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17
Q

What are the cautions of LTEE?

A

Light-headed, dizzy, hyperventilation

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18
Q

How can proprioception be provided during LTEE?

A

Physiotherapists hands placed on chest wall

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19
Q

FET is also known as?

A

Huffing

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20
Q

Why may an FET be more useful than a cough?

A

less effort and pain than a cough

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21
Q

Is the glottis open or closed during a ‘huff’?

A

open

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22
Q

Low lung volume, long huff moves secretions from where?

A

Peripheral, smaller airways

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23
Q

High lung volume, short huff moves secretions from where?

A

Upper, larger airways

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24
Q

How many ‘huffs’ are performed in FET

A

1-2, followed by BC

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25
Q

Is a low or high volume ‘huff’ usually performed first?

A

Low

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26
Q

FET is based upon the principle of what?

A

Equal pressure point (EPP)

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27
Q

Define equal pressure point

A

Point at which the pressure in the bronchi equals the pressure outside the airway

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28
Q

Where is the location of EPP during normal tidal breathing?

A

In the trachea

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29
Q

What is position of EPP during FET

A

EPP’s move distally into smaller peripheral airways

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30
Q

At lung volumes above functional residual capacity (FRC) where is the EPP located?

A

Lobar or segmental bronchi

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31
Q

EPP position is dependent on what 2 factors?

A

Lung volume and pressure outside airway

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32
Q

EPP is towards alveoli when…

A

lung volume decreases and/or pressure outside the airway increases

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33
Q

EPP is towards mouth when…

A

lung volume increases and/or the pressure outside the airway decreases

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34
Q

Airways should be cleared from…

A

peripheral airways up

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35
Q

During expiration airway pressure falls…

A

Falls along airway from alveolus to mouth

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36
Q

Proximal to EPP towards the mouth airway pressure falls below what? Resulting in…?

A

Airway pressure falls below pleural pressure - resulting in dynamic compression and narrowing of airway

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37
Q

Lung volume …. during FET

A

Decreases

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38
Q

A huff that is too long can lead to…

A

Paroxysmal coughing

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39
Q

Percussion involves what?

A

Rhythmical clapping with cupped hands by flexing/extending the wrist

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40
Q

Percussion uses a …. hand

A

Cupped

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41
Q

The lung that needs clearing using percussion is placed…

A

At the top

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42
Q

How long should percussion be performed for?

A

20-30 seconds of continuous percussions followed with pause

5-15 mins total in length

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43
Q

Physiology of percussion: what does percussion alter?

A

Intrapleural pressure

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44
Q

Physiology of how percussion assist the clearance of secretions?

A
  1. Intrapleural pressure change is transmitted through thoracic cage and lung tissue –> external shearing force assists dislodging secretions
  2. Creates oscillation of airflow –> stimulate cilial beat and/or change sputum viscosity
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45
Q

Contraindications of percussion

A 
Directly over rib fracture 
Directly over surgical incision 
Frank haemoptysis 
Severe osteoporosis 
Hypoxia
Active TB
Cancerous lung
Acute pain
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46
Q

Precautions of percussion

A 
Profound hypoxaemia 
Bronchospasm 
Pain
Osteoporosis
Bony metastases 
Near chest drains
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47
Q

Vigorous or rapid percussions may lead to…

A

Breath holding

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48
Q

Possible complications of percussion treatment

A

Pain during treatment
Fatigue during treatment
SaO2 decreases during treatment

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49
Q

What type of movement is applied to the chest during VIBRATIONS

A

fine, high frequency, low amplitude

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50
Q

What type of movement is applied to the chest during SHAKING

A

Coarse, low frequency, high amplitude

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51
Q

What phase is the vibration or shaking applied?

A

During expiration

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52
Q

In which direction is vibration/shaking applied?

A

In direction of normal movement of ribs

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53
Q

Vibrations = … oscillations

A

fine

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54
Q

Shaking = … oscillations

A

coarse

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55
Q

Physiology: what changes do vibrations/shaking produce?

A

Increases expiratory flow

Increases annular flow via two-phase gas-liquid flow mechanism –> secretions moved towards large airways

Lung recoil following maximal inspiration - correctly timed compressive and oscillatory forces applied affect lung recoil to increase expiratory flow

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56
Q

Vibrations/shaking are performed during what?

