PPC tut 5b

Respiratory Volume and Secretion Management

  • Reduced Volume and Ventilation

    • Lower lung volume results in lower ventilation rates due to restricted airflow.

  • Consolidation vs. Collapse

    • Differentiation between lung consolidation and collapse is essential.

    • Consolidation: Occupies space without reducing overall lung volume, filled with secretions; does not result in upward shift in mediastinal structures.

    • Collapse: Associated with a loss of volume.

  • Sputum Volume in Lung Diseases

    • Patients may have diminished sputum production as the disease progresses (e.g., lung cancer), reducing clearance capability.

Categorizing Secretion Movements

  • Movement of secretion categorized into general and specific:

    • General Secretion Problems

    • Widespread crackles in the lungs indicate general issues related to secretion clearance.

    • Specific Secretion Problems

    • Focal crackles indicate localized issues affecting specific lung areas, potentially requiring targeted treatments.

Oxygen Support and Patient Mobility

  • Oxygen Support

    • Considerations regarding the level of oxygen support for patients, affecting their mobility and interventions.

    • Extreme care should be taken to note how far patients can move from bedside when on oxygen support.

  • Mobilization Exercises

    • Begin with low-level activities (e.g., standing, sitting in a chair), then gradually increase intensity.

Combined Treatment Approaches

  • Discussing possibility of combining therapies:

    • Therapy may include BiPAP for ventilation assist, paired with exercise to strengthen respiratory function.

    • Consideration of medications (e.g., PCA, ketamine for pain) during physical activities is critical due to patient discomfort.

Role of PCA and Pain Management

  • Patient-Controlled Analgesia (PCA) might not fully suffice for pain management in post-surgery patients.

  • Multiple forms of infusion and localized blocks are often utilized due to high levels of discomfort in patients with rib fractures or surgical wounds.

Postural Drainage Techniques

  • Postural Drainage Positions

    • Positions that facilitate lung drainage while maximizing ventilation (e.g., upright positions).

  • Techniques like saline inhalation can be used to assist drainage.

Treatment Plan Considerations

  • Treatment plans can include:

    1. Pen Rolling: Enhances drainage.

    2. Airway Clearance Breathing Techniques (ACBT) on BiPAP.

    3. Mobilization on BiPAP to enhance endurance and strength.

  • Coughing often requires removal of BiPAP temporarily to facilitate sputum removal.

History and Assessment Considerations

  • Pre-existing Conditions

    • Evaluate any history of strokes which might affect physical abilities and require strength assessment prior to mobilization.

  • Cultural Considerations

    • Special attention needed when treating indigenous patients, including referral to Aboriginal health liaison officers for better support.

Practice and Techniques

  • Techniques for breathing control should emphasize comfortable techniques without the strict need for counting breaths.

  • Incorporate thoracic expansion exercises to improve respiratory mechanics and lung volumes.

Clinical Questions and Outpatient Considerations

  • CASES Management

    • Focus on patient impairments, particularly those related to secretion clearance and gas exchange.

  • Re-assessment mechanisms in outpatient settings often do not include advanced imaging or blood gases readily available; focus on subjective monitoring and observable patient response during treatment.

  • Education and Self-Management

    • Teach patients effective ways to manage their COPD post-discharge, encouraging exercises and airway clearance techniques.