Test 3 Flashcards
1
Q
4 postural positions for relief of dyspnea
A
- professorial position- sitting leaning over table
- standing leaning forward on wheel chair
- standing with back against the wall
- sidelying on bed with an incline
2
Q
When do we stop exercise:
A
- drop in O2 sats 3.-5% or below 90%- desaturates
- dyspnea index 2/4 or 5/10
- angina, dizziness, pallor
3
Q
objective rating of dyspnea level count to 15
A
0 able to count to 15 easily 1 count to 15 with one breath 2 count to 15 with 2 breaths 3 count to 15 with 3 breaths 4 Unable to count
4
Q
objective rating of dyspnea 1-10 scale
A
0- Nothing at all 1 very slight 2 slight 3 moderate 4 somewhat severe 5 severe 7 very severe 10 maximal
5
Q
6 minute walk test norms
A
max distance in 6 minutes is the out come measure
- normal , healthy = 571 +/- 90 m
- COPD avg 380 m
- <200 m is predictive of unacceptable post- op outcomes of LVRS
6
Q
aerobic Training for chronic pulmonary patients
A
1:1 ratio work: rest interval adding to 20 min
if less than 15-20 minute work capacity, increase frequency to 2-3 times/day
- work towards 30-45 minutes
- warmup/ work/cooldown
7
Q
Peripheral Muscle atrophy of COPD and CHF patients
A
decreased number of Type I fibers, shift to higher percentage of Type II
– use more anaerobic glycolysis = Incr PaCO2
-slow adaptation to exercise, slow recovery
8
Q
resistance training COPD and CHF
A
light resistance at least 6 reps x 3, build to 15 reps before increasing weight -theraband, wrist weights, wand exercise -RPE at 4-6/10 or 11-13/20 -2-3x/ week - no isometric/static ex - no Valsalva or breath holding no bending from waist
9
Q
Goals of respiratory medications
A
-Opening airways
- control inflammation
-secretion removal
-fighting infections
=improved oxygenation
10
Q
bronchodilators
A
prevent or decrease air ways constriction caused by irritants
- used with anti-inflammatories
- sTo produce bronchodilation: Beta adrenergic agonists, alpha adrenergic antagonists, cholinergic antagonists
11
Q
bronchomotor tone
A
- Balance between adrenergic and cholinergic influence
- cAMP: Bronchodilation (sympathetic)
- cGMP: Bronchoconstriction (parasympathetic)
12
Q
corticosteroids
A
may assist in preventing airway inflammation sometimes caused by an immune reaction to irritant
- administered by
- inhalation, metered-dose inhaler (flovent)
- oral, tablet (prednisone)
13
Q
Side effect of long- term Use of respiratory medication
A
immunosuppression osteoporosis GI upset proximal muscle weakness white patches in mouth or throat Cushingoid symptoms growth retardation
14
Q
non-steroidal anti-inflammatories
A
nedocromil sodium
15
Q
decongestants
A
decrease mucosal edema
- alpha 1 agonists (vasoconstriction in mucosa)
- cardiac irritability
16
Q
antihistamines
A
act on CNS to decrease mucosal discharges
-drowsiness
17
Q
antitussives
A
- cough center in brain to increase firing threshold
- sedation
18
Q
relaxation technique to minimize accessory muscles
A
- thinker’s pose
- max contract/relax
- maximize diaphragmatic
- posterior pelvic tilt
19
Q
improve diaphragmatic breathing in lying
A
- breathe into my hands (rise/fall)
- Facilitate with scoop technique
3 Inhibit accessories
*sniffing
20
Q
secretion removal clearance techniques
A
-aerobic exercise
-postural drainage
-percussion/vibration
- positive expiratory pressure- flutter valve
- active cycle breathing
facilitated cough
21
Q
goals of airways clearance and secretion removal techniques
A
- open airways
- optimize lung/alveolar expansion
- improve gas exchange
- discharge criteria: when independent in secretion removal and clearance techniques
22
Q
Postural drainage for upper lobe
- apical segment
- posterior segments
- anterior segments
A
apical segments: sitting up 30 degrees back hit to of shoulders
posterior segments: sitting at edge of table hunched over pillow hit behind shoulder
anterior segment: laying down pillow under head and one under knees hit front of shoulder
23
Q
Postural drainage for middle lobe and lingula
A
lingual: 15 decreased head down. sidelying and rotated back 1/4. hit front of mid-chest Left