A

thoracic expansion exercises

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57
Q

Contraindications of vibrations/shaking

A 
Directly over rib fracture 
Directly over surgical incision 
Severe bronchospasm
Osteoporosis
Frank Haemoptysis 
Active TB
Pulmonary embolism
Cancerous lung
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58
Q

Precautions of vibrations/shaking

A 
Long-term oral steroids 
Osteoporosis 
Near chest drains
Profound hypoxaemia
Bronchospasm
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59
Q

Define ventilation

A

Total volume of air the leaves the lungs each minute

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60
Q

Define perfusion

A

The total volume of blood reaching the pulmonary capillaries

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61
Q

What is the distribution of ventilation in the upright patient?

Why?

A

Bases of lungs most ventilated

There is a lesser transmural pressure, with many smaller, more compliant alveoli

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62
Q

What is the distribution of perfusion in the upright lung?

Why?

A

Bases of lungs most perfused

Low pressure pulmonary circulation affected by gravity

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63
Q

Perfusion … down the upright lung

A

increases

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64
Q

V/Q ratio is disproportionately … in the apices than bases

A

higher

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65
Q

V/Q matching is optimal in which region of the lung?

A

mid-lung

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66
Q

V/Q mismatch occurs in which regions of the lungs?

A

the least and most dependent - apices and bases

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67
Q

What is the value of V/Q ratio in “alveolar dead space”

A

V/Q > 1

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68
Q

Define alveolar dead space mismatch

A

Where there is good ventilation but reduced perfusion

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69
Q

What is the value of V/Q ratio in “shunt”

A

V/Q = 0

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70
Q

Define shunt mismatch

A

Where there is good perfusion but reduced ventilation

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71
Q

Give an example of what may cause “shunt” V/Q mismatch

A

sputum plug

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72
Q

Give an example of what may cause “alveolar dead space” V/Q mismatch

A

Pulmonary embolus disrupting blood flow

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73
Q

Why do we place “good lung down”

A

Best ventilated lung placed in region of best perfusion

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74
Q

Which lung is slightly better ventilated?

A

Right

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75
Q

Why does V/Q matching need to be maintained?

A

To achieve adequate gas exchange

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76
Q

In which position would you place a patient with bilateral lung disease?

Why?

A

Right lung down

R lung larger than L

Arterial oxygen tension increased secondary to improved ventilation of right lung

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77
Q

In which position would you place a patient with unilateral lung disease?

Why?

A

Good lung down

Arterial oxygen tension increased secondary to improved ventilation of unaffected dependent lung

Best ventilated lung placed in region of best perfusion

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78
Q

How does an upright position contribute to V/Q matching?

A

Increased FRC
Sympathetic NS stimulated
Lung volumes and flow rates maximised
Circulating blood volume and volume regulating mechanisms maintained

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79
Q

How does supine position have a negative impact on V/Q matching?

A

Decreases FRC
Closure of dependent airways
Reduced arterial oxygenation
Vascular congestion

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80
Q

What is the effect of prone position on V/Q matching?

A

Decreased gravitational pressure of heart/mediastinum on lungs
Decreased compression of abdominal organs on lungs
More chest wall compliance

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81
Q

Define alveolar dead space

A

The volume of air that never reaches the alveoli and never participates in respiration

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82
Q

What is the value of V/Q optimal matching?

A

V/Q = 1

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83
Q

What are the 4 recovery positions for chronic breathlessness?

A
  1. Forward lean - sitting
  2. Forward lean - standing
  3. Lean over - pillows and plinth
  4. High side lying
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84
Q

What instructions should be given to the patient during recovery positions for breathlessness?

A

Bend from hips not ‘tummy’
Breathe as normal as possible
and from diaphragm

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85
Q

How is the diaphragm affected during leaning recovery positions for breathlessness?

A

Abdominal contents raise anterior part of diaphragm, facilitating its contraction during inspiration

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86
Q

How is the diaphragm affected during high side lying recovery position for breathlessness?

A

Curvature of dependent part of diaphragm is increased - fibres can contract more effectively

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87
Q

How is the diaphragm affected during recovery positions for breathlessness?

