Treatment

Question 1

Sputum retention

Answer 1

1. ACBT (TE to get behind sputum then HUFF)
2. Positioning / mobilising
   - (if unilateral side lie for gravity to drain sputum from lobes to larger airways to be coughed up)
   - (forward lean to increase range of diaphragm and LV/FRC and stabilise shoulder girdle/ accessory muscles to assist coughing)
   - can cover wound w towel to increase pt confidence to cough (make sure pain under-control)
3. cough assist/ IPPB
4. Percussions and vibrations
   rhythmic shaking/ clapping to loosen and mobilise sputum from the chest walls and smaller airways to the larger ones to be coughed up
5. hydration/ pain relief and wound support

Question 2

V/Q mismatch

Answer 2

Treat the problem which is decreasing ventilation

1. positioning and mobilisation (make use of the dependent lung/ gravity to improve LV and perfusion)
2. ACBT to slow RR, SOB, improve oxygenation and clear sputum, increase LV and collateral ventilation
3. O2 therapy/ NIV
4. Manual techniques (vibs and percussions - with towel)
5. PEEP to improve atelectasis, SATS

Question 3

decreased exercise tolerance

Answer 3

1. bed exercises
   - ankle pumps
   - straight leg raise
   - heel slides towards self
2. chair based exercises
   - heel raises
   - marching
   - abduction to side
   - knee extensions
   - straight arm circles
   - straight arm bounce
   - active assisted resistance internal and external rotation (or press arm against arm rest)
3. standing
   - marching
   - mini squats
   - side stepping
   - hip abduction
   - hip extension

Question 4

Decreased lung volume

Answer 4

1. TE with holds and sniff
2. positioning (bad lung up) decreasing pressure and O2 goes to the non-dependent lung first
3. NIV (CPAP and BIPAP) , increases PEEP and opens airways and reduces chances for collapse
4. exercise to strengthen resp and accessory muscles to improve ability to expand chest and inhale
5. if reduced due to sputum, sputum clearance (Vibs, positioning, acbt)

Question 5

Increased WOB

Answer 5

1. if high RR, Give Breathing control/ relaxation techniques
2. positioning in high sitting or chair and support UL with pillows to fix shoulders and help relax the traps etc and decrease WOB
3. NIV, keep airways open and improve oxygenation to allow the resp muscle to not work as work to avoid fatigue and IV
4. secretion clearance (ABCT) if thats the problem

Question 6

Collateral ventilation (breath holding)

Answer 6

1) Hold allows more time for air to be distributed throughout the lung = promoting recruitment of collapsed or poorly ventilated alveoli
2) increase gas exchange because there is increased opportunity for gas exchange to occur between alveoli (interalveolar) so the surface area for gas exchange is increased