Interventions for Pulmonary Conditions

what is the positioning from best to worst?

upright and moving

erect sitting

forward lean sitting

erect long sitting

side lying/semi-prone

supine

how is ventilation affected in supine and what are therapeutic improvements?

decreased functional residual capacity

pulmonary secretions collect in dependent lung fields

therapeutic improvements: removing pillows under head, external rotation of shoulders, towel placed under thoracic spine

how is ventillation affected in side lying how can we improve htis?

FRC and work of breathing between sitting and supine volumes

therapeutic improvements: reduce pillow and a quarter turn to prone is beneficial for decreasing atelectasis

how is ventillation affected in sitting and what are therapeutic improvements?

increased FRC, diameter of main airways slightly increases

upper lungs-larger initial volume

lower lungs-smaller inital volume, larger volume changes with inspiration

therapeutic improvments: anterior pelvic tilt enhances

cna keep anterior pelvic tilt by placing towel

patients with COPD how can you help them?

stand and put hands on a chair and breathe, will help the pectoralis major muscles to work in reverse action to lift the upper chest and increase ventilation

what. is inspiration associated with naturally?

trunk extension

shoulder flexion, abduction, and external rotation

upwrad gaze

what is expiration associated with naturally?

trunk flexion

shoulder extension, adduction, and internal rotation

downward eye gaze

where is hand placement for diaphragmatic breathing?

left on chest and right on belly

breathe in=belly out

breathe out= belly in

what is a technique to help faciltiate inspiration?

a sniff, using a quick stretch on abdomen or a scooping technique just before inspiration

what is the goal of pursed lip breathing?

slow the rate of expiration, increase volume of expired air and limit hyperinflation

what is the goal of segmental breathing exercseis?

localized lung expansion, ask the patient to fill their hands with air,

what is the goal of stacked breathing exercises?

improve cough effectiveness and can reduce atelectasis, series of deep breaths that build on top of previous breath

what is diaphragm-strengthing done for fair and poor?

fair: weights or manual resistance over the epigastric area, goal is to perform for 15 minutes

poor: strengthen as above in supine with head raised

consider an abdominal corset

what are some ideas for things you can do for thoracic mobility exercises?

sitting in a chair, wall push-ups, corner stretch, scapular retractions, trunk rotations, rip and thoracic spine mobilizations

what are relative contraindications and precautiosn for postural drainage?

contraindications: increased ICP, hemodynmically unstable, recent spinal injury, recent head trauma, diaphrgamatic hernia, recent eye surgery

precautions: active hemoptysis, pulmonary edema with heart failure, large pleural effusion, massive ascites

what should be done before postural drainage?

auscultation, postural draiange is performed with breathing exercises, percussion/vibration the active cycle of breathing, cough or suction

how long should positions be held for only breathing or percussion/vibration?

breathing 5-10 minutes

vibration/percussion: 2-5 min

how do you drain upper lobe: anterior upper segments

patient sits and leans back on pillows against pillows or tables, at 40 degree angle, apply percussion or vibration over the clavicualr region

how do you drain the upper lobe posterior apical segment?

patient is in long sitting with a pillow under knees and leaning forward in the trunk 20 degree angle

apply percussion or vibration between clavicle and top of the scapula

how do you drain the upper lobe: anterior segments

patient lies flat on their back with knees on pillow. Apply percussion or vibration on the superior aspect of the upper chest

how do you drain the upper lobe: left posterior segment?

patient leans forward on pillows or a table at 30 degree angle then rolls left shoulder 45 degrees back with pillows placed for comfort

how do you drain the upper lobe: right posterior segment?

with the bed flat the patient lies on the left side then rolls the right shoulder 45 degrees forward with pillows placed for comfort

how do you drain teh left lingular lobe?

lies on the right side with the head 12 inches lwoer than the hips, patient rolls the left shoulder back 45 degrees onto a pillow

how do you drain the right middle lobe?

lies on left side with the head 12 inches lower than the hips; the patient rolls the right shoulder back 45 degrees onto a pillow how

how do you drain the lower lobe: superior segments

with the bed flat the patient lies prone with pillows placed under abdomen and legs for comfort

how do you drain the lower lobe: anterior segments?

with bed lifted 18 inches at the foot, the patient lies supien with pillows for comfot

how do you drain the lower lobe: posterior segments?

patient lies prone with the bed lifted 18 inches at foot, place pillows for comforthow

how do you drain the lower lobe: right lateral segment?

patient lies on their left side with the bed lifted 18 inches at teh foot, place pillows for comfort

how do you drain the lower lobe: left lateral segment

patient lies on their right side with the bed lifted 18 inches at the foot, place pillows for comfot

how should percussion be performed? how long should it be done?

a light layer of clothing, the cupping action is what is effective, performed on inspiration and expiration for 2-5 minutes per segment

how should vibration be performed?

at the end of deep inspiration, the clinician exerts pressure on the patients chest wall and genetly oscilates it through the end of expiratoin

what are relative contraindications and precautions for vibration?

relative contraindications: hemoptysis, untreated tension pneumothorax, low platelet count, unstable hemodynamic status, open wounds, subcutaneous emphysema, recent skin graphs

precautions:uncontrolled broncospasm, osteoporosis, rib fractures, metastatic cancer to the ribs, tumor obstruction of airway, anxiety, coagulopathy, convulsive or seizuire disorder, recent pacemaker placement

what is the active cycle of breathing?

breathign control

3-4 deep breathes

breathing control

3-4 deep breaths

breathing control

forced expiration technique

what is suctioning used for?

tracheostomy or endotracheal tube, when someone cannot clear mucus on their own

what are some contraindications for suctioning?

hypersensitivty or a vasovagal response to suctioning, recent trauma to the phayrnx, thrombocytopenia, or epiglottis

what is autogenic drainage?

uses expiratory airflow to mobilie secretions, technique has certain advantages over conventional postural drainiange

what are the 3 phases of the breathing exercise?

level one: unsticking of peripheral secretions by lung volume breathing

level 2: collecting the mucus in larger or mid-sized airways

level 3: evacuating, the mucus in the central airways is acheieved by breathing at normal to high volumes take in a slow deep breath holding for 1-3 seconds

what does the acapella device do?

creates oscillations or flutter in pressures in the airway, oscillatiosn help to loosen the mucus

what is the goal of incentive spirometry?

device is to facilitate a deeper inspiration and prevent atelectasis

patient exhales completely, repeat 10 times every hour

what do the vest systems do?

provide high frequency chest wall oscillations, designed as airway clearance systems and replace traidtional postural drainage

what are some energy conservation techniques?

establish a routine, pace yourself, sit whenever possible, eliminate unneessary tasks, avoid strenuous arm activites, keep cool, avoid lifting, organize your work areas, avoid isometric contractions, use assisitve devices, avoid sustained positions