A

Optimises length tension status - improving mechanical advantage

88
Q

Why is support given to the arms/shoulder girdle in recovery positions for breathlessness?

A

Optimises accessory muscle function without active fixing

Muscle tension and O2 uptake is reduced

89
Q

What other techniques can be used for breathlessness?

A

‘Blow as you go’
Pursed lip breathing
Pacing

90
Q

What is ‘blow as you go’ technique?

A

Breath out on effort when doing activities (eg. sit-to-stand, bending to tie laces, reaching for something)

91
Q

What is pursed lip breathing?

A

Breath out gently through pursed lips
No more effort than normal breathing
Expiratory phase longer than normal

92
Q

What does pursed lip breathing produce?

A

A small amount of positive end-expiratory pressure (PEEP)

93
Q

What is pacing for breathlessness?

A

Inspiration : expiration 1:2 or 2:3
In for 2 steps out for 3 steps
Avoid rushing to complete task/breath holding

94
Q

Name for breathlessness

A

Dyspnoea

95
Q

What is the taught inhaler technique?

A
  1. Cap off
  2. Shake inhaler
  3. Fully exhale
  4. Make tight seal with lips around inhaler
  5. Simultaneously squeeze inhaler and breath in deeply and slowly
  6. Hold for 10 secs
96
Q

What are the 3 types of bronchodilators?

A

Relievers, preventers, anticholinergic/antimuscarinic

97
Q

What are ‘reliever’ bronchodilators?

What type of drug are they?

A

Provide short-term symptomatic relief
Give immediate response

Short-acting beta-agonists (SABA)

98
Q

What are ‘preventer’ bronchodilators?

What type of drugs are they?

A

Provide long-term symptomatic relief
Management of condition
Slower, less pronounced response

Inhaled corticosteroids, long-acting beta-agonists (LABA) or combined steroid and LABA

99
Q

2 examples of SABAs

A

Salbutamol (Ventolin) and Terbutaline (Bricanyl)

100
Q

Which conditions may use SABAs?

A

Asthma and COPD

101
Q

2 examples of inhaled corticosteroids

A

Beclamethasone (Qvar) and Fluticasone (Flixotide)

102
Q

What are the side effects of using inhaled corticosteroids?

A

Oral thrush, fluid retention, osteoporosis

103
Q

2 examples of LABAs

A

Salmeterol (Serevent) and Eformoterol (Oxis, Foradile)

104
Q

2 examples of combined LABA and steroid

A

Seretide (Fluticasone and Salmeterol)

Foster (Beclamethosone and Formoterol)

105
Q

Which conditions may use combined LABA and steroid?

A

COPD and moderate/sever asthma

106
Q

What do anticholinergic/antimuscarinic drugs do?

A

Block binding of acetylcholine to muscarinic receptors in smooth muscle

Prevent bronchoconstriction and reduce mucous production

107
Q

2 examples of anticholinergic/antimuscarinic drugs

A 
Ipratropium Bromide (Atrovent)
Tiotropium (Spiriva)
108
Q

What are the side effects of anticholinergic/antimuscarinic drugs?

A

Increase risk of CV effects, dry mouth, urinary retention, constipation, nausea, headaches

109
Q

Inhaled drugs are delivered … to the airways

A

Directly

110
Q

Benefits of inhalation drugs

A

Rapid absorption due to large lung surface area –> rapid onset of action
Smaller dose required –> reduced side-effects

111
Q

What are the 3 mechanisms that particles of aerosol interact with the airway?

A
  1. Impaction
  2. Sedimentation
  3. Brownian diffusion
112
Q

What is impaction during aerosol delivery?

Where in the airways does impaction occur?

A

Due to inertia of aerosol particles and the change in direction they have to make

Mouth cavity entering to trachea and bifurcation of trachea

113
Q

What is sedimentation during aerosol delivery?

Where in the airways does sedimentation occur?

A

Due to gravity the particles settle

Small airways and alveoli

114
Q

What is Brownian diffusion during aerosol delivery?

Where in the airway does Brownian diffusion occur?

A

Particles move from high to low concentrations so deposit upon contact with airway wall

Lower respiratory regions and alveoli

115
Q

During inhalation of respiratory drugs via inhaler, what does the hold allow for?

