VIVA Flashcards
WHat is the evidence for Breathing exercises
Holland et al (2012)
WIth COPD patients - increased 6MWT
List the evidence for IMT
Shoemaker et al 2009 - chronic COPD increases Dyspnoea
Hill et al 2010 - chronic COPD - was a guide line for prescription
Bissett 2012 - Guide line for acute COPD patients
Name the evidence for pursed lip breathing
Bhatt 2012
COPD patients - increased exercise capacity
Name the evidence for PEP
Johnson and James 2013
For excessive respiratory secretions
need more research, they viewed articles showing the Bubble PEP is well used
Name the evidence for Mobilisation
Mackay et al 2003 - Addition of DB - not worth it. Mobilisation is king. Open abdominal surgery
Name the Evidence for mobilisation for PPC’s
Haines et al 2013
Showed relationship between delay in Mobilising and increase in PPC’s. Every day we don’t mobilises increase risk by 3 fold
What does Brasher et al 2013 say
There is no evidence that the addition of DB to normal chest physio including mobilisation actually prevents PPC’s
Describe what Stiller and Phillips 2003 say?
Mobilisation aims to increase avleolar ventilation and VQ mismatch but need to take lots of things into consideration when aiming to mobilise
What body systems should be take into consideration when mobilising a patient?
Cardiovascular: HR, BP, Cardiac status ( Recent AMI, Unstable ANging, arrythmia, aortic stenosis), more than the ocassional VEB, runs of VT, AF, new STEMI
Respiratory considerations: RR, PaO2/FiO2 ration >300, SpO2
Heamatological and MEtabolic - <20 000 platelet count (Increase in BP, avoid mobiisation)
SUbjective consideration - consciousness, muscle strength
Orthopaedic conditions
COntraindicated in Split skin grafts, burns, pressure wounds
Attachments
Environment
What do you do when the patient has Increase of WOB issues acutely
Lean forward
Pursed lip breathing
Breathing control
WHat can you do when a patient has WOB issues chronically
IMT
or Pulmonary rehab - especially for COPD patients
List the contraindications to IMT
Recent undrained pneumothorax
Large bullae
Marked Osteoporisis - spontaneous rib fractures
Lung surgery with the last 12 months
Prescribe IMT to an acute patient
Frequency 5-7 days a week
Intensity: 50% of MIP or greater
Duration: 6 breaths, 5 sets with rests inbetween
Prescribe IMT to chronic COPD patient
Frequency 3-4 days a week for 8 weeks
Intensity <30% of MIP
Duration 2 minutes on and 1 minute rest. Repeat 7 times
How many coughs should you prescribe at once?
No more than 2 at onces
How would you prescribe Bubble PEP to a patients
Blow bubbles for 4-6 seconds. Repate 10 times. At lest 3 times a day. Bernie says once every hours they are awake if possible
List some precautions to Postural drainage.
Hypertension, Unstable CV system, After Osophageal surgery, after a meal, Hiatus hernia, GORD, Osteoporosis, Recent head injury, orthopnoea, distressed or is distressed in the potion, PO, Abdominal distension, Recent head/ neck surgery, Cerebral aneurysm
List the precautions to Percussion, Vibrations, shaking
Fractured ribs, Frank Haemoptysis, Rab cancer, osteoporosis or long term steroid use, burns, surgical incisions, ICC drain, Severe bronchospasm, severe pleuritic pain, very low platelet levels
List the contraindications to Bubble PEP
Recent Pneumonectomy
Frank Haemoptysis
Extensive Bullae and Cysts
Undrained Pneumothorax
List the precautions for Bubble PEP
ALtered consciousness - confusion - risk of drinking water
Paediatric patients
Patients needing high levels of oxygen or continuous oxygen therapy
What are the risk associated with Oxygen therapy
Oxygen toxicity/ Carbon dioxide nercrosis Fire Absorption atelectasis Retrolental fibroplasis Mucosal damage
Explain Carbon Dioxide Nercrosis
Cehmoreceptors become insensitive to CO2 as the stimulus for ventilation and relies on low PaO2. If given too much O2 therapy, causing PaO2 to rise they loose their stimulus to breath - hypoventilate and have a respiratory arrest
Reeve et al, 2010 performed a couple studies on the same group of patients. What did the study, that was stopped early say
This study found that there was no statistical dfference between their two groups of patients receiving the two types of physio therapy. Aka mobilisation and Mobilisation and DB. Mobilisation is awesom
What was the purpose of Reeve et al 2012’s study
This was to show that shoulder exercises for post thoracotomy patients was of benefit to them in terms of less shoulder pain, and less total pain at D/C and function at 3 months post op compared to those of the non exercise group
What was the Surgery the patients in Reeve et al 2010 underwent?
Pulmonary resection via a Thoracotomy
What does the evidence say about mobilising acutely ill patients
Stiller and Phillips 2003. They showed that the you have to weigh up the risks and benefits of mobilizing the patient.