Middle lobe: down 15 degrees head down right arm up hit side of mid-chest. 1/4 rotate back
24
Q
postural drainage Lower lobe
- anterior basal segments
- posterior basal segments
- lateral basal segments
- superior segment
A
- anterior: 30 degrees head down. side lying hit bottom side chest
- posterior 30 degrees head down, side lying bottom posterior chest. 1/4 turn forward
- lateral 30 degrees head down, side lying hit bottom side chest 1/4 turn forward
- superior segment laying flat prone: hit upper posterior chest
25
How long do you hold a postural drainage positions
- postural drainage alone: 10 minutes each position
- postural drainage combined with percussion or vibration: 3-5 minutes each position
vibration or shaking applied during expiratory phase only
- deep breath and cough/huff after each position
26
contraindication of vibration/percussion
- osteoporosis
- rib fx
- anxiety
- seizure disorder
- tumor obstruction in airway
- pulmonary edema caused by heart failure
- recent spinal sx
- active hemoptysis
- hemodynamically unstable
27
4 phases of coughing
1 deep inspiration
2. glottis closure
3. increased intra-abdominal and intra-thoracic pressure
4. glottis opens, forceful abdominal contraction and expulsion
28
why do forced expiratory maneuver
huffing
- keeps glottis open, less forceful
- use for patients prone to bronchospasm
- mouth in "O"
29
active cycle of breathing
- obstructive dysfunction
1. breathing control: 5-10 sec of normal tidal volume
2. 3-4 thoracic expansion exercises Big breaths
----full inspiration with relaxed expiration, can be combined with vibration, breath hold, or sniff
3. full inspiration followed by 1-2 Huffs
4 repeat
30
Flutter valve
- provide back pressure to maintain airways open
- oscillating pressure loosens secretions and move centrally
- deep breath, hold 2-3 sec, exhale through device x10
- deep breath, forceful exhalation through device
- cough or huff
31
high frequency chest wall oscillation
- treat all lobes at once in upright
- progress through low, medium and high frequencies
- each frequency 5-10 minutes
- follow with cough
- adv: independence, easy
- disadv: expensive, cant target specific lobe
32
paraplegia T1-L1
Loss of abdominals
- w/o support, abdominal viscera fall anterior and inferior
- decreased diaphragm mechanical adv abd ability to increase intra-abdominal pressure
Loss of intercostals
- decreased rib cage stability
- decreased chest expansion
Paradoxical breathing
Lose ability to cough with forced expiration
33
C5-C8 Quadriplegia
-Complete loss of expiratory muscle function, loss of intercostals
- functioning diaphragm
- weak accessory muscles
- decreased anterior, lateral, and posterior chest expansion
- paradoxical breathing
34
C3-C4 quadriplegia
Varying degrees of weakness in diaphragm, scalenes
paradoxical breathing
impaired ability for speech
35
C1-C2 quadriplegia
- Only traps and SCM available
- Superior-anterior upper chest expansion
- mechanical ventilation usually necessary
36
costophrenic assist in supine
- hands at lower rib cage
- quick stretch at end of expiration
- Pt takes breath and holds at end of inspiration
- ask pt to cough- compress air out as pt coughs
- 2-3 coughs per breath
37
costophrenic assist - sidelying
- for asymmetrical weakness, specific lung segment pathology
| - quick stretch to facilitate inspiration, pressure applied to assist with cough on expiration
38
anterior chest assist
- involves upper and lower chest: one arm across Pecs one parallel on lower ribs
- pressure applied in direction
* * don't use with cavus deformity
39
Heimlich assist aka abdominal thrust
- supine, sidelying, or sitting
- heel of hand at level of naval
- deep breath and hold
- assist with cough : up and in under diaphragm
- use as last resort
40
suctioning
- indicated for patients w/ artificial airways, excess pulmonary secretions, and inability to clear secretions from the airway
- to facilitate removal of secretions and stimulate cough reflex
- freq determined by amount of secretions produced
- suction catheter can only reach to level of mainstem bronchi- postural drainage/percussion/vibration should be utilized to mobilize secretions centrally prior to suctioning