A

Sedimentation of aerosol particles

116
Q

Define pulmonary rehabilitation

A

An evidence-based, multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities

117
Q

What does a pulmonary rehab programme consist of?

A

Exercise training, education and behaviour change

118
Q

What does the exercise component of pulmonary rehab look like?

A

Circuit based, two hour session, twice-weekly with encouragement of home exercise

119
Q

Patients of what conditions may benefit from pulmonary rehab?

A

COPD, asthma, bronchiectasis, interstitial lung disease

120
Q

What types of exercise should be included in pulmonary rehab?

A

Aerobic/endurance and strength/resistance

Also consider flexibility and balance work

121
Q

Should pulmonary rehab exercises include upper limb, lower limb, or both?

A

Both upper and lower limb

122
Q

During what type of exercise might a pulmonary rehab patient find themselves more breathless?

A

Upper limb

123
Q

What principle is used to prescribe exercise for rehab?

A

FITT - frequency, intensity, time, type

124
Q

What should be monitored during exercise component of a pulmonary rehab class?

A 
Modified Borg Scale (0-10)
O2 saturations
Respiratory rate
HR
BP
125
Q

What topics might be covered in an education session of pulmonary rehab?

A 
What is COPD?
Breathlessness management
Anxiety management
Energy conservation
Chest clearance 
Medications
Benefits of exercise
Self-management of condition
MDT input
126
Q

What members of the MDT would be involved in pulmonary rehab?

A 
Respiratory nurses
Dieticians 
Occupational therapists
Smoking cessation services
Expert patients/recent graduates 
Pharmacist
Respiratory consultant 
Exercise instructors
127
Q

Contraindications for pulmonary rehab

A 
Recent MI 
Unstable angina 
Severe hypoxic lung failure
Uncompensated heart failure
Severe psychiatric impairment 
Patient non-consenting
128
Q

Cautions for pulmonary rehab?

A 
Very severe COPD (FEV<30%)
Cardiac arrhythmias
Mental health concerns 
Heart failure 
Mobility issues/falls
Recent stroke
Recent thoracic surgery
Recent fracture
Ongoing lower back pain
129
Q

What physical outcome measures could be used to assess the patients progress with pulmonary rehab?

A

Six minute shuttle walk test (6MWT)
Incremental shuttle walk test (ISWT)
Timed up and go test (TUG)
Ten metre walk test

130
Q

What ADL/psychological outcomes could be used to assess the patients progress in pulmonary rehab?

A

St George’s Respiratory Questionnaire (SGRQ)
Chronic Respiratory Disease Questionnaire (CRDQ)
London Chest Activities of Daily Living Scale (LCADL)
Hospital Anxiety and Depression Scale (HAD)

131
Q

What are the benefits of pulmonary rehab?

A 
Reduce symptom burden
Maximise exercise capacity 
Increase muscle endurance and strength 
Improve daily functioning/ADLs
Improve QoL
Promote health behaviour change 
Promote self-management of condition
Increase social interaction
132
Q

How does pulmonary rehab differ to cardiac rehab?

A

Less intense
Rest periods rather than active recovery
Encouragement for patients to set own limits - link with long-term self-management

133
Q

What is the typical duration of a pulmonary rehab programme?

A

8-12 weeks

134
Q

What are some possible exercises for pulmonary rehab circuit?

A 
Arm cycle ergometer 
Arm raises 
Walking - treadmill, shuttle walks
Jogging
Cycling 
Rowing 
Step-ups/stepping machine/stairs at home
Side steps
Bicep curls
Squats - bodyweight (high reps for aerobic) weighted (lower reps for strength)
Banded pull downs
135
Q

Define cardiac rehabilitation

A

Exercise prescription and non-pharmaceutical management of modifiable risk factors

136
Q

What does a cardiac rehab programme consist of?

A

Physical activity and exercise, education and psychosocial support

137
Q

What topics may be covered in the education portion of cardiac rehab?

A

Pathophysiology and symptoms
Benefits of physical activity, healthy eating
Smoking cessation
Self-management of risk factors (BP, lipids, glucose)
Emotional self-management
Resuming relationships/sexual dysfunction
Cardiopulmonary resuscitation

138
Q

What psychosocial interventions may be provided in a cardiac rehab programme?

