Unit 3 Week 10 Pulmonary Rehab Intervention Flashcards
What effects does immobilization have on the MSK system?
decreased strength, girth, and efficiency of contraction, joint contractures, and decubitus ulcers
what effects does immobilization have on the CNS?
emotional and behavioral disturbances, cognitive deficits, altered sensation and decreased balance
what effects does immobilization have on the metabolic system?
hypercalcemia and osteoporosis
what effects does immobilization have on the CV system?
increased basal HR and venous thrombosis risk, decreased max HR, max oxygen uptake, total blood volume, and hemoglobin concentration, and orthostatic hypotension
what effects does immobilization have on the respiratory system?
decreased vital capacity, decreased residual volume, decreased PaO2, impaired ability to clear secretions, and increased ventilation-perfusion mismatch
what is an acute cardiopulmonary condition?
diseases or states in which the pt’s oxygen transport system fails to meet immediate demands
What is the primary focus for PT for acute cardiopulmonary conditions?
promoting independence and functional mobility, maximizing gas exchange with ventilation and airway clearance, increasing aerobic capacity, respiratory muscle endurance and pt’s knowledge of condition
Therapeutic positioning techniques and paired breathing strategies are indicated for:
pts who have weakness or inhibition of the diaphragm
what is an example of stable positioning? what is the benefit?
Seated: feet flat, chair with no wheels and fixed back, arms supports, upright posture
decreases the amount of energy needed to breathe and can increase function and endurance
what does the side-lying position assist with?
lung expansion and secretion removal
what does the prone position assist with?
mobilizing secretions, greater volumes of ventilation, increased arterial partial pressure of oxygen (PaO2)
what does the Trendelenburg position assist with?
facilitating secretion drainage from the lower lobes of the lungs
If pairing breathing strategies and UE exercises, what should be paired with inhalation? exhalation?
inhalation: shoulder flexion, abduction, and ER along with upward eye gaze
exhalation: shoulder extension, adduction, and IR with downward eye gaze
what does a posterior pelvic tilt encourage?
diaphragmatic breathing pattern
what positions help with dyspnea relief? why?
tripoding: when pt leans forward on supported hands the intraabdominal pressure rises and pushes the diaphragm up in a lengthened position
arms supported: accessory breathing muscles can help with expansion for inspiration
stabilizing chest against the wall: decreases work of breathing and of keeping upright posture
what are the indications for pursed-lip breathing?
dyspnea at rest and/or with exertion, wheezing
what are the effects of pursed-lip breathing?
decreased symptoms of dyspnea, slowed respiratory rate, improved activity tolerance, and reduced wheezing
keeps airways from collapsing
creates a positive pressure splinting open the airways allowing for more gas exchange and increased time for exhale helping to promote prolonged expiration
what is paced breathing?
volitional coordination of breathing during activity
exhale slowly and comfortably, not forcibly, breathing out twice as long as your breathe in
what are the effects of paced breathing?
increased activity tolerance, reduced dyspnea, reduced fatigue, lower anxiety, and normal breathing
energy conservation techniques should be included for individuals with heart failure in order to __? chronic respiratory issues?
heart: decrease workload on the heart without loss of function
respiratory: minimize dyspnea and maximize endurance and ability to perform ADLs
what patient population is inspiratory muscle training indicated for?
pts with decreased strength or endurance of the diaphragm and intercostal muscles
what is the goal of inspiratory muscle training?
to increase ventilatory capacity and decrease dyspnea
what can an incentive spirometer be used for?
to practice diaphragmatic breathing, prevent or reverse atelectasis, and stimulate a cough
why use incentive spirometry?
to prevent atelectasis and promote diaphragmatic breathing
for which patients is incentive spirometry BEST utilized?
post surgical patients reluctant to take deep breaths d/t pain and anyone having difficulty getting air in
what is diaphragmatic breathing used for?
to manage dyspnea, reduce atelectasis, and increase oxygenation
what does the upper chest inhibiting technique help with?
helps a pt recruit the diaphragm during inhalation
what does lateral costal breathing address?
rib cage mobility and intercostal muscles
what is the difference between stacked breathing and progressive volume breaths?
stacked: series of inhalations that build of top the of previous breath without expiration up to maximal volume tolerated
progressive: take a series of breaths that are progressively increasing in depth but breath out between each breath
what is stacked breathing used for?