41
complications of suctioning
- hypoxemia
- bradycardia or tachycardia
- hypo or hyper tension
- increased intracranial pressure
- atelectasis
- tracheal damage
- infections
42
signs of restrictive lung dysfunction
```
tachypnea
hypoxemia
decreased Lung volume
decr breath sound
inspiratory crackles
nodules on Chest X-ray
pulmonary hypertension
(cor pulmonale)
```
43
symptoms of restrictive lung dysfunction
dry cough
SOB
weight loss
muscle wasting
44
infant respiratory distress syndrome
- prematurity <36 weeks
- inadequate surfactant production
- decreased compliance, incr work of breathing
- pulmonary hemorrhage, pneumonia
- ventilator - possible disruption of airways
- survivors: bronchopulmonary dysplasia - if FIO2 >60 % for 5 days
45
Aging changes in chest wall and lung tissue
wall- decr strength of respiratory muscles, decr compliance
lung tissue : loss of elastic tissue in alveoli, increased physiologic dead space
46
aging overall results
- incr work of breathing
- incr respiratory muscle fatigue
- decreased vital capacity by 25% between age 30 and 70
47
interstitial pulmonary fibrosis
Idiopathic - autoimmune, viral, genetic
alveolar walls- inflamed, turn to scar tissue
- -- decr compliance
- - decr volumes
- -- decr surface area for gas exchange
increased work of breathing
48
treatment for interstitial pulmonary fibrosis
corticosteroids, pulmonary rehab, lung transplantation
49
chest radiograph of idiopathic pulmonary fibrosis
- elevated diaphragm
50
occupational lung disease
- coal workers pneumoconiosis - 10-12 yearh hx of coal dust
- silicosis- silicon dioxide
- asbestosis- contruction, mining
- SSx: dyspnic, chronic infections, chronic cough
-treatment: nutrition, stop smoking, exercise, treat infections
51
sarcoidosis
- Black women 20-40 y.o unknown cause
- granulomas: spleen, liver, lymph nodes, lungs, subcutaneous skin
- heart: pericarditis, arrhythmias
- nervous system: meningitis, encephalitis
52
bronchiolitis Obliterans
- major infection, necrosis of epithelium, fibrosis
- -- Reaction in small airways (respiratory bronchioles)
- --medical treatment: corticosteroids
53
Pneumonia
| symptoms
bacterial, viral, fungal: destruction of cilia and mucosal surface, inflammation
- symptoms: fever, productive cough,pleuritic pain
54
Pneumonia results
medical Rx
PT Rx:
results: edema,hemorrhage, pus in alveoli
Medical Rx: antibiotics, nutrition, hydration
PT Rx: postural drainage, airway clearance, assisted coughing
55
ARDS- adult respiratory distress syndrome
- cause
- result
Cause:
- trauma, aspiration, drowning
- shock, sepsis
- oxygen toxicity
Result:
- increased permeability of alveolar capillary membrane
- fluid proteins into interstitial space, and alveoli
- 30-63% mortality
- subacute phase- chronic restrictive Lung disease
- CXR: diffuse , fluffy infiltrate
-PT Rx: position changes if any until subacute
56
Cancers of respiration
4 kinds
- 80-90% from tabacco use
- prognosis : 1 year survival 50%
- medical treatment : - radiation, chemotherapy
- sx, laser therapy
PT: pre and post surgery
57
radiation Pneumonitis
fibrosis, inflammation
| - up to 6 months after treatment
58
Pleural effusion - pleurisy
- collection of fluid in pleural space
- CHF, abdominal abscess, cirrohosis, pneumonia, TB, cancer
-caused by backup of fluid moving from parietal to visceral pleura
symptoms- pleuritic pain- dry cough
- medical RX: chest tube
- Pt RX: help to re-inflate compressed alveoli
59
pulmonary edema- space occupying
left ventricular failure
| - RX: medication
60
pulmonary embolism
- blood clots- LE
- ventilation/perfusion mismatch
- high risk for orthopedic patient
symptoms: acute dyspnea, pain
Medical RX: medication to dissolve clot
PTs: preventive exercise, no RX when acute
61
Neuromuscular Causes of Restrictive Dysfunction
SCI, hemiplegia, muscular dystrophies, ALS, Guillian Barre
- decr chest wall compliance due to paralysis
- if no intercostals, decr chest expansion, hypoventilation
- if no abdominals,no cough, prone to chest infections