A 
Relaxation techniques 
Stress management
Motivational interviewing 
CBT
Counselling
139
Q

What types of patients are referred for cardiac rehab?

A

Priorities:

  • Post MI/STEMI
  • Heart failure
  • Coronary revascularisation
  • Post CABG

Once priorities addressed:

  • Stable angina
  • Post transplantation
  • Post valve repair/replacement
  • Grown-up congenital heart disease (GUCH)
  • Post ICD implantation
  • Other atherosclerotic diseases
140
Q

What are the 4 stages of cardiac rehab?

A

Phase 1: inpatient
Phase 2: Early post-discharge
Phase 3: Supervised exercise training programme
Phase 4: Long term maintenance

141
Q

Phase 3 of cardiac rehab, exercise programme, is typically how long post-surgery?

A

at least 6 weeks

142
Q

What is the typical duration of cardiac rehab programme?

A

6-12 weeks

143
Q

Goals of cardiac rehab

A

Decrease cardiac morbidity and relieve symptoms
Increase fitness and ability to resume normal activities
Regain full physical, psychological and social status
Improve health behaviour through education
Slow/reverse progression of disease
Promote risk modification and secondary prevention

144
Q

What are the general benefits of exercise training?

A 
Improved survival 
Improved lipid profile
Lower BP
Improved glucose control
Reduced anxiety/depression
Reduced weight
reduced angina
Improved functional capacity 
Increased confidence 
Improved QoL
Reduced readmissions
Improved return to work and leisure 
Support self-management skills
145
Q

What are the cardioprotective mechanisms associated with regular exercise training?

A

Anti-ischaemic
Anti-atherosclerotic
Anti-thrombotic
Anti-arrhythmic

146
Q

How does exercise training lead to an improved exercise capacity?

A

Training-induced increase in maximal stroke volume due to:
Increased left ventricular mass and chamber size
Increased total blood volume
Reduced total peripheral resistance at maximal exercise

147
Q

What does an improved exercise capacity lead to in terms of O2?

A

Increased maximal O2 uptake

148
Q

What physiological changes occur to skeletal muscle as a result of exercise training?

A 
^ number and size of mitochondria
^ oxidative enzyme activity 
^ capillarisation
^ myoglobin 
all lead to increased extraction and utilisation of O2 from the blood
149
Q

Why is it beneficial for the patient to have a higher VO2 max as a result of exercise training?

A

Can perform repeated sub maximal ADLs with less physiological stress - ADLs now constitute a smaller % of increased max capacity

150
Q

What are the social benefits of cardiac rehab?

A

Increased return to work and leisure

151
Q

What are the psychological benefits of cardiac rehab?

A

Reduced anxiety and depression
Supports self-efficacy
Increased confidence
Increased well-being and QoL

152
Q

What members of the MDT may be involved in cardiac rehab?

A 
Cardiologist
Physio
Nurse
Dietician
OT
Pharmacist 
Psychology staff

GP’s and practice nurse - continuation in community

153
Q

What is the risk associated with exercise?

What increases the risk?

A

Ventricular fibrillation, MI, cardiac arrest

extensive cardiac damage, residual Ischaemia, ventricular arrhythmias on exercise

154
Q

Exclusion factors for participating in cardiac rehab

A 
Unstable angina
Uncontrolled arrhythmias 
Uncontrolled tachycardia
Dissecting aneurism
Active pericarditis/myocarditis 
Severe hypertension
Significant drop in SBP
Uncontrolled metabolic disorders - diabetes, thyroid
Mental disturbance
155
Q

What are the physical activity recommendations?

A

At least 150-300 minutes of moderate intensity aerobic activity OR at least 75-150 minutes of vigorous intensity aerobic activity
Muscle strengthening involving major muscle groups should be done on 2 or more days a week

156
Q

What are the acute responses to exercise?

A 
^ HR
^ SV
^ CO
Redistribution of blood to skeletal muscle and away from gut
^ systolic BP
diastolic BP stays relatively same
^ coronary blood flow
157
Q

What is the purpose of risk stratification?

A

To evaluate the degree of risk of further cardiac events associated with exercise

158
Q

What formula is used to set exercise intensity by heart rate for a patient?

A

Karvonen formula

159
Q

What is monitored during cardiac rehab?