hypoventilation, atelectasis, ineffective cough, pain, uncoordinated breathing pattern
improved ventilation and perfusion matching, resolution of atelectasis, reduced pain, and improves cough effectiveness
what does progressive volume breaths assist with?
increasing inspiratory volume
what is the inspiratory hold technique? what is its effect?
involves holding of breath at maximum inspiration for 2-3 seconds then relaxed exhalation
improved ventilation and profusion matching, resolution of atelectasis and improved cough effectiveness
allows for increased time for either gas exchange at the alveoli or collateral ventilation using lambert canals
Inspiratory muscle training may be used to:
strengthen the primary and/or accessory muscles of inhalation in patients with poor maximal inspiratory pressure
what are the effects of thoracic mobilization?
increase the ability of the thorax to expand during breathing
what are the effects of counterrotation and butterfly rotation?
increase tidal volume and decrease RR by reducing tone and increasing thoracic mobility
what are airway clearance techniques?
manual or mechanical procedures that facilitate mobilization of secretions from airways
what are the indications for airway clearance tecnhniques?
impaired mucociliary transport, excessive pulmonary secretions, and an ineffective or absent cough
selection of optimal airway clearance techniques are based on:
pathophysiology and symptoms, stability of medical status, and pt’s adherence to techniques
what are the goals of airway clearance?
optimize airway patency, increase ventilation and perfusion matching, promote alveolar expansion, and increase gas exchange
what are the 4 stages of an effective cough?
-an inspiration greater than tidal volume
-closure of the glottis
-contraction of abdominal and intercostal muscles, producing positive intrathoracic pressure
-sudden opening of the glottis and the forceful expansion of the inspired air
what is included in the evaluation of an ineffective cough?
inhalation: needed to have enough air behind the secretions
inspiratory hold
forceful exhalation: generation of the force to expel secretions
what is included in the sputum production and analysis?
amount: size, number of plugs
color: clear, white, yellow, green, bright red, brown/rusty
consistency: thick, thin
odor: waft down smell: no order, malodorous
what does each color of sputum indicate?
white
yellow
green
brown
red
white: normal, allergies, or viral infection
yellow: developing an infection
green: viral or bacterial infection
brown: dried blood or heavy smoking
red: bleeding in respiratory tract
what is huffing designed to do?
move the mucus with less risk of dynamic airway collapse than deep, strong coughing (less bronchial irritation)
what does medium volume huffing help with?
move secretions lower down in the airways
what does high volume huffing help with?
moving secretions in the upper airways
what is the difference between stacked cough and progressive cough?
stacked: one big breath in, 3 coughs in same exhalation
progressive: progressively larger coughs, in 3 different breaths
what is active cycle of breathing?
a series of maneuvers performed by the pt to promote independence in secretion clearance and thoracic expansion
what is autogenic drainage?
pattern of controlled breathing of different volumes to mobilize secretions
-large inhale with slow sign to exhale all the way to the bottom
-breathe in bottom 1/3 until crackles
-breathe in middle 1/3 until crackles
-breathe in top 1/3 until crackles
then huff out secretions
what is postural drainage?
positioning that allows gravity assist with draining secretions from each lung segment
stay in each position 5-10 minutes
what is the positioning for upper lobe posterior apical segment PT?
seated/reclined 15 degrees forward
what is the positioning for upper lobe anterior apical segment PT?
seated/reclined 15 degrees back
what is the positioning for upper lobe anterior segment PT?
bed flat 0 degrees
what is the positioning for lingula or right lobe PT?
1/4 supine head down 20 degrees or 12 inches
what is the positioning for lower lobe lateral segment PT?
side lying head down 30 degrees or 18 inches
what is the positioning for lower lobe posterior segment PT?
1/4 prone head down 30 degrees or 18 inches
what is the positioning for lower lobe posterior superior segment PT?
prone bed flat
what is the positioning for lower lobe anterior basal segment PT?
1/4 turn from supine at 18 inches or 30 degrees head down
what is percussion?
attempts to lossen retained secretions manually or mechanically
rhythmical clapping with cupped hands over the affected lung segment
what is vibration?
performed manually or mechanically in postural drainage positions to clear secretions
clinician exerts pressure on the pt’s chest wall at the end of a deep inspiration and gently oscillates in through the end of expiration