- excess diaphragmatic fatigue- headache, lack of concentration
62
Trauma affecting restrive disease
- blunt trauma/ contusions of lung
- rib fractures
- hemothorax
- ARDS
63
Pneumothorax
- Open: air goes in and out
- closed: air goes in. collapsed lung, mediastinum to opposite side
- Medical RX: Chest tube
64
post-surgery patients
Incisional pain
- Increased RR
- decr tidal volume
- decr cough
effects of anesthesia
- cilia
PT treatment
- deep breathing, chest expansion
- airway clearance
65
Sign on Physicla exam of restrictive disease
- decr lung volume, PaO2, CXR with small lung fields and nodules, FEV1/FVC
- -----restrictive disease: normal or incr 0.8-0.9
- rapid shallow breathing
- gradual, unintended weight loss
- incr resting HR
- lung auscultation- diminished breath sounds and inspiratory crackles
- chest mobility- decreased
- strength/ ROM - neck/shld/overall strength
-aerobic capacity- decr
66
Inspiratory Muscle training pFlex
begin as tolerated (?5 min) without increased dyspnea or drop in O2 squat
--Incr to 15-30 minutes , 2-3 times/day, 6-7 days/week
Incr resistance when able to complete 2x 15-30 min sessions/day
67
Inspiratory or expiratory Muscle Trainer
inspiratory
- Begin 20-40 % of MIP, 515 minutes, 2-3x/day
- -- Incr to 15-30 min, 2-3x/day
- -- then increase to 40-60% of MIP based on tolerance
expiratory
- Begin 5-10% or MEP, 5-15 min, 2-3x/day
- ----Incr to 10-15% of MEP based on tolerance
68
incentive spirometer
To incr volume
- post surgerypatients, immobile patients
- -- to reopen airways, improve oxygenation
- -- incr surfactant production
- -- 10 breaths/ hour
-ALso used to maintain and incr inspiratory muscle strength and endurance
69
Intervention to increase chest wall mobility and lung volumes: positions for success
-neck/trunk
arm position
-Pelvic position
neck and trunk: trunk extension fasciliates insp, trunk flexion faciliatates exp
arm: external roation facilitates insp, internal rotation facilitates exp
pelvic: post tilt facilitates exhalation, ant tilt facilitates insp
70
combining breathing with exercise
inspiration- head up, eyes up, arms up and out PNF
expiration- head down, eyes down, arms down and in
butterfly technique - hands behind head : insp and expi
- Bilateral shld flex with insp
- shld Abd
- horizontal ABd
71
Lateral costal expansion- bilateral
- lower ribs
- "breathe into my hands"
- add quick stretch at end of expiration for fasciliation if inspiration
72
lateral costal expansion- unilateral
- lie on one side of thorax and expand opposite side
- combine with pillow or towel roll for additional stretch
- inhibits "good" side
- add quick stretch for faciliation
73
facilitation of thoracic mobility
| - horizontal towel roll stretch
- for kyphotic, rounded shoulders posture
- place towel roll at peak of kyphosis
- combine with UE movement- shld flexion, anterior chest wall stretch
74
facilitation of thoracic mobility:
| - vertical towel roll stretch
- for rounded shoulders, anterior chest tightness
- place towel roll vertically along spine
- combine with UE movement - butterfly ABd/ ER
75
Facilitate Thoracic mobility
| Lateral costal stretch
- stabilize lower ribs
- side bend toward stabilized ribs - expands contralateral side
- combine with deep breathing
76
trunk rotation stretch
- stabilize lower ribs
| - roatte upper trunk toward stabilization- expans contralateral side
77
Beta adrenergics selective vs. nonselective
Beta 1- increase HR, contractility
B2 Bronchiole smooth muscle -
- selective Ventolin, alupent, serevent (long acting)
epinephrine- drug of choice for acute bronchospasm- nonselective
Isoproterenol, propranolol- hypertension, cardiac, Beta 1 and 2 blockers
78
rib mobilization
- start low on rib cage, paraspinals, just lateral to spine
- inspiration- slight trunk roation off the bal
- expiration- rotation on to the ball
- move ball up thorax, then opposite side
79
anticholinergic and Alpha blockers
block cholinergic receptors
- atropine
- atrovent
- inhaler, nebulizer
- side effectd: dizziness, headache. nausea
Block alpha receptor response
- phentolamine- SE hypotension
- catapress and Aldomet- SE drowziness
