Week 7 and 8 Flashcards
Goals of airway clearance techniques:
optimize airway patency, increase ventilation and perfusion matching, promote alveolar expansion, increase gas exchange
Postural drainage
♣ Assumption of one or more body positions that allow gravity to assist with draining secretions from each lung segment
♣ Priority given to treating most affected lung segment first
Percussion
♣ Chest percussion aimed at loosening retained secretions (manually or mechanically)
Rate of percussion
100-140 times per min.
Vibration rate:
12-20 Hz per min
Idea behind percussion:
♣ the pressure exerted on thorax during vibration causes a volume of air to be expired that is greater than what is expired during normal tidal breathing
Position during percussion:
♣ Performed manually or mechanically and utilized in postural drainage positions to clear secretions
Four stages of cough:
- Inspiration greater than tidal volume – adequate = 60% of pt’s predicted vital capacity
- Closure of the glottis
- Abdominal and intercostal muscles contract, producing positive intrathoracic pressure
- Sudden opening of the glottis and the forceful expulsion of inspired air
Effective cough:
deep inspiration combined with trunk extension, a momentary hold, and then a series of sharp expirations while the trunk moves into flexion
Expiratory aid
negative pressure (vacuum) to the airway via the nose and mouth during the patient’s attempt to cough, along with a manual thrust to the abdomen to further increase cough flows
Who are breathing strategies, positioning and facilitation indicated for?
weakness of the diaphragm, unable to correctly use the diaphragm for efficient inspiration, or who have inhibition of the diaphragm muscle due to pain
To facilitate inspiration
o and ventilator movement strategies
♣ To facilitate inspiration – instruct pt to breathe in during shoulder flexion, abduction, and external rotation along with an upward gaze
To facilitate expiration
♣ shoulder extension, adduction, and internal rotation with downward gaze
Posterior pelvic tilt encourages:
diaphragmatic breathing pattern
What can sidelying position do?
reduce pressure as well as assist in lung expansion and secretion removal
Trendelenberg Position
legs elevated higher than head while supine
Benefits of Trendelenberg Position:
- Optimal for facilitating secretion drainage from the lower lobes
- Can also be used to increase BP of a hypotensive pt
Who is trendelenberg position contraindicated in?
pts with CHF or cardiomyopathy
Reverse trendelenberg
helps reduce hypertension and facilitate movement of the diaphragm by using gravity to decrease the weight of the abdominal contents
Positioning for Dyspnea Relief
♣ Lean forward on supported hands – intraabdominal pressure rises and thus pushes the diaphragm up in a lengthened position
Rationale behind positioning for dyspnea relief:
With arms supported, accessory breathing muscles can act on the rib case and the thorax, allowing more expansion for inspiration
What is pursed lip breathing used for?
decrease symptoms of dyspnea
slows respiratory rate
Pursed lip breathing:
♣ decreasing the resistive pressure drop across the airways
decreasing airway collapse during expiration (advanced stages of COPD
Paced Breathing
volitional coordination of breathing during activity
Inspiratory Hold Technique
o Involves prolonged holding of breath at max inspiration
Stacked Breathing
series of deep breaths that build on top of previous breath without expiration
What is Diaphragmatic Controlled Breathing used for?
to manage dyspnea, reduce atelectasis, increase oxygenation
What does Diaphragmatic Controlled Breathing facilitate?
outward motion of abdominal wall while reducing upper rib cage motion during inspiration
Positioning of Diaphragmatic Controlled Breathing:
t to achieve in supine, progressing to sitting, standing and during activity
Scoop technique
o pt sidelying with posterior pelvic tilt
♣ PT places hand on pt’s abdomen and allows 2-3 breathing cycles
♣ After exhalation, PT scoops the hand up and under the anterior thorax, giving a slow stretch and instructs the pt to breathe into my hand
Lateral Costal Breathing:
o Addresses rib cage mobility and intercostal muscles
Unilateral costal breathing:
♣ Most effective in side lying with uninvolved side against bed
♣ Pt brings arm on involved side into abducted position to the level of the head
♣ PT gives a stretch before inspiration and continues giving resistance through the inspiratory phase
Bilateral costal breathing:
♣ Semireclined or sitting position
♣ PT places both hands on the lateral aspects of the rib case and gently applies pressure against the ribs during inspiration
What can upper chest inhibiting technique to?
help a pt recruit the diaphragm during inhalation
When is upper chest inhibiting breathing used?
Used only after implementation of other techniques
Upper Chest Inhibiting Technique
o A diaphragm scoop is used to facilitate the diaphragm while the therapists other hand rests on the upper chest and moves with inhalation and exhalation
o After assessing the pt’s chest movement through a respiratory cycle, the PT’s arm follows the upper chest to the resing position on exhalation
o When the pt inhales, the PT’s arm position does not move, thus applying pressure to the upper chest and resisting expansion
Counterotation:
Rotating the upper trunk to one side wihile the lower trunk is rotated in the opposite direction
What does counterotation do?
o Increases tidal volume and decreases respiratory rate by reducing neuromuscular tone and increasing thoracic mobility
Who is counterrotation effective for?
♣ Pts with impaired cognitive functioning after neurological insult
♣ Young children who are unable to follow verbal cues
♣ Pts with high neuromuscular tone
Who is inspiratory muscle training indicated for?
pts with s/s of decreased strength or endurance of diaphragm and intercostal muscles
Goal of inspiratory muscle training?
increase ventilator capacity and decrease dyspnea
Primary consideration of weaning:
resolution or relative resolution of the initial event or disease that led to acute respiratory failure
Precautions for postural drainage:
pulomonary edema hemoptysis massive obesity large pleural effusion massive ascites
Relative contraindications for postural drainage:
increased ICP hemodynamically unstable recent esophageal anastomosis recent spinal fusion recent head trauma diaphragmatic hernia recent eye surgery
Precautions for Vibration
uncontrol bronchospasm osteoporosis rib fractures metastsatic cancer to ribs tumor or airway obstruction anxiety recent pacemaker
Relative contraindications for vibration
hemoptysis untreated tension pneumothorax unstable open wounds grafts
