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PHTY 800 > Week 11 - Physio techniques for gas & secretion impairments > Flashcards

Week 11 - Physio techniques for gas & secretion impairments Flashcards

1
Q

Gas movement impairments are commonly due to:

A

Low lung volumes such as:

  • Low Vt
  • Low FRC
  • Reduced volume in a particular part of the lung
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2
Q

Gas movement physio techniques

A

(1) Deep breathing exercises (DBE)
(2) Positioning
(3) Mobilisation

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3
Q

DBE affects: (6)

A
  • Increase Vt
  • Alveolar stretch
  • Stimulates surfactant prod.
  • Decreases surface tension
  • Increases lung compliance
  • Increases VA / VE
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4
Q

Encourage deep inspiration to:

A

Total lung capacity

+ slow inspiration

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5
Q

What does slow inspiration during DBE do?

A
  • Better distribution of ventilation.
  • Slow inspiration gives you the ability to take in airflow to the dependent regions b/c it depends more on lung compliance
  • Greater compliance = greater flow
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6
Q

What does fast inspiration do during DBE?

A
  • Airflow depends more on airways resistance
  • Less resistance = greater flow
  • Resistance is less in the non-dependent regions, so airflow is better distributed here.
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7
Q

How does deep breathing exercises affect the direction of breathing?

A
  • It encourages lateral basal expansion (LBE) which increases distribution of VE to the dependent regions
  • Tries to decrease excess AP/upper chest breathing
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8
Q

When would you not want to prescribe DBE?

A
  • Emphysema patients: they are already hyper-inflated

- But post-op you WANT to give DBE

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9
Q

Inspiratory hold:

A
  • Recruits collapsed alveoli + alveolar interdependence
  • Appropriate in pts w/ atelectasis/low lung volumes
  • NOT hyper-inflated breathless patients
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10
Q

General positioning:

A

Aims to increase lung volumes

(most imp. increase FRC) [upright pos. are best or side-lying rather than slumped ]

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11
Q

Specific positioning aim:

A

Aims to re-expand areas of localised atelectasis

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12
Q

Closing capacity (CC)

A

The lung volume @ which the dependent airways begin to close/cease to ventilate

  • Normally FRC>CC so alveoli are open during tidal breathing
  • Increases w/ age/smoking
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13
Q

if FRC < CC

A

Small airway closure during tidal breathing

- Results in reduced gas exchange + decreased PaO2/SaO2

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14
Q

What does an increase in FRC do?

A
  • Increases lung compliance
  • Decreases respiratory load
  • Increases VQ matching + gas exchange
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15
Q

Specific positioning

  • When is it used?
  • What position is it aiming to target?
  • What does the position do that improves the issue?
A
  • Use w/ a localised gas movement problem; lung/lobar/seg. atelectasis
  • Position: Problem area is uppermost/non-dependent
  • Gravity will stretch the area open, stimulating surfactant release + increases local compliance
  • After - used generalised pos. + DBE to maintain FRC
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16
Q

Modified specific positioning

  • What is the aim
  • Common positions
A

Aim is to place the affected lung uppermost (non-dependent) relative to the rest of the lung w/o HDT
- Common positions: L + R sidelying

17
Q

Benefits of mobilisation: (4)

A
  • Increases FRC + distribution of vent. to dependent regions
  • Increases V/Q matching
  • Increases CO/lung perfusion
  • Increases O2 demand + RR/Vt
18
Q

Benefits of secretion clearance: (3)

A
  • Reduce infection
  • Improve ventilation/gas movement
  • Avoid deterioration of breathing mechanics (decrease work of breathing)
19
Q

Techniques to facilitate the movement + removal of secretions

A

huff/cough, postural drainage, percussion, vibrations

20
Q

What does cough do?

A
  • Clears secretions from Upper central airways
21
Q

What are the components of an effective cough (4)

A
  1. Deep inspiration to TLC
  2. Closure to the glottis
  3. Contraction of ab muscles
  4. Opening of glottis + an explosive breath out
22
Q

What does a huff do?

A

Can vary the size of the breath in for a huff + this will affect where the secretions are moved from w/in the lungs (i.e. central/peripheral)

23
Q

Components of an effective huff: (4)

A
  1. Breath in to specified volume
  2. Keep glottis open
  3. Contract ab muscles
  4. Controlled force expiration of specified volume
24
Q

The 3 main concepts of cough + huff:

A
  • 2 Phase gas-liquid flow
  • Dynamic compression
  • Equal pressure point
25
Q

2 phase gas-liquid flow:

2

A
  • Explains the interaction of liquid (airway secretions) + gas (air) w/ a conduit (airway)
  • Responsible for how secretions move towards the mouth
26
Q

Annular flow:

A

The surface of the liquid layer moves in waves

27
Q

Mist flow:

A

The liquid is carried as small droplets in the gas

28
Q

For gas-liquid flow to occur towards the mout the expiratory flow rate must be at least:

A

10% greater than inspiratory flow rate.

  • cough has a higher expiratory flow + uses mist flow
  • Huff has lower flow rates + uses annular flow
29
Q

Dynamic compression:

A
  • During a forced expiration some parts of airways narrow

- Leads to high airflow (velocity) + turbulence which causes shearing of the mucus layer + gas-liquid interaction

30
Q

Dynamic compression occurs:

A

towards the mouth @ the equal pressure point (EPP)

31
Q

Equal pressure point (EPP)

A

The point where intrapleural pressure is = to alveolar pressure

32
Q

What happens when Ppl>Pal

A

Dynamic compression > faster flow rate > movement of secretions

33
Q

Low volume cough does:

A
  • Moves peripheral secretions

- Small breath in > Less alveolar recoil > Less alveolar pressure to start with

34
Q

High volume huff/cough can:

A
  • Can clear secretions that are more central to upper airways
  • Big breath in > more alveolar recoil > greater alveolar pressure to start with
35
Q

Postural drainage:

A

Positioning the bronchus to a particular lung segment uppermost + perpendicular to horizontal to allow secretions to drain by gravity. (peripheral > central)
- Secretions removed by cough

36
Q

Common postural draining positions:

A
  • L&R horizontal side-lying
  • Supine 30 degree head up
  • Prone horizontal
  • Upright sitting
37
Q

Percussion

A
  • 1-10 min.
  • Imparts mechanical energy to airways to : loosen secretions, increase expiratory flow rate, + change mucus rheology
  • Useful in patients w/ excessive secretions
38
Q

Vibrations/shaking

A
  • Patient takes max inspiration to TLC then applies vib/ in the direction of normal movement of ribs during EXPIRATION
39
Q

Phys. of vibrations/shaking

A
  • Increases peak expiratory flow rate (PEFR)
  • Aids 2 phase gas-liquid flow via annular flow
  • Decreases mucus viscosity
  • Elicits spontaneous cough

PHTY 800 (8 decks)

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