Tutorial revision

Question 1

What is a high intesnity interval IMT program for breathless patients?

Answer 1

3-5 days a weak
5 sets f 6th breathes, rests in between
Insensity > 50% MIP - highest tolderable intensity to just complete 6th in each set

Question 2

What are contraindications for IMT in chronic COPD

Answer 2

Recent undrain pneumothorax, or history of recurrect sponatneous pneumotheroax
Large Bullae on CXR
Marked osteoporosis with a history of spontaneous rib fractures
Lung surgery within the last 12 months

Question 3

Prescribe an IMT program for a patient with stable chronic COPD

Answer 3

Frequency: 3 days per week for 8 weeks
Duration 21 mins in total - intervals of 2 minutes work: 1 minute rest
Intensity > 30% MIP ( increased as tolerated by RPE scores, aim for 4/10, somewhat sever
Pattern
1 min warm up at 505 training load (e.g. 15% of MIP)
2 minutes at training load (at least 30% MIP)
1 minute rest
repeat cycle 7 times = 21 minutes

Question 4

List the sputum clearance techniques

Answer 4

Cough, HUFF ( forced Expiration technique (FEF)), breathing control, ACBT, PEP

Question 5

What is ACBT

Answer 5

Active cycle of breathing technique (ACBT)
cycles of breathing control, thoracic expansion exercises and forced expiration technique FET
Thoracic Expasnion - deep breathing exercises empahsisng inspiration. Inspiration and a 3 second hold and then a pssive expiration

Question 6

What are wanrings for ACBT

Answer 6

Pain, SOB, dizzy

Question 7

Contraindications to Bubble PEP are:

Answer 7

Undrained Pneumothorac
Frank haemoptysis
Extensive bullae or cysts
Recent pneymonectomy

Question 8

WHat are some precautions to Bubble PEP

Answer 8

Altered consciousness/ confusions/ NB< - risk of drinking the water
Paediatric patients - risk of drinking/ aspirating
Patients requiring high/ continuous oxygen therapy

Question 9

How do you make a at home bubble PEP

Answer 9

Suction tubing - 75 cm
1 L bottle
Tape to secure tubing
empty water to a level of approximatelty 13 cm and discard bottle lid
put suction tubing to bottom of water, tape to side of neck. Leave neck of bottle open
Attach patient label and write a date of set up

Question 10

What is the prescription for Bubble PEP

Answer 10

Blow for 4-6 seconds continuously!
repeat 10 times
Rest/ hugg/ cough inbetween sets of 10 to clear sputum

Question 11

What are precautions for Postural Drainage

Answer 11

HT, Unstable CV system, Immediately following a meal,Hiatus hernia, GORD (reflux), Orthopnoes (breathless when lying flat), recent head injury, PO/ severe cardiac failure, severe obsetity/ abdominal distension - increases pressure on diaphragm and compresses lung volumes, recent head/ neck surgery or facial trauma
Cerebral or aortic aneurysm

Question 12

What are precautions to vibrations and shaking

Answer 12

ribs, frank haemoptysis, rib caner, osteoporosis or long term steroid use, burns, surgical incisions, intercostal drain, severe bronchospasm, severe pleuritic pain, very low platelet level

Question 13

Danger of oxygen therapy

Answer 13

Carbon dioxide narcosis
Oxygen toxicity
Aborption atelectasis
Retrolental fibroplasia
Mucosal damage
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