Treatment of Acute Cardiopulm Conditions Flashcards
What are diseases of “state” in which pts oxygen transport system fails?
Increased secretions Hypoxia Altered mental state: unconsciousness Changes in cardiac function Pneumonia
What are effects of hospitalization on cardiovascular system?
Increased basal HR Decreased maximal HR and O2 consumption Orthostatic hypotension Increased venous thrombosis risk Decreased total blood volume Decreased hemoglobin concentration Decreased blood flow
What are effects of hospitalization on respiratory system and musculoskeletal system?
Respiratory: decreased vital capacity and residual volume, decreased PaO2, impaired ability to clear secretions, increased ventilation perfusion mismatch
Muscles: decreased muscle strength and girth, decreased efficiency of contraction, joint contractures, decubitus ulcers
What are effects of hospitalization on CNS?
Emotional issues, behavioral disturbances, cognitive function, altered sensation, joint position sense
What are 4 stages of effective cough?
Inspiration greater than tidal volume
Closure of glottis
Abdominal and intercostal muscles contract (increases intrathoracic pressure)
Sudden opening of glottis and air forced out
Deficiency in stages=ineffective cough (surgical pts can do splint the incision, pain meds)
What happens with individuals with asthma or emphysema?
Difficulty with exhalation d/t over distended lungs
May have expiratory wheeze with forced and prolonged exhalation: bronchospasm or respiratory distress
What are cough techniques for emphysema, neuromuscular weakness, post op patients?
Emphysema: small or medium breaths sized breaths followed by 2-3 huffs and series of small coughs, active cycle of breathing techniques
Weakness: may have to actively assist them with coughs
Post op: series of coughs (small breath and small cough, then medium breath and medium cough, large and large)
What is active cycle of breathing technique?
Breathing control: diaphragmatic breathing at normal tidal volume
Thoracic expansion: in postural drainage position with deep inhalation with relaxed exhalation
Repeat breathing control followed by expansions, followed by breathing control
Forced expiratory technique: 1-2 huffs, concentrate on ab contraction
Follow with breathing control
what are ways to maximize airway clearance?
Position for success
Maximize inhalation first
Ask for breath hold
Encourage maximal intra thoracic and intra abdominal pressure
Instruct in appropriate timing and trunk movements for expulsion
Make procedure as active as possible for pt
What are some assisted coughing techniques?
Costophrenic assist
Counter rotation assist
Self assisted: prone on elbows, head flexion, long sitting, short sitting
What happens to control of breathing with primary lung diseases? SCI?
Overuse of accessory muscles
Treatment: energy conservation, relaxation, pacing activity with breath control
Exercise is important: pace/coordinate breathing with activities= less dyspnea
SCI: decreased inspiratory time and cough, upper chest collapse but can use accessory muscles to balance upper/lower chest (increase vital capacity)
What are aspects of PT in acute cardiopulm conditions?
Physiological measures: O2 saturation, HR, BP Breath sounds Dyspnea scale Expiratory flow rates/PFT Scales: RPE, dyspnea, angina
What are the ratings for dyspnea and angina scale?
Dyspnea: 0= no dyspnea, 1= mild, noticeable, 2= mild, some difficulty, 3= moderate difficulty, but can continue, 4= severe difficulty, cannot continue
Angina: 1+= light barely noticeable, 2+= moderate bothersome, 3+= severe, very uncomfortable, 4+= most severe pain experienced, unbearable
What are things to remember in acute cardiopulm conditions?
Adhere to current oxygen orders
Always monitor recovery time for 5 min
Encourage warm up before session
Always record exercise induced changes