A

HR, BP, RPE, Symptoms

160
Q

What 4 components of an exercise programme for cardiac rehab must be included?

A
  1. warm up
  2. aerobic work
  3. resistance/strength work (usually as active recovery)
  4. cool down
161
Q

How long should an extended warm up be for cardiac rehab?

A

15 mins

162
Q

Why is it important to warm up?

A

Reduces risk of arrhythmia
Incremental - gradually raises pulse
Focuses mind on activity ahead

163
Q

What are the physiological effects of a warm up?

A

Increases ischaemic threshold through coronary artery dilation
Redistributes blood to active muscles
Increases core and muscle temperature

164
Q

What is the purpose of the active recovery exercises in a cardiac rehab exercise circuit?

A

Prevent a sudden drop in BP by maintaining venous return

165
Q

How long should a cool down be?

A

10 mins

166
Q

Why is it important to cool down after exercise?

A

Reduce risk of hypotension, reduce risk of arrhythmias due to raised sympathetic activity

167
Q

Example of a good cardiac rehab session?

A 
15 min warm up
20 mins main session
 - aerobic and active recovery stations
 - 10 stations, 1 minute at each station
 -  repeat circuit twice - 20 mins working time
10 min cool down
168
Q

Possible warm up exercises for cardiac rehab

A

March on spot
Arm circles
Dynamic stretches

169
Q

Possible aerobic stations for cardiac rehab

A 
Ball around body
Shuttle walks
Knee raises
Rowing 
Cycling
Swimming
Stepping/step-ups/stepping machine
Side steps
Sit-to-stand
Quick squats
Treadmill
Lunge backs
170
Q

Possible active recovery stations for cardiac rehab

A 
Light bicep curls
Ball lifts
Push up against wall
TheraBand exercises
Lateral arm raises
171
Q

Possible cool down exercises for cardiac rehab

A

Slow march

Thoracic rotations

172
Q

What is postural drainage also known as?

A

Gravity assisted drainage (GAD)

173
Q

What is the principle of postural drainage?

A

Use of gravity to assist clearance of bronchial secretions from peripheral airways to more central, upper airways

174
Q

What are the indications for postural drainage?

A

breath sounds - course crackles
cough
X-Ray - white out, patches of consolidation

175
Q

Contraindications and precautions for head down tipped positions

A 
Epistaxis
Frank haemoptysis
Cardiac failure
Severe hypertension
Cerebral oedema
Aortic and cerebral aneurisms 
Abdominal distension
Reflux
Recent head/neck trauma or surgery
Sinus pain/headaches
Post abdominal/thoracic surgery
176
Q

Drainage position for upper lobe, apical segments

A

Sitting upright

177
Q

Drainage position for upper lobe anterior segments

A

Supine with knees flexed

178
Q

Drainage position for LEFT upper lobe, posterior segment

A

Right side lying quarter turn, pillows to lift shoulders 30cm from bed

179
Q

Drainage position for RIGHT upper lobe, posterior segment

A

Left side lying quarter turn, lying on pillow

180
Q

Drainage position for RIGHT middle lobe

A

Supine with quarter turn to left, pillows under right side, foot of bed raised 12 inches

181
Q

Drainage position for LEFT lung, lingula segments

A

Supine with quarter turn to right, pillows under left side, foot of bed raised 12 inches

182
Q

Drainage position for lower lobe, apical segments

A

Prone with pillow under abdomen

183
Q

Drainage position for lower lobe, anterior segments

A

Supine, knees flexed, foot of bed raised 18 inches

184
Q

Drainage position for lower lobe, posterior segments

A

Prone, pillow under abdomen, foot of bed raised 18 inches

185
Q

Drainage position for RIGHT lower lobe, lateral segment

A

Left side lying, foot of bed raised 18 inches

186
Q

Drainage position for LEFT lower lobe, lateral segment

A

Right side lying, foot of bed raised 18 inches

187
Q

What does CABG stand for?

A

Coronary Artery Bypass Graft

188
Q

Purpose of early mobilisation of post-surgical patients

A 
Prevent post-op complications and post-op pulmonary complications (PPC's)
Decrease length of hospital stay
Prevent deconditioning 
Promote independence 
Return to work 
Increase functional capacity
189
Q

What are the physiological benefits of early mobilisation of the patient?

