Treatments Flashcards
Neuro and respiratory
ACBT
- hand on stomach, gentle breath in through nose and out through mouth, looking to expand into stomach on breath in, use pursed lips if breath is difficult on the way out, repeat 5x
- place hands on rib cage (like hands on hips but a little higher), longer and deeper breath in through nose and out through mouth, looking for movement of ribs out and then back in, repeat 5x, either back to phase 1 or on to phase 3
- mimic steaming up window or mirror using hand, long breath in through nose and then huff out, can take shorter breath in and longer huff or longer breath in an short huff, cough and clear
1 -> 2 ->1 ->2 -> 3
Acapella
- Set acapella device to lowest resistance (level 1)
- Instruct pt to complete 3-5 normal breaths in through nose and out through mouth
- Instruct pt to inhale as far as possible, place the device in their mouth, create a tight seal, and breathe out through the device with the breath out lasting at least 4-6 seconds
- Repeat the above step 10 times, increasing the resistance at appropriate stages
- The pt can leave the device in their mouth during each inhale through their nose
- Once 1 cycle (10 repetitions) is complete encourage the pt to cough/huff to clear the secretions
- Allow pt to repeat until they need to take a break, either for light breathing or to cough and clear
Contraindications/precautions: inability to tolerate increased work of breathing, intracranial pressure >20mmHg, recent oral or skull surgery/trauma, oesophageal surgery, untreated pneumothorax, middle ear pathologies, haemodynamic instability, acute sinusitis, nausea
Indications: - Used when patient isn’t able to clear secretions by coughing or huffing
Bed to chair transfer
Prior to transfer ensure you are on the side of the bed that is their stronger side and ensure that the bed is at the right height for standing.
Aiding a patient from lying to sit on edge of bed - ask if while lying they can twist their trunk (a bit like rolling over but only trunk) to test core strength, then ask them to bend their leg and roll like recovery position towards you and onto their stronger side, straighten both legs hanging off the bed and ask them to use their strong arm to push up, supporting them throughout from in front.
Transfer from bed to chair – ensure chair is on opposite side of patient to you and sure you are on the side that best supports the patient, place your foot in front of theirs and knee in line, one hand opposite waist, one hand shoulder, direct them that in a moment they’re going to stand on the count of ready steady stand, ask them to lean forward and use their arms to push off the chair, count ready steady stand, keep one hand on waist and hold patients hand with the other ensuring palm to palm grip, walk with them to the chair and ask them to shuffle so the back of their legs are touching the chair, encourage them to reach for the arms of the chair while you support their shoulder and waist and lower themselves back.
Open suction
- Speak to the patient and gain consent.
- Ensure the patient is positioned in supine or high sitting with slight hyperextension.
- Turn the machine on and check the pressure (200mmHg).
- Verbalise that you would auscultate now.
- Wash hands and apply gloves.
- Pick catheter (green, white, or potentially orange for an adult).
- Open catheter packet only at the end and attach suction machine tube.
- Pull out small amount of the catheter and fold in half.
- Hold in ND hand with packet still on.
- Use ND hand to apply second glove to dominant hand.
- With sterile hand pull catheter fully out of packet and put packet down.
- Slowly feed catheter into airway.
- Once in place pull up 1-2cm.
- Use thumb to cover the hole on the catheter.
- Pull catheter out in slow, smooth motion.
- Wrap catheter around glove on dominant hand and remove glove around catheter.
- Throw away catheter and gloves.
- Turn off the machine.
- Wash hands.
- Verbalise that you would now auscultate again to ensure secretion removal.
- Verbalise that if any secretions were present in the mouth, you would now perform oral suctioning.
Closed suction
- Speak to the patient and gain consent.
- Ensure the patient is positioned in supine or high sitting with slight hyperextension.
- Turn the machine on and check the pressure (200mmHg).
- Verbalise that you would auscultate now.
- Wash hands and apply gloves.
- Lock the closed suction tube.
- Connect the closed suction tube to the suction machine tube.
- Feed the closed suction tube fully into the ET tube.
- Release the lock and press the switch to allow suction.
- Pull suction tube out in slow, smooth motion.
- Verbalise that you would now flush out the tube by opening the green flap at the ET tube connection. Fill a syringe with saline water and, while pressing the switch to allow suction, flush the tube with the saline.
- Lock the closed suction tube.
- Remove the suction machine tube.
- Turn off the machine.
- Remove gloves and wash hands.
- Verbalise that you would now auscultate again to ensure secretion removal.
3 day walking programme
Day 1- seated calf raises (2 sets of 8), seated heel digs (2 sets of 8), seated marches (2 sets of 10), seated extensions (2 sets of 8), assisted glute bridge in bed if possible (2 sets of 3)
Unsupported sitting (2 sets of 5 mins)
Day 2- assisted to stand, standing with zimmer frame ( 3 sets 1 min)
2nd+3rd time->
Weight shifting/lift each leg (2 sets)
Day 3- taking step from standing with frame
Calf raises with frame (2 sets 4)
Prehab cancer exercise class
Why- improve CV health and muscle strength before treatment, reduces complications, broadens treatment possibilities
Shoulder rolls/Half jacks
Squats/sit to stands
Marching
FITT
BORG- hard, 3x weekly, 2-3 mins as tolerated per exercise, aerobic/functional/strength exercises
Balance training
- Unsupported sitting
- sit to stands
- standing balance
- side walking
- tightrope walking
- weight shifting/ standing on one leg
Gait training
- Marching- for hip flexion
- SLS- for balance
- Seated knee extensions- for swing phase
- Side leg raises- glute med to stabilise and prevent pelvis from dropping
- Calf raises- for PF
- Dorsiflexion with band (holding whilst seated)
Therapeutic positioning
Aim for maximum BoS using pillows
Sitting upright when struggling to breathe
Postural Management in chair
- Common position - bum on edge of chair, hips and knees extended - painful, unsafe, uncomfortable, lack of functional ability, aggravating contractures, decreased lung capacity, social implications.
- First, bend the knees to get the feet flat on the floor, one at a time, often needs 2 physiotherapists.
- Second, bring patients trunk forwards and then patient shuffles backwards onto chair.
- Can then use pillows to support upper limb for spasticity or flaccidity.
