Treatment 2.0 Flashcards
Why do you perform breathing exercises
- Increase ventilation
- to prevent atelectasis
- Decrease WOB and O2 consumption
- to remove secretions,
- Increase chest wall mobility and for relaxation
When performing breathing exercises:
Breath in through ____ and breath out through _____
nose
mouth
Indications for diaphragmatic breathing
post op patients, respiratory failure, chronic respiratory distress
Benefits of diaphragmatic breathing
Increase lung expansion and compliance
reduces VQ mismatch
Increases respiratory muscle strength
How do you do diaphragmatic breathing
o Slow inspiration to lower lung lobes (start with patient in lying or sitting, you use your hand then they use their own hand for feedback), expansion of belly is PASSIVE monitor upper chest movement, do 3-4 cycles of deep breaths, prescription: 10 breaths per hour
What are some possible additions to diaphragmatic breathing
end inspiratory hold (hold 3-5 seconds before relaxed expiration)
single percussion
sniff
lateralcostal breathing (use hands for feedback)
Pursed lip breathing indications
good for COPD patients
Pursed lip breathing how
Inhale with lips in pucker position for 2 counts, exhale for 4 counts (exhalations 2x longer then inhalations)
Segmental breathing indications
healthy individuals can direct O2 in the upper or lower lung fields upon instruction
Segmental breathing HOW?
Tactile stim or pressure to increase expansion of specific areas
**pressure on inspiration and relax on expiration
Incentive spirometry/sustained max inspiration indications
same uses as diaphragmatic breathing, just as good
Incentive spirometry/sustained max inspiration how?
Sustain inspiratory effort for 3 seconds, then relax expiration, max inspiration to TOC, give a visual reminder and an incentive goal; can be flow or volume sensitive
Breath stacking indications
When breathing is painful, vent dependent patients NOT COPD PATIENTS!!
Breath stacking HOW?
Take a breath, hold, add another breath, hold and repeat until capacity is reached (can follow up with pursed lip breathing), slow exhalation
Indications for SOS for SOB
For respiratory distress in COPD patient
Steps for SOS for SOB
- stop and rest in comfortable position
- get head down
- get shoulders down
- breathe in through mouth
- breathe out through mouth
- breath in and out as fast as you want
- begin to blow out longer, but not forcibly, used pursed lip breathing if you find it effective
- begin to slow breathing
- begin to use nose
- begin diaphragmatic breathing
- stay in position for 10 minutes longer
Indications for assisted cough
an ineffective cough seen in patients SCI, NMD, chemically paralyzed, weak respiratory muscles
Contraindications to assisted cough
ruptured diaphragm
Precautions to assisted cough
inferior vena cava filter
- rib #
- abdominal or thoracic surgery
- pneumothorax
- perforated bowel *
- use clinical judgment may only have to change hand position
Assisted cough procedures
- consent
- hand placement (1-2 people, landmark xiphoid process and umbilicus), or upper chest
- position as indicated
- palpate breathing pattern, tell patient plan for 3 big inspirations then on the 4th you will cough * watch body mechanics
- after coughing, ensure proper secretion removal (suction or patient spit)
What might you combine a plain cough with for treatment
manual techniques
splinting (for pain, use pillow)
tracheal tickle
Indications for huffing
For improving secretion clearance, as an adjunct to manual techniques
Huffing procedure
- 2 reps of huffing (not forceful enough to cause pain, just to move a tissue away from you if you held one up), mouth is in “O” shape, glottis remains open
- arms can be by side or in chicken wing position
- abdominals and chest wall will tighten
- follow with diaphragmatic breathing
What is important to know before doing any postural drainage
the unique contraindications of the patient: spinal injury, blood pressure
What is the best postural drainage position
Upright and mobile
Indications for the use of postural drainage
to put patient in position that drains the airway in gravity directed movement
How long do you maintain the positions in postural drainage
3-10 minutes
Contraindications and precautions to postural drainage positions
- untreated pneumothorax, hemoptysis, unstable CV status, inc ICP
- esophageal anastomosis, aneurism, PE or CHF, patient upset or agitated
- Recent laminectomy
- large Pulmonary embolism
Postural drainage position for RUL/LUL
sitting upright in bed, back supported
Postural drainage position for LUL anterior
Semi-fowler’s (supine HOB at 45)
Postural drainage position for RUL anterior
Supine, hips in ER
Postural drainage position for posterior LUL
Semi-prone (lt side elevated by pillows), HOB 30 degrees
Postural drainage position for RUL posterior
semi-prone (Rt side elevated by pillows), bed flat
Postural drainage position for LUL lingula (middle)
Rt sidelying (semi-supine, Lt side elevated by pillows), bed inverted 30°
Postural drainage position for RML
Lt sidelying (semi-supine, Rt side elevated by pillows), bed inverted 30°
Postural drainage position for RLL/LLL superior
Prone
Postural drainage position for RLL/LLL anterior
Supine, bed inverted 30 deg.
Postural drainage position for RLL/LLL posterior
prone, bed inverted 30 deg.
Postural drainage position for RLL lateral
Lt sidelying, bed inverted 30 deg
Postural drainage position for LLL lateral and RLL medial (cardiac)
Right sidelying bed inverted 30