A

Increased ventilation
V/Q matching - increased gas exchange
Increase muscle strength
Increase functional capacity

190
Q

What are some of the limitations to mobilisation?

A 
Drips/drains/catheters
Pain
Decreased arousal 
Anxiety
Surgical incisions 
Medication
191
Q

What should be monitored during treatment of post-surgical patient?

A 
Respiratory rate
HR
BP
O2 and CO2 saturations
Breath sounds - auscultation
Sputum - volume/colour/viscosity
Drains
Temperature and pulse
Incision site - infection/re-opening/stitches
Central venous pressure (CVP)
Consciousness
Pain level 
Urine output
192
Q

When transferring post-surgical patient out of bed, what should they be instructed NOT to do?

What should they do instead?

A

Not push through/apply any weight through their hand

Use their deltoid instead - push through back of upper arm ‘chicken wing’

193
Q

What should the physio consider when transferring a patient from lying to sitting?

A

Dizziness and fatigue

194
Q

When transferring a patient, drips/drains should be placed where?

A

On the side of transfer, not in the way

195
Q

Transfer patient out of bed - lying to sitting

A
  1. drips/drains to side of transfer
  2. far side arm over to front edge of bed - patient rolls onto side
  3. push up through deltoid NOT hands
  4. swing legs over side of bed
  5. physio one hand on hip and one on shoulder to help to sit up
  6. consider fatigue/dizziness
196
Q

When performing sit-to-stand mobilisation transfer out of bed, what can the patient do to provide wound support?

A

Cross arms

197
Q

Transfer patient out of bed - bed to chair

A
  1. drips/drains to side of transfer
  2. chair to side of bed
  3. bed height so patients feet flat on floor
  4. patient cross arms for wound support
  5. direct to stand up - lean forward and push through feet - guide by shoulders
  6. once standing relax arms and take deep breaths - consider dizziness
  7. take hand for support and guide to chair - taking small steps around
  8. patient feel chair on back of legs, then sit
198
Q

What should patients be direct to do during auscultation? Why?

A

Cross arms at front

Moves scapula and associated tissues out of the way - can auscultate directly onto thorax

199
Q

In unilateral lung disease, which lung should be listened to first?

A

‘Normal’ lung first

200
Q

How long should you listen for in each auscultation position?

A

A whole respiratory cycle - complete breath in and complete breath out

201
Q

What are the risks during auscultation?

A

Hyperventilation, dizziness/light-headed

202
Q

What kind of breaths should the patient take during auscultation? Why?

A

Deeper breaths than normal

More turbulent airflow

203
Q

Normal breath sounds

A

Noisy, turbulent airflow in trachea and large airways

204
Q

A) Bronchial breath sounds

B) Caused by?

A

A) loud and harsh, throughout inspiration and expiration, pause between the two
B) air replaced by solid tissue - eg. consolidation, areas of collapse, tumour

205
Q

A) Diminished breath sounds

B) Caused by

A

A) reduced sound

B) obstruction or decrease in airflow - eg. atelectasis, emphysema, pneumothorax

206
Q

Fine Crackles heard in which lung areas?

A

small, distal airways

207
Q

Coarse crackles heard in which lung areas?

A

large, proximal airways

208
Q

What causes ‘crackles’ in breath sounds?

A

Airways that have been closed or narrowed are suddenly forced open on inspiration

209
Q

Early inspiratory crackles

A

reopening of large airways (eg. bronchiectasis and bronchitis)

210
Q

Late inspiratory crackles

A

reopening of alveoli and peripheral airways (eg. atelectasis, pneumonia)

211
Q

Early expiratory crackles

A

secretions in large airways

212
Q

Late expiratory crackles

A

secretions in peripheral airways

213
Q

Wheeze breath sounds can be …. or …. pitched, and … or …

A

High or low pitched, and monophonic or polyphonic

214
Q

What causes ‘wheeze’?

A

Air being forced through narrowed or compressed airways

215
Q

Pleural rub breath sounds

A

Creaking, grating sounds

216
Q

What causes pleural rub sounds?

A

pleural surfaces are inflamed or infected and rub together

Cardiorespiratory 1 (4 decks)

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